Genetic subtypes of HIV type 1 and HIV type 2 strains in commercial sex workers from Bamako, Mali

In Africa the highest HIV infection rate has been reported among female commercial sex workers (CSWs) who are at increasing risk of acquiring and transmitting HIV infection. In October 1995, 176 CSWs were studied in Bamako, the capital city of Mali. The ages of the CSWs ranged from 15 to 50 years old (mean, 28.8 years). Only 20.45% of the 176 CSWs were Malian; the majority were from Nigeria (32.9%) and Ghana (31.8%), and the remaining were from other African countries. Forty-one percent were active for less than 1 year as a commercial sex worker, and the length of prostitution for the remaining women ranged from 1 to 15 years (mean, 2.76). A total of 81 (46.02%) of the 176 CSWs were positive for HIV antibodies; 63 (35.8%) were HIV-1 positive, (3.9%) were HIV-2 positive, 11 (6.2%) had antibodies to HIV-1 and HIV-2, and none of them had antibodies to group O viruses. For all HIV antibody-positive samples, PBMCs were separated and genetic subtypes of HIV-1 were determined using the heteroduplex mobility assay (HMA), with ED5-ED12 as outer and ES7-ES8 as inner primers. Among the 66 HIV-1 strains characterized, 53 (80.3%) were subtype A, 2 (3.1%) belonged to subtype C, 1 (1.5%) belonged to subtype D, and 10 (15.1%) were identified as subtype G. Among the 10 subtype G strains, 8 were obtained from women who were very recent CSWs, with an activity of 1 year or less, assuming that there is a high probability that these infections occurred recently. Genetic subtypes of five HIV-2 viruses were determined by sequencing of the env and/or gag genes followed by phylogenetic analysis, and all of them belonged to subtype A. Comparison of HIV-1 and HIV-2 seroprevalence data from our study with previous data from Mali shows a significant rise in HIV-1 prevalence and a significant decrease in HIV-2 prevalence and confirms similar trends observed in neighboring countries. We have found four different genetic subtypes of HIV-1; however, subtype A is predominant and accounts for 80% of the cases and 15% of the HIV-1 infections were subtype G. It is important to continue the surveillance of subtypes on a systematic basis in order to see to what extent the proportions of the different subtypes will change over time.

Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae isolated from blood cultures in Africa

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have been isolated from many regions of the world. Epidemiological studies are being conducted in Europe, North America, and Asia. No study has however been conducted in Africa to determine the prevalence and distribution of ESBLs on the continent. This literature review aimed at describing the prevalence of ESBL-producing Enterobacteriaceae isolated from blood cultures, as well as the ESBL genes involved at the international level. Our focus was mainly on Africa. We conducted a literature review on PubMed. Articles related to our study field and published between 1996 and 2014 were reviewed and entirely read for most of them, while we only focused on the abstracts of some other articles. Relevant articles to our study were then carefully reviewed and included in the review. The prevalence of ESBL-producing Enterobacteriaceae differs from one country to another. The results of our literature review however indicate that class A ESBLs prevail over the other types. We took into consideration articles focusing on various types of samples to assess the prevalence of ESBL-producing Enterobacteriaceae, but information on isolates from blood cultures is limited. The worldwide prevalence of ESBL-producing Enterobacteriaceae has increased over time. Evidence of ESBL-producing Enterobacteriaceae can be found in all regions of the world. Studies conducted in Africa mainly focused on the Northern and Eastern parts of the continent, while only rare studies were carried out in the rest of the continent.

The feasibility of integrated STI prevalence and behaviour surveys in developing countries

BACKGROUND

In countries where STI/HIV prevalence data and behavioural data are scarce UNAIDS second generation HIV surveillance guidelines recommend measuring STI/HIV prevalence and risk behaviours in vulnerable populations but do not recommend conducting these surveys concurrently because of concerns about participation rates, cost, and provision of services.

OBJECTIVES

To assess the feasibility of conducting a national combined STD prevalence and behaviour survey in Mali among vulnerable populations with the intention of institutionalisation.

METHODS

From March to June 2000 an integrated STI prevalence and behaviour survey was conducted using cluster sampling among five risk groups in four sites in Mali, west Africa. 2229 individuals in non-traditional settings such as taxi/bus stations, market areas, households, and brothels participated in any one or all components of the study: (1) behavioural questionnaire, (2) urine sample for Neisseria gonorrhoeae (GC)/Chlamydia trachomatis (CT) testing, (3) a fingerstick drop of blood for syphilis, and/or (4) HIV testing.

RESULTS

High participation rates of 84%-100% were achieved despite specimen collection and HIV testing. Rates fell only slightly when participants were asked to provide biological samples and participants were more likely to provide urine than blood. Rates among the different groups for HIV and syphilis testing are similar and suggest that refusal was most probably because of a reluctance to give blood rather than because of HIV testing. The cost of the biological component added approximately $30 per participant. Included in the $30 are the costs of training, participant services, laboratory personnel and supplies, STI drugs, and STI testing costs. The total cost of the survey was $154,905. Biomarkers aided in validation of answers to behavioural questions. Consenting individuals received HIV pretest and post-test counselling and referral to a trained health provider for treatment of STI and the provision of services provided the framework for interventions in the groups following the survey.

CONCLUSION

This represents an effective methodology for collecting risk behaviour and STI/HIV prevalence information concurrently and should be considered by countries expanding STI/HIV surveillance as part of UNAIDS second generation HIV surveillance.

[RESAOLAB: West African network of laboratories to enhance the quality of clinical biology]

The Fondation Mérieux, in partnership with the Ministries of Health of Burkina Faso, Mali and Senegal, implemented for four years a project to reinforce the laboratory sector in the three participating countries: the RESAOLAB project (West African Network of Biomedical Analysis Laboratories).The objective of RESAOLAB project, in partnership with the WHO Office for West Africa and the West African Health Organization, was to strengthen the systems of biomedical laboratories to improve diagnostic services, access, monitoring and management of infectious diseases. Following the successful results achieved under the RESAOLAB project and due to the demand of the neighbour countries ministries, the RESAOLAB project is now extended to four other countries of the West African region: Benin, Guinea-Conakry, Niger and Togo. The RESAOLAB project has become the RESAOLAB programme, its purpose is to strengthen the quality of the medical biology services thanks to a regional and transversal approach.

Prevalence of extended-spectrum beta-lactamase phenotypes in enterobacteria isolated from blood cultures of patients at admission to the University Hospital of Bamako

The aim of our study was to determine the frequency of extended-spectrum beta-lactamase (ESBL) phenotypes among the enterobacteria present in blood cultures of patients at admission to two university hospitals of Bamako (Mali). During a period of three months, we isolated enterobacteria from blood cultures from patients upon admission to the Point G and Gabriel Toure University Hospitals. The ESBL-positive enterobacteria were initially identified by API 20E strips and VITEK^®2 and then confirmed in France by MALDI-TOF mass spectrometry at the Bichat Hospital bacteriology laboratory. Antibiotic susceptibility was determined by the diffusion method as recommended by EUCAST. The species isolated were K. pneumoniae (14/40, 35.0 %), E. coli (11/40, 27.5 %), and E. cloacae (9/40, 22.5 %); 21/34 (61.8 %) had an ESBL phenotype, including 10/14 (71.4 %) K. pneumoniae, 8/11 (72.7 %) E. coli, and 3/9 (33 3 %), E. cloacae. The ESBL strains of K. pneumoniae, E. coli, and E. cloacae were associated, respectively, with resistance to the following antibiotics: gentamicin (10/10, 100 %; 6/8, 75%; 2/3, 67%), amikacin (2/10, 20 %; 0/8, 0%; 0/3, 0%), ofloxacin (8/10, 80. %; 7/8, 87%; 3/3, 100%), cotrimoxazole (10/10, 100 %; 6/8, 75%; 3/3, 100%). Almost two thirds (61.8%) of the enterobacteria isolated from blood cultures produced extended-spectrum beta-lactamases. They retained regular sensitivity only to carbapenems and amikacin.

[Epidemiologic aspects of pulmonary tuberculosis with positive bacilloscopy in the decade of 1995-2004]

The purpose of this study is to make an epidemiological description of pulmonary tuberculosis with sputum smear positive in Mali. This is a retrospective study conducted from January 1st, 1995 to December 31st, 2004 by the National Program for fighting against tuberculosis (located at the National Department of health), and where data were centralized. From this ten years period, 33,000 cases of tuberculosis (all forms of TB) have been notified in Mali, which represented an annual rate of 2750. Of those, 22,275 cases (67.5%) were sputum smear positive (with Ziehl Nielsen), this represented 1856 as annual rate. The prevalence of pulmonary TB with sputum smear positive is 185/100,000. During the study period a total of 13,638 (61.22%) cases of 22,275 cases of pulmonary TB with sputum smear positive have been given ant tuberculosis drugs; From these patients under therapy 2371 cases (17.38% ) disappear before the end of treatment.; 5851 cases (42.90%) have been considered as cured; 161 (1.18%) cases of treatment failure and 523 (3.93%) cases of death. The sex-ratio was 3.57 with young adults representing the majority of cases. Pulmonary TB with sputum smear positive treatment remains a challenge for National Programs for fighting against TB as well as its prevention.

[Not Available]

Haemorrhagic fever of Creaman virus is a worse virus disease without specific care. It has been described in Africa and in some closed counties to Mali as Mauritania and. The purpose of this study was de determine the serological rate of Crimean Congo Virus Ig G among population living in agro pastoral region in Mali : "Office du Niger" and Baguineda. The study have been taken a period from Jun to November 1991. 228 subject have been involved from "Office du Niger" and 221 sujets from Baguineda area. We used Elisa test to detect the monoclonal antibodies Ig G againt Creaman Congo virus. No antibodies had been founded among the 228 subjects from office du Niger. But 10 subject amont the 212 subject from Baguineda area were positive that means the serological rate of Creaman Congo virus was 4,5% in this area. This study showed that the Creaman Congo virus should circulate in Mali with at lowed spead. The emphazise of the epidemiological survey must be enforced to avoid born and spraying a epidemic due to this virus in Mali and in Africa.

[Assessment of endoscopic surgery at the Hospital of Point G in Bamako]

PURPOSE OF THE STUDY

To carry out the first 45 months assessment of activities of coeliochirurgie at the hospital of the Point G Bamako.

PATIENTS AND METHODS

It was about a retrospective study of 45 months carried out in the service of surgery "A" of the CHU of the Point G All the patients having undergone an intervention by technique coeliochirurgicale with or without conversion into conventional surgery were retained.

RESULTS

for 45 months, 426 patients profited from the technique, i.e., 18.99% of the patients operated in the service for this period. The most frequent indications were the gynaecological surgery (61.27%), with pathologies tubaires, followed digestive surgery (33.33%) with the lithiasic cholécystite and acute appendicitis. The parietal surgery and the "staging" of cancerous pathologies represented respectively (3.05%) and (2.35%). Conversion into conventional surgery related to 7.5% of patients. We listed few accidents and incidental per operational. The duration of the hospital stay shorter was compared with that of the conventional surgery. The operational continuations were simple in 97.9% of the cases.

CONCLUSION

the coeliochirurgie is realizable and reliable under the conditions of exercise of the surgery in Mali. The indications are to be measured in order to avoid the complications inherent in the technique and to progress positively. The benefit of the technique is ensured for the patient and the hospital.

[Bacteriological aspects of purulent meningitis in Bamako district. Apropos of 1,541 bacterial strains collected from 1979 to 1991]

This study is about bacteriological aspects of purulent meningitis in Bamako area upon 1,541 strains collected from 1979 to 1991. It showed that N. meningitidis, S. pneumoniae and H. influenzae b are responsible. In general, N. meningitidis is the most frequent, but this depends on years and months. Since 1988, N. meningitidis serogroup C has supplanted serogroup A. N. meningitidis is predominant between 7 to 30 years. S. pneumoniae between 1-28 days and 31 to 68 years, H. influenzae between 1 month to 6 years. The frequency of these species is the same in male and female. The 3 species are quite sensitive to antibiotics tested except sulphonamides and cotrimoxazole. Meanwhile, the appearance of strains of S. pneumoniae to penicillin and H. influenzae to ampicillin must be followed with interest to check any time the importance of the phenomenon.

[Radiographic and bacteriologic data on pulmonary tuberculosis in Bamako as a function of HIV status]

This prospective study included patients treated for tuberculosis between January 998 and April 1999 in the pneumology unit of the Point G Hospital in Bamako. The purpose was to analyze chest x-ray and bacteriological findings in HIV+ and HIV- patients. All patients had clinical and radiographic signs suggestive of tuberculosis with one or several sputum samples and HIV serology. Among the 127 patients, 36 were HIV positive (28.3%). There was no sex predominance in the HIV+ patients (p = 0.3). The most common radiographic aspect associated nodules and infiltration irrespective of the immune status (p = 0.014). Characteristic features of the chest x-rays in HIV-positive patients were: frequent military forms and rare cavernous forms (p = 0.007). Sputum tests were positive more often in HIV-negative than HIV-positive patients (p = 0.0003). The diagnosis of tuberculosis was retained in 11.7% of the patients with negative microbiology despite repeated samples. A normal chest x-ray was observed solely in one HIV-negative patient.

[Tetanus in a hospital setting in Bamako, Mali]

AIM

The purpose of this study was to describe the epidemiological, clinical, and prognostic profile of tetanus patients managed in the infectious diseases department of the "Hopital du Point G", in Bamako, Mall.

PATIENTS AND METHODS

This retrospective descriptive study was conducted from July 2001 to August 2004. The following data were collected: age, sex, infection route, clinical features, delay to hospitalization, and outcome.

RESULTS

A total of 54 patients hospitalized for tetanus were included. Men accounted for 68.5% of cases. Ages ranged from 15 to 66 years with a mean of 39 years. The most common professional activity was farming: 27.8%. The route of infection was determined in 87% of cases and involved cuts in 46.3% of cases located on the lower limbs in 42.6%. Generalized paroxystic tetanus with opisthotonos was the most prevalent form accounting for 18.5% of cases. Localized tetanus accounted for 12.9% of cases. Outcome was unfavorable with a death rate of 38.9%. All deaths occurred within the first week of hospitalization.

CONCLUSION

Mass vaccination of the population should be a national priority to reduce tetanus-related morbidity and mortality to levels observed in industrialized countries.

[The etiological, clinical and prognosis of diarrhea occurs during AIDS in to hospital in Bamako]

Its was a descriptive survey achieved in the service of the infectious and tropical illnesses of the teaching hospital of the "Point G" from 31 December 2002 to 30 June 2004 was about the analysis of 76 files. Its goal was to determine the clinical, etiological and prognostic aspects, of the diarrhea during the AIDS. The oral-pharyngeal candidiasis (50%), the deshydratation (60,5%), the fever (67,5%) and the thinning (77,6%) were associated to the diarrhoea frequently. Cholera syndrome was (52.6%), dysenteric syndrome was (36.8%) and the diarrhea syndrome was (10.5%). According to the etiological aspect, the parasites were founded in 51,3 % of cases, bacteria 9,2 % of cases, and fungus 5,3%. Any pathogen hasn't been founded in 34,2% of cases. Cyptosporidium parvum (15,8 %), and Isospora Belli (11,8%) was the most common parasites founded, but some unusual pathogens as: Entamoeba hystolitica, Trichomonas intestinalis , Giardia intestinalis , Shistosoma mansoni , Dicrococelium dendriticum, Trichostrongylus were present . The most common bacteria were Escherichia coli 5,3%. The fungus family was represented by Candida albicans . The lethality rate was 46,1%.

CONCLUSION

The etiology of diarrhea occurs during aids is variable and include opportunistic and non opportunistic. The fatality rate remains incised because the delay of care and the poverty of the patients.

[Impact of market place activity on the spread of STI/AIDS in Sikasso, Mali]

Since the beginning of the global HIV pandemic, more than 47 million people have been infected and more than 14 millions of people have died with 95% living in developing countries. Mali is located in West Africa that has been relatively less affected. However Mali is a country with a migratory culture. This study was conducted in primary health care centers located on the main road to neighboring countries with higher HIV prevalence. Attention was focused on healthcare services provided around market places in the main cities where diverse populations converge on a weekly basis. Attendance measured at five health centers on market day was compared with attendance on the other days of the week. In addition the level of sexually transmitted infections (STI) diagnosed on market days was determined to compare prevalence in the resident versus non-resident population in function of market activity. Attendance at all the centers was significantly higher on market days. This increase was due mainly to the non-resident population (60.2% vs. 46.5%; p=0.005). Findings also showed that the proportion of STI diagnosed was higher in the non-resident than resident population, but the difference was not statistically significant (15.6% vs. 11.3%; p=0.320). These results indicate that migration has an impact on the spread of STI. This is probably the same for HIV since these pathologies are known to be linked. Control strategies to fight against STI/AIDS could be improved by taking into account market place activity that is common in all localities of Mali and Africa.

[Gastrointestinal manifestations of AIDS in adults in Mali]

Our main objective consists in evaluating the frequency of digestive signs and digestive opportunistic infections in AIDS patients with diarrhea. The prospective study occurred from January 1997 to July 1998 in Bamako hospitals. The patients underwent a clinical examination, blood and stools tests, and sometimes upper digestive endoscopy. Among 434 cases of AIDS, 426 patients (98%) had at least one digestive sign. The main digestive signs were diarrhea (80.1%), abdominal pains (62.2%), vomiting (47.2%) and dysphagea (36.6%). Isospora belli and Cryptosporidium parvum have been pointed up in respectively 9% and 16.3% of examined specimen. Echerichia coli was found in 8.6% of stool cultures and in 2.9% in the case of Salmonella Arizonae. Twenty cases of Kaposi's sarcoma were diagnosed and mycosis was found in 71.9% of patients. In conclusion, digestive change is a constant phenomenon in AIDS patients. Patients survival could be improved by early management, improvement of diagnosis and provisioning of medicines.

[Epidemiological aspects of human and animal rabies in the urban area of Bamako, Mali]

The district of Bamako is the political and economical capital city of Mali with 1,800,000 inhabitants. The goal of the present retrospective study was to determine the frequency of animal bites, human and animal rabies on the one hand and to determine the frequency and the nature of mad animals on the other hand from January 2000 to December 2003 (4 years). To achieve this goal, we have analysed registers and documents related to rabies in the department of prevention and fight against diseases, the central veterinary laboratory, and also at the lazaret clinic involved in caring for human rabies cases. Human rabies diagnosis has been brought up based upon the following clinical arguments: agitation and lethal hydrophobia within few days following bites by known or unknown animal. Agitation and aggressiveness followed by the animals' death within an observation period of 15 days maximum, allowed to evoke the diagnosis in animals. In Bamako an average of 1470 persons have been bitten each year. In 97.1% of the cases, the mad animal was a dog; cats (1.6%), donkeys, horses, cattle and rats (1.4%) have also been identified on a total of 5870 cases of notified human bites by animals; 10 cases of notified human rabies have been recorded. The dog has been incriminated in 6 cases of human rabies out of 10, in the 4 other cases, it has not been possible to identify the mad animal. Among the 3924 mad animals in observation at the veterinary clinic, 187 have been clinically mad that is 4.8%. The rabies virus has also been researched by direct immunofluorescence in 121 specimens of dead mad animals brain. This research has been positive in 119 cases among which 116 dogs, 2 sheep and 1 cow. Anyway the vaccinal status of people bitten by mad animals has not been clearly established. According to these results, we recommend the implementation of a national specific program to eradicate rabies in Bamako.

[Haemophilus influenzae b among bacterial meningitis in Bamako (2002-2004)]

In Mali little study exist on the meningitis with Haemophilus influenzae b (Hib). This weak data availability on Hib meningitis, didn't permit to introduce the immunization against this pathology in the Expanded Program Immunization (EPI) of Mali. The present survey aims to improve the availability of the data on Hib meningitis and to advocate for the introduction of immunization against Hib in EPI in Mali. The survey consisted to the exploitation of spinal fluid examination data for the suspected cases of meningitis, sent by the different health centers to National Institute for Public Health Research (INRSP) on the period going from October 1st, 2002 to September 30, 2004. According to the survey, on 230 cases of meningitis whose germs have been identified to the latex and the culture, Hib occupies the 3rd place with 21.3% among the bacterial meningitises. In Bamako Hib occupies the 2nd place (27.4%) according to the source. The persons less than 1 year (59.6%) were the more affected (p < 0.001) and the diseases distribution has been observed during the dry seasons (51.0%) and rainy (49.0%) without meaningful impact of temperature and rainfall (p > 0.05) (p = 0.8249). The cases of Hib identified were more sensitive to ciprofloxacine (100%) and to ceftriaxone (100%). Taken into consideration the cost raised of quinolones and cephalosporines, and in reference to the high mortality and frequent complications known of Hib meningitis, the introduction of immunization against Haemophilus influenzae in the Expanded Program Immunization should contribute to a better control of this disease.