[Cellulitis of male external genitalia in Mali]

The observation presented is that of cellulitis of the external genitalia (Fournier's gangrene) in an elderly diabetic male hospitalized in Kati in Mali. The speed of progression and severity of this syndrome are detailed.

A172 THE LACK OF CHROMOGRANIN A PROTECTS THE COLONIC EPITHELIAL BARRIER FUNCTIONS FROM COLITIS IN MALE MICE AND EXACERBATES COLITIS IN FEMALE MICE

Background

Ulcerative colitis (UC) is associated with compromised mucosal barrier function and colonic epithelial repair in a sex-dependent manner. Chromogranin A (CHGA), a pro-hormone, correlates positively with UC disease severity. In male mice, deletion of CHGA has been shown to decrease the inflammatory process; however, the effect of CHGA on mucosal barrier function and colonic epithelial repair between males and females is unknown.

Purpose

We investigated whether the lack of CHGA modulates gut barrier function, mucosa integrity, and colonic epithelial repair between males and females in a mice model of colitis.

Method

Male and female wild-type (WT) and CHGA (CHGA^-/-) deficient mice (13-17 weeks old) were given 5% dextran sulfate sodium (DSS) to induce colitis or water for 5-days (n=5-8 mice per group). The disease activity index (DAI) was assessed. Colons were collected, and tumor necrosis factor (TNF)-α and IL-25 concentrations were measured by ELISA. Expression of structural and functional markers specific to epithelial cells, namely, colonocytes (Na-K-Cl cotransporter [Nkcc]1), goblet cells function (resistin-like molecule [Relm]β), and mucin [MUC]2) and stem cells (reserve Hopx, fast-cycling Lgr5, and fetal-like Ly6a cells) were evaluated by qRT-PCR.

Result(s)

Colitic male CHGA^-/- did not show significant changes in DAI compared to WT mice. Conversely, female CHGA^-/- mice demonstrated a trend toward higher susceptibility to colitis compared to female WT mice with increased weight loss and bleeding. This was associated with elevated levels of colonic TNF-α and IL-25 (p<0.05) in CHGA^-/- females compared to CHGA^-/- males. TNF-α levels were not different between female groups at baseline and during colitis. While colitic CHGA^-/- female had elevated Relmβ expression (p<0.01) compared to WT mice. No significative change was noted in Relmβ expression between female WT mice at baseline and during colitis. Similarly, Nkcc1 and Muc2 expression was not different between female groups. By contrast, male CHGA^-/- were less susceptible to colitis than male WT mice with elevated Nkcc1and a lower Relmβ and Muc2 expression (p<0.01). In colitis, expression of stem cell markers, Hopx and Lgr5, was markedly reduced in all groups, while male WT, CHGA^-/-, and female WT had elevated Ly6a expression. However, the magnitude of Hopx and Ly6a expression was associated with sex. Thus, colitic male CHGA^-/- mice had a higher Hopx expression than male WT and female CHGA^{-/ -} mice, with a lower reduction of 1.9 compared to 4.9 and 6.6, respectively (p<0.05, 0.01, and 0.0001). While colitic male CHGA^-/- mice had elevated Ly6a expression (p<0.05) in contrast to female CHGA^-/- mice (p=0.5). The magnitude of the decrease in Lgr5 expression was not different between all groups.

Conclusion(s)

In the absence of CHGA, male mice preserved their colonic mucosa integrity and repair potential, while female mice suffered significant loss of mucosa integrity and repair potential during colitis.

Disclosure of Interest

None Declared

Human African trypanosomiasis cases diagnosed in non-endemic countries (2011-2020)

BACKGROUND

Sleeping sickness, or human African trypanosomiasis (HAT), is transmitted by tsetse flies in endemic foci in sub-Saharan Africa. Because of international travel and population movements, cases are also occasionally diagnosed in non-endemic countries.

METHODOLOGY/PRINCIPAL FINDINGS

Antitrypanosomal medicines to treat the disease are available gratis through the World Health Organization (WHO) thanks to a public-private partnership, and exclusive distribution of the majority of them enables WHO to gather information on all exported cases. Data collected by WHO are complemented by case reports and scientific publications. During 2011-2020, 49 cases of HAT were diagnosed in 16 non-endemic countries across five continents: 35 cases were caused by Trypanosoma brucei rhodesiense, mainly in tourists visiting wildlife areas in eastern and southern Africa, and 14 cases were due to T. b. gambiense, mainly in African migrants originating from or visiting endemic areas in western and central Africa.

CONCLUSIONS/SIGNIFICANCE

HAT diagnosis in non-endemic countries is rare and can be challenging, but alertness and surveillance must be maintained to contribute to WHO's elimination goals. Early detection is particularly important as it considerably improves the prognosis.

A182 THE LACK OF CHROMOGRANIN A IMPACTS COLONIC EPITHELIAL CELLS MARKERS IN AN EXPERIMENTAL MODEL OF ULCERATIVE COLITIS

Background

Ulcerative colitis (UC) is a chronic and acute inflammatory disorder of the colon linked to dysregulated gut mucosal immune response and compromised colonic epithelial barrier function and integrity. Chromogranin-A (CHGA), a pro-peptide secreted by enteroendocrine cells, is highly expressed in colonic tissues of patients with UC. Elevated CHGA has been shown to correlate with UC disease activity and severity. Moreover, complete deletion of CHGA was shown to result in a diminution of pro-inflammatory markers known to disrupt the colonic epithelial barrier function and gut mucosal healing process. However, little is known about the effect of the absence of CHGA on colonic epithelial barrier function and gut mucosal integrity.

Aims

Here, we characterized the impact of the lack of CHGA on the colonic mucosa and epithelial barrier structure and function using CHGA knockout (CHGA-/-) mice treated with dextran sulfate sodium (DSS) to induce colitis.

Methods

13–17 weeks old male C57BL/6 wild-type (CHGA+/+) and C57BL/6 CHGA-/- mice were treated for 5 days with 5% DSS to induced acute colitis, control mice received regular water. CHGA mRNA expression, disease activity index (DAI), and macroscopic score (MS) were analyzed. Distal colonic tissues were isolated, and mRNA expression of markers associated with regenerative stem cells (fast-cycling stem cells [Lgr5+] and reserve stem cells [HOPX+] and [LY6a+], Goblet cells functions mucus barrier mucin 2 [MUC2], resistin-like molecule β [RELMβ], WAP 4-disulphide core domain 2 [WFDC2]) and trefoil factor 3 (TFF3) was evaluated by qRT-PCR.

Results

We validated a beneficial effect of the Lack of CHGA on colitis severity, associated with significantly lower DAI and MS. In colitic CHGA+/+ and CHGA-/- mice, Lgr5+ and HOPX+ were both highly down-regulated, although, compared to CHGA+/+, CHGA-/- mice presented a 10.5fold higher expression of HOPX+. Compared to non-colitic states, Ly6a+ expression was significantly elevated in both colitic CHGA+/+ and CHGA-/- mice, however, no differences in Lgr5+ and Ly6a+ expression were noted between CHGA+/+ and CHGA-/- mice in all conditions. In CHGA+/+ mice, inflammatory conditions led to higher MUC2 and RELMB expression, although, compared to CHGA+/+, these markers were significantly lower in CHGA-/- mice. In colitic conditions, compared to CHGA+/+, CHGA-/- had a significant increase of WFDC2. In non-colitic conditions, mRNA expressions of all markers evaluated between CHGA+/+ and CHGA-/- in this study were unaltered. Finally, no differences were observed in TFF3 gene expression.

Conclusions

These results indicate in the absence of CHGA, the colonic epithelial barrier integrity and function are maintained through the modulation of goblet cells functions and elevated gut mucosa regenerative potential, thus enhancing the mucosal protection to colitis damage.

Funding Agencies

CIHR

[Epidemiology and prognosis aspects of upper gastrointestinal bleeding of NianankoroFomba hospital in segou]

AIMS

The goal of our work was to clarify the epidemiologicals, clinicals, etiologicals and prognostics of upper gastrointestinal bleeding at Segou Regional Hospital.

PATIENTS AND METHODS

This cross-sectional study, which took place from October 1, 2017 to September 31, 2018, involved patients hospitalized for digestive hemorrhage.

RESULTS

Upper gastrointestinal bleeding represented 9.7% of all hospitalizations. The mean age of the patients was 50, 94 ± 21, 6 years with a sex ratio of 1.6 in favor of men. Housewives and farmers were represented in 37.7% and 34% of cases. The main modes of disclosure were hematemesis and melena. Evolution was favorable with a mortality of around 34%.

CONCLUSION

upper gastrointestinal bleeding is relatively common in our context. High mortality is linked to delayed treatment.

The elimination of human African trypanosomiasis: Achievements in relation to WHO road map targets for 2020

Background

In the 20th century, epidemics of human African trypanosomiasis (HAT) ravaged communities in a number of African countries. The latest surge in disease transmission was recorded in the late 1990s, with more than 35,000 cases reported annually in 1997 and 1998. In 2013, after more than a decade of sustained control efforts and steady progress, the World Health Assembly resolved to target the elimination of HAT as a public health problem by 2020. We report here on recent progress towards this goal.

Methodology/principal findings

With 992 and 663 cases reported in 2019 and 2020 respectively, the first global target was amply achieved (i.e. fewer than 2,000 HAT cases/year). Areas at moderate or higher risk of HAT, where more than 1 case/10,000 people/year are reported, shrunk to 120,000 km² for the five-year period 2016–2020. This reduction of 83% from the 2000–2004 baseline (i.e. 709,000 km²) is slightly below the target (i.e. 90% reduction). As a result, the second global target for HAT elimination as a public health problem cannot be considered fully achieved yet. The number of health facilities able to diagnose and treat HAT expanded (+9.6% compared to a 2019 survey), thus reinforcing the capacity for passive detection and improving epidemiological knowledge of the disease. Active surveillance for gambiense HAT was sustained. In particular, 2.8 million people were actively screened in 2019 and 1.6 million in 2020, the decrease in 2020 being mainly caused by COVID-19-related restrictions. Togo and Côte d’Ivoire were the first countries to be validated for achieving elimination of HAT as a public health problem at the national level; applications from three additional countries are under review by the World Health Organization (WHO).

Conclusions/significance

The steady progress towards the elimination of HAT is a testament to the power of multi-stakeholder commitment and coordination. At the end of 2020, the World Health Assembly endorsed a new road map for 2021–2030 that set new bold targets for neglected tropical diseases. While rhodesiense HAT remains among the diseases targeted for elimination as a public health problem, gambiense HAT is targeted for elimination of transmission. The goal for gambiense HAT is expected to be particularly arduous, as it might be hindered by cryptic reservoirs and a number of other challenges (e.g. further integration of HAT surveillance and control into national health systems, availability of skilled health care workers, development of more effective and adapted tools, and funding for and coordination of elimination efforts).

Human African trypanosomiasis (HAT) is a lethal neglected tropical disease (NTD) transmitted by the bite of infected tsetse flies. The disease is also known as “sleeping sickness”. During the 20^th century it caused enormous suffering in the endemic areas in sub-Saharan Africa. HAT transmission last soared in the late 1990s, triggering a renewed, coordinated and very successful control effort. In this paper, we present achievements towards HAT elimination, with a focus on the WHO road map targets for 2020. In particular, reported cases continue to decline, from over 30,000 cases per year at the turn of the century to 663 cases in 2020. Despite the impact of the COVID-19 pandemic, HAT surveillance was largely sustained, and the network of health facilities able to diagnose and treat the disease further expanded. Looking to the future, the World Health Organization (WHO) set bold new targets for HAT in its 2021–2030 road map for NTDs, namely: the elimination of transmission of gambiense HAT, which occurs in western and central Africa, and the elimination as a public health problem of rhodesiense HAT, which is found in eastern and southern Africa. The strong commitment of national health authorities and the international community will be essential if these goals are to be achieved.

Detection of SARS-CoV-2 variant 501Y.V2 in Comoros Islands in January 2021

Background. Genomic data is key in understanding the spread and evolution of SARS-CoV-2 pandemic and informing the design and evaluation of interventions. However, SARS-CoV-2 genomic data remains scarce across Africa, with no reports yet from the Indian Ocean islands. Methods. We genome sequenced six SARS-CoV-2 positive samples from the first major infection wave in the Union of Comoros in January 2021 and undertook detailed phylogenetic analysis. Results. All the recovered six genomes classified within the 501Y.V2 variant of concern (also known as lineage B.1.351) and appeared to be from 2 sub-clusters with the most recent common ancestor dated 30 th Oct-2020 (95% Credibility Interval: 06 th Sep-2020 to 10 th Dec-2020). Comparison of the Comoros genomes with those of 501Y.V2 variant of concern from other countries deposited into the GISAID database revealed their close association with viruses identified in France and Mayotte (part of the Comoros archipelago and a France, Overseas Department). Conclusions. The recovered genomes, albeit few, confirmed local transmission following probably multiple introductions of the SARS-CoV-2 501Y.V2 variant of concern during the Comoros's first major COVID-19 wave. These findings demonstrate the importance of genomic surveillance and have implications for ongoing control strategies on the islands.

Monitoring the elimination of human African trypanosomiasis at continental and country level: Update to 2018

Background

In 2012 human African trypanosomiasis (HAT), also known as sleeping sickness, was targeted for elimination as a public health problem, set to be achieved by 2020. The World Health Organization (WHO) provides here the 2018 update on the progress made toward that objective. Global indicators are reviewed, in particular the number of reported cases and the areas at risk. Recently developed indicators for the validation of HAT elimination at the national level are also presented.

Methodology/Principal Findings

With 977 cases reported in 2018, down from 2,164 in 2016, the main global indicator of elimination is already well within the 2020 target (i.e. 2,000 cases). Areas at moderate or higher risk (i.e. ≥ 1 case/10,000 people/year) are also steadily shrinking (less than 200,000 km² in the period 2014–2018), thus nearing the 2020 target [i.e. 90% reduction (638,000 km²) from the 2000–2004 baseline (709,000 km²)]. Health facilities providing diagnosis and treatment of gambiense HAT continued to increase (+7% since the previous survey), with a better coverage of at-risk populations. By contrast, rhodesiense HAT health facilities decreased in number (-10.5%) and coverage. At the national level, eight countries meet the requirements to request validation of gambiense HAT elimination as a public health problem (i.e. Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Mali, Rwanda, and Togo), while for other endemic countries more efforts are needed in surveillance, control, or both.

Conclusions/Significance

The 2020 goal of HAT elimination as a public health problem is within grasp, and eligible countries are encouraged to request validation of their elimination status. Beyond 2020, the HAT community must gear up for the elimination of gambiense HAT transmission (2030 goal), by preparing for both the expected challenges (e.g. funding, coordination, integration of HAT control into regular health systems, development of more adapted tools, cryptic trypanosome reservoirs, etc.) and the unexpected ones.

Human African trypanosomiasis (HAT), a lethal disease transmitted by tsetse flies, wreaked havoc in Africa at different times in the 20^th century. Over the past twenty years, huge efforts made by a broad coalition of stakeholders curbed the last epidemic and brought the disease to the brink of elimination. In this paper, the latest figures on disease occurrence, geographical distribution and control activities are presented. Strong evidence indicates that the elimination of sleeping sickness ‘as a public health problem’ by 2020 is well within reach. In particular, fewer than one thousand new cases were reported in 2018, and the area where the risk of infection is estimated as moderate, high or very high has shrunk to less than 200,000 km². More than half of this area is in the Democratic Republic of the Congo. The interruption of transmission of the gambiense form, targeted by the World Health Organization (WHO) for 2030, will require renewed efforts to tackle a range of expected and unexpected challenges. The rhodesiense form of the disease represents a small part of the overall HAT burden. For this form, the problem of under detection is on the rise and, because of an important animal reservoir, the elimination of disease transmission is not envisioned at this stage.

A212 CHROMOFUNGIN PROTECTS AGAINST DSS-INDUCED COLITIS BY REGULATING P-53 APOPTITIC PATHWAY

Background

Development of ulcerative colitis is associated with epithelial apoptosis mediated by p53-apoptotic pathway through the activation B-cell lymphoma 2 (Bcl-2), Bcl-2 associated-X protein (BAX) and Bcl-2 antagonist/killer-1 (BAK1) proteins. Chromofungin (CHR), a chromogranin-A derived peptide expressing a cell penetrating peptide motif, decreased the severity of colitis via the suppression of mucosal and pro-inflammatory macrophages-related p53-dependent apoptosis.

Aims

We aimed to investigate a) whether the gene profile expression of apoptosis could be extended to other p53-associated genes; b) whether the gene expression of some of the p53-apoptosis marker could be confirmed by protein analysis; and c) whether due to the cell penetrating peptide motif, CHR could enter into peritoneal macrophages.

Methods

UC-related colitis was induced in C57BL/6 mice (7 weeks) by administering dextran sulfate sodium (DSS) (5%, 5 days). Preventive CHR (2.5 mg/kg/day) or vehicle treatment started 1-day before colitis induction and lasted for 5-days. Profiler™ PCR Array was performed to screen a panel of 84 genes representative of the p53 signal pathway in colitic whole mucosa distal colonic samples treated or not with CHR. Western blot analysis was performed to confirm individual protein changes. Naïve macrophages were plated overnight and nonadherent cells were removed the next day. Cells were incubated with rhodamined CHR (4 ul) for 5, 10, 20, 30 min before washing and fixing them, detection was made via confocal microscopy.

Results

In colitic conditions, an up regulation of 26 genes associated to the p53-dependent apoptosis pathway were detected including Apaf1, Bax, Bbc3, Bcl2, Cradd, Fadd, Cul9, Pmaip1, Tnfrsf10b. In vivo CHR treatment decreased significantly the colitis and was associated with a significant downregulation of 19 genes including the 9 aforementioned when compared with biopsies from colitic groups. Compared to untreated groups, colitic mice treated with CHR demonstrated a significant decrease of BAX and BAK protein and the apoptotic ER stress inducer marker, X-Binding Protein 1. A large number of peritoneal macrophages displayed rhodamine within the all intracellular compartment. The presence of the peptide inside the cell can be visible as early as 5 min and the signal gradually increases.

Conclusions

CHR decreases the inflammatory process via the suppression of a large number of p53-related apoptotic proteins. CHR quickly enters the macrophage but the exact mechanism of entrance needs to be further defined. Targeting functional analysis of CHR may lead in the future to novel therapeutics for UC.

Funding Agencies

CCCNSERC

A260 THE LACK OF CHROMOGRANIN-A MODIFIES THE GUT MICROBIOTA COMPOSITION AND REGULATES EXPERIMENTAL COLONIC INFLAMMATION

Background

Ulcerative colitis (UC)is characterized by distinct changes in the gut microbiome and elevated chromogranin-A (CHGA) level, which seem to be a relevant pathogenetic mechanism.CHGA, a prohormone produced by enterochromaffin (EC) cells and cleaved into several bioactive peptides, regulates experimental colonic inflammation. In the rodent, intra-rectal infusion of catestatin, a Chga-derived peptide, alters the distal colonic microbial composition. However, the interplay between CHGA, as a pro-hormone, and the gut microbiome remains elusive.

Aims

in homoeostatic and pathophysiologic conditions, we investigated the functional consequences of the lack of Chgaon the distal colonic microbiota.

Methods

Acute colitis (5 % dextran sulfate sodium [DSS], 5 days) was induced in Chga-C57BL/6-deficient (Chga-/-) and wild-type (Chga+/+)mice. Feces and mucosa-associated microbiota (MAM) samples were collected and the V4 region of 16s rRNA was subjected to Miseq Illumina sequencing. Alpha diversity was calculated using Shannon’s diversity index. OTU abundances were summarized using the Bray-Curtis index and non-metric multidimensional scaling (NMDS) analysis to visualize microbiome similarities and a permutational analysis of variance (PERMANOVA) to test the significance of groups were performed respectively.

Results

In non-colitic homoeostatic condition, the absence of Chga (Chga-/) significantly increased the bacterial richness and modified the bacterial community composition at the genera level between the groups, represented by increased abundance of Lactobacillus species and reduced abundance of Helicobacter& Oscillospira species compared to Chga+/+mice in fecal and colonic MAM. Moreover, the absence of Chga (Chga-/-) resulted in a significant change in the alpha-diversity of fecal and colonic MAM compared to Chga+/+mice. DSS induced-colitis resulted in a significant microbial dysbiosis in Chga+/+mice, however, deletion of Chgaprotected against DSS-induced colitis and reduced the microbial dysbiosis, reduced the family of Rikenellaceaeand maintained the abundance of Bacteroides species, compared to wild-type (Chga+/+).

Conclusions

The lack of CHGA regulates the biodiversity and the composition of the colonic gut microbiota suggesting a cross-talk between the EC cell and the microbiome. Therefore, targeting CHGA could provide a novel therapeutic strategy by regulating the gut microbiome in physiological and pathophysiological conditions.

Funding Agencies

CIHR

[Superior lumbar hernia or hernia of GRYNFELTT, a case study]

The superior lumbar hernia or hernia of GRYNFELTT is a rare pathology. It accounts for less than 1.5% of all hernias in the abdomen. An 84 year-old man with upper right lumbar swelling. The clinical examination revealed a right upper lumbar swelling of 5 cm in diameter, soft, gurgling, reducible, impulsive to cough and expansive to intra-abdominal hyperpressure. There was no history of trauma, surgery, tuberculosis or dysuria. The diagnosis of an uncomplicated upper lumbar hernia was retained. Intra-operatively, the sac was dissected up to the hernia opening, separated from the edges of the hernia orifice and discharged. The repair was performed by suturing the back of the hernia opening with a non absorbable thread. The patient was released on day 1 postoperatively. The suites were simple.

[Surgical site infections at Bocar Sidy Sall University Hospital Center of Kati]

INTRODUCTION

Surgical site infections (SSI) are frequent and dangerous in the surgical ward. They represent an obsession for the surgeon. The objectives were to determine the frequency of ISOs and risk factors, to identify the germs and to study their sensitivity to different antibiotics.

MATERIALS AND METHODS

This was a cross-sectional study with prospective data collection, performed at the general surgery department of the Bocar Sidy Sall University Hospital Center (Kati CHU) from January 2015 to December 2018.

RESULTS

During this period of study we recorded 55 cases of ISO out of 650 operated patients with a frequency of 8.46%. 450 patients were operated on the cold operating program (69.23%) and 200 patients on emergency (30.77%). The average age was 39, the sex ratio was 2.66. Among the 55 cases of ISO, 60% of these patients were operated in emergency and 40% in the operating program. The most common strains found were Escherichia coli (E. coli) in 38.3% of cases, Staphylococcus aureus in 23.4% and Klebsiella pneumonia in 13.3%. Hemoglobin levels were normal in 70% of cases. 4 of our patients or 7.27% were diabetic. We did not have any cases of obesity. Of the 55 cases of ISO, 66% were of class 3 and 4 of Altemeier, 59% were of ASA score 2 and ASA 3, 55% were of score 2 of NNISS (National Nosocomial Infection Surveillance System), 5.45% were NNISS score 3 or 3 cases and these 3 cases developed ISO. The ISOs were parietal in 49 cases, ie 89%. The recovered germs were 100% sensitive to imipenem. The most informative interventions of the ISOs were peritonitis 25 cases (45.45%), intestinal occlusions 12 cases (21.82%), appendicular abscess 8 cases (14.55%). We had 2 death cases, 3.64%, the average hospital stay was 13 days.

CONCLUSION

Escherichia coli was the common germ found in the ISO in general surgery at Kati BSS Hospital. The usual resistance to antibiotics must provoke effective preventive actions.

Semaphorin-3E attenuates intestinal inflammation through the regulation of the communication between splenic CD11C+ and CD4+ CD25- T-cells

BACKGROUND AND PURPOSE

An alteration in the communication between the innate and adaptive immune cells is a hallmark of ulcerative colitis (UC). Semaphorin-3E (SEMA3E), a secreted guidance protein, regulates various immune responses.

EXPERIMENTAL APPROACH

We investigated the expression of SEMA3E in colonic biopsies of active UC patients and its mechanisms in Sema3e^-/- mice using an experimental model of UC.

KEY RESULTS

SEMA3E level was decreased in active UC patients and negatively correlated with pro-inflammatory mediators. Colonic expression of SEMA3E was reduced in colitic Sema3e^+/+ mice, and recombinant (rec-) Plexin-D1 treatment exacerbated disease severity. In vivo rec-SEMA3E treatment restored SEMA3E level in colitic Sema3e^+/+ mice. In Sema3e^-/- mice, disease severity was increased, and rec-SEMA3E ameliorated these effects. Lack of Sema3e increased the expression of CD11c and CD86 markers. Colitic Sema3e^-/- splenocytes and splenic CD11c⁺ cells produced more IL-12/23 and IFN-γ compared to Sema3e^+/+ , and rec-SEMA3E reduced their release as much as NF-κB inhibitors, whereas an NF-κB activator increased their production and attenuated the effect of rec-SEMA3E. Colitic Sema3e^-/- splenic CD11c⁺ /CD4⁺ CD25^- T-cell co-cultures produced higher concentrations of IFN-γ and IL-17 when compared to colitic Sema3e^+/+ splenic cell co-cultures, and rec-SEMA3E decreased these effects. In vitro, anti-IL-12p19 and -12p35 antibodies and rec-IL-12 and -23 treatment confirmed the crosstalk between CD11c⁺ and CD4⁺ CD25^- T-cells.

CONCLUSION AND IMPLICATIONS

SEMA3E is reduced in colitis and modulates colonic inflammation by regulating the interaction between CD11c⁺ and CD4⁺ CD25^- T-cells via an NF-κB-dependent mechanism. Thus, SEMA3E could be a potential therapeutic target for UC patients.

[Fracture of the penis at teaching university hospital Luxemburg in Mali : two cases report]

The fracture of the penis is a rare andrological emergency. We report 2 cases of fracture of the penis including one by false-no coitus. These were young adults aged 34 and 40 respectively. The painful swelling with deviation of the penis was the dominant symptomatology of the clinical picture of the 2 patients. Surgical management was performed with favorable functional results in both cases. The long-term functional prognosis of the fracture of the penis depends on the speed of its management.

Monitoring the elimination of human African trypanosomiasis: Update to 2016

BACKGROUND

Human African trypanosomiasis (HAT) is a neglected tropical disease targeted for elimination 'as a public health problem' by 2020. The indicators to monitor progress towards the target are based on the number of reported cases, the related areas and populations exposed at various levels of risk, and the coverage of surveillance activities. Based on data provided by the National Sleeping Sickness Control Programmes (NSSCP), Non-Governmental Organizations (NGOs) and research institutions-and assembled in the Atlas of HAT-the World Health Organization (WHO) provides here an update to 2016 for these indicators, as well as an analysis of the epidemiological situation.

RESULTS

Trends for the two primary indicators of elimination are on track for the 2020 goal: 2,164 cases of HAT were reported in 2016 (as compared to the milestone of 4,000 cases), and for the period 2012-2016 280,000 km2 are estimated to be at moderate risk or higher (i.e. ≥ 1 case/10,000 people/year), as compared to the milestone of 230,000 km2. These figures correspond to reductions of 92% and 61% as compared to the respective baselines (i.e. 26,550 HAT cases in the year 2000, and 709,000 km2 exposed at various levels of risk for the period 2000-2004). Among the secondary indicators, an overall improvement in the coverage of at risk populations by surveillance activities was observed. Regarding passive surveillance, the number of fixed health facilities providing gambiense HAT diagnosis or treatment expanded, with 1,338 enumerated in endemic countries in 2017 (+52% as compared to the survey completed only sixteen months earlier). Concerning rhodesiense HAT, 124 health facilities currently provide diagnosis or treatment. The broadening of passive surveillance is occurring in a context of fairly stable intensity of active case finding, with between 1.8 million and 2.4 million people screened per year over the period 2012-2016.

DISCUSSION

Elimination of HAT as a public health problem by 2020 seems within reach, as the epidemiological trends observed in previous years are confirmed in this latest 2016 monitoring update. However, looking beyond 2020, and in particular to the 2030 goal of elimination of transmission as zero cases for the gambiense form of the disease only, there is no room for complacency. Challenges still abound, including ensuring the effective integration of HAT control activities in the health system, sustaining the commitment of donors and HAT endemic countries, and clarifying the extent of the threat posed by cryptic reservoirs (e.g. human asymptomatic carriers and the possible animal reservoirs in gambiense HAT epidemiology). WHO provides through the network for HAT elimination the essential coordination of the wide range of stakeholders to ensure synergy of efforts.

Baseline Mapping of Schistosomiasis and Soil Transmitted Helminthiasis in the Northern and Eastern Health Regions of Gabon, Central Africa: Recommendations for Preventive Chemotherapy

In order to follow the Preventive Chemotherapy (PC) for the transmission control as recommended by WHO, Gabon initiated in 2014 the mapping of Schistosomiasis and Soil Transmitted Helminthiasis (STH). Here, we report the results of the Northern and Eastern health regions, representing a third of the land area and 12% of its total population. All nine departments of the two regions were surveyed and from each, five schools were examined with 50 schoolchildren per school. The parasitological examinations were realized using the filtration method for urine and the Kato-Katz technique for stool samples. Overall 2245 schoolchildren (1116 girls and 1129 boys), mean aged 11.28 ± 0.04 years, were examined. Combined schistosomiasis and STH affected 1270 (56.6%) with variation between regions, departments, and schools. For schistosomiasis, prevalence were 1.7% across the two regions, with no significant difference (p > 0.05) between the Northern (1.5%) and the Eastern (1.9%). Schistosomiasis is mainly caused by Schistosoma haematobium with the exception of one respective case of S. mansoni and S. guineensis. STH are more common than schistosomiasis, with an overall prevalence of 56.1% significantly different between the Northern (58.1%) and Eastern (53.6%) regions (p = 0.034). Trichuris trichiura is the most abundant infection with a prevalence of 43.7% followed by Ascaris lumbricoides 35.6% and hookworms 1.4%. According to these results, an appropriate PC strategy is given. In particular, because of the low efficacy of a single recommended drug on T. trichiura and hookworms, it is important to include two drugs for the treatment of STH in Gabon, due to the high prevalence and intensities of Trichuris infections.

Monitoring the elimination of human African trypanosomiasis: Update to 2014

BACKGROUND

The World Health Organization (WHO) has targeted the elimination of Human African trypanosomiasis (HAT) 'as a public health problem' by 2020. The selected indicators of elimination should be monitored every two years, and we provide here a comprehensive update to 2014. The monitoring system is underpinned by the Atlas of HAT.

RESULTS

With 3,797 reported cases in 2014, the corresponding milestone (5,000 cases) was surpassed, and the 2020 global target of 'fewer than 2,000 reported cases per year' seems within reach. The areas where HAT is still a public health problem (i.e. > 1 HAT reported case per 10,000 people per year) have halved in less than a decade, and in 2014 they corresponded to 350 thousand km2. The number and potential coverage of fixed health facilities offering diagnosis and treatment for HAT has expanded, and approximately 1,000 are now operating in 23 endemic countries. The observed trends are supported by sustained surveillance and improved reporting.

DISCUSSION

HAT elimination appears to be on track. For gambiense HAT, still accounting for the vast majority of reported cases, progress continues unabated in a context of sustained intensity of screening activities. For rhodesiense HAT, a slow-down was observed in the last few years. Looking beyond the 2020 target, innovative tools and approaches will be increasingly needed. Coordination, through the WHO network for HAT elimination, will remain crucial to overcome the foreseeable and unforeseeable challenges that an elimination process will inevitably pose.

Resurgence of Ebola Virus Disease in Guinea Linked to a Survivor With Virus Persistence in Seminal Fluid for More Than 500 Days

We report on an Ebola virus disease (EVD) survivor who showed Ebola virus in seminal fluid 531 days after onset of disease. The persisting virus was sexually transmitted in February 2016, about 470 days after onset of symptoms, and caused a new cluster of EVD in Guinea and Liberia.

Monitoring the Progress towards the Elimination of Gambiense Human African Trypanosomiasis

Background

Over the last few years, momentum has gathered around the feasibility and opportunity of eliminating gambiense human African trypanosomiasis (g-HAT). Under the leadership of the World Health Organization (WHO), a large coalition of stakeholders is now committed to achieving this goal. A roadmap has been laid out, and indicators and milestones have been defined to monitor the progress of the elimination of g-HAT as a public health problem by 2020. Subsequently, a more ambitious objective was set for 2030: to stop disease transmission. This paper provides a situational update to 2012 for a number of indicators of elimination: number of cases annually reported, geographic distribution of the disease and areas and populations at different levels of risk.

Results

Comparing the 5-year periods 2003-2007 and 2008-2012, the area at high or very high risk of g-HAT shrank by 60%, while the area at moderate risk decreased by 22%. These are the areas where g-HAT is still to be considered a public health problem (i.e. > 1 HAT reported case per 10,000 people per annum). This contraction of at-risk areas corresponds to a reduction of 57% for the population at high or very high risk (from 4.1 to 1.8 million), and 20% for moderate risk (from 14.0 to 11.3 million).

Discussion

Improved data completeness and accuracy of the Atlas of HAT enhanced our capacity to monitor the progress towards the elimination of g-HAT. The trends in the selected indicators suggest that, in recent years, progress has been steady and in line with the elimination goal laid out in the WHO roadmap on neglected tropical diseases.

Control activities conducted over the last 15 years against gambiense human African trypanosomiasis (g-HAT) have had a tremendous impact on disease transmission, and the elimination of g-HAT now appears achievable. In this context, accurate monitoring is crucial. This paper analyzes g-HAT epidemiological trends by comparing two periods: 2003–2007 and 2008–2012. The number of reported cases decreased from 19,963 in 2003 to 7,106 in 2012. The areas at high or very high risk shrank by 60% between the two study periods. For 2008–2012, 43.4 million people out of a total of 56.4 million at risk lived in areas at low or very low risk of infection, and they have therefore met the criterion of elimination as a public health problem (i.e. < 1 case per 10,000 inhabitants per year). The challenge for the future is twofold. First, to prevent these 43.4 million people from sliding back into a situation of higher risk through effective surveillance. Second, to develop sustainable and adapted strategies to curb transmission in the areas where people are still living at moderate to very high risk. The WHO network for g-HAT elimination provides an opportunity to synergize efforts and to overcome the hurdles in this challenging endeavour.

Human African trypanosomiasis in the Democratic Republic of the Congo: disease distribution and risk

Background

For the past three decades, the Democratic Republic of the Congo (DRC) has been the country reporting the highest number of cases of human African trypanosomiasis (HAT). In 2012, DRC continued to bear the heaviest burden of gambiense HAT, accounting for 84 % of all cases reported at the continental level (i.e., 5,968/7,106). This paper reviews the status of sleeping sickness in DRC between 2000 and 2012, with a focus on spatio-temporal patterns. Epidemiological trends at the national and provincial level are presented.

Results

The number of HAT cases reported yearly from DRC decreased by 65 % from 2000 to 2012, i.e., from 16,951 to 5,968. At the provincial level a more complex picture emerges. Whilst HAT control in the Equateur province has had a spectacular impact on the number of cases (97 % reduction), the disease has proved more difficult to tackle in other provinces, most notably in Bandundu and Kasai, where, despite substantial progress, HAT remains entrenched. HAT prevalence presents its highest values in the northern part of the Province Orientale, where a number of constraints hinder surveillance and control.

Significant coordinated efforts by the National Sleeping Sickness Control Programme and the World Health Organization in data collection, reporting, management and mapping, culminating in the Atlas of HAT, have enabled HAT distribution and risk in DRC to be known with more accuracy than ever before. Over 18,000 locations of epidemiological interest have been geo-referenced (average accuracy ≈ 1.7 km), corresponding to 93.6 % of reported cases (period 2000–2012). The population at risk of contracting sleeping sickness has been calculated for two five-year periods (2003–2007 and 2008–2012), resulting in estimates of 33 and 37 million people respectively.

Conclusions

The progressive decrease in HAT cases reported since 2000 in DRC is likely to reflect a real decline in disease incidence. If this result is to be sustained, and if further progress is to be made towards the goal of HAT elimination, the ongoing integration of HAT control and surveillance into the health system is to be closely monitored and evaluated, and active case-finding activities are to be maintained, especially in those areas where the risk of infection remains high and where resurgence could occur.

Electronic supplementary material

The online version of this article (doi:10.1186/s12942-015-0013-9) contains supplementary material, which is available to authorized users.

Epidemiology of human African trypanosomiasis

Human African trypanosomiasis (HAT), or sleeping sickness, is caused by Trypanosoma brucei gambiense, which is a chronic form of the disease present in western and central Africa, and by Trypanosoma brucei rhodesiense, which is an acute disease located in eastern and southern Africa. The rhodesiense form is a zoonosis, with the occasional infection of humans, but in the gambiense form, the human being is regarded as the main reservoir that plays a key role in the transmission cycle of the disease. The gambiense form currently assumes that 98% of the cases are declared; the Democratic Republic of the Congo is the most affected country, with more than 75% of the gambiense cases declared. The epidemiology of the disease is mediated by the interaction of the parasite (trypanosome) with the vectors (tsetse flies), as well as with the human and animal hosts within a particular environment. Related to these interactions, the disease is confined in spatially limited areas called “foci”, which are located in Sub-Saharan Africa, mainly in remote rural areas. The risk of contracting HAT is, therefore, determined by the possibility of contact of a human being with an infected tsetse fly. Epidemics of HAT were described at the beginning of the 20th century; intensive activities have been set up to confront the disease, and it was under control in the 1960s, with fewer than 5,000 cases reported in the whole continent. The disease resurged at the end of the 1990s, but renewed efforts from endemic countries, cooperation agencies, and nongovernmental organizations led by the World Health Organization succeeded to raise awareness and resources, while reinforcing national programs, reversing the trend of the cases reported, and bringing the disease under control again. In this context, sustainable elimination of the gambiense HAT, defined as the interruption of the transmission of the disease, was considered as a feasible target for 2030. Since rhodesiense HAT is a zoonosis, where the animal reservoir plays a key role, the interruption of the disease’s transmission is not deemed feasible.

Mapping the capacities of fixed health facilities to cover people at risk of gambiense human African trypanosomiasis

Background

The emphasis placed on the activities of mobile teams in the detection of gambiense human African trypanosomiasis (HAT) can at times obscure the major role played by fixed health facilities in HAT control and surveillance. The lack of consistent and detailed data on the coverage of passive case-finding and treatment further constrains our ability to appreciate the full contribution of the health system to the control of HAT.

Methods

A survey was made of all fixed health facilities that are active in the control and surveillance of gambiense HAT. Information on their diagnostic and treatment capabilities was collected, reviewed and harmonized. Health facilities were geo-referenced. Time-cost distance analysis was conducted to estimate physical accessibility and the potential coverage of the population at-risk of gambiense HAT.

Results

Information provided by the National Sleeping Sickness Control Programmes revealed the existence of 632 fixed health facilities that are active in the control and surveillance of gambiense HAT in endemic countries having reported cases or having conducted active screening activities during the period 2000-2012. Different types of diagnosis (clinical, serological, parasitological and disease staging) are available from 622 facilities. Treatment with pentamidine for first-stage disease is provided by 495 health facilities, while for second-stage disease various types of treatment are available in 206 health facilities only. Over 80% of the population at-risk for gambiense HAT lives within 5-hour travel of a fixed health facility offering diagnosis and treatment for the disease.

Conclusions

Fixed health facilities have played a crucial role in the diagnosis, treatment and coverage of at-risk-population for gambiense HAT. As the number of reported cases continues to dwindle, their role will become increasingly important for the prospects of disease elimination. Future updates of the database here presented will regularly provide evidence to inform and monitor a rational deployment of control and surveillance efforts. Support to the development and, if successful, the implementation of new control tools (e.g. new diagnostics and new drugs) is crucial, both for strengthening and expanding the existing network of fixed health facilities by improving access to diagnosis and treatment and for securing a sustainable control and surveillance of gambiense HAT.

[Knowledge and practices of hypertension in nursing staff of the Hospital Gabriel Touré and Point G]

OBJECTIVE

This work aimed to study the quality of diagnosis and management of high blood pressure (HBP) by the practitioners of the Gabriel TOURÉ and point G teaching hospitals of Bamako.

MATERIALS AND METHODS

It was a descriptive and analytical, cross-sectional study during the study period from 1st March 2009 to 28 February 2010. It included all physicians and paramedics of the teaching hospital of the Point G and Gabriel TOURÉ in Bamako.

RESULTS

A total of 283 practitioners (physicians and the paramedics) from both teaching hospitals have accepted our questionnaire, including 133 doctors and 185 paramedics. CHU Gabriel TOURÉ accounted for 55.1%, the majority came from the department of cardiology with 18.4%. Doctors accounted for the largest square with 47.0%. The majority of our practitioners (59%) say it takes at least one session during three medical consultations to diagnose the HBP. Only 29,60% define the HBP from 140/90 mm Hg. With a blood pressure goal of 58, 30% and 57.20% of practitioners claimed to retain 140/90 mm Hg, respectively for the diabetic and the renal-insufficient patients. A considerable number of our practitioners (27.9%) still used in pregnant women the triplet diuretic/IEC/diet without salt. The information of patients on some important aspects of the pathology prior to any therapeutic strategy had been conducted in 63.6.

CONCLUSION

The high blood pressure must be a major concern for medical and paramedical staff today.

[Social integration of women operated for obstetric urogenital fistula]

OBJECTIVE

To study the social integration of women supported in the urology department of the University Hospital of Point G for obstetric urogenital fistula.

PATIENTS AND METHOD

Prospective study conducted over a period of 13 months from June 2008 to June 2009 in the Department of Urology at the University Hospital of Point G. The study included all patients who have been operated on at least twice for obstetric fistula genitourinary. Records of surgical, medical records and tracking sheets for each patient were the media database.

RESULTS

Situation before treatment: before surgical treatment, 76.92% of patients were rejected by their spouses. The family attended the patient in 84.62% of cases. Situation after treatment: after treatment, 90.31% of women with fistula lived in the matrimonial home or family. The resumption of business activity was announced by 11.2% of patients. Among the women, 93.7% participated in housework. The number of patient intervention ranged from two to five. Healing (fistula closed and no sphincter dysfunction) was complete in 50% of cases. Among the women, 11.54% had sphincter dysfunction after closure of the fistula, which makes a total of fistula closed more than 61% after at least two attempts.

CONCLUSION

The urogenital fistulas are not a fatal disease but is a real handicap for women who suffer to conduct a socio-cultural and economic mainstream. Generally excluded from the ongoing operations of the company, these women are more integrated after successful surgical treatment of the fistula.

Diversity of human African trypanosomiasis epidemiological settings requires fine-tuning control strategies to facilitate disease elimination

In 2001, the World Health Organization (WHO) established a public-private partnership to fight human African trypanosomiasis (HAT). As a result of this continuous collaboration, and in addition to the coordination with nongovernmental organizations and bilateral cooperation agencies, the number of new cases of HAT annually reported by the WHO has strikingly decreased. In 2012, HAT was included in WHO's roadmap on neglected tropical diseases with a 2020 target date for elimination. Although the prevalence of HAT is decreasing and its elimination is targeted, control approaches must be adapted to the different epidemiological patterns in order to adopt the most adequate strategies to maintain their cost-effectiveness. These strategies must be flexible and dynamic in order to be adapted to the disease progression, as well as to the changes affecting the existing health facilities in transmission areas, including their accessibility, their capabilities, and their involvement in the elimination process. Considering the different patterns of transmission (Trypanosoma brucei (T.b.) rhodesiense HAT) and transmission intensity (T.b. gambiense HAT), different settings have been defined. In the case of T.b. rhodesiense, this form exists primarily where wild animals are the main parasite reservoir, and where the main parasite reservoir is cattle. In T.b. gambiense, this form exists in areas with high intensity transmission, areas with moderate intensity transmission, and areas with low intensity transmission. Criteria and indicators must be established to monitor and evaluate the actions implemented toward the elimination of HAT.

[Chronic kidney failure at subclinical stage in hypertensive patients in the cardiology department of the Gabriel TOURE university hospital]

OBJECTIVE

This work aimed to describe the epidemiological, clinical, biological and ultrasound aspects of the subclinical renal failure in hypertensive patients in the department of cardiology of the Gabriel TOURÉ University Hospital of Bamako.

PATIENTS AND METHODS

The study was cross-sectional and prospective from 1 January 2007 to 31 December 2007 in the cardiology department of the Gabriel Touré University Hospital. These were all patients who achieved at least the basic test for renal impairment such as serum creatinine, 24h proteinuria, renal ultrasound.

RESULTS

Total of 114 patients with kidney failure without evocative clinical symptoms have been included, among them 60 men and 54 women, average age of 57 years. In the hypertensive population, the beginner to moderate chronic renal failure had a frequency of 12.9% (114/880), the sex ratio was 1.11 in favor of men. Patients aged less than 60 years were more numerous with a frequency of 61.5%. Dyspnea (38.6%), and headache (36.8%) were the main manifestations of the high blood pressure (HBP). Renal disease characterized by microalbuminuria was predominant compared to the macro-albuminuria: 25.5% versus 7%. Renal ultrasound was abnormal in 14.1% with a predominance of stage 0 (86%), stages 1 and 2 were each 7%, we have not found any stage 3.

CONCLUSION

Chronic renal failure is a frequent complication of the hypertension. Some biological tests are necessary for the diagnosis. Renal ultrasound remains a useful test for its assessment. The optimal treatment of high blood pressure is essential, as it not only reduces the overall cardiovascular risk of patients, but also slows or even stabilizes the worsening of renal function.

Estimating and mapping the population at risk of sleeping sickness

BACKGROUND

Human African trypanosomiasis (HAT), also known as sleeping sickness, persists as a public health problem in several sub-Saharan countries. Evidence-based, spatially explicit estimates of population at risk are needed to inform planning and implementation of field interventions, monitor disease trends, raise awareness and support advocacy. Comprehensive, geo-referenced epidemiological records from HAT-affected countries were combined with human population layers to map five categories of risk, ranging from "very high" to "very low," and to estimate the corresponding at-risk population.

RESULTS

Approximately 70 million people distributed over a surface of 1.55 million km(2) are estimated to be at different levels of risk of contracting HAT. Trypanosoma brucei gambiense accounts for 82.2% of the population at risk, the remaining 17.8% being at risk of infection from T. b. rhodesiense. Twenty-one million people live in areas classified as moderate to very high risk, where more than 1 HAT case per 10,000 inhabitants per annum is reported.

DISCUSSION

Updated estimates of the population at risk of sleeping sickness were made, based on quantitative information on the reported cases and the geographic distribution of human population. Due to substantial methodological differences, it is not possible to make direct comparisons with previous figures for at-risk population. By contrast, it will be possible to explore trends in the future. The presented maps of different HAT risk levels will help to develop site-specific strategies for control and surveillance, and to monitor progress achieved by ongoing efforts aimed at the elimination of sleeping sickness.

Monitoring the use of nifurtimox-eflornithine combination therapy (NECT) in the treatment of second stage gambiense human African trypanosomiasis

After inclusion of the nifurtimox-eflornithine combination therapy (NECT) in the Model List of Essential Medicines for the treatment of second-stage gambiense human African trypanosomiasis (HAT), the World Health Organization, in collaboration with National Sleeping Sickness Control Programs and nongovernmental organizations set up a pharmacovigilance system to assess the safety and efficacy of NECT during its routine use. Data were collected for 1735 patients treated with NECT in nine disease endemic countries during 2010-2011. At least one adverse event (AE) was described in 1043 patients (60.1%) and a total of 3060 AE were reported. Serious adverse events (SAE) were reported for 19 patients (1.1% of treated), leading to nine deaths (case fatality rate of 0.5%). The most frequent AE were gastrointestinal disorders (vomiting/nausea and abdominal pain), followed by headache, musculoskeletal pains, and vertigo. The most frequent SAE and cause of death were convulsions, fever, and coma that were considered as reactive encephalopathy. Two hundred and sixty-two children below 15 years old were treated. The characteristics of AE were similar to adults, but the major AE were less frequent in children with only one SAE and no deaths registered in this group. Gastrointestinal problems (vomiting and abdominal pain) were more frequent than in adults, but musculoskeletal pains, vertigo, asthenia, neuropsychiatric troubles (headaches, seizures, tremors, hallucinations, insomnia) were less frequent in children. Patient follow-up after treatment is continuing, but initial data could suggest that NECT is effective as only a low number of relapses have so far been reported (19 cases). However, additional monitoring is required to assess the efficacy of the treatment, particularly in children. NECT has given satisfactory results of safety in the usual conditions where HAT patients are managed and it is currently the best option for treatment of second stage of gambiense HAT.

FcγRIIa polymorphism and anti-malaria-specific IgG and IgG subclass responses in populations differing in susceptibility to malaria in Burkina Faso

FcγRIIa is known to be polymorphic; and certain variants are associated with different susceptibilities to malaria. Studies involving the Fulani ethnic group reported an ethnic difference in FcγRIIa-R131H genotype frequencies between the Fulani and other sympatric groups. No previous studies have addressed these questions in Burkina Faso. This study aimed to assess the influence of FcγRIIa-R131H polymorphism on anti-falciparum malaria IgG and IgG subclass responses in the Fulani and the Mossi ethnic groups living in Burkina Faso. Healthy adults more than 20 years old belonging to the Mossi or the Fulani ethnic groups were enrolled for the assessment of selected parasitological, immunological and genetic variables in relation to their susceptibility to malaria. The prevalence of the Plasmodium falciparum infection frequency was relatively low in the Fulani ethnic group compared to the Mossi ethnic group. For all tested antigens, the Fulani had higher antibody levels than the Mossi group. In both ethnic groups, a similar distribution of FcγRIIa R131H polymorphism was found. Individuals with the R allele of FcγRIIa had higher antibody levels than those with the H allele. This study confirmed that malaria infection affected less the Fulani group than the Mossi group. FcγRIIa-R131H allele distribution is similar in both ethnic groups, and higher antibody levels are associated with the FcγRIIa R allele compared to the H allele.

Risk for human African trypanosomiasis, Central Africa, 2000-2009

Comprehensive georeference records for human African trypanosomiasis in Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, and Gabon were combined with human population layers to estimate a kernel-smoothed relative risk function. Five risk categories were mapped, and ≈3.5 million persons were estimated to be at risk for this disease.

Avian influenza and Newcastle disease in three risk areas for H5N1 highly pathogenic avian influenza in Mali, 2007-2008

Our survey aimed to investigate avian influenza (AI) and Newcastle disease (ND) prevalence and risk factors in three areas of Mali at risk for occurrence of H5N1 highly pathogenic avian influenza. Blood samples and cloacal and oropharyngeal swabs were collected from 1470 birds between February 2007 and May 2008 and were tested by commercial enzyme-linked immunosorbent assay to detect antibodies and real-time reverse-transcription (rRT)-PCR to detect virus. Risk factors associated with seropositivity or positive rRT-PCR were identified by random effect logistic regression. AI seroprevalence was significantly lower in birds from commercial farms (0%) than in village backyard birds (3.1%). For backyard birds, no individual risk factors (species, age, sex) were identified, but birds in the Mopti area in the Sahelian zone, where millions of wild birds migrate, were more seropositive than in the Sikasso area in the Sudano-Guinean zone (odds ratio [OR] = 2.0, P = 0.051). Among backyard birds nonvaccinated against ND, ND seroprevalence was 58.4%, and the odds of seropositivity was 2.0 higher in chickens than in ducks, 1.7 higher in females than in males, 3.1 higher in adults than in young birds, and 3.0 higher in poultry from the Sikasso area than from the Mopti area (P < 0.01 in all cases). Prevalence established by rRT-PCR was low for both AI virus (1.1%) and ND virus (2.6%) and was associated with no risk factors for AI but was higher in chickens than in ducks (OR = 5.3, P = 0.05) and in the Sikasso area than in the Mopti area (OR = 3.4, P = 0.027) for ND. For AI and ND, prevalence assessed by serology or rRT-PCR varied over time, although seasonal and interannual variation could not be clearly distinguished. The intracluster correlation coefficient for serologic data was low for AI (0.014) and higher for ND (0.222). These results are useful to optimize surveillance and control strategy for notifiable avian diseases in African countries with similar agroecological and resource-limited contexts.

[Efficacy of artemether-lumefantrine in the treatment of uncomplicated malaria in children living in a rural area of Burkina Faso in 2009]

In order to implement community case management of malaria strategy in a rural area of intense transmission, of children using artemether-lumefantrine combination, we assessed the therapeutic efficacy of the medicine. We conducted an open label and uncontrolled clinical trial in an unique centre from September 2009 to December 2009 in children 6-59 months old who consulted at health facilities for uncomplicated malaria. The primary endpoint was clinical and parasitological cure rate at day 28 corrected by PCR. In total 106 children were enrolled. Parasite clearance at day 2 was 99.04% and the adequate clinical and parasitological response corrected by PCR at day 28 was 90.5%. Our results confirm that artemether-lumefantrine combination is still effective.

Human African trypanosomiasis in non-endemic countries (2000-2010)

BACKGROUND

Human African trypanosomiasis (HAT) can affect travelers to sub-Saharan Africa, as well as migrants from disease endemic countries (DECs), posing diagnosis challenges to travel health services in non-disease endemic countries (non-DECs).

METHODS

Cases reported in journals have been collected through a bibliographic research and complemented by cases reported to the World Health Organization (WHO) during the process to obtain anti-trypanosome drugs. These drugs are distributed to DECs solely by WHO. Drugs are also provided to non-DECs when an HAT case is diagnosed. However, in non-DEC pentamidine can also be purchased in the market due to its indication to treat Pneumocystis and Leishmania infections. Any request for drugs from non-DECs should be accompanied by epidemiological and clinical data on the patient.

RESULTS

During the period 2000 to 2010, 94 cases of HAT were reported in 19 non-DECs. Seventy-two percent of them corresponded to the Rhodesiense form, whereas 28% corresponded to the Gambiense. Cases of Rhodesiense HAT were mainly diagnosed in tourists after short visits to DECs, usually within a few days of return. The majority of them were in first stage. Initial misdiagnosis with malaria or tick-borne diseases was frequent. Cases of Gambiense HAT were usually diagnosed several months after initial examination and subsequent to a variety of misdiagnoses. The majority were in second stage. Patients affected were expatriates living in DECs for extended periods and refugees or economic migrants from DECs.

CONCLUSIONS

The risk of HAT in travelers and migrants, albeit low, cannot be overlooked. In non-DECs, rarity, nonspecific symptoms, and lack of knowledge and awareness in health staff make diagnosis difficult. Misdiagnosis is frequent, thus leading to invasive diagnosis methods, unnecessary treatments, and increased risk of fatality. Centralized distribution of drugs for HAT by WHO enables an HAT surveillance system for non-DECs to be maintained. This system provides valuable information on disease transmission and complements data collected in DECs.

Diversity of response to Trypanosoma brucei gambiense infections in the Forecariah mangrove focus (Guinea): perspectives for a better control of sleeping sickness

At a time when human African trypanosomiasis (HAT) elimination again seems a reachable goal in many parts of sub-Saharan Africa, it is becoming increasingly important to characterise the factors involved in disease resurgence or maintenance to develop sustainable control strategies. In this study conducted in the Forecariah mangrove focus in Guinea, HAT patients and serological suspects (SERO) were identified through mass screening of the population with the Card Agglutination Test for Trypanosomiasis (CATT) and were followed up for up to 2 years. Analysis of the samples collected during the follow-up of HAT patients and SERO was performed with PCR (TBR1/TBR2) and the trypanolysis serological test (TL) in order to clarify the role played by these individuals in the epidemiology of HAT. PCR positivity was higher in TL⁺ than in SERO TL⁻ (50% vs. 18%, respectively). Whereas CATT plasma titres decreased both in treated HAT patients and SERO TL⁻, SERO TL⁺ maintained high CATT titres. Four out of 17 SERO TL⁺ developed HAT during the study. These results strongly suggest that SERO TL⁺ individuals are asymptomatic carriers. In the context where disease prevalence is sufficiently low, treating SERO TL⁺ individual may thus be of crucial importance in order to cut transmission.

[Prevalence and risk factors of hepatitis C virus infection in chronic hemodialysis patients at the University Hospital of Point G, Bamako, Mali]

The objective of this prospective study conducted in November 2008, was to determine the prevalence and the factors associated with Hepatitis C Virus (HCV) infection in chronic hemodialysis patients. The study was carried out in the hemodialysis unit of the university teaching hospital of Point G. Serum samples were tested for anti-HCV antibody, anti-HIV antibody and HBs Ag using enzyme immunoassay methods (ELISA) at the laboratory of immunology of the National Blood Transfusion Service of Bamako. The following parameters were assessed: initial nephropathy, duration of the dialysis, history of blood transfusion, number of blood units transfused since the beginning of the dialysis, history of nosocomial exposure. A total of 66 patients were enrolled. The mean age of the patients was 42,27±14, 8 years, with a male to female sex-ratio of 1,44. Anti-HCV antibodies were found in 13 chronic hemodialysis patients, leading to a prevalence of 19,7%. A significant association was found between the bearing of HCV and the duration of the dialysis. These results indicate that hepatitis C is frequent in the chronic hemodialysis patients of the university teaching hospital of Point G, and that the duration of dialysis constitutes the main factor associated with the contamination by the HCV.

The Atlas of human African trypanosomiasis: a contribution to global mapping of neglected tropical diseases

BACKGROUND

Following World Health Assembly resolutions 50.36 in 1997 and 56.7 in 2003, the World Health Organization (WHO) committed itself to supporting human African trypanosomiasis (HAT)-endemic countries in their efforts to remove the disease as a public health problem. Mapping the distribution of HAT in time and space has a pivotal role to play if this objective is to be met. For this reason WHO launched the HAT Atlas initiative, jointly implemented with the Food and Agriculture Organization of the United Nations, in the framework of the Programme Against African Trypanosomosis.

RESULTS

The distribution of HAT is presented for 23 out of 25 sub-Saharan countries having reported on the status of sleeping sickness in the period 2000-2009. For the two remaining countries, i.e. Angola and the Democratic Republic of the Congo, data processing is ongoing. Reports by National Sleeping Sickness Control Programmes (NSSCPs), Non-Governmental Organizations (NGOs) and Research Institutes were collated and the relevant epidemiological data were entered in a database, thus incorporating (i) the results of active screening of over 2.2 million people, and (ii) cases detected in health care facilities engaged in passive surveillance. A total of over 42 000 cases of HAT and 6 000 different localities were included in the database. Various sources of geographic coordinates were used to locate the villages of epidemiological interest. The resulting average mapping accuracy is estimated at 900 m.

CONCLUSIONS

Full involvement of NSSCPs, NGOs and Research Institutes in building the Atlas of HAT contributes to the efficiency of the mapping process and it assures both the quality of the collated information and the accuracy of the outputs. Although efforts are still needed to reduce the number of undetected and unreported cases, the comprehensive, village-level mapping of HAT control activities over a ten-year period ensures a detailed and reliable representation of the known geographic distribution of the disease. Not only does the Atlas serve research and advocacy, but, more importantly, it provides crucial evidence and a valuable tool for making informed decisions to plan and monitor the control of sleeping sickness.

A geographical approach to identify sleeping sickness risk factors in a mangrove ecosystem

OBJECTIVES

To provide a better understanding of sleeping sickness transmission and spread in mangrove areas to optimize its control.

METHODS

In the Forecariah mangrove area, Guinea, 19 sleeping sickness cases and 19 matched controls were followed up in their living areas (at home, in fields and at water points). All occupational sites and pathways were mapped and then placed in their environmental context.

RESULTS

The sleeping sickness cases displayed a significantly broader and more diverse spatial occupation than the controls. They covered double the daily walking distances of controls and had on average two more occupational sites, most of which were located in mangrove forests. Activities with a higher transmission risk (rice culture, attendance of pirogue jetties) were identified as well as high-risk areas and pathways.

CONCLUSIONS

An entomological control strategy targeting transmission risk areas is proposed. Its implementation in a control programme would reduce by 86% the efforts needed for a classical vector control programme throughout the area. Medical surveys set up at specific locations, such as pirogue jetties and high-risk paths, should also enable better targeting of the population at highest risk.

[Major cardiovascular risk factors according to gender in the hospital environment]

AIM

The study aims to describe cardiovascular risk factor according to gender in hospital.

MATERIAL AND METHODS

Il was a prospective study from april 2007 to march 2008 including 146 highblood pressure patients from 2 medical centre in Bamako. Gathering and analysis were performed with SPSS 11.

RESULTS

67% were female, the mean age reached 48,82. the BMI was significantly higher in female (P <0,001). Female were mainly registered between 30 and 44 years, and male between 45-59 years. Overweight and obesity were more represented in female and obesity in 30-44 years old patients. Isolated highblood pressure was found in 58,90%, 7,53% of patients had the 3 major cardiovascular risk factor

CONCLUSION

Isolated highblood pressure was by far the most frequent. Although the cardiovascular risk rises with the others associations, they were rare and don't significantly differ in each gender. The tendency to overweight and obesity in female should be confirmed by others studies.

Humoral and cell-mediated immunity to MSP3 peptides in adults immunized with MSP3 in malaria endemic area, Burkina Faso

We performed a single-blind, randomized phase 1 trial of the long synthetic peptide (LSP) of merozoite surface protein-3 (MSP3) in adults living in Burkina Faso. Thirty eligible volunteers were randomized to receive either the MSP3-LSP candidate vaccine or tetanus toxoid vaccine as a control. A dose of each vaccine was administered on days 0, 28 and 112 and the vaccine was formulated with aluminium hydroxide. Humoral immune responses were assessed by ELISA at days 0, 28, 56, 112, 140, 252 and 365 and cell-mediated immune responses by lymphoproliferation assay and by ELISA on days 0, 56 and 140. IgG responses to four peptides of MSP3 were similar in both vaccine groups. Higher IgG concentrations were recorded after the beginning of malaria high transmission season in both vaccine groups. The lymphocyte proliferation and the production of IFN-γ in response to stimulation with the four overlapping peptides increased following vaccination in the MSP3-LSP vaccine group, but did not change appreciably in the control group. In contrast to natural infection, MSP3-LSP did not boost humoral responses to the four overlapping peptides of MSP3 to any detectable degree in our semi-immune adult. MSP3-LSP may be more immunogenic in young children with little or no acquired immunity.

HIV, HCV, HBV and syphilis rate of positive donations among blood donations in Mali: lower rates among volunteer blood donors

Good data on background seroprevalence of major transfusion transmitted infections is lacking in Mali. We gathered data on the rate of positive donations of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis among blood donations in Mali for calendar year 2007. Donations with repeatedly reactive results on screening enzyme immunoassay (EIA) were considered to be seropositive. Rate of positive donations per blood unit collected was 2.6% for HIV, 3.3% for HCV, 13.9% for hepatitis B surface antigen (HBsAg) and 0.3% for syphilis. For HIV, HBsAg and syphilis, rate of positive donations was significantly (p<0.001) higher among donations from replacement donors than those from volunteer donors, while HCV rate of positive donations was similar in the two groups. Rate of positive donations was also significantly (p<0.0001) lower in blood units from regular than from first-time donors. These data reinforce WHO recommendations for increasing the number of regular, volunteer blood donors in Africa.