Perinatal risk factors associated with severity of haemolytic disease of the foetus and newborn due to Rhc maternal-foetal incompatibility: A retrospective cohort study

BACKGROUND AND OBJECTIVES

Anti-c is the third red blood cell antibody responsible for haemolytic disease of the foetus and newborn (HDFN) requiring intrauterine transfusion. We aimed to identify risk factors associated with HDFN and severe HDFN due to Rhc maternal-foetal incompatibility.

MATERIALS AND METHODS

A retrospective cohort study was conducted in Paris and the surrounding area (France), between 2013 and 2015. We included mothers and their children managed by the National Reference Centre in Perinatal Hemobiology for alloimmunization and maternal-foetal incompatibility for the Rhc antigen (N = 121). We conducted bivariate analyses to assess a relationship between perinatal factors (e.g., titre and concentration of anti-c antibodies, direct antiglobulin test) and HDFN, its severity and duration.

RESULTS

The incidence of HDFN was 30% (n = 36), including 11% of severe HDFN (n = 13). Seven percent (n = 9) of neonates received at least one transfusion during the first week and 21% (n = 26) after this period until 3 weeks of life. During pregnancy, a concentration ≥7.5 IU/ml and a titre ≥4 and above were associated with HDFN and severe HDFN (p < 0.05). At birth, the high intensity of the quantitative direct antiglobulin test was associated with HDFN and severe HDFN (p < 0.05). A concentration ≥15 IU/ml is the best factor (area under curve [AUC] = 0.78) in predicting HDFN, followed by a titre ≥8 (AUC = 0.76).

CONCLUSION

Anti-c alloimmunization causes neonatal anaemia, which is often belated. Paediatricians have to be aware of these risk factors and organize prolonged monitoring of neonates.

Multidisciplinary management of anti-PP1Pk or anti-P alloimmunization during pregnancy: A new case with anti-P and a literature review

BACKGROUND

Red blood cell alloimmunization is the first cause of fetal and neonatal anemia. Alloimmunizations with anti-PP1P^k or anti-P can cause recurrent miscarriages and hemolytic disease of the fetus and newborn in the 2nd and 3rd trimesters of pregnancy. We report on a pregnant patient immunized with anti-P and a history of recurrent miscarriages.

CASE REPORT

This P₂ ^k (GLOB:-1; P1PK:-1,3) patient had a first pregnancy marked by a caesarean at 38 weeks of gestation (WG) for non-reassuring fetal heart rate. Then, she had three early spontaneous miscarriages. The fifth pregnancy began with a high titer of anti-P at 128. Early initiation of treatment with Intravenous Immunoglobulins (IVIg) and plasma exchanges (PE) starting at 5 WG permitted us to reduce the titer of anti-P below 32. A healthy infant was delivered by caesarean at 38 WG without anemia at birth and no exchange transfusion was required.

DISCUSSION AND REVIEW OF THE LITERATURE

The P and P^k antigens are expressed on placental, trophoblastic, and embryonic cells. This explains why P₁ ^k (GLOB:-1; P1PK:1,3), P₂ ^k (GLOB:-1; P1PK:-1,3), or Tj(a-)/p (GLOB:-1; P1PK:-1,-3) patients are prone to recurrent abortions in the first trimester of pregnancy. A literature review demonstrated 87% (68/78) of miscarriages in p patients. However, publication biases are possible with the most severe cases being reported.

CONCLUSION

Immunizations to P and PP1P^k antigens differ from others in their physiopathology and precocity. The association of PE and IVIg seems to be an effective treatment in the management of anti-PP1P^k or anti-P fetomaternal incompatibilities.

[Post-circumcision Tetanus: Epidemiological, Clinical, Prognostic and Evolutionary Aspects of 16 Cases Collected at the Department of Infectious and Tropical Diseases in Fann Hospital (Dakar)]

This retrospective, descriptive study carried out in the Infectious Diseases Department of CHNU, Fann from 1^st January 2012 to 3st December 2016 aimed to describe the epidemiological aspects and the course of post-circumcision tetanus and to formulate public health recommendations. During our study period, 16 cases of post-circumcision tetanus were collected out of a total of 452 patients with tetanus, equivalent to a rate of 3.5%. The median age was 8 years (3-40). None of the patients had a vaccination card. In 63% of cases, circumcision was performed at home, by a practitioner whose qualification was not documented in 63% of cases. All signs of tetanus were found with trismus (100%), dysphagia (63%) and paroxysms (88%). These were mostly Mollaret stage II forms in 14 cases, and grade 3 Dakar score in 7 cases. The median duration of hospitalization was 10 days [6-15]. Mechanical or infectious complications were noted in two cases, with a lethality rate of 13%. Post-circumcision tetanus is a reality in Senegal. Good community awareness, continuous training of staff and implementation of vaccination catch-up strategies for children of circumcised age should eradicate this form of tetanus.

[Tuberculosis Abscess of the Chest Wall on an Immunocompetent Patient in the Teaching Hospital of Dakar (Senegal)]

Tuberculosis remains a problem of public health, in spite of the numerous significant advances noted in the diagnosis in recent years. The involvement of the thoracic wall is a rare extra lung shape. Its clinical presentation is not specific and a collected thoracic tumefaction is the main clinical demonstration. The diagnosis is improved by the use of non-invasive tools such as the Xpert MTB/Rif® test with a good sensibility on the pus. Medical care is based on medical treatment and sometimes associated with surgical treatment.

Correction: Safety of Seasonal Malaria Chemoprevention (SMC) with Sulfadoxine-Pyrimethamine plus Amodiaquine when Delivered to Children under 10 Years of Age by District Health Services in Senegal: Results from a Stepped-Wedge Cluster Randomized Trial

[This corrects the article DOI: 10.1371/journal.pone.0162563.].

[Malaria associated with bacterial infection in the department of infectious diseases at the National and University Hospital of Fann, Dakar]

OBJECTIVES

To describe severe malaria cases with bacterial infection.

PATIENTS AND METHODS

We conducted a prospective, descriptive and analytical study over 8 months.

RESULTS

15 of the 86 severe malaria cases had bacterial infections: enteritis (7 cases), urinary tract infection (4 cases), meningitis (4 cases), pneumonia (cases), sepsis (1 case), and sinusitis (1 case). Convulsions, jaundice, abnormal bleeding, pulmonary edema were more frequent in patients with associated infections. The average number of leukocytes and CRP were significantly higher in patients with bacterial infection. The mean parasite density was higher in patients without bacterial infection (56,362/mm3 vs. 239,162.2 ± 3326/mm 3 ± 7175.3). Lethality was higher in patients with bacterial infection (20% versus 16.9%).

CONCLUSION

Bacterial infections are common in severe malaria and may influence the prognosis.

Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal

OBJECTIVE

We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50 cells/μL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load (<50 copies/mL).

METHODS

Logistic regression and Cox's proportional hazards model were used to examine risk factors for SIR and the association between SIR and the risk of new clinical events or death, respectively after six months of ARVT.

RESULTS

One hundred and two (15.5%) of the 657 patients presented with SIR. Age > 40 years (aOR = 1.74, 95% CI = 1.10-2.75), baseline CD4 ≥ 100 cells/μL (aOR = 2.06, 95% CI = 1.24-3.42), ARVT including AZT (aOR = 4.57, 95% CI=1.06-19.76), and the occurrence of a severe opportunistic infection during the first semester of ARVT (aOR = 2.38 95% CI= 1.49-3.80) were associated with SIR. After six months of ARVT and up to seven years of follow-up, 39 patients with SIR had presented with an opportunistic infection or death (rate= 9.78/100 person-years) compared to 168 with a normal recovery (rate = 7.75/100 person-years) but the difference was not statistically significant (aHR = 1.22, 95% CI = 0.85 to 1.74).

CONCLUSION

SIR is less common in our country and is not associated with increased mortality or a greater incidence of opportunistic infections after six months of ARVT.

[Evaluation of tolerance of zidovudine-lamivudine-nevirapine combination in HIV 1 patients in Fann Teaching Hospital in Dakar]

We conducted a study to evaluate the tolerance of the zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving AZT-3TC-NVP combination between 2008 and 2011. Seventy patients were included. Two thirds of the patients presented at least one side effect (44 cases). The digestive disorders (15 cases) and neuropsychiatric (14 cases) were the most frequent. Epigastralgia (20%), headaches (20%) and arthralgias (13%) were main side effects. A maculo-papular exanthema was noted in three cases. During the follow-up, five patients presented with anemia. No patient presented hepatic cytolysis due to NVP. All the patients followed for more than six months presented a side effect against 29.7% when the duration of treatment was equal to or less than 6 months (p=10(-5)). Most of the side effects due to the association AZT/3TC/NVP are minor. The evaluation of the clinical and biological tolerance must be maintained during all the follow-up.

[Efficacy and tolerance of tenofovir-lamivudine-efavirenz combination in HIV-1 patients in Fann Teaching Hospital in Dakar]

We conducted a study to evaluate the efficacy and tolerance of the tenofovir (TDF), lamivudine (3TC) and efavirenz (EFV) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving TDF-3TC-EFV combination between 2007 and 2011. Collected data was analysed using EpiInfo™ version 6.04. One hundred patients were included, with an average follow-up duration of 27 months and 19 days (± 21 months and 14 days).We observed an average increase in body weight of about 8 kg per annum, with an average rise in CD4 count of 100/mm(3) by the end of the second year. A reduction in viral load with 71% of patients in therapeutic success at 24 month of treatment was noted. Ninety-two patients presented with at least one side effect, mostly being Grade 1 or 2 (96.36%). Neurological (24 patients) and digestive (20 patients) complaints comprised the commonest reported side effects. Four patients had adverse effects severe enough to warrant a change in treatment regimen, principally due to renal insufficiency. Thirteen subjects died. Patients receiving TDF-3TC-EVF combination therapy need rigorous surveillance because this combination, although efficient, is not without significant adverse effects.

[Human rabies: diagnostic pitfalls]

The purpose of this report is to describe two cases of human rabies in Senegal that illustrate possible diagnostic and therapeutic pitfalls even in an endemic area. Although outcome is almost always fatal and interhuman transmission is uncommon, prompt diagnosis of rabies is important since delay increases the risk of exposure to the virus for the entourage.

[Maternal tetanus in Dakar from 2000 to 2007]

The objective of this study conducted between January 2000 and December 2007 was to assess the current epidemiological, clinical and outcome features of maternal tetanus (MT) observed in the Infectious Diseases Clinic of Fann University Hospital in Dakar, Senegal. A total of 1156 patients were admitted for tetanus during this period including 9 (0.8%) presenting MT. A progressive decrease in the annual number of MT cases was observed. The mean age of MT patients was 28.3 years [range, 18 to 40 years]. Most cases (n=6) involved persons living in suburban areas, as did tetanus in women of childbearing age (WCBA) (51.9% of 129 cases) and in neonates (63.1% of 103 cases) admitted during the same period. All patients had fallen behind the vaccination schedule. Septic abortion (n=7) was the main etiological factor. Although tetanus was graded as moderate in 8 patients (Mollaret stage 2), the death rate was high (44.4%) due to infectious and obstetric complications. This rate was similar to that associated with tetanus in newborns (48.5%), but higher than that associated with tetanus in WCBA (25.6%). The incidence of life-threatening MT is declining in the Infectious Diseases Clinic of Fann University Hospital in Dakar. A systematic immunization program along with campaigns to prevent unwanted pregnancy in women of childbearing age will be needed to eliminate maternal and newborn tetanus in Dakar.

[Tetanus in women of childbearing age at the infectious diseases clinic in Dakar]

The objective of this article was to describe the epidemiological and outcome features of tetanus in the woman of childbearing age (WCBAT) and compare them with neonatal tetanus (NT) and other tetanus cases in a hospital department in Dakar from 1998 to 2007. A retrospective study was conducted using the files of WCBAT (15 to 49 years old), NT (3 to 28 days old) and other tetanus cases admitted at the Infectious Diseases Clinic, in Fann University Hospital, from 1998 to 2007. 1484 cases of tetanus were admitted in 10 years, with 176 cases of tetanus of WCBAT (11.8%) and 178 cases of NT (11.9%). In comparison with WCBAT the NT annual hospital rate significantly decreased during the study period whereas other tetanus cases rate remained stable. The average age of WCBAT was 26.1 year old and 57.9% were between 15 and 25 years old. The geographical origin was identical for all patients, with more than 71% coming from suburban areas. Most of the WCBAT cases were housewives (50.9%), single women (75%) without updated tetanus immunization (92%). The main portals of entry of WCBAT were injuries and wounds (67.4%) and maternal tetanus cases were rare (8%), mainly post-abortum. At admission, WCBAT cases were less severe than NT cases but more severe than other tetanus cases. The lethality rate of WCBAT cases (28.4%) was significantly lower than NT cases (50%, p = 0.00003), but higher than the other tetanus cases (22.2%; NS). Prognostic factors were: non-identified or intramuscular injection portal of entry and a Mollaret state III at admission. An intensification of the extended immunization program associated with supplementary immunization campaigns targeting women of child bearing age in high risk districts, are necessary to eradicate neonatal and maternal tetanus in Dakar.

[Parasitic and fungal neuroinfections at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar]

OBJECTIVES

This retrospective study was carried out to describe the epidemiological, clinical and aetiological profile of parasitic and fungal neuroinfections at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar.

PATIENTS AND METHODS

Data were collected for analysis from patients files recorded from January 1, 2001 to December 31, 2003.

RESULTS

We found 126 cases of parasitic and fungal neuroinfections, representing 62% of the total of neuroinfections cases (126/203) and 27% of cerebro-meningeal diseases encountered at the clinic during the study period (126/470). Sex ratio M/F was 1.7 and the mean age of patients was 32 years +/- 14.4. Thirty seven patients (30%) were HIV seropositive. Aetiologies were represented by cerebral malaria (85 cases), neuromeningeal cryptococcosis (37 cases) and toxoplasmosis (4 cases). The overall case fatality rate was 38% (48 deaths/126). The fatality rate varied according to aetiologies: 27% in cerebral malaria, and 59.5% in neuromeningeal cryptococcosis that was found mainly among HIV positive patients (34 cases/37).

CONCLUSION

These results give evidence of the frequency and the gravity of the adult's cerebral malaria in Dakar, but also the growing place of the neuromeningeal cryptococcosis in the neuromeningeal opportunist pathology of HIV positive patients.

[Adult purulent meningitis caused by Streptococcus pneumoniae in Dakar, Senegal]

The purpose of this retrospective study was to describe epidemiological, clinical, bacteriological and outcome features of purulent meningitis caused by Streptococcus pneumoniae in adult patients hospitalized in the infectious diseases clinic of the Fann University Hospital in Dakar, Senegal from 1995 to 2004. A total of 73 cases of pneumococcal meningitis were recorded during the study period. Streptococcus pneumoniae was the second cause of purulent meningitis after meningococcal infection. Sickle-cell disease (n=3) and HIV infection (n=9) were the main underlying factors and pneumonia was the main portal of entry into the CNS (51.8%). Coma was a frequent complication (61.6%). Penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) accounted for 27.3% of isolated strains. However strains were sensitive to third-generation cephalosporin (100%) and chloramphenicol (68.2%) which were the most frequently used antibiotics. The mortality rate was 69.8% and neurological complications occurred in 13.7% of patients. The main unfavorable prognostic factors were cardiovascular collapse and/or coma at the time of admission and detection of pneumococcal strains by direct examination of CSF. The high mortality of pneumococcal meningitis in adult patients in Dakar shows the need to improve intensive care facilities and the growing incidence of PNSP underlines the requirement for better control of antibiotic prescription.

[Cholera in Senegal from 2004 to 2006: lessons learned from successive outbreaks]

Between October 2004 and March 2006, a series of cholera outbreaks occurred in the West African nation of Senegal. The purpose of this study was to describe and analyze these outbreaks as a basis for prevention and control. A total of 29556 cases were reported during the 18-month epidemic. The attack rate ranged from 0.6 to 100 per 10(4) inhabitants depending on region. The epidemic unfolded in three phases. The first phase (11 weeks) was promptly contained using basic control measures such as public information campaigns and environmental hygiene. The second and longest phase (12 months) was marked by two outbreaks caused by massive religious gatherings and severe flooding. Cities particularly the capital Dakar (25.5% of cases) and the religious district of Touba in the north (41.1% of cases) were most affected due to the many social and environmental problems related to poor urban infrastructure. The isolated strains of Vibrio cholerae O1, biotype El Tor, were susceptible to doxycycline and fluoroquinolones (100%) but resistant to cotrimoxazole (90.3%). The overall death rate was 1.38%. Unfavorable prognostic factors included age over 60 years, delayed treatment and severe dehydration at the time of admission. Despite lower mortality this cholera epidemic was more widespread and longer than the previous outbreaks in Senegal and was associated with a trend to endemicity in urban areas.

[Tetanus in neonates and women of child-bearing age in the Dakar hospital infectious diseases unit]

OBJECTIVES

This study had for aim to describe and compare the epidemiological, clinical and outcome features of tetanus in neonates (NT) and women of child bearing age (WCBAT) in Dakar.

PATIENTS AND METHOD

This retrospective study was made on NT (3 to 28 days of age) and WCBAT (15 to 49 years of age) patient files, admitted in the Fann University Hospital Infectious Diseases Clinic from 2000 to 2007.

RESULTS

One hundred and thirty-eight WCBAT (11.9%) and 103 NT (8.9%), for a total of 1156 cases of tetanus were admitted. A decrease of the annual rate of these populations was noted over this 8 year period. The majority (59.4%) of WCBAT was between 15 and 25 years of age and the mean age of NT was 9.3 days. Most of the patients in both groups came from suburban areas (78%). The tetanus immunization status was not updated for 92% of WCBAT. The most frequent portals of entry were cutaneous wounds for WCBAT (77.4%) and umbilical stumps for NT (85.4%). On admission, 64% of NT presented with severe tetanus (stage III on the Mollaret scale) compared to 11.6% for WCBAT. The death rate was significantly higher in NT (48.5%) than in WCBAT (26.8%); p=0.0005.

CONCLUSION

To eliminate neonatal tetanus, the prognosis of which is worse in Dakar, an intensification of the large vaccination program is needed with supplementary vaccination campaigns including women of child bearing age in areas of risk.

[Late diagnosis of HIV infection in the Fann, Dakar clinic of infectious diseases: testing circumstances, therapeutic course of patients, and determining factors]

BACKGROUND AND METHODOLOGY

The delay in the diagnosis of HIV infection is a major obstacle to optimal care for this disease. To deal with this problem, we conducted this study among newly diagnosed HIV patients hospitalized in the Fann University Hospital Infectious Diseases Clinic in Dakar. The epidemiological, clinical, biological and outcome aspects are described and patient history reviewed. A qualitative socio-anthropological study was made to understand and describe the logic of the decision processes in the patient's search for treatment.

RESULTS

One hundred patients were included, with a mean age of 39.5+/-11.1 years and a sex-ratio: 1.08. The transmission was mainly heterosexual (90%), and chronic diarrhea (64%) and/or chronic cough (66%) were the principal symptoms leading to diagnosis. The mean delay before diagnosis was 5+/-4.27 months. The major opportunistic diseases were tuberculosis (44 cases) and infectious diarrhea (23 cases). Most patients were diagnosed at the AIDS stage (97%) and the death rate was 30% among hospitalized patients after admission. Sixty-eight percent of patients had consulted at least three times, generally a "traditional practitioner", at first and 43% had been hospitalized at least once. The qualitative investigation revealed that the "representation" or the "feeling of severity" of the disease were the principal justifications for consulting the "traditional practitioner" or the physician, respectively.

CONCLUSION

Better information for health workers and global population is necessary for an earlier diagnosis of HIV infection in Dakar.

[The place of malaria in an infectious disease department in Dakar, Senegal]

The aims of this study were to determine the place of malaria at the Infectious Disease Clinic in Dakar, Senegal, to identify diseases associated with malaria, and to assess malaria mortality with or without co-morbidity. The files of all patients hospitalized from 2001 to 2003 in whom at least one test for malaria (thick films/spears) was performed to detect malaria parasites were reviewed. Malaria was diagnosed in patients presenting fever and positive thick films demonstrating asexual blood stages of Plasmodium. Data were collected from hospital charts. A total of 416 patients presented malaria (prevalence rate, 25.9%). The male-to-female sex ratio was 1:7 and mean age was 33 +/- 18 years. Of the 416 patients diagnosed with malaria, 273 (65.6%) presented severe forms. The overall mortality rate of malaria with or without co-morbidity was 25.7% (107/416). There was not a statistically significant difference between mortality due to isolated malaria and malaria associated with tuberculosis (23.4% versus 18.5%) (p = 0.7) or tetanus (23.4% versus 17.6%) (p = 0.34). Conversely mortality of malaria in HIV-positive patients was higher (58% versus 19%) (p = 10(-6)). Thus, malaria is of major concern in our department.

[Cholera and pregnancy: epidemiological, clinical, and evolutionary aspects]

OBJECTIVES

This descriptive study had for objective to describe the epidemiological, clinical, therapeutic, and evolutionary aspects of the association cholera and pregnancy during the cholera epidemic in Senegal in 2004 and 2005.

MATERIAL AND METHOD

We analyzed the files of pregnant women admitted in the infectious diseases department of the Fann national University Hospital for suspicion of cholera, from October 11, 2004 to December 31, 2005.

RESULTS

Fifty-two pregnant women were hospitalized and accounted for 1.76% of the patients admitted for cholera in the department. They were an average of 24+/-4.9 years of age and came from the Dakar suburbs in 60% of cases. The source of contagion was food and/or water in 70% of cases. These patients contracted the disease during the summer term of the pregnancy in 31% of cases. Clinically, they presented with a typical choleriform syndrome in 90% of cases, emesis in 100% of cases, and severe dehydration in 27% of cases. The coproculture for 14 women was positive for Vibrio cholerae in 12 cases. For treatment, these patients benefited from intravenous rehydration in 75% of cases and antibiotherapy with doxycyclin 300 mg in unidose. The following complications were noted: 6 abortions, 2 premature childbirths, and a maternal death.

CONCLUSION

The association cholera and pregnancy presents high risks for the fetus and for the mother, requiring a fast and adequate management.

[Acute Vibrio parahaemolyticus gastroenteritis in Dakar]

OBJECTIVES

The aim of this study was to describe the epidemiological, clinical and bacteriological features of gastroenteritis due to Vibrio parahaemolyticus diagnosed during the 2004 and 2005 cholera outbreak in Senegal.

PATIENTS AND METHODS

This retrospective study was made on data recorded between October 11, 2004 and December 31, 2005 at Dakar Fann Hospital. The diagnosis of V. parahaemolyticus was made after identification in stool cultures.

RESULTS

Thirty-five cases of V. parahaemolyticus gastroenteritis were identified, accounting for 8.7% of bacterial gastroenteritis (35/403) and 1.18% of all cholera-like gastroenteritis (35/2942). The patients' median age was 26 years [range=10-70 years] and the M/F sex ratio was 1.5. Most patients came from Dakar city (30 cases). Contamination occurred within the family in 27 cases, and food was suspected to be the source of contamination in 33 cases. Clinical presentation upon admission included acute watery diarrhea with dehydration (35 cases), vomiting (30 cases), abdominal pain (25 cases), muscular cramps (12 cases), and fever (4 cases). All V. parahaemolyticus isolates were susceptible to amoxicillin, quinolones, cotrimoxazole, chloramphenicol, and cyclines. Patients were treated by rehydration and doxycycline. The outcome was favorable in all cases, with a mean hospital stay of 24 hours [range=4-72 hours].

[The point on human rabies in Senegal from 1986 to 2005]

Between 1986 and 2005, 54 patients were hospitalized for rabies in the infectious diseases clinic, with an average of 3 cases a year. The patients came from almost all regions of Senegal, Dakar (11 cases), Thiès (9 cases), and Fatick (9 cases). They were native of rural and suburban zones. The median age was 19 years (range 5-72). Children and teenagers between 5 and 15 years of age were the most concerned (53.7%). Stray dogs were the main vector (75% of cases) but a case of bite by a puppy and a case of bite by a jackal were noted. Bites were mostly located in limb extremities (98%). Only 12 patients consulted a health institution after the bite and among these cases, 4 were referred to the Dakar Pasteur Institute but consulted late. Incubation was 45 days on average (range 25 to 90 days). All our patients presented a furious form of rabies. The average duration of hospital stay was 6 days (range 1-15 days). The local investigation proved an under reporting of cases in a proportion of 1 case reported for 4 non-reported cases.

[Malaria: knowledge, behaviour and practices among a rural population of Gossas, Senegal]

Malaria remains a major public health problem in Sub-Saharian Africa, in terms of morbidity and mortality rate. To assess the knowledge and behaviour of population regarding the transmission, the treatment and the prevention of malaria, we conducted a cluster sample household survey in Gossas, a rural District in Senegal, from May 2nd to May 6th 2005. A questionnaire that focused on socioeconomic conditions, beliefs, knowledge about and behavior toward antimalarial medication and the prevention means used was given to 480 household owners. Overall, 107 pregnant women and 1,201 children aged less than 5 years old lived within these household. More than a half of the household owners (51%) were illiterate and 25.2% ignored how malaria is transmitted. Fever was the most common symptom suggesting malaria (61%). In 46.1% of febrile cases, people did not seek for treatment from a physician. Home treatment of febrile episodes was based on paracetamol or aspirin (84%), chloroquine (13%) and cotrimoxazole (2.9%). Overall, the proportion of insecticide treated nets users were 22.7%. This percentage was 14.9% and 11.4% for pregnant women and children younger than 5 years old, respectively. People having radio sets, regular access to television, and people aware of the transmission route of malaria were more likely to use bed nets. In most cases, organic material burning was used as repellent against mosquitoes. The low prevalence of bed net use was most often explained by participants' limited accessibility to and by the high cost of insecticide-treated nets. Knowledge about malaria prevention and treatment is low in the rural district of Gossas. The rate of insecticide-treated-bed nets use in vulnerable people is very low, far from the Abuja meeting objective. A sensibilization program and a social marketing plan for insecticide-treated-bed nets could improve this situation.

[Efficacy and tolerance of antiretroviral therapy in HIV-2 infected patients in Dakar: preliminary study]

OBJECTIVE

The authors had for aim to evaluate the clinical and immunological response as well as the tolerance to antiretroviral therapy in HIV-2 infected patients.

DESIGN

A retrospective chart review was made from August 1998 to August 2004.

RESULTS

188 patients were on protease inhibitor based regimen. 153 (81.38%) were HIV-1 and 35 (18.62%) HIV-2 infected patients. The mean weight gain was significantly higher in the HIV-2 group at months 9 and 12 (P=0.02 et P=0.01 respectively), whereas CD4 cells count gain was higher in the HIV-1 group at month 6 (P=0.004). New AIDS defining criteria are less likely to occur in HIV-2 infected patients on HAART than in HIV-1 (P=0.004). Lipodystrophy syndrome was present only in HIV-1 infected patients.

CONCLUSION

Antiretroviral therapy in HIV-2 infected patients shows similar clinical and immunological efficacy than in HIV-1 infected ones and is also well tolerated.

[Cholera epidemic of 2004 in Dakar, Senegal: epidemiologic, clinical and therapeutic aspects]

During the cholera epidemic that occurred in Dakar, Senegal in 2004, we treated a total of 593 confirmed or suspected cases in our department. The purpose of this report is to describe epidemiologic, clinical, bacteriologic and therapeutic aspects of these cases. Study was conducted at the infectious diseases clinic from October 11 to December 20, 2004. Mean patient age was 30 years and the sex ratio was 133. The likely source of contamination was food or water intake in 92% of cases. The duration of the epidemic was short (75 days). Onset was sudden in 98% of cases and the main clinical manifestations were watery diarrhoea (95%) and vomiting (78%). The mean delay between symptoms and hospitalization was 11 hours and the number of stools before admission to the hospital was greater than 10 in 23% of cases. At the time of admission 119 patients (20.1%) were severely dehydrated. A total of 250 coprocultures were performed. Results were positive in 145 cases (58%) including 112 (44%) for Vibrio cholerae 01. Antibiotic testing carried out on 36 strains demonstrated excellent sensitivity to doxycycine and pefloxacine but resistance to cotrimoxazole, amoxicilline and chloramphenicol. Oral rehydration therapy was used in most cases (61%). The mortality rate was 0.5%. Cholera is a medical emergency that can have a favourable prognosis with properly organized management.

[Epidemiology, clinical features and prognosis of juvenile tetanus in Dakar, Senegal]

This study was conducted to determine the prevalence of juvenile tetanus and to describe its epidemiological aspects, clinical features and prognosis. We prospectively recruited tetanus cases among patients in the age group 1-15 years admitted to the Infectious Diseases Clinic in Fann teaching hospital, Dakar, from March to September 2002. Forty cases of juvenile tetanus were recruited, accounting for 5.3% of total patients and 43% of all tetanus cases hospitalized during the study period. Mean age was 8.8 years +/- 4.4 years and sex-ratio M/F was 3. None of the patients was reported to have completed a full course of tetanus toxoid and most of them (77%) had been living in suburbs in Dakar were uneducated (77%) and had parents with no occupation (70%). Portals of entry were: skin injuries (62%), circumcision (20%), ear pearcing (5%) and suppurative otitis (8%). Tetanus became widespread in all cases, most of which having mild grade disease (72%). Pseudomonas aeruginosa bacteremia was diagnosed in the development of two fatal cases of otogenous tetanus. The overall case fatality rate was 8% (three deaths) and no sequelae was observed among those who recovered. The expanded programme on immunization should be reinforced and complemented with booster doses strategy to avoid tetanus whatever the age group.

[Cardiovascular events in the course of tetanus: a prospective study on 30 cases in the infectious diseases clinic, in the Fann teaching hospital, Dakar]

OBJECTIVES

This prospective study had for aim to determine the frequency and characteristics of cardiovascular events in the course of tetanus.

PATIENTS AND METHODS

From September to December 2002, we studied all patients over 4 years of age presenting with tetanus without any documented underlying disease.

RESULTS

Thirty cases were included (mean age 36+/-20 years; sex-ratio 2.3). Seventy-three per cent had a mild-gravity tetanus (stage II of Mollaret) upon admission. One hundred and seventeen ECG were recorded and 93.3% of the patients had more than one abnormality: arrhythmia (24 cases), prolonged QT interval (23 cases), ventricular hypertrophia (17 cases), and atrial hypertrophia (4 cases) especially left (3 cases), failure of AV conduction (3 cases), ST segment depression (3 cases), left and right axis deviation (3 cases), baseline undulation (3 cases) and repolarization disturbances (1 case). All patients had a normal Doppler echocardiographic examination. The mean hospitalization stay was 11.6+/-1.4 days and complications were noted in 60%; sinus tachycardia in apyrexia (5 cases), instable BP (5 cases), excessive sweatiness in apyrexia (1 case), and access of bradycardia with sudden cardiac arrest (2 cases). 8 patients died (26.7%). Six patients with cardiac autonomic dysfunction died, the case fatality rate being statistically higher in this group (P=0.007). A prolonged QT interval, sinus tachycardia and left ventricular hypertrophia were statistically more frequent at the acute phase of the illness.

CONCLUSION

The case fatality rate of tetanus is still high, due among others to autonomic dysfunctions.

[Update on neuromeningeal cryptococcosis in Dakar]

This study was carried out to provide current information on neuromeningeal cryptococcosis at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar. Epidemiological, clinical, biological and therapeutic data were collected retrospectively from files of patients treated between 1999 and 2003. A total of 45 cases including 34 in HIV-positive patients were analyzed. The prevalence of neuronieningeal cryptococcosis in H1V-infected patients was 2.9% in 2000 and, 7.9% in 2003. Only 6 patients had been using antiretroviral therapy. The male-to-female sex ratio was 2 and mean age was 34 years (range, 18-61 years). Clinical presentation involved fever (73.3%), persistent headache (86.7%), vomiting (66.7%), meningeal syndrome (60%), coma (20%), convulsion (13.3%), focal neurological deficit (15.6%), and cranial nerve dysfunction (11.1 %). The CD4-cell count was less than 200/mm3 in 14 of 15 patients tested. Cerebrospinal fluid was clear in most cases (88.9%) and lytuphocytic in half (52%) with a mean albumin concentration of 0.79 g/l. Positive results were obtained with India ink smears in 35 of 45 cases, cultures in 30 of 31 cases and cryptococcic antigen detection in CSF in 9 of 9 cases. The most frequently used antifungal drug was fiuconazole (93%). The mortality rate was 71.1% (32 deaths) overall and reached 78.9% in patients with less than 20 cells/mmm3 in CSF (78.9%). Three measures are necessary for control of neuromeningeal crytococcosis: routine screening in severely immunodeficient HIV patients, distribution of effective systemic antifungal drugs and primary prevention by widespread use of antiretroviral therapy.

[Epidemiological, clinical, etiological features of neuromeningeal diseases at the Fann Hospital Infectious Diseases Clinic, Dakar (Senegal)]

OBJECTIVES

This retrospective study was carried out to determine the prevalence of cerebromeningeal diseases at the Fann Teaching Hospital Infectious Diseases Clinic, in Dakar, and to describe their epidemiological, clinical, and etiological features.

PATIENTS AND METHODS

Data was collected for analysis from patients files recorded from January 1, 2001 to December 31, 2003.

RESULTS

Four hundred seventy cases were identified (11.4% of total admissions) with a M/F sex ratio of 1.38 and a mean age of 33 years. Eighty-nine patients were infected by HIV and clinical presentations included fever (78%), meningeal syndrome (57.4%), coma (64.9%), convulsions (19%), focal neurological deficits (15.5%), and cranial nerves dysfunction (7.2%). Etiologies presented as cerebral malaria (85 cases), purulent meningitis (51 cases), neuromeningeal cryptococcosis (37 cases), tuberculous meningitis (11 cases), intracranial abscess (10 cases), toxoplasma encephalitis (4 cases), cerebrovascular attack (11 cases), and cerebromeningeal hemorrhages (3 cases). In as many as 248 cases (52.8%) no etiology could be found. The case fatality rate was 44.5% overall (209 deaths) and 68.5% among HIV-infected patients. Neurological sequels were found in 22 survivors (8.8%), consisting in focal neurological deficit (12 cases), deafness (5 cases), diplopia (2 cases), dementia (2 cases), postmeningitic encephalitis (1 case).

CONCLUSION

These results show the need to improve our technical capacities in our diagnostic laboratories, the prevention of opportunistic infections in the course of HIV/AIDS infection, and the involvement of various specialists in the management of cerebromeningeal diseases.

[Prescription of morphinics in the management of pain in Dakar teaching hospitals]

The correct management of pain is one of the most frequent problems in a daily medical practice. To achieve this goal physicians have to use many drugs. Among these drugs morphinics represent a special category with specific rules of administration. To assess the use of morphinics in the management of pain in Dakar teaching hospitals and to determine the reasons of under or over prescription, we carried out this study A questionnaire was sent to 200 medical doctors in two teaching hospitals in Dakar between February and April 1999. The response rate was 89.5% (179). According to 73.2% of medical doctors who answered the questionnaire, pain frequently leads to consultation but surprisingly only 14 physicians (7.8%) recognize a regular use of morphinics while 70.1% of them prescribe morphinics exceptionally Morphinics are mainly used to control pain in cancerology (37.2%) and post-operative pain (21.3%). The main reasons to explain the under-use of morphinics were: the fear of respiratory side-effects of morphinics (35.3%), the ignorance of prescription rules (23.5%). The training regarding prescription of morphinics was provided during medical studies and only 10 out of the medical doctors had an adequate postgraduate training in this domain. As expected 51.4% of physicians thought that their training during medical studies was inadequate. To improve the management of pain in our country we recommend a better training of medical doctors during medical studies and the promotion of postgraduate seminars on the use of these molecules. The legislation and rules of administration must be cleared and these drugs should be more available in drugstores and hospital pharmacies. All of these modifications are necessary to help medical doctors to overcome the fear of morphinics for a better management of pain in our country.

[Clear-fluid meningitis in HIV-infected patients in Dakar]

This retrospective study was carried out to describe the epidemiological, clinical and aetiological aspects of clear-fluid meningitis among HIV-positive patients admitted at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar Data were collected for analysis from patients files recorded from January 1, 2001 to December 31, 2003. Forty-six cases of clear-fluid meningitis were found among HIV-infected patients, representing 51.7% of cerebro-meningeal diseases and 92% of meningitis encountered in those patients. Sex ratio MIF was 1.5 and the mean age of patients was 40.7 years [range 23-61 years]. Clinical presentations comprised headache (80%), fever (67%), meningeal syndrome (74%), coma (28%), convulsions (9%), focal neurological deficits (11%), cranial nerves dysfunction (9%). Aetiologies were represented by neuromeningeal cryptococcosis (29 cases) and tuberculous meningitis (5 cases). In 26% of cases no aetiology was found. The case fatality rate was 63% overall (29 deaths) and 83.3% among cases with unknown aetiology. It did not vary significantly according to epidemiological and clinical variables studied. Neurological sequelae were found in 4 patients who recovered. A better management of clear-fluid meningitis among HIV-positive patients should benefit from the reinforcement of our diagnostic capacities, the availability of effective systemic antifungal drugs and the prevention of opportunistic infections in the course of HIV/AIDS infection.

[Tetanus following intramuscular injection in Dakar: epidemiological, clinical and prognostic features]

INTRODUCTION

tetanus stills a major public health problem in developing countries despite the availability of an efficient and accessible vaccine. The aim of this study was to evaluate the epidemiological and clinical pattern and the prognosis of intramuscular injection.

PATIENTS AND METHODS

This is a retrospective study from the medical charts of 4 6 patients admitted for tetanus following intramuscular injection in the infectious diseases clinic ward of Fann hospital of Fann, in Dakar, between January 1999 and December 2002.

RESULTS

The prevalence was 10% with a mean of 11.5 cases per year. The mean age was 34.5 years. The substance injected was known in 33 cases. Quinine injection was responsible in 32 cases. The period of onset was shorter than 48 hours in 39 cases (84.8%). The lethality rate was high (60.8%). The prognosis factors were the mean delay before h ospitalisation lower than 3 days (p = 0.03) and a scoring stage more than 4 (P = 0.01).

CONCLUSION

Tetanus following intramuscular injection is usually caused by quinine injection. The effective prevention relies on the training of health care workers and the strict application of the Guidelines of the National Program against Malaria.

[Efficacy and tolerance of non nucleosidic reverse transcriptase inhibitors containing tritherapy in HIV-1 infection]

INTRODUCTION

Antiretroviral therapy has dramatically changed the natural history of HIV infection. The aim of this study was to evaluate the effectiveness and tolerance of Non Nucleosidic Reverse Trancriptase Inhibitors containing regimens in HIV-1 infection.

PATIENTS AND METHODS

This is a retrospective chart review of 257 HIV-1 infected patients followed in the infectious clinic ward of fann, from august 1998 to February 2002.

RESULTS

Overall 195 patients (75.87%) were on efavirenz and 62 (25.2%) on nevirapine, with a male predominance (sex-ratio = 1.44). Baseline HIV-1 viral load was higher in efavirene group (p = 0.03). The two groups were comparable for immune restoration, tolerance, rate of treatment discontinuation and letality. The viral suppression was greater in efavirenz group at month 6 (p = 0.04).

CONCLUSION

Non nucleosidic reverse transcriptase inhibitor containing regimens are effective and well tolerated. Those results make them suitable for first line therapy in HIV-1-infection.

[Antibiotic resistance of the most frequently isolated germs at the Fann University Teaching Hospital between January 1999 and December 2000]

Bacterial infections take up an important place in tropical pathology and have an increased death-rate. Among the causes of this strong mortality, the resistance of bacteria to antibiotics keeps a dominant part. We carried out, between January 1999 and December 2000 a study aiming to establish the distribution of the most frequently isolated germs at the Laboratory of Bacteriology of Fann Hospital, their sensibility to antibiotics and the different phenotypes of resistance. We noticed a predominance of enterobacteria (69.30%), notably Escherichia coli (56.76%) and Klebsiella pneumoniae (47.69%), but also Staphylococcus aureus (13.91%). Enterobacteria present 39.7% of resistant phenotypes to beta-lactams (E. coli: 61.75% and K. pneumoniae: 47.69%). Only the third generation cephalosporins and fluoroquinolons are constantly actives on enterobacteria, and 69% of S. aureus strains are resistant to methicillin, and so to all beta-lactams. Pseudomonas aeruginosa become difficult to overcome: 51.13% of the strains produce beta-lactamase. The quinolons are the most active antibiotics on this germ. It is very important to settle network that will be in charge to survey the evolution of these bacterial resistances.

[Resistance of bacteria and antibiotic prescription in Fann University Teaching Hospital, Dakar]

The objective of this study conducted in Fann University Teaching Hospital in Dakar, is to establish correlation beetwen the prescription and consummation of antibiotics in the one hand, and the susceptibility of strains isolated in this hospital on the other hand. An interview of medical practitioners and pharmacists was realised to appreciate the antibiotics used in the clinics, the bacteria taken aim, the criteria of choice, the place of antibiogram, the place of antibiotics in orders of medicines and pharmacists, the consummest family of antibiotics. In the lab, all of pathogen bacteria were tested by disc diffusion test (antibiogram) to appreciate the susceptibility to antibiotics. The results show that Enterobacteria represented 60.8% of isolates and among them, Escherichia coli (30.6%) was the most representative specie in hospitalized and non hospitalized patients. 52% of the strains of E. coli were susceptible to aminopenicillins in external patients, versus less than 35% in hospitalized. In Neurosurgery, Pseudomonas aeruginosa was the most frequent bacteria and all of the strains were susceptible to imipenem, dibekacin and ciprofloxacin. Beta-lactams were the most used drugs in the first place (78.8%), related to habits of prescription of medical staff and to avaibility of antibiotics. The choice of antibiotics must take the susceptibility of strains into account.

[Clinical, bacteriological and therapeutic aspects of meningococcal meningitis in Dakar in 1999]

Two major outbreaks of meningitis due Neisseria meningitidis serogroup A occurred in Senegal in 1998 and 1999. The purpose of this report is to describe clinical, bacteriological and therapeutic findings in 70 patients admitted for cerebrospinal meningitis to the Infectious Disease Clinic at the Fann University Teaching Hospital in Dakar in 1999. Diagnosis was based on direct microscopic examination after Gram staining in 71% of the cases, culture in 76%, and detection of soluble antigens in cerebrospinal fluid in 24%. Median patient age was 20 years. The highest incidence, i.e. 66% of cases, was recorded during February, March and April. Meningitic syndrome and fever were observed with 86% of the cases. The average duration of antibiotic therapy was 8 days. Chloramphenicol was the most commonly used drug (84% of cases). All strains identified in cultures were sensitive to chloramphenicol, ceftriaxone and cefotaxime but resistant to cotrimoxazole. Outcome was favorable in 93% of the cases. Three patients (4%) died and two (3%) developed hearing loss. Despite the low death rate in this series of patients treated in a hospital setting, mass vaccination is still the most effective mean of controlling meningococcal meningitis.

A simple clinical and paraclinical score predictive of CD4 cells counts below 400/mm3 in HIV-infected adults in Dakar University Hospital, Senegal

In industrialized countries the decision to start co-trimoxazole (CMX) prophylaxis of HIV-related opportunistic infections is based on the CD4+ cell count. The value of CMX prophylaxis has also been demonstrated in Africa, where CD4+ cell counts are rarely available. We therefore developed a simple score predictive of a threshold CD4+ cell count (400/mm3) below which CMX prophylaxis is indicated. In a retrospective cross-sectional study, we collected clinical and biological data on 211 HIV-infected patients recruited from January 1996 through January 1998 at Fann University Hospital in Dakar, Senegal. Several variables were identified as being predictive of a CD4+ cell count below 400/mm3 by stepwise logistic regression. Each variable was weighted according to its regression coefficient, as follows: male sex (+1), weight loss (+2), body mass index < 22 (+2), herpes zoster (+4), tuberculin induration < 5 mm (+3) and haemoglobin < or = 10 g/dL (+1). A score of > or = 4 (sum of weights) selected patients with CD4+ cell counts below 400/mm3 with a sensitivity of 98% and a negative predictive value of 83%. Such a score should be applicable in the African context and should facilitate the management of HIV-infected patients, especially the prescription of CMX prophylaxis.

[Place and resistance of epidemic strains of Shigella dysenteriae-1 isolated at the Fann Hospital from 1995 to 1999]

Shigella dysenteriae-1 (S.d-1) takes a more and more important place in intertropical countries, with multiresistant strains to antibiotics. the objectives of the study is to determine the prevalence of S.d-1 among bacterial isolations at Fann Hospital at Dakar, and to identify the resistant profiles of the strains. This retrospective study was conducted on the strains isolated between 1995 and 1999 by examination of faeces for bacterial pathogens. the susceptibility of the strains to antibiotics was studied by disc diffusion test with Mueller Hinton agar, and detection of extended broad spectrum beta-lactamase. Shigella dysenteriae-1 represented 45.18 % of Shigella strains and was particularly isolated in winter season (from August to September), more frequently in men (sex ratio: 2 / 1). Among the strains, 72 % were resistant to beta-lactams, and the ratio of multiresistant strains represented 42 %, concerning cotrimoxazol, chloramphenicol, tetracyclin and aminopenicillins. Only one strain produced extended broad spectrum beta-lactamase. Quinolons were the most active antibiotics but have to be used rationally.

Modulating effects of mucoregulating drugs on the attachment of Haemophilus influenzae

Non-typable Haemophilus influenzae (NTHI) is one of the three major pathogens implicated in human respiratory infections. The ability to attach with pharyngeal epithelial cells is an important factor for infection and virulence. In the present study we describe the effects of two mucoregulating drugs, S-carboxymethylcysteine (S-CMC) and ambroxol, on the attachment of NTHI to pharyngeal epithelial cells. There was a significant (P < 0.0001, < 0.001 and <0.01) decrease of attachment (8.8 +/ 2.4, 9.2+/-2.5 and 15.4 +/- 5.7 bactreria/cell) compared with the control (17.5 +/- 2.9, 15.5 +/- 3.1 and 18.8 +/- 6.8 bacteria/cell) after cells were treated wth S-CMC at a dose of 100, 10 and 1 microg/ml. After attachment assay, cells treated with S-CMC (100 microg/ml) showed a significant decrease (P < 0.01) of attached bacteria (3.1 +/- 0.8 bacteria/cell) compared with the control (5.9 +/- 1.8 bacteria/cell). Treatment of cells with ambroxol did not influence bacterial attachment. By scanning electron microscopic observation it was found that NTHI attaches to the surface elevations (microplicae) of human pharyngeal epithelial cells. Atomic force microscopic observation revealed that the surface potential of microplicae decreased significantly in cells treated with S-CMC compared with the untreated control cells. As bacteria with negative surface charge attach to the positively charged domain, i.e. microplicae of human pharyngeal epithelial cells, this study suggests that the decrease of attachment of NTHI with epithelial cells after treatment with S-CMC was possibly due to the decrease of surface charge. This study suggests that S-CMC decreases the episodes of respiratory infections in patients with respiratory diseases both by inhibiting the attachment of bacteria to the upper respiratory tract, and by detaching the adherent one.

AIDS caused by HIV1 and HIV2 infection: are there clinical differences? Results of AIDS surveillance 1986-97 at Fann Hospital in Dakar, Senegal

OBJECTIVE

To compare the clinical manifestations observed in AIDS patients infected with HIV2 and HIV1 infection.

METHODS

The medical records of AIDS patients hospitalized between January 1986 and July 1997 at the Department of Infectious Diseases of Fann Hospital, Dakar, were reviewed.

RESULTS

599 hospitalizations (76%) were HIV1 seropositive patients, 137 (17%) were HIV2 seropositive patients and 54 (7%) were patients serologically dually reactive to HIV1 and HIV2. There was no significant difference in medium CD4 lymphocyte count between patients with HIV1 and HIV2 infection. Chronic diarrhoea and diarrhoea caused by bacterial infections were more frequently observed in HIV2-infected individuals. Oral candidiasis and chronic fever were more often noted in patients with HIV1 infection. Bacterial and cryptococcal meningitis was only observed among patients with HIV1 infection.

CONCLUSIONS

Certain clinical differences were observed comparing AIDS patients with HIV1 and those with HIV2 infection. As there is no clear physiopathological explanation for these differences, additional studies with larger numbers of AIDS patients are needed to determine whether these differences are real.

[Sensitivity to cotrimoxazole of bacteria isolated at the Central University Hospital of Fann, Dakar]

This study concern a survey of bacterial resistance to cotrimoxazole; 510 strains of Enterobacteria (167), Vibrio cholerae(206) and Staphylococcus aureus(137) were tested by disc diffusion and agar dilution methods. An interview was conducted with 86 health personals to appreciate the influence of prescription. Staphylococcus aureus were the most susceptible bacteria (13% of resistance), and Vibrio cholerae the most resistant (95%). Related to the gender, Enterobacteria present 43 to 72% of resistance. The data of interview show a very frequent use of cotrimoxazole, related to the disponibility and the accessibility of this drug.

[Epidemiological, clinical and therapeutic aspects of severe malaria in adults in the infectious disease department of Central University Hospital of Dakar]

To assess epidemiological, clinical and therapeutic features of severe malaria among adults in Dakar (Senegal), we carried out a 5-year retrospective study in Infectious Diseases Ward (January 1992-December 1996). Over this period, 222 cases of severe malaria were included according to WHO definition criteria, 120 of them (54%) being adult patients. Monthly distribution of cases showed 2 peaks, on October and November. Most of the patients were males (sex-ratio = 2.1) and lived in urban area (91.7%). The mean age was 28.9 years (range = 16-73 years). Clinically, all of the cases presented with stage II coma. Association existed with convulsion (20%), severe anaemia (29.2%), renal failure (19.2%), hypoglycaemia (17.5%) and jaundice (34%). Patients were treated using quinine intravenously. Case fatality rate reached 26.7%, indicating life-threatening potential of malaria in adults living in urban area.

[Urinary tract infections in Dakar: etiologies, therapeutic basis]

This prospective study, performed in Fann University Teaching Hospital from January 1st to December 31st 1998, concern 1446 samples of urine. Enterobacteria (87.56%) were the most frequent aetiology, and Escherichia coli (48.7%) was the leading species in this family. The strains of E. coli present more resistant profil to beta-lactams (70.27%). Fluoroquinolons are active on more than 80% of the strains responsible of urinary tract infection in Dakar.

[Tetanus: epidemiological aspects at the Infectious Disease Clinics at the Fann University Hospital Center in Dakar]

This retrospective study was carried out to assess the recent epidemiological aspects of tetanus in Senegal. Based on the records of tetanus cases admitted at the Infectious Diseases Clinic in Dakar over a 7-year periode (1990-1996), this study showed that tetanus is still a major public health concern in Senegal. A global prevalence rate of 18.8% was found. Portals of entry were noticed to be: dirty wounds (48%), the umbilical stumps (19%), non sterile intra-muscular injections (4.5%), surgery (3.3%) and traditional practices (4.2%). Nevertheless, in a high proportion of cases (13.3%), the portal of entry was not found. A 30.3% case fatality rate was observed, that varied significantly according to portals of entry, reaching 60.4% in umbilical tetanus. It is recommended here that the immunization programme against tetanus be reinforced and supported by I E C Strategies together with retraining of medical personnel.

[Shigella bacteraemia: a report of two cases observed in Dakar]

Shigellosis is usually a self-limiting enteric disease, rarely accompanied by extra-intestinal manifestations. In Senegal, shigella bacteraemia is poorly documented. The authors report two retrospective cases of Shigella dysenteriae 1 bacteraemia in an infant aged 12 months and a 32 years-old adult admitted at the Infectious Diseases Clinic in Dakar. In both cases, a fatal outcome was observed, in relation to complications: endotoxic shock in the infant, severe intestinal haemorrhage in the adult.

[Sensitivity profiles of enterobacteria isolated at th Fann University Hospital Center, Dakar]

This study concerns 180 strains of Enterobacteria isolated at Fann University Teaching Hospital (Dakar, Senegal). The susceptibility to antibiotics was tested by disc diffusion test (antibiogram) and by dilution method determining the minimum inhibitory concentration (MIC). All of the species present more resistant profile to beta-lactams (> 55%); however ceftriaxon and aztreonam present the lower MIC 50 (< 0.06 microgram/ml). Fluoroquinolon inhibits more than 90% of the strains of E. Coli and Proteus. Chloramphenicol is active on Salmonella, but ceftriaxon, aztreonam and the fluoroquinolon present good alternatives. Cotrimoxazole is active only on 54% of Shigella strains.