Characterization of Typhoid Intestinal Perforation in Africa: Results From the Severe Typhoid Fever Surveillance in Africa Program

Background

Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria.

Methods

Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures.

Results

A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5-14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation.

Conclusions

Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability.

Simultaneous bilateral femoral fracture in children

Introduction

Bilateral femoral fractures in children (BFFC) are an uncommon condition. Only a few cases were reported in the literature. The frequency and outcome in low-setting facilities are unknown. This study aims to describe our experience in managing BFFC.

Patients and Methods

A 10-year ongoing study spanning from 2010 to 2020 was held in a level-1 paediatric facility. We included all cases of BFFC on a bone-free disease with at least 10 months of follow-up time. Data were collected and analysed with statistical software.

Results

A total of eight patients with ten BFFC were collected. It involved mainly boys (n = 7/8) with median age of 8 years. Mechanism of injury were a road traffic accident (n = 4), a fall from height (n = 3), and been crushed by a falling wall (n = 1). Associated injuries were frequent (n = 6/8). Patients were managed nonoperatively with spica cast (n = 5) and by elastic intramedullary nails (n = 3). After 6.11 years of mean follow-up time, all fractures healed. The outcome was excellent and good in 7 cases. One patient sustained knees stiffness.

Conclusion

Non-operative management of BFFC showed satisfactory outcomes. Early surgical care must be developed in our low-income settings to reduce in-hospital stay and encourage early weight-bearing.

Caustic oesophageal stricture treated by instrumental dilatation: A review of 6 years of practice at the pediatric university hospital charles de gaulle of Ouagadougou

Background

Oesophageal stricture is one of the most important and redoubtable complications following caustic ingestions in children. Instrumental dilatation is usually considered the first line of treatment.

Aims and Objectives

This study aims to evaluate the outcomes of caustic stenosis treatment when using Lerut dilatators.

Materials and Methods

This is a descriptive retrospective study from May 2014 to April 2020. All children under 15 years hospitalised in our department for caustic oesophageal stricture and had a gastrostomy and oesophageal dilatation with insertion of an endless wire were included.

Results

A total of 83 patients were included. The sex ratio was 2.2. The mean age was 4 years. The mean time from caustic ingestion to presentation was 90 days. Oesophageal stricture was mostly caused by caustic soda (n = 41) and potash (n = 15). We performed in total 469 dilatations and had only three oesophageal perforations. After a mean follow-up of 17 months, we had 60.2% good results (n = 50) and 7.2% (n = 6) failures. The mortality rate was 13.2% (n = 11).

Conclusion

The results of the dilations by Lerut dilatators give encouraging results in our department. It is easy to perform and its complications remain rare. Mortality could be reduced by adequate nutritional support.

72 - État des lieux de la vaccination contre la COVID-19 du personnel d'un hôpital africain

Contexte

Selon l'OMS, le 26 décembre 2021, 278 millions de cas confirmés de COVID-19 ont été enregistrés dans le monde avec environ 5,4 millions de décès. Au Burkina Faso, 17 632 cas avec 318 décès ont été enregistrés. La vaccination est une des stratégies mise en place pour lutter contre cette pandémie. L'objectif de l’étude était de faire un état des lieux de la vaccination contre la COVID-19 chez des personnes travaillant dans un hôpital du Burkina Faso, un pays d'Afrique de l'Ouest.

Méthodes

Nous avons conduit une étude descriptive allant du 2 juin 2021 au 31 décembre 2021 au Centre hospitalier universitaire de Tengandogo. L’étude a concerné tout le personnel tous profils confondus. Les informations ont été obtenues par entretien. Les variables quantitatives ont été décrites en utilisant la moyenne et les variables qualitatives la proportion.

Résultats

Au total, 174 agents ont été vaccinés sur 559 soit une proportion de 31 % IC 95 % [27-35]. L’âge moyen était de 41 ans ± 8. Le sexe masculin représentait 55 %. Les principaux profils représentés étaient les médecins 39 %, les infirmiers 36 %, les filles et garçons de salles 5 %. La principale raison à la vaccination était la protection contre la maladie dans 76 %. Le vaccin AstraZeneca a été utilisé chez 63,22 %, suivi de Johnson & Johnson chez 36 %. Des effets secondaires mineurs ont été signalés chez 80 % des vaccinés. Aucun évènement indésirable grave n'a été signalé. Trois personnes vaccinées avec le vaccin Johnson & Johnson ont développé la COVID-19 respectivement après 30 jours, 66 jours, 74 jours. Une personne vaccinée avec AstraZeneca l'a développé au bout de 174 jours.

Discussion/Conclusion

La proportion des vaccinés est faible. Au vu de la résurgence actuelle de la COVID-19, des interventions visant à améliorer l'adhésion chez ce personnel de première ligne doivent être développées dans de meilleurs délais.

Déclaration de liens d'intérêts

Les auteurs déclarent ne pas avoir de liens d'intérêts.

Left posterolateral strangulated congenital diaphragmatic hernia in children: About a case at the Charles de Gaulle Paediatric Teaching Hospital in Ouagadougou (Burkina Faso)

Late presentation of congenital diaphragmatic hernia is uncommon. It poses considerable diagnostic challenges when it strangulates. The authors report a case of a left posterolateral strangulated congenital diaphragmatic hernia in a 5-year-old child diagnosed at the stage of acute intestinal occlusion with intestinal necrosis and managed successfully. A strangulated congenital diaphragmatic hernia should be suspected in the case of an association of sudden-onset respiratory and digestive manifestations with no sign of trauma or specific pulmonary history. It then requires an antero posterior thoracic X-ray or, even better, a thoracic-abdominal scan to confirm the diagnosis.

First Report of Rice stripe necrosis virus Infecting Rice in Burkina Faso

Rice stripe necrosis virus (RSNV) was first described in 1977 as a new virus infecting rice in Cote d'Ivoire (3) and was subsequently observed in Liberia, Nigeria, and Sierra Leone (2). RSNV is a soil-borne virus transmitted by the fungus Polymyxa graminis (1) and belongs to the genus Benyvirus (4). During a survey carried out in April of 2013, severe symptoms characterized by seedling death, severe plant malformation, and foliar striping were observed on rice plants in an experimental field of INERA at Banfora located in western Burkina Faso. Disease incidence in the field was estimated to be 80 ± 5%. The symptoms of disease were successfully transmitted to the susceptible rice (Oryza sativa) cultivar IR64 by soil transmission experiments (1). RSNV was detected by ELISA using a polyclonal antiserum (1), kindly provided by Dr. Denis Fargette, IRD, Montpellier, France. Total nucleic acid was extracted with TRIzol reagent (Invitrogen) from IR64 and field infected samples. The presence of the virus was confirmed by RT-PCR using primers 5'-CATCTTGTCGAGATGAG-3' and 5'-GCGTTGTCTTTATCAGTG-3' for specific sequences flanking the RNA2 CP gene. The RT-PCR product was directly sequenced and the sequence was deposited in GenBank (Accession No. LK023710). Sequence analysis showed that the CP gene of the RSNV isolate from Burkina Faso shared the highest nucleotide sequence identity (97.6%) with the known RSNV CP gene sequence from the Colombian isolate (EU099845) available in GenBank, confirming the presence of RSNV in the rice crops in Burkina Faso. To our knowledge, this is the first confirmed report of RSNV in Burkina Faso. Further studies are needed to determine its incidence and spread in the country. Detection of RSNV in Burkina Faso signals the urgent need for adoption of appropriate measures to restrict the spread and impact of this virus within Africa. References: (1) C. Fauquet and J. C. Thouvenel. Proc. Acad. Sci. Ser. D 296:575, 1983. (2) C. Fauquet et al. Develop. Appl. Biol. 2:71, 1988. (3) D. Louvel and J.-M. Bidaux. Agronomie Tropicale 32:257, 1977. (4) I. Lozano and F. Morales. Eur. J. Plant Pathol. 124:673, 2009.

Hernie diaphragmatique post-traumatique de l’enfant: à propos d’un cas au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou

La hernie diaphragmatique post-traumatique est une urgence chirurgicale rare chez l’enfant mais pouvant mettre rapidement en jeu le pronostic vital. Les auteurs rapportent le cas d’un garçon de 04 ans admis aux urgences pour douleur abdominale suite à une contusion thoraco-abdominale par accident de la voie publique. Le bilan radiologique initial a consisté en une échographie abdominale qui a révélé un hémopéritoine de petite abondance sans lésion focale. Douze heures après son admission, le patient a présenté une détresse respiratoire avec tableau clinique de pneumothorax gauche qui a nécessité une exsufflation en urgence. Le diagnostic de hernie diaphragmatique gauche a été posé à la radiographie du thorax réalisée après la ponction. L’enfant a bénéficié d’une cure chirurgicale. L’évolution a été favorable. La hernie diaphragmatique post traumatique, bien que rare chez l’enfant, devrait être systématiquement recherchée par une radiographie thoracique ou un scanner thoraco-abdominal devant tout traumatisme abdominal avec hyper pression. Son traitement est chirurgical.

[Morgagni hernia: Concerning 2 pediatric cases in Sub-Saharan Africa]

Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far, very limited data is available about them. We report two cases of repaired successfully Morgagni hernias using a transabdominal approach. The aim of this study is to illustrate the diagnostic difficulties and the excellent post operational prognostic observed following the transabdominal procedure. Both patients were female, one 8 months old and the other 3 months old. The presenting symptom was recurrent chest infection. Chest x-rays were carried out on both patients, which showed a pre-cardiac gas mass. A transabdominal surgical approach enabled surgeons to sow the defect with non resorbable suture material in one patient, and a prolene plate in the other. The patients fully recovered and no postoperative difficulties were reported.

Hirschsprung's disease: management problem in a developing country

BACKGROUND

The management of Hirschsprung's disease remains a problem in developing countries. Our aim is to identify the main epidemiological, clinical, and therapeutic characteristics of Hirschsprung's disease at the University Child Hospital Charles De Gaulle of Ouagadougou (CHUP-CDG).

PATIENTS AND METHOD

It is a retrospective study carried out in the period from January 2001 to December 2007 in the Surgery Unit at CHUP-CDG, which is a reference centre for Paediatric Surgery in Burkina Faso.

RESULTS

There were 52 patients (M: F=3.3:1). The annual incidence was seven cases. Age at presentation and diagnosis ranged from two days 10 years (median 20 months). Twenty five patients were from poor socio-economic conditions. Presentations were mainly intestinal obstruction, chronic constipation and enterocolitis. There were two cases of associated trisomy 21. Average age at operative intervention was 3.17 months. The rectosigmoidal form was the most frequently encountered. Over two-thirds (67.31%), with no complications at presentation, had benefited from nursing before their final treatment. A temporary colostomy was requested in case of complication. Swenson's technique was practiced for all the patients who underwent surgery operation. The assessment of functional results in eight patients after an average decrease of 3.5 years gave excellent results. Post-surgery complications were mainly enterocolitis in 12% of patients. Mortality rate was 16%.

CONCLUSION

Management of Hirschsprung's disease is a problem in Burkina Faso. It is characterised by its late presentation and difficult diagnosis due to inaccessibility and the non-availability of some investigation services (barium enema, histochemistry, and histology), resulting in high morbidity and mortality rates. Effective technical capacities, adequate staff training, and public education will be necessary to improve care quality.

[Preliminary results of endoscopic treatment of vesicoureteric reflux in children. Prospective comparative study of Deflux vs. Coaptite]

INTRODUCTION

The objective of this study is to compare the short-term and medium-term efficacy of Coaptite versus Deflux in the endoscopic treatment of vesicoureteric reflux in children.

MATERIALS AND METHODS

Over a period of 24 months, a cohort of 31 children with 44 refluxing vesicoureteric units were treated alternately by either Deflux implants (Group I, 24 refluxing units) or Coaptite implants (Group II, 20 refluxing units). This series comprised 40 solitary ureteric systems and 2 complete duplications. The two groups were comparable in terms of age at the time of the operation and distribution of severity of reflux. The quantity of product injected was identical in the 2 groups: 0.5 cc per ureter. All patients in group II received only one injection, while 2 Deflux injections were necessary in 2 patients and 3 injections were necessary in 1 patient in group I. All children were reviewed by ultrasound and retrograde cystography 3 months after the operation.

RESULTS

Reflux, regardless of grade, resolved in 70% of cases in the 2 groups (no significant difference). The cure rate was 75% for grade II and III in group I and 62.5% (grade II) and 70% (grade III) in group II, with no significant difference between the 2 groups. Two cases of grade IV reflux were cured after a single implantation of Coaptite in 1 case and Deflux in the other case. Complications, such as ureteric stasis or haemorrhage at the injection site, were not observed.

CONCLUSION

Although the efficacy of endoscopic treatment has now been clearly established, the choice of material to be injected is still controversial. This preliminary study did not reveal any significant difference in terms of cure rate, regardless of grade, between patients treated with Coaptite or Deflux. The medium-term and especially the long-term morbidity of these products still needs to be evaluated.

[Laryngo-tracheo-bronchial foreign bodies in children at the University Hospital Center of Ouagadougou (analysis of 96 cases)]

Over a 10-year period, a series 96 patients were treated for laryngotracheal and bronchial foreign bodies in the ENT department of the Ouagadougou University Hospital Center (Burkina Faso). The purpose of this study was to analyze the epidemioclinical features and therapeutic pitfalls encountered in that series and to propose measures to improve management. The age of patients ranged from 10 months to 14 years. The male-female ratio was 1.7. Anamnesis documented foreign body aspiration was obtained in 77% of cases. The foreign body was organic in 78 cases (81.2%) including vegetal material in 56 cases. Management was delayed due to late diagnosis since only 59.3% of the patients were admitted to the hospital within the 48 first hours. Endoscopic removal was performed in all cases but such procedures remain challenging in developing countries due to a lack of proper anesthetic facilities, skilled personnel and adequate equipment. Tracheostomy was performed in 10.4% of cases mainly in patients with foreign bodies located in larynx. One patient died during extraction. In addition to providing more information and education on prevention of laryngotracheal and bronchial foreign bodies, better management requires better training of medical personnel and improvement of technical facilities.

[Noma in children in a hospital environment in Bobo-Dioulasso: epidemiologic, clinical and management aspects]

A retrospective study covering ten years (1987-1996) was conducted to assess the epidemiology, clinical features and management of cancrum oris (noma) in children from Burkina Faso. Fifty nine (59) children were admitted with cancrum oris at the paediatrics and maxillo-facial surgery units of Bobo-Dioulasso, the second town of Burkina Faso. The hospital prevalence of noma is 1.5/1000. 81% of the cases were in the 1 to 5 years age group and 58% were females. Predisposing factors include poverty, lack of immunization, malnutrition, bad oral hygiene, measles and parasitic diseases. The cheek was involved in 31% of the cases. Cure was obtained in 80% of patients after medical and surgical treatment. However, many sequels were observed. Post operative outcome is complicated by the children's growth and often results in retractions, recurrence of ulcers or constriction. Psychological and social problems are associated. Management is difficult in our setting because of the lack of information, cost of the treatment and the absence of well-equipped plastic surgery units.

[Perihepatitis and HIV/AIDS infection. Apropos of 13 cases at the National Hospital of Bobo-Dioulasso]

Perihepatitis or Fitz-Hugh syndrome, peritonitis located in the right hypochondriasis (RH), is a relatively rare affectation. However, the HIV-AIDS pandemic has brought about the emergence and re-emergence of disease-states either uncommon or formerly on the decline as well as the appearance of opportunistic illness. We report the results of a retrospective study conducted in the National Hospital of Bobo-Dioulasso (Burkina-Faso) between 1 June 1997 and 31 December 1999 in an effort to contribute to a wider vision of diseases associated with HIV-AIDS. We based our study on 130 laparoscopies carried out for unexplained pain linked to RH (with or without fever), as well as abdominal-pelvian or diffuse abdominal pain. Thirteen cases (11 women, 2 men) of perihepatitis were diagnosed. The mean age for women and men was respectively 31.4 and 39.5. HIV serology was systematically carried out for all patients and, in case of perihepatitis, cultures were taken. All patients were infected with HIV and some presented signs of AIDS according to the WHO classification. In clinical terms, a shalking pain for RH was noted for 5 patients, abdominal sensitivity in 8 cases as well as gynaecological anomalies: cul-de-sac moving pain (4 cases), leuchorrea (3 cases) and mucosic vulvovaginitis (1 case). Paraclinical tests revealed a slight hepatic cytolysis for only 3 patients (1.5 N). 6 patients tested positive for Chlamydia trachomatis; the 7 others could not be tested, but this aetiology was assumed for evaluating the efficacy of the treatment under study. The high frequency of perihepatitis in these patients, all of whom were suffering from HIV-AIDS, and its presence in the 2 male cases, suggest that immunodepression is conducive to the appearance of this disease.

[Peritoneal tuberculosis and HIV infection. Reflection apropos of 22 cases at the National Hospital of Bobo Dioulasso]

Peritonitis tuberculosis is still a frequently encountered pathology in our hospital. Since the AIDS pandemic, cases of peritonitis tuberculosis present increasingly atypical characteristics, largely diverging from classical descriptions. The authors report on 22 cases of peritonitis tuberculosis associated with HIV infection. The study was carried out from June 1997 to December 1999 in the National Hospital Centre Souro SANOU of the Bobo Dioulasso internal office. It concerned 10 women and 12 men of a mean age of 37.9 years. The sex-ratio was 1.2 in favour of men. Diagnosis was established by laparoscopy. Peritonitis tuberculosis associated with HIV accounted for 78.5% of peritonitis tuberculosis cases. The clinical picture was dominated by isolated ascite (100%) associated with an oscillating high fever in 68.2% of cases. Negative results for IDR seemed to reflect poor prognosis. Response to treatment was slow but acceptable. The general prognosis was poor with a mortality rate of 18%.

[Compared characteristics of peripheral facial paralysis according to HIV status in Bobo-Dioulasso (Burkina Faso)]

Facial paralysis is a well-described manifestation of HIV infection. We report 27 cases of peripheral facial paralysis observed at Bobo-Dioulasso Hospital in a prospective study over a period of 9 months: 55 of the cases were HIV positive and 12/15 (80%) were in the 20-39 age group. Nine out of 11 females and 6 out of 16 males were seropositive. 13 of the cases were at stage B of CDC classification and 2 at stage C. ESR was elevated in all the HIV patients. CSF examination revealed lymphocytic pleiocytosis, elevated proteins and a positive HIV serology. CD4 counts were obtained in 8 cases and were under 400/mm3 in 4 cases. The clinical presentation was more severe in HIV seropositives with a longer duration of symptoms. Isolated peripheral facial paralysis associated with an elevated ESR in young adults suggest HIV infection and should lead to HIV counselling and testing.

[Neurologic manifestations associated with HIV infections at the Bobo-Dioulasso Hospital Center (Burkina Faso)]

Neurological manifestations of HIV infection are frequent and diverse. Diagnosis is often difficult due to geographical factors. 686 of the 3409 patients admitted to the Internal Medicine ward of Bobo-Dioulasso in 1995-1996 were HIV seropositive. This represents a prevalence of 20.1%. The sociodemographic and clinical characteristics of 101 patients with neurological problems during the study period are reported in this paper. This case series represents 14% of the HIV-positive admissions. The mean age was 35.7 years and 43% of the cases were aged 30 to 40 years. Sex-ratio was 1.6 male for 1 female. Focal deficits were observed in 36 of cases. Peripheral neuropathy (37%), meningitis or meningoencephalitis (20%), fitting (8%) and myelitis (8%) were the other clinical presentations. The etiology of the focal deficits was not ascertained because of the lack of tomodensitometry, specific serology and necropsy. Any neurological manifestation in a HIV seropositive patient should prompt investigations in order to diagnose those infections which can be treated, especially Toxoplasma gondii abscess and Cryptococcus neoformans meningitis.

[Malaria morbidity in adults living in urban Burkina Faso]

Urbanization in countries located in areas of endemic malaria can decrease the level of immunization and make malaria a more serious public health problem in adults. The purpose of this prospective study was to describe the clinical and parasitological features of malaria in adults in the city of Bobo Dioulasso in Burkina Faso. Study was carried out between July and November 1992 at the medical testing laboratory of the Muraz Center in 494 patients including 378 adults and 116 children under the age of 15 years. The parasitic index was 23% in adults as compared to 62% in children. There was not a significant difference in the parasitic index according to whether the place of residence was located in the city center or outlying suburbs. Parasite density ranged from 6 to 145,000 parasites per mm3 in adults as compared to 6 to 426,000 parasites per mm3 in children. Median parasitemia was 696 parasites per mm3 in adults as compared to 8800 per mm3 in children. The threshold of parasitemia for appearance of clinical symptoms was thus lower in adults than in children. Because of the poor positive predictive value of the main clinical features and the high incidence of self-treatment, microscopic examination is indispensable to confirm diagnosis of malaria. The results of this study indicate that urbanization in the city of Bobo Dioulasso has not significantly changed the level of immunization to malaria in adults.