Medecine tropicale et sante internationale最新文献

Tropical medicine, initially associated with colonial medicine and exotic pathology, focused on infectious diseases of warm regions and on environmental and socioeconomic imbalances. Global upheavals such as globalization, urbanization and climate change have broadened the scope of diseases, with the emergence of tropical pathologies in temperate regions and an increase in non-communicable diseases (traumatic, metabolic, psychiatric, etc.) in southern countries.Médecine Tropicale et Santé Internationale (MTSI) accompanies this paradigm shift by integrating noncommunicable diseases and contextualizing the local conditions in which pathologies occur, are diagnosed and treated. It favors analyses based on local specificities, including cultural, socioeconomic and environmental aspects, as well as health system constraints.MTSI therefore insists on contextualization in submitted articles, especially for original studies and clinical cases, emphasizing the impact of local conditions, diagnostic and therapeutic barriers, and the consideration of traditional medicines. It invites authors to demonstrate the relevance and novelty of their observations, while respecting the formal recommendations for publication.

Objectives: The aim of this study was to identify chikungunya vectors and study their bioecology in order to contribute to the response to the 2020 epidemic in the cities of Abéché and Biltine in eastern Chad.

Materials and methods: Immature stages of Aedes mosquitoes were collected and epidemic risk indices (Container index, House index and Breteau index) were calculated and compared using the Chi-square test. The collected larvae and nymphs were reared, and the resulting adults were morphologically identified using a dichotomous key. Residual endophilic fauna was sampled by morning insecticide spraying in chambers. Only female mosquitoes were collected.

Results: A total of 2,039 mosquito specimens belonging to three genera were collected: 470 (23%) were identified as Aedes aegypti, 731 Anopheles spp (36%), and 838 Culex spp (41%). Flowerpots were the most common breeding sites (69%), followed by jars/water barrels (17%) and abandoned tires or containers (14%). The risk indices were all well above the epidemic thresholds defined by the WHO. Between the two cities, only the house index showed a significant difference (p=0.004): it was higher in Abéché than in Biltine.

Conclusion: The study identified A. aegypti as a likely vector of chikungunya in both cities. It is important to understand its biting and resting behavior, as well as its sensitivity to different classes of insecticides, in order to organize effective vector control.

Primary liver cancers are tumors that develop from different liver cells. Hepatocellular carcinoma (HCC), which develops from hepatocytes, accounts for approximately 75-85% of primary liver cancers.HCC is the 6^th leading cause of cancer worldwide and the 3^rd leading cause of cancer-related death. Its incidence is low in northern Europe, but high in sub-Saharan Africa and the Far East, where both hepatotropic viruses and exposure to mycotoxins are. It complicates cirrhosis in over 90% of cases and is predominantly male.The prevalence of HCC is increasing due to improved diagnostic techniques and criteria, but also to the persistence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in adults. A worldwide increase in the incidence of steatopathy makes it the leading cause of liver disease worldwide, associated with alcohol abuse and/or steatohepatitis associated with metabolic dysfunction (MASH), including type 2 diabetes.Chronic hepatotropic viral infections, cirrhosis and chemical carcinogens combine to produce an annual incidence of 2-5% of hepatocellular carcinoma arising from cirrhosis. This justifies biannual surveillance of known cirrhosis, without which late diagnosis limits therapeutic options.Major advances have been made in curative treatment (liver transplantation, surgery, radiodestruction) and palliative treatment (chemo- or radioembolization, sorafenib chemotherapy or immunotherapy), depending on how early HCC is diagnosed (size, number of hepatic or extrahepatic lesions) and the severity of underlying liver disease and associated comorbidities.

Objectives: The aim of this study was to determine the prevalence of respiratory symptoms, their determinants, and the state of respiratory function in millers exposed to cassava, maize, and soybean dust in Lubumbashi, Democratic Republic of Congo (DRC), compared with a group of unexposed workers.

Methods: A descriptive and analytical cross-sectional study was conducted in 2015 on 288 millers and 118 agents (n = 406) from a security agency (control group) in Lubumbashi, DRC. Participants were examined at their place of work. Respiratory health information was collected using a standardized questionnaire. Spirometry was performed on each participant.

Results: Mean age was 27.6 ± 9 years in millers and 28.5 ± 7 years in controls. Daily working hours were 12.1±1.7 hours for millers and 14.4±6.2 hours for controls. No significant differences were found when comparing the two groups. However, the prevalence of respiratory symptoms was higher in the millers than in the controls, especially wheezing (1.9 times higher), dyspnea (2.1 times higher), breathlessness at rest (6 times higher), breathlessness on exertion (6.4 times higher), chronic bronchitis (6.2 times higher), cough (5.3 times higher) and morning sputum (5.1 times higher). Thus, an association was found between the milling occupation and all respiratory symptoms. Spirometric data showed that forced expiratory volume in one second (FEV1), peak expiratory flow (PEF) (p<0.05) and Tiffeneau ratio (FEV1/FVC) (p<0.001) were significantly reduced in millers compared to controls.

Conclusions: This study showed a high prevalence of respiratory symptoms with impaired lung function among millers in Lubumbashi, suggesting the need for preventive measures to reduce exposure in mills.

Introduction: Snakebite envenomations are a real public health problem in rural areas of sub-Saharan Africa, especially as the cost of management is often beyond the reach of the victims. The aim of our study was to evaluate the costs of treating snakebite envenomations at the Saint Jean de Dieu hospital in Tanguiéta, northern Benin, in a savannah area.

Methods: This was a descriptive cross-sectional study conducted over a three-month period from May 25 to August 25, 2023. Snakebite patients were followed from admission to hospital discharge. All care-related expenses incurred by patients and/or their families were accounted for on a daily basis.

Results: Fifty-seven patients were included. The median age (interquartile range) of the patients was 27 years (16-40), and the sex ratio was 1.6 (35 males and 22 females). In 81% of cases, the bites were associated with agricultural activities. Approximately 72% of the patients had sought traditional care before coming to the hospital. The median time from bite to admission was 7 hours (2-52) and the median hospital stay was 4 days (2-5). The median cost of care was €168 (154-242). It varied according to the severity of the bite: €31 for a dry bite (26-47); €179 for external bleeding (154-286). The only antivenom used was Inoserp™ PAN-AFRICA (Inosan Biopharma). Its average cost was €128 and was the main expense.

Conclusion: The cost of treating snakebite is high and dominated by the cost of antivenom. These economic constraints reinforce the vicious circle of poverty in an already vulnerable population. It is therefore important to find a financing mechanism for this treatment in the most exposed areas.

Dengue fever is spreading rapidly around the world, affecting nearly half the world's population. Causes include urbanization, human mobility, climate change and the spread of mosquito vectors such as Aedes albopictus. In 2023 and 2024, there was a marked increase in cases and deaths worldwide. In mainland France, the increase in imported cases has generated local transmissions.Dengue fever is asymptomatic in over 50% of cases, but can progress to severe forms with potentially fatal complications in 1-5% of symptomatic cases. There are four serotypes of the virus, and re-infection with another serotype increases the risk of severe disease.Two dengue vaccines are currently available: Dengvaxia^® and Qdenga^® (TAK-003). Dengvaxia^® is reserved for people already infected with dengue fever, but production was discontinued in 2024 due to low demand. Qdenga^® is recommended for children aged 6-16 years in high transmission areas. The Société francophone de Médecine tropicale et Santé internationale (SFMTSI) proposes extending vaccination to at-risk adults in endemic overseas territories and to travelers. A communication campaign is proposed to inform the public about the benefits of vaccination while anticipating the risks of anti-vaccination misinformation.

Introduction: Thyrotoxic hypokalemic periodic paralysis (THPP) is a sporadic form of hypokalemic periodic paralysis (HPP). It is a diagnostic and therapeutic emergency rarely described in the black population. We report a case in a black subject from Côte d'Ivoire.

Clinical case: Mr. NK, 37 years old, was admitted to hospital with rapidly progressive motor deficit in all four limbs. The patient had hyperthyroidism, which was treated with neomercazole. His medical history revealed an initial episode that resolved within 30 minutes, followed by a more severe recurrence 4 months later, associated with discontinuation of treatment. Clinical examination revealed flaccid tetraparesis mainly affecting the lower limbs. Biological tests showed hypokalemia of 2.6 mEq/L, ultrasensitive TSH was low (less than 0.005 µL/mL) with T3 and T4 elevations of 24.42 µL/mL and 79.68 µL/mL respectively. We have retained the diagnosis of THPP. The clinical course was satisfactory after correction of the kalemia and readjustment of the hyperthyroidism treatment.

Discussion: THPP is common in young Asians and rare in black Africans. The duration of paralysis varies from 1 to 72 hours, with an average of almost 24 hours. Respiratory paralysis, which is potentially serious, is rare. However, discontinuation of treatment in patients already on the drug may predispose to paralysis.

Conclusion: The favorable evolution of paralysis after correction of kalemia was confirmed. Our observation highlights the importance of maintaining good thyroid function in patients monitored for hyperthyroidism.

Background: HIV/AIDS infection is endemic in sub-Saharan Africa. It is manifested by a variety of opportunistic diseases that usually occur when the CD4 count is below 200/mm³, but also during the immune restoration syndrome (IRS) that occurs under highly active antiretroviral therapy (HAART). Autoimmune and inflammatory diseases are rarely associated with this condition. We report nine Gabonese cases of systemic lupus associated with HIV.

Material and methods: This was a retrospective, descriptive and analytical study conducted from 1 June 2016 to 30 April 2024 at the Department of Internal Medicine of the CHU of Libreville. All patients with this association were identified to specify the different characteristics.

Results: Nine female patients with an average age of 36 years were identified. Systemic lupus was associated with the diagnosis of HIV1 disease (n = 1) or occurred after the initiation of antiretroviral treatment (n = 6) or a new line of antiretroviral treatment (n = 2), with a mean CD4 count at diagnosis of 284.5/mm³, rising to 578.3/mm³.

Discussion and conclusion: There is a structural similarity at the origin of autoantibody production in HIV1 and systemic lupus, with clinical, biological and immunological signs that are sometimes superimposed, which may make the diagnosis of this association difficult.

Case report: We present the successful management of the consequences of voluntary knife ingestion in a 24-year-old male with undocumented psychiatric disorders. The patient was admitted to the emergency department with a fistulized epigastric skin abscess, with the tip of a knife protruding from it. This extraordinary case involved the migration of an ingested knife, which perforated the stomach and externalized through an epigastric abscess. Surgical removal of the foreign body was performed.

Discussion: Several hypotheses explain the ingestion of the knife in a person with psychiatric disorders, including self-mutilation, the pernicious mystical influence of malevolent third parties, or self-administration of a neomystical ritual.

Conclusion: The development of a skin abscess secondary to foreign body ingestion is rare but should be considered in the absence of other causes.

Introduction: Acute flaccid paralysis (AFP) caused by acute anterior poliomyelitis (AAP) remains endemic in some Asian and African countries, particularly Niger. Performance indicators defined by the WHO are used to evaluate the AFP surveillance system in affected countries. The objective of this study is to assess its outcomes in Niger from 1998 to 2021. The objective of this study is to assess its outcomes in Niger from 1998 to 2021.

Methodology: This is a cross-sectional study based on all secondary data from AFP case surveillance reported to the Directorate of Surveillance and Epidemic Response in Niger, over a 24-year period from 1998 to 2021.

Results: The sample included 9,659 patients of all ages and sexes. The sex ratio was 1.23, and 92.01% of patients were under 5 years old. The Maradi region ranked first among Niger's eight regions in terms of reported cases (32.27%). It hosts a large portion of the population from neighboring Nigeria, a country also endemic for AFP. More than half of the patients (66.59%) had received 1 to 10 doses of oral polio vaccine. From 1998 to 2021, 8,419 stool samples from 9,494 cases (88.70%) were usable upon arrival at the laboratory. Confirmed and compatible poliovirus cases accounted for 0.80% and 2.35%, respectively. Of the 276 patients who presented with paralysis, 71.73% suffered from paralysis in both limbs, and in 94.35% of the cases, the paralysis had progressed within 3 days.

Conclusion: This study allowed for an analysis of the performance of the active AFP surveillance system. In Niger, this surveillance is acceptable according to performance indicators, but there is still much progress to be made at both the population level and within the healthcare workforce.