Etiologies des fièvres prolongées inexpliquées au Service de Médecine Interne du CHU de Bouaké (Côte d'Ivoire) / Causes of unexplained prolonged fever in the Bouake CHU Internal Medicine Department (Ivory Coast)

Objectif : déterminer les étiologies des fièvres prolongées inexpliquées au service de médecine interne du CHU de Bouaké. Matériel et méthodes : Il s'agissait d'une étude rétrospective à visée descriptive mené de janvier 2019 à décembre 2020. Nous avons inclus les patients hospitalisés pour fièvre prolongée inexpliquée ou ayant présentés une fièvre prolongée durant l'hospitalisation. Les données anamnestiques, cliniques et paracliniques ont été analysées. Résultats : Nous avons retenus 204 patients sur 1650 patients hospitalisés (12,6%). L'âge moyen des patients était de 32±16,1 ans avec des extrêmes de 16 et 87 ans. Le sexe ratio était de 1,1. La fièvre (32,4%) et AEG (22%) constituaient les motifs d'hospitalisation les plus fréquents. La fièvre était le plus fréquent des symptômes physiques (94,1%) suivi de l'amaigrissement (50%), de la déshydratation (18,1%), de l'hépatomégalie (12,7%) et de l'obnubilation (12%). Les principales étiologies étaient les infections (82,3%), les tumeurs (10,3%), et les maladies inflammatoires (1,5%). Dans 5,9% des cas l'étiologie n'avait pas été retrouvée. Les principales infections étaient le VIH et ses complications (38,1%), la tuberculose (21,4%), et les infections urogénitales (19,9%). Les tumeurs étaient dominées par le cancer primitif du foie (33,4%) et le cancer de la prostate (19,4%). La polyarthrite rhumatoïde, le lupus érythémateux disséminé et la sclérodermie étaient maladies inflammatoires retrouvées. La létalité était de 36%. Conclusion : Les étiologies des fièvres prolongées inexpliquées sont variées. Elles sont dominées dans notre contexte par la tuberculose, l'infection à VIH et ses complications infectieuses.

Profil épidémiologique des patients consultants et des cas positifs Covid-19 de l'unité de triage EHU Oran (mars 2020 - août 2020) / Epidemiological profile of consulting patients and Covid-19 positive cases in the triage unit - EHU Oran (March 2020 - August 2020)

Introduction. En décembre 2019, la population de Wuhan, une grande ville chinoise de 11 millions d'habitants, est atteinte par une pneumonie virale extrêmement contagieuse due au coronavirus SARSCoV-2. En Algérie, le premier cas a été identifié le 25 février 2020, un plan de riposte national élaboré par le ministère de la santé a été mis en place pour affronter l'épidémie. Dès le début de la pandémie, l'établissement hospitalier et universitaire d'Oran (EHUO), centre de soins de première ligne, d'une capacité 780 lits desservant environ 2 millions d'habitants s'est complètement réorganisé, en aménageant principalement des circuits pour le tri des patients « suspects Covid 19 ¼. L'objectif de notre travail consiste à décrire le profil épidémiologique des patients consultants et des cas incidents Covid-19 au niveau de l'unité de triage EHUO depuis le début de l'épidémie au 07 Aout 2020. Méthodes. Les données sont collectées à partir des enquêtes épidémiologiques auprès des patients consultant au niveau de l'unité de triage Covid-19 de l'EHUO. Résultats. À la date du 7 aout 2020, un total de 7110 cas suspects de Covid-19 ont été enregistrés. Du total des cas suspects, 3036 (42,7 %) étaient positifs par RT-PCR. Il s'agissait de 1421 de sexe masculin (46,8 %) et de 1615 de sexe féminin (53,2 %), soit une sex-ratio de 0,88. La répartition globale des cas Covid19 par tranches d'âge était la suivante : 21,9 % des patients avaient un âge entre 30 et 39 ans, 17,3 % entre 40 et 49 ans. Le tableau clinique était dominé par la toux (26,5%), suivi de céphalées (19 %), de fièvre (16,2 %) et d'anosmie (15,9 %). 234 patients (7,7 %) avaient une SpO2 < 95 %. Conclusion. L'épidémiologie de l'infection Covid 19 reste encore peu connue à l'heure actuelle dans notre wilaya. Un dépistage de masse permettrait d'avoir une vision plus claire sur le nombre réel de patients atteints. La Covid 19 est une infection avec un large panel de symptômes autres que respiratoires, souvent non spécifiques, faisant d'elle une pathologie difficile à diagnostiquer cliniquement, d'où la nécessité de la confirmation biologique (PCR).

Atypical Kawasaki syndrome in COVID-19 infection: a case report of a multisystem inflammatory syndrome in a child (MIS-C)

The emergence of COVID-19 by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) in 2019 has seen evolving data reporting infrequent infection in children and mostly mild disease for children who contract the infection. A severe form of COVID-19 in children recently reported in Europe and North America describes a multisystem inflammation syndrome in children (MIS-C), presenting as toxic-shock-like and Kawasaki-like syndromes. Data on MIS-C in Africa is being documented with recent reports from South Africa and Nigeria in black children, but information on MIS-C in Ghana is yet to be characterized. We report the first case of multisystem inflammatory syndrome in a child who tested PCR positive to SARS-CoV2 in a tertiary hospital in Ghana. The case describes a 10- year-old boy who reported Kawasaki-like syndrome without shock but with moderate respiratory distress requiring supportive acute care without the need for intensive care.

Breastfeeding and common childhood diseases in Zambia: does breastfeeding have a protective effect against diarrhea, fever and acute respiratory infections among children in Zambia?

Background: This paper aimed at answering two specific questions: does breastfeeding reduce the occurrence of ARIs, Fever and Diarrhea in children who are breastfeeding; and is the occurrence of these common childhood diseases affected by duration (period) of breastfeeding? Data source and Method: Secondary analysis of the 2013 Zambia Demographic and Health Survey (ZDHS) was applied by using the children recode dataset (ZMKR61FL). Analysis was done at three levels: Descriptive, bivariate and multivariate (Binary and Multinomial Logistics regressions). Results: Results in this paper show that breastfeeding does not protect children against Diarrhea (OR 1.3; 1.1-1.4) but does so against Fever and ARIs (OR 0.9; 0.8-1.0). Children whose mothers were employed were more likely to suffer from all the three disease outcomes compared to those not employed (OR Diarrhea 1.2; Fever 1.5; ARIs 1.2). Conclusion: Diarrhea seems to be more pronounced in children who are breastfeeding than those not breastfeeding, especially those breastfed beyond 6 months

The sore throat: a clinical approach to tonsillopharyngitis

Acute sore throat is a common complaint encountered by medical practitioners and health care workers routinely. The disease is mostly caused by viral infections of the upper respiratory tract and is usually self limiting. Symptoms rarely exceed two weeks, irrespective of the cause. Group A beta-haemolytic streptococci accounts for the majority of bacterial instances of tonsillopharyngitis. Clinical examination is not always adequate to diagnose bacterial infections, resulting in the irrational and over-prescribing of antibiotics, especially in upper respiratory tract infections, contributing to communal antimicrobial bacterial resistance. A few scoring systems are available to assist physicians in deciding on the aetiology without resorting to unnecessary laboratory investigations. This article briefly reviews the scoring systems and antimicrobial management of streptococcal throat infections

Place of malaria in the etiologies of febrile attacks in children in a conflict area zone: Case of department of pediatric regional hospital of Timbuktu

Introduction: Malaria, a public health problem in tropical countries, depends on several factors, some of which are social and environmental. In Mali in the Sahel zone, a socio-security crisis has prevailed in recent years. It was therefore interesting to study the epidemiology of this condition in situation. Objective: To determine the frequency of malaria among febrile syndromes in children aged 1 to 59 months in the pediatric ward of the Regional Hospital of Timbuktu. Material and methods: the study was longitudinal retrospective descriptive for a period from January 1 to December 31, 2015. The data were collected with fact sheets and consultation records. They were captured and analyzed on the Statistical Package for Social Scientist (SPSS) software version 21. Results: a total of 789 children hospitalized, 276 children had a febrile syndrome (35%). During the study period, we collected 180 cases of malaria, with a positive biological examination. The hospital frequency of malaria was 22.8% (180/789) and a frequency in febrile syndromes of 65.2% (180/276) of malaria cases. Of these 180 cases, 147 cases of uncomplicated malaria (81.7%) and 33 cases of severe malaria (18.3%) were found. In 34.8%, the etiology of febrile syndromes was other than malaria. Seasonal variation in malaria was found in terms of months of the year, peaking in September. The hospital lethality was 1.1% in our series. Conclusion: Malaria was the leading febrile syndromes among children under 5 in hospitals in Tombouctou

Place du paludisme en saison de haute transmission dans les urgences fébriles au Centre Hospitalier Universitaire Gabriel Touré de Bamako

Le but de cette étude est d'évaluer la fréquence du paludisme parmi les causes de fièvres chez les patients admis au Service d'Accueil des Urgences (SAU) du CHU ­Gabriel Touré de Bamako. Il s'agissait d'une étude transversale allant du 1er août au 30 novembre 2015. Tous les patients admis au Service d'Accueil des Urgences étaient inclus dans notre étude. La goutte épaisse ou le Test de Diagnostic rapide étaient utilisés pour la confirmation biologique des cas de paludisme. Nous avions enregistré 6 641 patients parmi lesquels 5,07 % étaient fébriles. L'âge moyen des patients était de 21 ans avec une prédominance de la tranche d'âge de 18-40 ans soit 52 %. Le sex-ratio était de 1,5 en faveur des hommes. Les élèves-étudiants représentaient 34,85 % des cas suivis des ménagères avec 20,71 %. Le diagnostic clinique réalisé par des médecins avait donné un taux de 74,5 % de paludisme contre 58,8 % selon la GE/TDr. L'incidence du paludisme comme cause de la fièvre était de 58,8 %. Tous les cas de paludisme simple ont été traités avec les CTA et les cas graves avec des formes injectables de l'artesunate dans 68,38 %, l'artemether dans 17,65 % et la quinine dans 13,17 %. Le paludisme est fréquent parmi les urgences fébriles au SAU du CHU-GT. Les dispositions doivent être renforcées pour une confirmation biologique systématique de tous les cas suspects de paludisme pour éviter les erreurs diagnostics

Intravenous paracetamol ­ waste not, want not: a retrospective audit on the appropriate use of intravenous paracetamol at Universitas Academic Hospital Complex­Bloemfontein

Background: Paracetamol can be given both orally and intravenously (IV) with similar clinical efficacy, but the IV formulation is 360 times more expensive. IV paracetamol is therefore only recommended when the oral route is not available. This study investigated whether IV paracetamol was being used appropriately and whether there had been a change in prescribing patterns between 2008 and 2015 after the introduction and update of a prescribing protocol at an academic hospital complex in Bloemfontein, South Africa. Methods: A retrospective comparative audit of patient files was undertaken. The prescribing and administration habits of IV paracetamol were compared for two consecutive months, seven years apart, including 88 and 83 patients, respectively, who had received IV paracetamol. Results: IV paracetamol was administered appropriately in 37.5% of patients in 2008 and in 43.4% of patients in 2015 (p = 0.43). There was an improvement in the duration that IV paracetamol was prescribed for, which decreased from a median two days in 2008 to one day (p < 0.01) in 2015. In total, 55 (32.4%) patients had a concomitant oral and IV paracetamol prescription, of which 37 (21.6%) patients also received concomitant paracetamol administration. Twenty patients exceeded the 24-hour maximum dose. Seventeen patients weighed less than 40 kg; six of these patients (three paediatric and three adult) did not receive the correct weight adjusted dose of paracetamol, 15 mg/kg, resulting in excessive doses of paracetamol being administered (21­ 32.3 mg/kg). Conclusions: Patients are receiving IV paracetamol when the oral route is available; this is an unnecessary waste of money. Excessive doses of paracetamol were administered due to concomitant oral and IV paracetamol prescription and administration, and a failure to calculate dose of paracetamol according to body weight in low body weight patients. Further remedial interventions are therefore required

Clinical management of children with fever: a cross-sectional study of quality of care in rural Zambia

Objective:To evaluate current practices and standards of evaluation and treatment of childhood febrile illness in Southern Province, Zambia.Methods:From November to December 2013, we conducted a cross-sectional survey of facilities and health workers and we observed the health workers' interactions with febrile children and their caregivers. The facility survey recorded level of staffing, health services provided by the facility, availability and adequacy of medical equipment, availability of basic drugs and supplies and availability of treatment charts and guidelines. The health worker survey assessed respondents' training, length of service, access to national guidelines and job aids for managing illnesses, and their practice and knowledge on management of neonatal and child illnesses. We also conducted exit interviews with caregivers to collect information on demographic characteristics, chief complaints, counselling and drug dispensing practices.Findings:This study included 24 health facilities, 53 health workers and 161 children presenting with fever. Facilities were insufficiently staffed, stocked and equipped to adequately manage childhood fever. Children most commonly presented with upper respiratory tract infections (46%; 69), diarrhoea (31%; 27) and malaria (10%; 16). Health workers insufficiently evaluated children for danger signs, and less than half (47%; 9/19) of children with pneumonia received appropriate antibiotic treatment. Only 57% (92/161) were tested for malaria using either rapid diagnostic tests or microscopy.Conclusion:Various health system challenges resulted in a substantial proportion of children receiving insufficient management and treatment of febrile illness. Interventions are needed including strengthening the availability of commodities and improving diagnosis and treatment of febrile illness

Leptospirose, une étiologie de fièvre prolongée peu diagnostiquée. A propos d'une observation

Les conditions bio-climatiques prédisposent à la transmission de la leptospirose au Gabon. Paradoxalement, cette affection est rarement voire peu diagnostiquée par les praticiens de ce pays. Nous rapportons une observation de leptospirose révélée par une fièvre au long cours

Factors Associated with Bacteraemia in Febrile; Non-Neonatal Children 5 Years Old at the Paediatric Outpatient Clinic of the University of Port Harcourt Teaching Hospital; Nigeria

Background. Fever is one of the most common presenting symptoms in the emergency room. Bacteraemia can be a cause of febrile illness in children and can have a fatal outcome if untreated. Therefore; it is important to identify factors associated with bacteraemia in febrile children in order to aid its early diagnosis and prompt treatment. Objectives. To determine the factors associated with bacteraemia among febrile; non-neonatal; under-five children seen in the Children's Clinic of the University of Port Harcourt Teaching Hospital; Nigeria. Methods. Febrile children aged 29 days - 59 months who presented at the outpatient clinic and whose parents gave consent were recruited between September 2010 and January 2011. Information on their age; gender; weight; symptoms; physical examination and blood culture results was collected and analysed.Results. A total of 362 children were studied. The prevalence rate of bacteraemia was 11.5% and 22.2% in moderately and severely malnourished children; respectively (p=0.010). Children with systemic inflammatory response syndrome (SIRS) had the highest bacteraemia prevalence rate (66.7%; p0.001); while children with focal infection and children with fever without other symptoms or signs had bacteraemia rates of 7.1% and 3.7%; respectively. There was no significant relationship between the magnitude of fever and bacteraemia (p0.050).Conclusion. Blood cultures should be performed in febrile children who are malnourished or who have SIRS. Antibiotics should also be commenced while blood culture results are awaited

Knowledge of Caregivers of Febrile Children about Fever; Paracetamol Use and Paracetamol Induced Hepatic Toxicity in Lagos Nigeria

Background: Fever is as a result of immune response to many pathogens. Paracetamol is widely and irrationally used at home for treatment of fever in children before presentation at the health facility but it is not clear whether caregivers are aware of the toxicity that can result from non-rational use of paracetamol.Objectives: The aim of this study was to evaluate the knowledge of fever; the use of paracetamol; and paracetamol induced hepatic toxicity amongst caregivers of febrile children. Methods: This was a prospective descriptive study in which we interviewed two hundred and ten caregivers who brought febrile children to Onwusikawa Children's Medical Center Okota Lagos over a period of one year (Jan 2013- Dec 2013). A pretested closed ended questionnaire was used to collect data on the use of paracetamol; knowledge about fever; and toxicity of paracetamol during routine clerking.Result: Paracetamol in both syrup and tablet formulations was administered by the study population to febrile children before presentation in hospital . Majority of the respondents (61%) knew fever as an increase in body temperature. About 8% of those interviewed gave paracetamol to their children including neonates almost on a daily basis to prevent fever or because they felt the baby especially the head was hot. Ninety five percent of all respondents were not aware that paracetamol could cause adverse effects while 98% did not know that paracetamol could cause hepatic toxicity. Conclusion: The knowledge regarding toxicity of paracetamol was poor. It is proposed that education of caregivers by health workers on dangers of paracetamol misuse should be routine. Pharmaceutical companies that manufacture paracetamol for children must provide a risk management plan

Socioeconomic Correlates and the Choice of Treatment for Childhood Fever in Ghana

The study investigated the effect of household socioeconomic factors on the choice of treatment for childhood fever among children under age five in Ghana. Data from the 2008 Ghana Demographic and Health survey was used employing the multinomial probit model. Three treatment choices were considered: Government facility; Private facility and traditional/self-medication. The results suggest that the treatment of childhood fever is related to household wealth; health insurance status and residence. Government health facilities are mostly used by household's with higher wealth and household's with health insurance. Rural households are more likely to use traditional/self-medication; except those with health insurance who use government facilities. The age of the mother and birth order of the child were also found to influence the choice of treatment facility for childhood fever

Recent Change of locality as Risk Factor for Malaria Fever among New Residents of Ahoada East Local Government Area in Southern Nigeria

Relocation which is a well-known determinant of malaria in non-immune travelers to malarious areas; has also been found to be a risk factor for malaria among semi-immune persons who change locality within endemic regions. Further research evidence suggests that the higher transmission intensity at the travel location is an underlying factor which may indicate exposure to new variants of P falciparum for which specific immunity is lacking. This study was conducted to determine if recent change of locality increased the risk of malaria fever among semi-immune National Youth Service Corps members serving in a district in southern Nigeria.Method: Ninety six corps members who had just been posted to Ahoada-East LGA in southern Nigeria and 83 others that had been in service for six months; were followed up for malaria fever in a prospective cohort design over a 3 month period from September 2010 to December 2010. Active surveillance was used to obtain reports of fever among the cohort; followed by medical examination at designated local health facilities.Results: No significant differences in age and use of protection against malaria were found between the study groups. The incidence proportion of malaria for the recently relocated group (34) was significantly higher than that of the resident group (15.7). Recent change of locality was more associated with malaria fever (RR 2.19; 95 CI 1.243.88; AR 54.4).Conclusion: The recent change of locality within an endemic region; which serves as an indicator of exposure to new variants of P falciparum; for which specific immunity is lacking; is a significant risk factor for malaria fever. Protection against malaria is recommended for semi-immune individuals moving to new locations with significant risk of malaria transmission

L'association paracetamol+ibuprofene est-elle preferable au paracetamol seul ou a l'ibuprofene seul pour le traitement de la fievre chez les enfants?

Il apparait de plus en plus sur le marche burkinabe des medicaments; des associations de substances d'indication similaire; et dont l'interet therapeutique reste a demontrer. Ces associations contribuent-elles a un usage rationnel des medicaments? Faut-il continuer a homologuer ces associations ? Nous presentons ici les resultats d'une etude sur l'association paracetamol+ibuprofene dans la fievre chez les enfants

Evaluation of the analgesic activity of the methanolic stem bark extract of dialium guineense (wild)

Background: Dialium guineense is a medicinal plant used by some communities of Enugu-Ezike in Enugu State; Nigeria for treatment of fever; headache and other diverse ailments. Objectives: The present study evaluated the analgesic activity of the methanolic stem bark extract of the plant. Method: Acetic acid-induced abdominal constriction or writhing; tail immersion and hot plate analgesic models in albino Wistar mice were used for the study. Three test doses (250; 500; 1000 mg/kg body weight) of the extract were administered orally by gastric gavage. The activity was compared with a standard reference drug; acetylsalicylic acid (aspirin) (400 mg/kg) and negative control. The results were analysed by SPSS version 17 using ANOVA and Post Hoc Duncan. Result: In the acetic acid-induced writhing reflex model; D. guineense extract and the reference drug significantly (P =0.014 - 0.002) decreased the mean total number of abdominal constriction in the mice in a dose dependent fashion. The percentage inhibition of the abdominal constriction reflex was increased dose dependently from 0in the negative control group to 71at the highest dose of the extract (1000mg/kg). In the tail immersion model the extract at the dose of 1000 mg/kg significantly (P = 0. 048) increased the pain reaction time (PRT) while in hot plate model the extract and drug also significantly (P = 0.048 - 0.05) increased the mean PRT at the doses of 500 and 1000 mg/kg. The dose of 250 mg/kg showed no analgesic activity in tail immersion and hot plate models. Conclusion: Dialium guineense demonstrated significant analgesic activity that may be mediated through peripheral pain mechanism

The Antibiotic Susceptibility of Bacteria Isolated from Blood Cultures during Episodes of Neutropenic Fever in Patients with Acute Myeloid Leukaemia

Neutropenic fever (NF) is a common and life-threatening complication of high-dose chemotherapy in patients with acute myeloid leukaemia (AML). Induction chemotherapy may result in complete remission in approximately 50-70of AML patients but is associated with an increased risk of infection due to immune suppression by the disease itself or as a result of treatment. Chemotherapy causes neutropenia as well as defective chemotaxis and phagocytosis. Chemotherapy-induced mucositis often occurs throughout the gastrointestinal tract; facilitating spread of endogenous flora to the blood circulation; leading to NF. The aim of this study was to determine the spectrum of bacteraemic microorganisms isolated during episodes of NF (NFEs) in AML patients in the Haematology Unit of the Universitas Academic Complex (UAC); as well as antibiotic susceptibility profiles of these organisms. Duration of NF; the time-span between chemotherapy and onset of NF; and the efficacy of antibiotics administered to patients; were also investigated

Clinical Complications of Chikungunya Fever in Mauritius

Chikungunya fever; an emerging mosquito-borne viral disease; has affected Mauritius with two recent outbreaks in 2005 and 2006 respectively. A study was carried out in 2007 to describe the clinical complications post-Chikungunya infection. Ethical clearance was obtained for this study. Data collection was carried out in February and March 2007 on a sample of people who had suffered from Chikungunya fever by means of a comprehensive questionnaire. Participants comprised 77 people; there were 41 males and 36 females. Participants ranged from 6 to 69 years. 70 participants experienced persisting joint pains for at least 6 months following the acute phase. Of these; 35 had residual joint complaints after 6 months. 44 participants suffered from psychological sequelae. 10 participants had dermatological sequelae; 6 had iatrogenic complications due to non-steroidal anti-inflammatory drug (NSAID)-induced gastritis; and 3 participants with serologically confirmed Chikungunya fever had neurological manifestations and changes on CT/MRI which could correspond to demyelination. Statistical analysis demonstrated that there was a weak linear relationship between the number of complications and increasing age; there was a significant difference in the number of complications according to gender; females being more affected than males; participants with co-morbidities had more complications and psychological sequelae than previously healthy participants. This study highlights that Chikungunya fever; which causes a significant impact on health in the acute phase; can have significant sequelae months afterwards and this includes psychological sequelae