[Factors associated with the death of tuberculosis patients treated in Bamako, Mali, 2017 - 2018]

GOALS

We studied the socio-demographic and paraclinicalcharacteristics of tuberculosis patients to identify the factors associated with their deaths in Bamako.

MATERIALS AND METHODS

A retrospective cohort study was carried out on tuberculosis patients registered in Bamako from October 1, 2017 to September 30, 2018. Quantitative variables were presented by their mean, qualitative ones by their proportions. Analysis was performed with R version 3.5.0.

RESULTS

Out of 2396 patients enrolled, 25 to 45-year olds represented 50.3% and children 4.51%; the average age 37.3 years; the sex ratio M/F 1.94 and co-infected TB/HIV 8.64%. 25 to 45 year olds (HR=2.58; 95% CI [1.35-4.92]; p=0,0042) and those ≥ 46 years (HR=4.64; 95% CI [2.39-9.01] ; p=5.69e-06) and positive HIV status (HR= 5.87 ; 95% CI [2.24-15.41] ; p= 0.0003) were associated with an increased risk of patient death.

CONCLUSION

Tuberculosis affects young and old males. The risks of death identified were the patient's age and positive HIV status. We recommend specific monitoring of patients aged 25 to 45 and 46 and over and those with positive HIV status.

[Painful ophthalmoplegia in a woman from Burkina Faso: cerebral venous thrombosis (CVT) of the cavernous sinus]

Cerebral venous thrombosis (CVT) is a rare cerebral vascular pathology with highly variable clinical features and outcome. The purpose of this report is to describe a case of CVT of the cavernous sinus that presented as painful ophthalmoplegia. A 26-year-old woman with a contraceptive implant for seven months consulted at the Neurology Department of Yalgado Ouedrago hospital for a painful ophthalmoplegia that was initially diagnosed and treated as ophthalmoplegia migraine. One month later, clinical symptoms had progressed to asymmetric muscle weakness in all four limbs, right cerebellum ataxia and involvement of the trigeminal ophthalmic branch. Computerized axial tomography of the brain depicted a zone of unusual contrast extending from the cavernous sinus up to the tentorium cerebelli and a mass effect on the fourth ventricle. Analysis of the cerebrospinal fluid demonstrated a cellular reaction with 8 lymphocytes and high protein rate (0.64 g/L). The levels of C reactive protein (CRP) and D-Dimeres were elevated: 16.6 mg/L and 0.99 microg/mL respectively. Based on a presumptive diagnosis of CVT, heparin treatment was undertaken and led to almost complete remission of the signs and symptoms. This case again shows the wide range of clinical features and outcomes of CVT that can oscillate between encephalitis, intracranial tumor or infection. As a result, CVT should be considered as a possible diagnosis in patients with focal neurological signs, intracranial hypertension syndrome, loss of consciousness or cavernous sinus syndrome whenever the context is right (post-partum, oestroprogestative, congenital thrombophilia).

[Athetosis in relation with intracranial tuberculomas in a patient from Burkina Faso]

Athetosis is generally characterized by involuntary movements due to damage of the extrapyramidal tract secondary to neonatal cerebral anoxia or nuclear icterus. The purpose of this report is to describe the case of a 41-year-old man who was admitted to the neurology department of the Ouagadougou teaching hospital in Burkina Faso for right hemiathetosis in relation with intracranial tuberculomas ongoing for two years. Diagnosis was based on clinical findings, i.e., lymph node tuberculosis and positive HIV1 serology; on CT scans showing multiple low density nodular lesions of variable size with annular contrast at the level of the right cerebellum and calcification at the left parietal level and in projection of the left capsulolenticular area; and on favorable response to tuberculosis treatment.

[Wallenberg syndrome and neurocysticercosis: about one case in Ouagadougou, Burkina Faso]

Neurocysticercosis (NCC) frequently appears by seizures following parenchymatous location of encysted worms of Taenia solium. We report a case of NCC revealed by a Wallenberg's syndrome. A man of 44 years old, without any cardiovascular risk factor was admitted at the neurology department of Yalgado-Ouédraogo hospital in Ouagadougou for an abrupt onset of vertigos, recurrent falls on the right side, hiccough, and deglutition weakness. The clinical examination found a blood pressure at 130 mmHg/80 mmHg, a CMI at 24, a Wallenberg's syndrome. The CT scan showed a laterobulbar lacunar infarct with punctiform calcifications of cerebellum, third ventricle, frontal, right temporal, occipital and left parietal lobes. The CSF showed a raise of cells number at 23 lymphocytic elements, proteins rose to 1.5 g/l, glucose and chloride were normal. Cysticercosis blood and CSF serologies were positive. The blood cells count showed only an eosinophilia and the blood sedimentation rate reached 119 mm in the first hour. The accepted diagnosis was: laterobulbar lacunar infarct following a NCC angiitis. The course of the disease under albendazole at 15 mg/kg during two weeks combined with a short steroid therapy by prednisolone at 1 mg/kg during 5 days was favourable. NCC should be more and more regarded as a cerebrovascular risk factor in endemic area, especially in young people.

[Lumbar canal stenosis in Ouagadougou: aetiological, clinical aspects and prognosis regarding 80 cases]

The authors report their experience about 80 cases operated for lumbar spinal stenosis. Etiological clinical aspects and prognosis are studied. Lumbar arthrosis (83.8%) is the most frequent aetiology. The mean age is 50.7 years. Men are most affected than women (sex-ratio 2/1). Heavy work has a part to play in the genesis, in effect it tends to low the age of symptomatic stenosis. Lumbar and radicular pains are the most frequent symptoms (82.5%). Neurogenic intermittent claudication is less frequent (65%). Heavy cases with neurologic complications are frequent (32.5%). Surgical results are satisfactory in 74.3% of the cases. The authors insist in the interest of extensive laminectomy, respecting however as much as possible, the structure of stability of the vertebral column.

[Myocardial localization of a disseminated cysticercosis. Echocardiographic diagnosis of a case]

Cysticercosis (cysticercus cellulosoe) is a parasitic infestation of human by a larval form of Taenia solium. The localisations are mostly the central nervous system, skeletal muscles and subcutaneous tissue, but other organs can be concerned. Myocardial cysticercosis is an extremely rare infection. We report a case of myocardial cysticercosis in a 37 year old patient who presented a disseminated form. The myocardium involvement is diagnosed by echocardiography. The clinical and echographic evolution was favourable after a treatment with albendazole. The other cardiovascular manifestations described in the literature are discussed.

[Apropos of a case of rabies occurring despite vaccination after exposure]

Rabies is endemic in Sub-Saharan Africa. Control is based on vaccination of subjects at high-risk for exposure and prompt post-exposure treatment. However the severity of some animal bites and early mismanagement can lead to development of rabies despite post-exposure treatment. This danger is illustrated by the case described herein involving a 35-year-old man who was bitten by a rabid dog and treated with 5 doses of antirabies vaccine. The wound, which consisted of two deep punctures on the forearm, was promptly washed with water and disinfected. Despite this treatment, characteristic clinical manifestations of rabies appeared one month after exposure and the patient died 48 hours later. This case raises the question of the causes for failure of the preventive recommendations proposed by the WHO for category III animal bites. In our case, two possible causes of failure and subsequent lethal outcome are that serotherapy was not associated and the incubation period was short. Other possible causes of rabies after post-exposure therapy are discussed with reference to the literature.

[Diabetes mellitus at the National Hospital Center of Ouagadougou (Burkina Faso)]

The study, conducted over 4 years among 400 diabetic patients, reports the epidemiological and clinical aspects of diabetes mellitus at the National Hospital of Ouagadougou, Burkina Faso. Epidemiologically, diabetes mellitus affects men by 64% and women by 36%. 76% are over 40 y. o., whereas only 2.2% are under 20. Clinically, the classification of diabetic patients shows that 10.7% are insulin-dependent and 76.5% non insulin-dependent. No usual tropical diabetes has been found. The calcifications observed in 2.5% of cases were combined with chronic alcoholic pancreatitis. The classic triad (polyuria, polyphagia, polydipsia) led to diagnostic by 41% of the patients, whereas 27.5% have been identified when having complications, and 23% by a systematic check-up. Cardio-vascular risk factors combined with diabetes have been found: obesity (28%), high blood pressure (20%), hyperuricaemia (14%), addiction to smoking (20%). The epidemiological characteristics, as well as the various clinical aspects, mostly complies with the observations of the african authors.