Medecine tropicale et sante internationale最新文献

The yellow fever virus (YFV), recently renamed Orthoflavivirus flavi, is an arbovirus of the Flaviviridae family and Orthoflavivirus genus endemic in South America and Tropical Africa. Brazil experienced an epidemic of unprecedented magnitude between 2016 and 2018. The resurgence of new cases in French Guiana in recent years has rekindled interest in the disease. In December 2019, the global pandemic of Covid-19 began and rapidly reached South America. The first cases were reported in French Guiana in March 2020. Many tropical diseases circulate in the region and the possibility of co-infections is therefore high. Here, we report the first case of YF virus-SARS-CoV2 co-infection in a 14-year-old French Amerindian boy who died within nine days. He had received a single dose of YF vaccine in childhood.

Introduction: Hypertensive emergencies are defined as hypertensive crisis with signs of visceral distress. They are relatively common and require urgent, but not necessarily normotensive, antihypertensive therapy. The aim of this study was to describe the epidemiology of hypertensive emergencies..

Patients and methods: This was a descriptive cross-sectional study conducted from March 5, 2017, to December 31, 2023, at the cardiology department of the Bogodogo University Hospital (CHU-B), Burkina Faso. All patients admitted to the department for hypertensive emergencies were included in the study. Epidemiologic, sociodemographic, clinical, paraclinical, therapeutic, and evolutionary characteristics were evaluated in a descriptive analysis.

Results: Among 2,610 hospitalized patients, 96 cases of hypertensive emergencies were identified, representing a prevalence of 3.6%. Mean age was 50.5 (±10.4) years. Cardiovascular risk factors were hypertension, sedentary lifestyle, diabetes, and smoking in 80.8%, 72.3%, 12.7%, and 9.5% of cases, respectively. Headache was the most common reason for consultation (46.8% of cases), followed by dizziness (19.1%). Ischemic stroke and acute pulmonary edema were observed in 18.7% of cases.

Conclusion: Hypertensive emergencies are quite frequent at CHU-B and the majority of patients are relatively young.

Introduction: Tuberculosis and sickle cell disease are common in sub-Saharan Africa. Multifocal tuberculosis, more common in immunocompromised patients, is rare in SC sickle cell patients, especially when localized to the sternoclavicular joint.

Case report: A 44-year-old male sickle cell patient, black African, of Burkina Faso origin, with no other pathological history, presented with chronic inflammatory low back pain associated with right-sided inflammatory gonalgia and hacking cough. This symptomatology had been developing for 7 months in the context of fever and altered general condition. Examination revealed oligoarthritis of the right sternoclavicular joint and the left knee associated with pulmonary condensation syndrome and pleural effusion, a cold abscess in the right sternoclavicular joint, and a purulent fistulized right inguinal adenopathy. Biology revealed a biologic inflammatory syndrome. The GeneXpert test was positive in sputum, with no resistance to rifampin. Intradermal tuberculin test was positive. Chest CT revealed right sternoclavicular osteoarthritis and lumbar CT revealed L3-L4 spondylodiscitis. A standard radiograph of the left knee showed signs of arthritis. The diagnosis was tuberculosis with multifocal bone, pleural, and lymph node involvement. The patient was started on standard analgesics and antituberculosis drugs. The course was favorable.

Conclusion: Multifocal tuberculosis may affect SC sickle cell patients and requires vigilance to prevent complications, especially in rare articular localizations such as the sternoclavicular joint.

Introduction: Scabies is an often-neglected skin parasitosis which can affect patients' quality of life, and its treatment may be delayed in some poor African countries due to a lack of trained healthcare personnel or a lack of financial resources. The aim of this study was to describe the treatment-seeking paths of patients seen in dermatological consultations in Lomé for scabies, the direct costs of treatment and the impact of this condition on the quality of life of patients suffering from it.

Patients and method: This was a descriptive and analytical study of patients diagnosed with scabies in one of Lomé's dermatology departments from January 1 to December 31, 2021. The variables studied were sociodemographic; the patient's therapeutic course prior to the dermatology consultation; the direct cost of the present consultation and the patient's quality of life. The Dermatology Life Quality Index (DLQI) was used. Statistical analysis was performed with EPI Info software version 7.2.5.0.

Results: A total of 157 patients were selected, including 114 cases of clinical scabies. The median age of patients was 26 years, and 29.3% were under 15 years of age. The sex-ratio M/F = 1.03. Out of them, 139 patients had one or more courses of treatment prior to the dermatological consultation, including self-medication (80.9%), consultations with non-dermatological healthcare personnel (62.4%). The average cost to the patient and family of drugs prescribed during the dermatological consultation was 19,817 CFA francs (30.2 €). The mean DQLI score for adults was 7.4, and 34.9% had moderate impairment of quality of life. The mean CDQLI score for children was 7.2, and 71.4 % had moderate impairment of quality of life.

Conclusion: Scabies is a parasitosis that impair patients' life quality. In the absence of subsidized treatment and financial resources for patients, treatment remains limited, which could contribute to the spread of the disease.

Introduction: Colorectal cancer (CRC) is a major public health problem, including in Tunisia. It is classified as the second leading cause of cancer-related mortality on a global scale. The carcinogenesis process is multifactorial, mainly involving genetic and environmental factors. Recent studies in various countries suggest that Cryptosporidium, an emerging intestinal protozoan, may be associated with this cancer pathology.

Objective: This study aimed to estimate the prevalence of Cryptosporidium in intestinal biopsies from Tunisian CRC patients.

Materials and methods: Formalin-fixed, paraffin-embedded intestinal biopsies from 39 Tunisian CRC patients were studied. After DNA extraction, Cryptosporidium was detected using two PCR techniques, one TaqMan targeting 18S rRNA and the other HRM (High Resolution Melt) targeting the DHFR (Dihydrofolate reductase) gene. PCR-HRM was also used to identify Cryptosporidium species.

Results: The protozoan parasite was detected in five biopsies from CRC patients by at least one PCR (three by the TaqMan technique and three by the HRM technique, including one by both techniques). The overall Cryptosporidium infection rate was 13% (5/39). This prevalence was well above those reported in the few studies carried out in the Tunisian population. Cryptosporidium parvum was identified in three of the five infected biopsies. This species is the most implicated in intestinal carcinogenesis.

Conclusion: The high prevalence (13%) of Cryptosporidium infection observed in Tunisian CRC patients correlates with data from similar series and would suggest a potential association between this protozoan and CRC. Further studies on more numerous and more suitable biological samples, such as stool and fresh intestinal biopsies, would enable this hypothesis to be investigated in greater depth.

Introduction: The diagnosis of superficial cutaneous mycosis (SCM) is very frequently evoked during dermatological consultations in tropical zones, but mycological confirmation is very rarely performed routinely. The aim of this study is to describe the profile of fungal species encountered during dermatology consultations in Lomé (Togo), to establish their relative frequencies and, above all, to discuss their responsibility in the lesions observed.

Method: This was a descriptive study carried out from February 2020 to March 2022, involving patients presenting lesions suspected of MCS, seen in dermatological consultations. Three dermatological consultation centers, all located in the city of Lomé, served as the setting for case enrollment. Each patient consulted who met the inclusion criteria (i.e. presenting a lesion of SCM and not under antimycotic treatment or having respected an adequate therapeutic window) had a sample taken from the suspected lesion(s). Samples were taken on site and analyzed at the Mycology Laboratory of CHU Sylvanus Olympio for biological confirmation.

Results: During the study period, 565 patients were enrolled and sampled, of whom 364 (64.4 %) were women. The median age was 31 years, with interquartile range (IQR) from 22 to 41 years. Direct examination and/or culture were positive in 84.7 % (479/565) of cases. The main fungal species identified were yeasts (63%), including Malassezia sp. (23.8%), other yeasts (39.2%), but also dermatophytes (22.8%), with Trichophyton mentagrophytes as the predominant species (10.8%), and molds (13.1%) including Aspergillus niger and A. fumigatus (3.1% each). Pseudo-dermatophytes were found in only 1% of cases. Fungal associations were also noted in 3.5% of cases. The most frequent associations were C. tropicalis, A. fumigatus and T. mentagrophytes-C. albicans, each found in 0.5% of cases.

Conclusion: The spectrum of fungi isolated in suspected cases of SCMs in Lomé is broad, but not all can be held responsible for the lesions observed. This diversity makes it essential to take a mycological sample for accurate identification of the fungus in any suspected case of SCM. Depending on the species isolated, this will enable treatment to be tailored to the patient's needs.

Introduction: Data on HIV infection in sub-Saharan Africa show high prevalences in key populations. The objectives of this study were to measure the prevalence of HIV, syphilis and factors associated with HIV infection among men who have sex with men (MSM) and female sex workers (FSW) in Togo.

Method: We conducted a cross-sectional study targeting MSM and FSW in the 6 health regions of Togo in 2022. Respondent-Driving Sampling (RDS) was used. Sociobehavioral, HIV and syphilis seroprevalence data were collected and expressed as percentages of balanced risks.

Results: A total of 2 110 MSM and 3 221 FSW were included in our study. Half of the MSM (53.3%) and FSW (49.7%) were aged between 15 and 24 years. The weighted prevalence of HIV was estimated at 8.7% (95% CI: 7.5%-9.9%) among MSM and 5.8% (95% CI: 5%-6.6%) among FSW. Syphilis incidence was 0.6% (95% CI: 0.3%-0.9%) and 0.2% (95% CI: 0%-0.3%), respectively in MSM and FSW. In multivariate analysis, MSM with: an age over 25 years (OR = 1.71; 1,96: p = 10^-8); a notion of condom tear in the last twelve months (OR = 1.26: p = 0.001), and more than two male sexual partners in the last six months (OR = 1.96: p = 10^-7), would be at greater risk of contracting HIV. FSW with at least one sign of sexually transmitted infections (STI) in the last six months were at greater risk of contracting HIV than those with no sign of STI (OR = 1.24: p = 10^-7).

Conclusion: The results of our study show that HIV prevalence is high in Togo among MSM and FSW. Efforts must be redoubled to create a more favorable socio-cultural and legal environment for these populations in order to achieve a greater impact from HIV control interventions.

Extended-spectrum beta-lactamase-secreting Enterobacteriaceae (ESBL-E) infections constitute a real global public health problem, particularly in sub-Saharan Africa. We report here two cases of ESBL-E meningoencephalitis in young female patients occurring in a gestational context observed at the infectious and tropical diseases department of the Point G university hospital in Bamako. The first woman, who recently had an abortion, was being treated with ceftriaxone when she was admitted for meningeal syndrome and pyramidal syndrome associated with brain damage. Escherichia coli resistant to penicillins and cephalosporins was isolated from cerebrospinal fluid (CSF), blood and a purulent genital swab. She recovered under meropenem treatment for 21 days, with few sequelae.The second had given birth in the weeks prior to the onset of generalized infection. She was admitted for meningeal syndrome and pyramidal syndrome associated with several cerebral lesions disclosed by the CT scan. Multidrug-resistant E. coli was isolated from CSF and genital purulent sample. She recovered (with sequelae) under treatment with meropenem for 21 days. These two observations show that female genital infections (postpartum or post abortum) with E. coli can cause forms as serious as meningoencephalitis, in addition to the abortion they cause. ESBL-E -producing strains may be involved and represent a major therapeutic challenge. Better infection prevention and control would prevent multi-drug-resistant infections and their spread. Regulating the use of carbapenems and other antibiotics still effective against multi-resistant bacterial strains within the framework of global health (one health) would avert an incurable pandemic of highly resistant and emerging bacteria (HRB).

Background: Vaccination adherence among populations is a complex process involving, on the one hand, the expected benefit of a vaccine, and on the other, the perceived risk. To develop an evidence-based communication strategy aimed at improving vaccination coverage in Niger, we conducted a mixed socio-anthropological study of the perceptions among the population on the benefit and the risk of the childhood (Expanded Program on Immunization, EPI) and the Covid-19 vaccines. While the vaccine coverage for some of the EPI vaccines is above 80%, only 33% of the children are fully vaccinated, according to the national vaccination schedule. The first objective of our study was to understand the perceptions that might explain this drop off.The second objective was to identify the drivers of the low adherence to the Covid-19 vaccination, 22% of the illegible population being vaccinated.

Materials and methods: In March 2023, we interviewed 509 people for the quantitative study and 40 people through focus groups and individual interviews for the qualitative one, in Niamey (80% of the interviewees) and two villages.

Results: 96.9% of the interviewees think that childhood vaccines are "a good thing," even though 30.6% know that they might have negative side effects. While 87.8% think that it is "easy" or "very easy" to get children vaccinated, 21.4% point out as "annoying" the lack of amiability by the health care workers and 16.9% the waiting time. The qualitative study showed that these two complaints drive some women not to complete the vaccination schedule. We might also hypothesize that, given the perceived lack of amiability, some women don't get enough information on the side effects and their management. Surprisingly, 73.3% of the interviewees think that vaccines against the disease are a good thing, and 83% of those who have heard messages promoting the vaccination approve them. This apparent contradiction with the low vaccine uptake is explained by a very low perception of the Covid-19 risks. More than half of the population surveyed believe that the disease is not present in the country, a very large majority believe that only ill people can transmit the disease, while only 12.8% think they know anybody who has ever been sick with Covid-19. According to our results, the circulating rumors on the vaccines don't play a significant role in the low adherence to Covid-19 uptake, nor in the insufficient completeness of the EPI vaccination schedule.

Conclusion: The communication efforts on EPI vaccination should focus on the explanation of the side effects and their management, as well as improving the organization of the vaccination sessions. The communication on Covid-19 vaccination should focus on the reality of the disease in the country and the groups at risk for severe forms.