Medecine tropicale et sante internationale最新文献

Introduction: The sexual transmission of intestinal parasites has been reported for a long time, even before the HIV pandemic. It mainly involves protozoa. More rarely, helminths are involved: Strongyloides stercoralis, Enterobius vermicularis. This type of transmission is almost exclusively observed in men who have sex with men (MSM) through direct oral-genital-anal sexual contact.

Observations: We present four cases of sexually transmitted strongyloidiasis in MSM.

Discussion: Several associated factors were found: HIV infection, recurrent episodes of other sexually transmitted infections, or risk factors: sexual relations with men from regions endemic for S. stercoralis, rimming, chemsex, scatological practices. In MSM, strongyloidiasis must be considered and investigated in the presence of eosinophilia, which may be fluctuating, with or without digestive and/or cutaneous signs, even in the absence of a stay in a tropical zone.

Conclusion: These MSM patients must be thoroughly questioned, with details of their sexual behavior leading to appropriate prophylactic advice, such as unprotected oral-genital-anal intercourse.

Introduction: Brucella endocarditis (BE) is a rare but serious complication of brucellosis and is the leading cause of death from this infection. It is often difficult to diagnose due to its non-specific symptoms and low prevalence.

Observation: This clinical case concerns a 59-year-old man with a mechanical aortic prosthesis who presented with heart failure with prosthetic disconnection, aortic annulus abscess, and negative blood cultures. The diagnosis was confirmed by serologic testing and culture of the surgical specimen, which revealed infection with B. melitensis associated with consumption of unpasteurized raw milk. Treatment required surgery to replace the prosthesis and drain the abscess, and prolonged antibiotic therapy with doxycycline, cotrimoxazole, and rifampicin. Despite postoperative complications, hemodynamic and infectious outcomes were favorable.

Conclusion: This case highlights the importance of a multidisciplinary approach, including targeted serologic testing and cardiac imaging, for early diagnosis. It also emphasizes the need for surgical management combined with appropriate antibiotic therapy to improve the prognosis of patients with BE.

Objective: Submicroscopic Plasmodium infections, mostly undetected by routine diagnostic techniques, represent a potential reservoir that contributes to the continued transmission of malaria in the community. To achieve the World Health Organization's goal of malaria elimination, it is therefore essential to identify all parasite carriers and treat them effectively with recommended antimalarial drugs. The aim of this study was to estimate the proportion of submicroscopic Plasmodium spp. infections not detected by microscopy in symptomatic patients with suspected malaria attending health centers in Togo, and to identify the factors associated with it.

Materials and methods: A cross-sectional study was conducted between September 2021 and January 2022 and between July and December 2022 in three health facilities in Togo. Each patient suspected of having malaria had a capillary blood sample taken for detection of Plasmodium species by thick blood film/blood smear (TBF/BS) and PCR. A logistic regression model was used to evaluate the factors linked to the parasitic results.

Results: A total of 553 participants were selected, 44.6% of whom were female, with a median age of 25 years (± 2 years). The proportion of Plasmodium spp. infections detected by TBF/BS was 25% and by PCR 29.1%. The frequency of submicroscopic Plasmodium spp. infections detected by PCR in patients with negative microscopic TBF/BS was 5.5% (23/415) [95% CI: 3.7-8.2], and P. falciparum was the most common species (83%, 19/23, 95% CI: 60-94). Participants from the Anié and Kouvé sites were more likely to have submicroscopic infections.

Conclusion: This study provides preliminary data on the incidence of submicroscopic Plasmodium infections in Togo.

Introduction: In sub-Saharan Africa, autoimmune myasthenia gravis (AMG) is still poorly known and underdiagnosed (delayed diagnosis, poor availability and accessibility of proven effective diagnostic and therapeutic tools), resulting in a poor functional prognosis and high mortality. The aim of the present study was to evaluate the therapeutic and clinical course of AMG in Burkina Faso.

Patients and methods: This was a longitudinal, multicenter study conducted from March 2015 to April 2023. It included patients with clinical signs suggestive of myasthenia associated with the presence of serum anti-acetylcholine receptor (anti-RACh) antibodies and/or anti-muscle specific kinase (anti-MuSK) antibodies, and/or with the presence of a decrease >10% on electroneuromyography, and/or with a positive therapeutic test to oral anticholinesterase drugs. Data on treatment modalities and clinical evolution were analyzed using Epi InfoTM 7.2.5.0 software. Bivariate analysis with p-value calculation (<0.05) was used to identify factors associated with adverse clinical outcome.

Results: A total of 40 patients with AMG were included, with a female predominance (60%). The median age of onset was 25 years (IQ=7). The median time to neurological consultation and diagnosis was 21 months (IQ=12) and 22 months (IQ=12), respectively. The disease affected young adults in 85% of cases and was generalized in 35 cases. Anti-RACh and anti-MuSK antibodies were present in 22 and 4 of 33 patients, respectively. Thymic hyperplasia and thymoma were found on chest CT in 22 and 6 of 38 patients, respectively. All patients received symptomatic treatment with oral anticholinesterase agents and 36 patients received background treatment with corticosteroids and/or immunosuppressants (azathioprine). Four of 9 patients received a course of intravenous immunoglobulin (IVIG) or plasma exchange (PE) for myasthenic crises. Thymectomy was performed in 16 of the 40 patients. At the end of a median outpatient follow-up of 53 months (IQ=16), of the 40 patients included in the study, 6 (15%) had died, 14 (35%) were in stable clinical remission, and 17 (43%) had partial clinical improvement.

Conclusion: AMG suffers from delayed diagnosis in Burkina Faso. Almost all patients treated for AMG receive anticholinesterase and corticosteroid therapy alone or in combination with azathioprine. Access to IVIG, PE and thymectomy remains limited. Mortality occurs in nearly one in six patients, and stable clinical remission affects only about one third of patients. To improve the prognosis, we need to make available and accessible diagnostic tools and treatments of proven efficacy, such as thymectomy, immunosuppressants, IVIG and PE.

Introduction: Delays in entry to care are a barrier to immediate initiation of antiretroviral therapy (ART) at diagnosis, as recommended by the World Health Organization. The aim of this study was to determine and compare delays in entry into care and associated factors among people living with HIV (PLHIV) seen at two outpatient treatment centers in Libreville between 2012 and 2020.

Materials and methods: Retrospective study based on PLHIV records collected from January 2012 to March 2020 at the two largest outpatient treatment centers (CTA) in Libreville, that of the Centre Hospitalier Universitaire de Libreville (CHUL) and that of Nkembo Hospital. Early entry into care was defined as less than 28 days between diagnosis of HIV infection and first consultation at the CTA. Late entry was defined as more than three months. For analysis, patients were divided into two periods: 2012-2015, when treatment initiation was linked to CD4 count, and 2016-2020, the period when the Test and Treat method was introduced in Gabon.

Results: A total of 979 patients were newly treated in the two CTAs, and the records of 672 individuals could be used. In 48.3% of the cases, HIV infection was diagnosed at a late stage (WHO 3 or 4). The median time to entry into care was 1.2 [IQ: 0-3] months after diagnosis of HIV infection. Between 2016 and 2020, 47% entered care in less than 28 days, compared with 35.7% in 2012-2015 (p < 0.01). The percentage of PLHIV with late entry into care was comparable between the two periods (14.4% vs. 15.9% in 2012-2015; p = 0.62). Factors associated with late entry were WHO stage 3, failure to achieve CD4 count, employment, and pregnancy (p<0.05).

Conclusion: In the era of Test and Treat in Libreville, the delay in seeking care is still long. A better understanding of the associated factors and a decentralized, integrated approach to the management of HIV infection would make it possible to achieve the second pillar of "95-95-95" target in Libreville.

Objective: To evaluate the satisfaction of patients surgically treated in a Otolaryngology Department in a developing country. This survey was caried out from consultation to surgical management in the Sylvanus Olympio University Hospital in Lomé.

Patients and methods: Cross-sectional study from December 1, 2022 to November 30, 2023, a period of one year. People included were the patients or relatives for under 18 years of age who gave their consent, seen by the surgical team and operated on in the department during this period. The parameters assessed by a closed self-administered questionnaire were related to satisfaction from admission to diagnosis, from preoperative evaluation to the day before surgery, from the day of surgery to the end of hospitalization, and finally to discharge formalities. The data were analyzed and processed using Epi info 7.2.5.0 software.

Results: One hundred and twelve individuals, including fifteen relatives, met the survey criteria (70.4%). The mean age was 41 years, with extremes of 19 and 76 years. The participants had a secondary education level in 59.5% of the cases. They were shopkeepers and housewives in 26.8% and 24.1% of cases, respectively. Thyroidectomy was the most common type of surgery, performed in 43.7% of cases. From admission to diagnosis, 66.1% of patients found the service satisfactory, while 12.5% found it very poor. From the preoperative examination to the day before surgery, this examination and the purchase of prescriptions were judged to be poor in 33.9% and 40.2% of cases, respectively. From the day of the operation to discharge, the quality of the sanitary facilities and of the hospital ward was poor in 44.6% and 54.4% of cases, respectively. Participants were satisfied with the quality of visits (58.9%), behavior of medical-surgical team in the operating room (30.4%), follow-up information and surgical procedure in all cases.

Conclusion: Dissatisfaction of patients and their relatives exists at all levels, administrative and medical. More efforts need to be done in our department to improve the quality of care.

Introduction: Toxoplasma gondii (T. gondii) is an obligate intracellular parasite that infects a wide range of animal species, including humans and livestock. Contamination can have significant health, economic and epidemiological consequences. Birds in general, and poultry in particular, appear to play an important role in the epidemiology and circulation of the parasite. The aim of this study was to determine, for the first time, the seroprevalence of T.gondii in chicken in the Marrakech-Safi region.

Materials and methods: Sera were collected between January 2019 and March 2020 from 486 chickens from three types of farming: 122 traditional (domestic) chickens, 109 free-range chickens, and 255 commercial (battery) chickens intended for consumption in the Marrakech-Safi region. Immunoglobulin Y (IgY) testing was performed by ELISA using a total T. gondii antigen.

Results: The mean seroprevalence of T.gondii in chicken in the study region was 30.65%. This study also showed a significant association (p<0.0001) between seroprevalence and type of farming: domestic chickens had a higher seroprevalence than free-range and commercial chickens.The high seropositivity in chicken could be explained by the widespread presence of T. gondii oocysts and/or cysts in their environment and diet.

Conclusion: Consumption of undercooked or uncooked poultry products may be a source of potential contamination for humans and carnivores, including cats.

Introduction: Cervical Pott's disease is a very rare localization of bone tuberculosis. Its association with cercico-thoracic cold abscesses is also exceptional.

Observation: A 36-year-old black African patient of Burkinabè origin, with a history of tuberculosis infection (his mother had pulmonary tuberculosis) and no other pathological history, presented with chronic inflammatory cervicalgia that had been developing for six months in a non-febrile context of altered general condition. Examination showed a left latero-cervical swelling associated with a left basithoracic swelling, both fluctuant. Pleuropulmonary and neurological examinations were normal. HIV serology and tuberculin skin test were negative. Cervico-thoracic computed tomography revealed multiple abscesses. The abscesses were incised and drained. Analysis of the specimen showed the presence of acid-fast bacilli by direct examination and Mycobacterium tuberculosis by Xpert test, with sensitivity to rifampicine. The diagnosis was multiple tuberculous cold abscesses associated with cervical Pott's sore. The patient was started on standard analgesics and antituberculosis drugs for 12 months. The course was favorable, with a follow-up of one year after treatment.

Conclusion: Cold cervical abscess complicating Pott's disease is exceptional. Imaging and the geneXpert assay are now rapid and effective diagnostic tools for tuberculosis. This particular form should always be suspected in endemic areas.

Introduction: Introduction. Still's Disease (SD) is a rare systemic inflammatory disorder that is most common in children. In the adult form, it can be primary or the resurgence of an infantile form. We report 10 observations of Still's disease in the Gabonese population, with the aim of confirming its existence in this country an studying its specific features.

Material and methods: This was a retrospective, descriptive and analytical study carried out in the Internal Medicine Department of the CHU of Libreville from 1.12.2003 to 31.12.2021, using the records of patients hospitalized in this department and/or followed up on an outpatient basis. The selected patients fulfilled the Yamaguchi and Fautrel criteria. Epidemiologic, socioeconomic, clinical, biological, morphologic, immunologic, therapeutic, evolutionary and seasonal data were detailed.

Results: Ten patients (4 men and 6 women), mostly students with a mean age of 22 years, were included. The time to diagnosis of SD was 31.3 months, with fever in 100% of cases, joint and skin involvement in 80%, and ENT involvement in 70%. An inflammatory syndrome, predominantly neutrophilic hyperleukocytosis, hepatic signs, and hyperferritinemia coexisted with an immunologic work-up that was always negative. Corticosteroid therapy (n=10) combined with per os methotrexate from the beginning (n=1) or in cases of corticoresistance (n=4) was the rule. One patient died and one was lost to follow-up.

Discussion and conclusion: The clinical and biological presentation of SD is comparable to that of the Caucasian population. However, our study confirms in the low incidence of liver, lymph node and heart damage, which needs to be confirmed by other studies in a larger cohort. The high cost of this disease, which is a diagnosis of exclusion, may partly explain the difficulties in diagnosing SD.

Introduction and objectives: Spondylodiscitis is a serious and suggestive complication of brucellosis. Few studies have been devoted to it in Algeria, although the infection remains a public health problem. The aim of this study was to report the epidemiological and clinical aspects of brucellosis spondylodiscitis and to identify the neurological complications.

Material and methods: This is a descriptive analysis of a cohort of adult patients with Brucella spondylodiscitis, based on data collected from patient records recruited between January 2016 and December 2022.

Results: Thirteen females and 24 males with a mean age of 48 ± 15 years [21 to 71 years] were included in the study. Diagnosis was made on average 120 days ± 100 [30-360] after the onset of clinical symptoms. Commonly reported symptoms were: back pain (100%), fever (46%), sweating (70%), asthenia (84%), chills (22%), and weight loss (27%). Neurological complications were numerous and sometimes varied in the same patient: one case of paraplegia, three cases of paraparesis, six cases of sensory disturbances, and one case of sphincter disorders. Involvement of the lumbar spine was predominant, observed in 22 patients, including 15 at the L4-L5 level.In addition to discovertebral lesions, imaging revealed 27 cases of epiduritis, 13 cases of spinal cord compression, 25 cases of radicular compression, and pre- or para-vertebral and psoas abscesses.Two treatment regimens were used: doxycycline-cotrimoxazole-gentamycin (22 cases) and doxycycline-rifampicin-gentamycin (15 cases). At the end of the one-year post-therapeutic follow-up, we observed one relapse, sequelae of paraparesis, and sequelae of spinal pain in 12 patients.

Discussion and conclusion: This study has allowed us to observe prognostic elements. Early spinal imaging is essential to combat the excessive delay in diagnosis in our patients. There is no clear consensus in the scientific literature regarding neurological complications, such as epiduritis, and optimal treatment. The results of our study may contribute to the development of more personalized management algorithms.