Features of malaria among patients HIV infected in a Department of Infectious Diseases in Bamako

Introduction. We studied malaria in HIV infected subjects hospitalized in the department of infectious diseases at Point G Teaching Hospital in Mali, with the objective to have current data on malaria in patients infected by HIV. Materials and methods. We conducted a prospective study from October, 1st 2016 to September 30th 2018 in patients seropositive for HIV having positive thick smear for Plasmodium and hospitalized in the department of infectious diseases at Point G Teaching Hospital. We collected sociodemographic, clinical and lab data form those patients. Data have been entered and analyzed using SPSS20.0 software. Results. Hospital frequency of malaria among People living with HIV was 24.4% (151/618). This population has a mean-age of 44.1±12.4 y/o and a sex ratio (M/F) of 0.86. Majority of patients were at WHO stage IV of HIV infection (63.4%). Symptoms were by decreasing frequency: fever (98.3%); headache (86.4%); anorexia (72.9%); asthenia (61.0%) and vomiting (42.4%). the mean parasitemia was 172.9±352.1 trophozoite/mm3 . Mean hemoglobin level was 9.1±3.2 g/dl and the mean CD4 count was 9±3 cell/mm3 . Severe malaria was independent from WHO HIV stage and from immunologic deficiency. The malaria treatment when correctly followed conduct to good improvement of the anemia (p = 0.03) and the negativity of the parasitemia (p = 0.00). Death in our HIV patient is linked to association with severe malaria (p = 0,012). Conclusion. Malaria is relatively common and severe among PLWHA in Mali. Prompt treatment is still effective and must be implemented to ensure a good prognosis. Despite cotrimoxazole chemoprophylaxis, a certain number of PLHIV suffer from malaria, raising the hypothesis of plasmodium resistance to antifolates.

Système National de Pharmacovigilance au Niger : a propos d'un cas de syndrome de Lyell associé au Cotrimoxazole

A partir de 2015, le programme national de lutte contre le paludisme (PNLP) du Niger a mis à grande échelle la chimioprévention du paludisme saisonnier (CPS) avec la sulfadoxine pyriméthamine plus amodiaquine(SPAQ). Le Ministère de la santé publique a saisie l'opportunité pour renforcer le système national des vigilances (SNV).Nous rapportons un cas de syndrome de Lyell dû au cotrimoxazole (Triméthoprime sulfaméthoxazole)dans son aspect clinique, pronostic et thérapeutique.Il s'agissait d'une patiente de soixante ans, soufrantd'une diarrhée et admise au centre de santé intégré (CSI) de Maijirgui au Niger. Elle a été traitée avec du cotrimoxazole. Quelques jours après, elle était léthargique et les yeux enfoncés. L'examen du système cutanéo-phanérien, laisse apparaitre un vaste décollement cutané faisant le tour du thorax, s'étendant à toutl'abdomen et prenant les deux membres thoraciques.Cette perte de l'épiderme laissait découvrir un derme rouge suintant à nu. Tout ceci réalisait un décollement épidermique en « linges mouillées » avec une atteinte de plus 70% de la surface corporelle. A l'examen des muqueuses, on note au niveau buccal des ulcérations muqueuses recouvertes de croutes. On notait également une érosion des paupières supérieures et une conjonctivite diffuse. Malgré son évacuation à l'hôpital national de Zinder, elle fut décédée à l'admission.Le syndrome de Lyell ou nécrolyse épidermique toxique est une dermatose bulleuse grave et rare, le plus souvent d'origine médicamenteuse. Toute distribution de masse de médicaments doit s'accompagner d'un renforcement du SNV pour rechercher, documenter et prendre en charge rapidement les évènements indésirables

Usefulness of rapid diagnostic test in the diagnosis of asymptomatic malaria in HIV infected children on cotrimoxazole prophylaxis in Benin City, Nigeria

Background: Rapid diagnostic test (mRDT) is a useful tool in demonstrating parasitologically proven malaria. Its efficacy is however hampered when parasite density is low. Prophylactic use of cotrimoxazoleas in cases of HIV infected children can cause reduction in parasite count. It is doubtful if mRDT will retain its diagnostic usefulness among such individuals.Objectives: The study sought to evaluate the diagnostic value of mRDT in HIV infected children on cotrimoxazole prophylaxis in Benin City.Methods: In the prospective, cross sectional and descriptive study, we assessed malaria parasitaemia using standard methods in microscopy and parasite density and malaria antigenaemia using Care Start Pf (monoclonal antibodies specific to histidine rich protein ­ 2 antigen) in 221 each of HIV infected subjects on cotrimoxazole managed in a specialist clinic and HIV negative controls all seen at the University of Benin Teaching Hospital between April and June 2016.Results: Malaria antigenaemia rate MAr (20.8%) was lower than malaria parasitaemia rate MPr (24.4%) in subjects. MAr (20.8) and MPr (24.4%) in subjects were higher than MAr (18.10%) and MPr (17.7%) in controls. Mean (SEM) parasite count in subjects of was low (50.88 + 2.24 per µl). Using microscopy as gold standard the sensitivity, specificity, PPV and NPV of mRDT in subjects were 77.8%, 97.6%, 91.3% and 93.1%. Corresponding values in controls were 100.0%, 99.5%, 97.5% and 100.0%. Youden indices for subjects and controls were 0.75 and 0.99. Conclusions/Recommendations: Sensitivity of mRDT in HIV infected children on cotrimoxazole prophylaxis for opportunistic infections (OI) is reduced. However, the indices of specificity, PPV and NPV are high enough to retain its value in the evaluation of HIV infected children for asymptomatic malaria and perhaps the clinical disease

Medicine use among HIV/AIDS Patients in public hospitals, Kwara State

Background: The prognosis of HIV/AIDS and HIV-related comorbidities has been revolutionized by the use of medicines. However, World Health Organization reported that 50% of patients do not use their medicines as prescribed.Objective: To assess HIV/AIDS patients' knowledge of the use of medicines dispensed to them.Method: This study was conducted in seven public hospitals in six local government areas, Kwara State. Exit interviews of 780 eligible HIV/AIDS patients were conducted through use of structured questionnaire. Additionally, there were exit observational checks of medicines dispensed to these patients. Descriptive statistics and Fisher Exact test were used for data analyses.Results: Of the 780 study participants, 36.1% had no formal education, 99.9% knew the 'quantity' of medicines to be administered, while 99.2% knew the frequency of administration. All the patients knew the route of administration, 96.7% and 94.3% knew the general precautions to avoid concomitant use of dispensed medicines with alcohol or herbal products respectively, while 93.7% of those who received co-trimoxazole knew of the precaution to use "plenty of water" as the vehicle for its administration. There were no significant associations between the patients' knowledge of these precautions and duration of antiretroviral therapy (P>0.05). However, the patients lacked knowledge of specific precautions of some dispensed medicines.Conclusion: Most of the patients knew of the administration and the general precautions of dispensed medicines. However, lack of knowledge of specific precautions of some dispensed medicines calls for intervention

Childhood respiratory morbidity and cooking practices among households in a predominantly rural area of Ghana

Background: Household air pollution is a leading risk factor for respiratory morbidity and mortality in developing countries where biomass fuel is mainly used for cooking. Materials and Method: A household cross-sectional survey was conducted in a predominantly rural area of Ghana in 2007 to determine the prevalence of respiratory symptoms and their associated risk factors. Household cooking practices were also assessed as part of the survey. Results: Household heads of twelve thousand; three hundred and thirty-three households were interviewed. Fifty-seven percent 7006/12333) of these households had at least one child less than five years of age. The prevalence of symptoms of acute lower respiratory infections (ALRI) was 13.7% (n= 957; 95% CI 12.8 - 15.5%). A majority (77.8%; 95% CI; 77.7 - 78.5%) of households used wood as their primary fuel. Majority of respondents who used wood as their primary fuel obtained them by gathering wood from their neighborhood (95.6%; 9177/9595) and used a 3-stone local stove for cooking (94.9%; 9101/9595). In a randomly selected subset of respondents; females were the persons who mostly gathered firewood from the fields (90.8%; 296/326) and did the cooking (94.8%; 384/406) for the household. Conclusion: Symptoms of ALRI reported by caregivers is high in the Kintampo area of Ghana where biomass fuel use is also high. There is the need to initiate interventions that use improved cook stoves and to test the health benefits of such interventions

Les toxidermies graves chez les sujets infectes par le VIH : A propos de 43 cas colliges au centre de dermatologie de Treichville

Introduction et objectif. L'avenement des antiretroviraux (ARV) a permis de reduire le taux de mortalite lie aux VIH/SIDA. Cependant; ces molecules utilisees seules ou associees au cotrimoxazole (CTX); sont responsables de nombreux effets secondaires dont les toxidermies. L'objectif de cette etude etait de demontrer la gravite de ces toxidermies en vue d'elaborer des mesures de preventions adequates. Patients et methode. Nous avions initie une etude transversale unicentrique sur une duree de trois ans (2006 a 2008) au centre de dermatologie du CHU de Treichville-Abidjan. Resultats. Durant cette periode 43 cas de toxidermies bulleuses avaient ete hospitalises; dont 16 cas de syndrome de Lyell (32;2); 21 cas de syndromes de Stevens Johnson (48;8) et 06 cas d'ectodermes pluriorificiel (19;0). Les principales molecules incriminees dans ces accidents cutanees graves etaient la nevirapine dans 33 cas (76;7); le CTX dans 08 cas (18) et l' efavirenz dans 02 cas (04;7). Ces accidents cutanes survenaient precocement en moyenne 13;8 jours. Discussion et conclusion. La prise en charge des sujets vivant avec le VIH sous ARV et/ou sous CTX doit se faire dans un cadre multidisciplinaire. Le prise en charge des cas de toxidermie liees a ces molecules; doit etre precoce; afin de reduire le caractere gravissime et le taux de mortalite du a ces accidents cutanes

Pre-hospital and prescription use of antibacterial drugs at a secondary health centre in Ibadan, Nigeria

The overall goal of this study is to reduce morbidity and mortality ascribable to bacterial infections by encouraging rational use of antibiotics. Antibiotics use prior to and prescriptions of antibiotics by the attending physicians were evaluated in a group of patients attending a secondary health facility. A quasi-exit interview was conducted using a structured questionnaire. The major presenting symptoms were sought from patients and/or parents and/or guardians; drug history was taken and doctors' prescriptions were copied onto an already prepared format. All data were entered into EPI-INFO version 6 for analyses. The mean age of patients who were enrolled was 14 ±±±± 16.96 [range: 0.08-78 years] but males patients were statistically younger than females: respectively 9.94 ±±±± 15.48 years (0.08-78 years) and 18.43 ±±±±17.10 years (range: 0.08 ­ 70 years); F: 122 P< 0.00. Pre-hospital use of antibiotics was documented in about a third of all the patients and cotrimoxazole was the most commonly used antibiotics accounting for 68.5% of antibiotics use in this group patients. Antibiotics were contained in more than half of all the prescriptions and erythromycin and cephalosporin were antibiotics of choice. This is contrary to the previous findings in the same area of study but different health facility. There is need for formulation of appropriate drug policy and establishment of continuing medical education for doctors as well as public enlightenment programmes on rational use of antibiotics