Vertebromedular histoplasmosis: About a case of transverse myelitis in a young and immunocompetent adult

Systemic mycosis raging endemic, histoplasmosis has an increasing incidence with the advent of HIV-AIDS. The authors report a case of vertebra-medullar histoplasmosis mimicking tuberculous spondylodiscitis in a patient without proven immunosuppression. This was a patient who spent 3 years in a highly endemic area. He presented with signs of transverse myelitis. MRI of the lumbar spine showed a para-vertebral tumor lesion that partially infiltrated the spinal cord. The positive diagnosis of histoplasmosis was made by histomorphology, and symptoms were reduced with administration of itraconazole. These findings show the need for a proper coding of the management of patients living or having stayed in histoplasmosis endemic areas, whether they are immunocompromised or not.

Influence of Socioeconomic Factors on the Nutritional Status of Pupils of 5 to 11 in Rural Areas in Cameroon: Case of the Nyambaka Municipality in the Adamawa Region

Malnutrition greatly increases the risk of infant mortality and vulnerability to various diseases later in the long run. It has been shown that children’s malnutrition is the result of low household income. Rural areas in Cameroon are mainly made up of poor families. This guided the present research to analyze some socioeconomic factors and their impact on the nutritional status of pupils. Using a simple random sampling technique, 300 pupils were recruited. About 66.33% of pupils were from poor families. Obesity was more prevalent in the category of rich pupils (09.52%) compared to poor (06.53%). The height and weight of pupils studied were lower than the reference (P < 0.001). This study carried out in a single council is proven to be limited for a better understanding of the epidemiology of malnutrition among students, and large-scale studies would be adequate to better prevent and control malnutrition in rural areas.

[First documented cases of systemic lupus erythematosus in Niger]

Objective: We describe in this first series of lupus documented in Niger, the epidemiological, diagnostic, therapeutic and prognostic aspects

Method: This is a prospective study in internal medicine at the National Hospital of Niamey during 10 years. ACR criteria were used as diagnostic criteria

Results: We identified only 9 cases with a frequency of 0.05% [7 women, 2 men] with a mean age of 36.7 years [range, [26, 48]]. Frequent manifestations were prolonged fever [8 cases], malar rash [6 cases], arthritis [6 cases], alopecia [5 cases], discoid lupus [3 cases], haematological disorders [7 cases], serositis [4 cases] and renal failure [4 cases]. All patients had at least 4 ACR criteria with an average of 6.11 criteria. ANA were positive in 8 patients with an average of 1/568, 68 [extremes [1/1280-1/160]]. The most commonly molecules used were Prednisone, Azathioprine and Hydroxychloroquine. The Mycofénolate Mofétil, Cyclophosphamide and Rituximab were used in a single patient. The outcome was favorable in 8 patients and we deplore the death of one patient

Conclusion: Under diagnosis would be the basis of the low prevalence of lupus in Niger. Diagnostic means are necessary for epidemiological studies in order to have more representative data

Facteurs associes a la neuropathie diabetique a l'hopital national de Lamorde (Niamey-Niger)

OBJECTIFS. Identifier les facteurs associes a la neuropathie chez les patients diabetiques suivis a l'Hopital National de Lamorde. MeTHODES. Il s'agit d'une etude transversale; prospective sur une duree de 6 mois (Avril a Octobre 2014). Ont ete inclus les patients diabetiques vus en consultation durant la periode d'etude. Le score de Michigan neuropathy screening instrument(MNSI) a permis d'etablir le diagnostic de neuropathie peripherique et la douleur neuropathique a ete diagnostiquee sur la base du score DN4. ReSULTATS. Sur 200 patients inclus; 46% avaient une neuropathie peripherique dont 24% une douleur neuropathique. La survenue de la neuropathie peripherique est significativement correlee au diabete de type 2; a l'age des patients; au sexe masculin; a l'anciennete du diabete et a un bas niveau socio-economique. Une association au desequilibre glycemique a ete observe chez 46;2 % des cas mais non significative (p=0;055). La neuropathie etait egalement associee a la nephropathie; a une retinopathie diabetique et a la dysfonction erectile chez hommes.CONCLUSION. La neuropathie diabetique est frequente au Niger. Sa survenue denote de la presence d'autres facteurs

Evaluation de la prise en charge intégrée du paludisme, de la diarrhée et de la pneumonie chez les enfants de 0 à 5 ans en milieu communautaire : Cas du district sanitaire de Dosso

Au Niger, la lutte contre les maladies de l'enfant au niveau communautaire occupe une place de choix parmi les priorités en matière de santé publique. L'Etat du Niger a introduit une nouvelle initiative visant à renforcer la prise en charge intégrée de la pneumonie, de la Diarrhée et du Paludisme chez les enfants de moins de 5 ans au niveau communautaire par des relais communautaires. Cette nouvelle initiative est pilotée par l'ONG World Vision dans le District sanitaire de Dosso. Après un (1) an de mise en œuvre de cette stratégie, il est important d'évaluer et d'analyser les progrès accomplis à fin de déterminer le degré de satisfaction des mères ; des relais communautaires ; des responsables des CSI Cases de santé et des autorités coutumières. Il s'agit d'une étude transversale. La population de notre étude est composée :  Des mères/ gardiennes d'enfants de 0 à 5 ans dans les villages du district sanitaire de Dosso;  Les chefs coutumiers ;  Les responsables des CSI ;  Les responsables des Cases de santé du District sanitaire de Dosso ;  Les relais communautaires du District sanitaire de Dosso. ⇨Pour le choix des mères/ gardiennes d'enfants âgés de 0 à 5 ans, nous avons combiné la méthode d'échantillonnage en grappe à quatre (4) degrés avec la méthode de commodité. ⇨Pour le choix des relais communautaires ; des chefs coutumiers, les responsables CSI/CS et les membres des Comités de Gestion de santé villageois c'est la technique d'échantillonnage exhaustive. Les données ont été saisies ; traitées et analysées à l'aide du logiciel Epi_info et Excel, ensuite transférées sur le logiciel STATA 12 pour faire certaines analyses. MS Word est utilisé pour la rédaction du rapport. La présente étude, nous a permis d'aboutir aux principaux 95% de mères/gardiennes d'enfant enquêtées sont satisfait des messages véhiculés par les relais communautaires 98% de mères/gardiennes d'enfant enquêtées sont satisfait des traitements administrés par les relais communautaires ; 89,1% des enfants pris en charge par les relais communautaire sont guéris après le traitement ; 83,6% des mères/gardiennes d'enfants enquêtées n'ont jamais été référées. 100% des relais communautaires enquêtés ont un niveau d'instruction secondaire; 81% des relais communautaires enquêtés ont reçu 3 à 4 formations pendant les 12 mois précédents ; 93% des relais sont satisfait des services qu'ils rendent pour la communauté ; 75% des agents de santé du CSI/CS enquêtés ont affirmés que les services offerts par les relais sont bonnes. Pour améliorer cette prise en charge, il est recommandé de :  Résoudre les problèmes de gestion logistique, en particulier les ruptures de stock en médicaments ;  Renforcer activement les séances de sensibilisation ;  Assurer une supervision formative des relais communautaires ;  Revoir le système de motivation des relais communautaire

Prevalence of intestinal parasites and its impact on nutritional status among preschool children living in Damanhur city, El-Behera goveftnorate, Egypt

This cross sectional study was done in Damanhur City, the Capital of El-Behera Governorate to detect the prevalence of intestinal parasitic infection among preschool aged children and to find out its effect on their nutritional status. Five-hundreds children aged between 2-6 years were enrolled; a detailed questionnaire, complete clinical and anthropometric assessment as well as complete stool analysis and blood picture were done. The study revealed that 51.8% preschool children were infected; Cysts of Entamoeba histolytica and Giardia lamblia were found in 16.8%, and 14.8% respectively. In 1.8% of cases, both cysts were found together. Ova of Ascaris lumbricoides, Enterobius vermicularis, Ancylostoma duodenale and Hyme-nolepis nana were detected in 14%, 3.4%, 5% and 0.2% of cases, respectively. In 0.4% of cases, ova of A. lumbricoides and E. vermicularis were found together. Mixed infections were found in 3.6% of children. Significantly lower weight for age z-score [WAZ] and weight for height z-score [WHZ] were found among infested children compared to non-infested ones [P<0.05]. Moreover, stunting was found in 44.1%, underweight in 39.1% and wasting in 11.5% of infested children. Prevalence of anemia among all studied population was 39%; 48.6% in infested group compared to 28.8% in non-infested children [x=20, P<0.001]. Improper hand washing, and playing in the street bare footed, together with playing with animals and family history of parasitic infestation were considered the independent predictors of parasitic infestation by using binary logistic regression

Clinical and Microbiological Assessment of Trachoma in the Kolofata Health District, Far North Region, Cameroon

Background and aims: Trachoma is a sight-threatening process triggered by the infection of the conjunctiva with <i>Chlamydiae</i>. Blindness associated with trachoma was reported in Sahelian areas of Cameroon. However, data on the prevalence of this neglected infection in the Far North Region are not available. The aim of this study was a) to assess clinical trachoma and b) to detect <i>Chlamydia</i> in the conjunctiva of trachomatous populations living in the Far North Regions of Cameroon.Methods: A total of 2,423 randomly selected children (1–10 years) and 1,590 women over 14 from randomly selected villages from the Kolofata Health District (115,000 inhabitants) were included in a cross-sectional study in February 2009. Trained staff examined and obtained conjunctival swabs from trachomatous subjects. DNA was extracted and amplified to detect <i>Chlamydia</i> DNA by real-time PCR. The quality of sampling was assessed by quantifying the number of epithelial cells.Results: Children (2,397 or 98.9% of the predicted number) and women (1,543; 97.0%) were examined. The prevalence of follicular trachoma (TF) in children was 21% (95% CI 17.8–24.5) and of intense inflammatory trachoma (TI) 5.2% (95% CI 3.6–7.3). Among the women, trichiasis (TT) was observed in 3.4% (95% CI 2.4–4.7), corneal opacities (CO) in 1.4% (95% CI 0.8–2.3) and trachoma-related blindness in 0.9% (95% CI 0.4–1.8). Conditions related to income, illiteracy, latrines, water supply and animals wandering close to dwellings were similar in all the villages. PCR was positive in 35% of children with active trachoma and in 6% of adult females presenting TT and/or related corneal opacities.Conclusion: The prevalence of trachoma and the severe trachoma <i>sequelae</i> found during this survey underline the urgent need to implement efficient blindness prevention interventions to improve the visual future of the people in the Sahelian region.

Identification of the diagnostic and epidemiological potential of camel strain G6 in human cystic echinococcosis

Recent molecular studies detected the presence of camel G6 genotype in human samples in different countries including Egypt. However, none of them studied the diagnostic and epidemiological role of camel G6 genotype in patients' sera with cystic echinococcosis [CE]. Detection of camel G6 strain in patients' sera by polymerase chain reaction [PCR] and determination of changes in the genotype profile that might be influenced by the predominant transmission cycle during a certain time. Eighty subjects were divided into 2 main groups with 3 subgroups in each: Group I [31 CE cases with positive G6 PCR in parasite material obtained from their cysts] subdivided into Group IA [21 hepatic CE], Group IB [5 pulmonary CE], Group IC [5 multiple organ CE], Group II [49 control subjects] including Group IIA [29 patients with other parasitic diseases], Group IIB [10 patients with space occupying lesions] and Group IIC [10 healthy individuals]. DNA was extracted from CE patients' sera for amplification and sequencing. Hot-start specific G6 PCR for patients' sera [PCRs] revealed that all CE cases [100%] were of G6 genotype, with 100% sensitivity and 100% specificity and a specific band at 254 bp. Indirect hemagglutination test [IHAT] showed 61.29% sensitivity and 95.92% specificity. DNA sequencing of the amplified DNA fragments of patient's sera showed 100% homology with extracts from parasite materials taken from their own cysts [Gen Bank under the accession no. from GQ476732 to GQ476735], as well as with that of an Argentinean reference strain [provided from WHO reference laboratory]

Detection of G1 genotype of human cystic echinococcosis in Egypt

The first trial to detect G1 genotype in Egyptian human isolates of hydatid cysts [HC] and serum samples to approach diagnosis of cystic echinococcosis [CE] using human sera by PCR. Using strain specific primers, 27/36 confirmed CE patients [75%] showed G1 specific band in their sera at 254 bp. Specificity was 100% without detecting bands for either other parasitosis, or mass occupying lesions. Using PCR, G1 genotype was detected in 83.3% of HC samples, without significant difference between types of human isolates [pulmonary, hepatic, or multi-organ]. G1 genotype detection in human sera was in 75% of CE patients compared to 83.3% in HC samples of the same group of patients proved satisfactory, simple and safer than HCF sampling. IHAT gave sensitivity of 58.3% compared to histopathological examination of surgically removed cysts or examination of hydatid cyst fluid [HCF] for pro-toscolices [gold standards]. The specificity was 70% with false positive reactions with other parasitic infections and mass occupying lesions. PCR detection of G1 genotype in Egyptian animal hydatid cysts showed 90% in camel isolates and 80%; in sheep isolates, but pig isolates were negative. The presence of this genotype in a high percentage in camel isolates incriminated sheep strain as the source of CE camel infection. The results may give an explanation to the contradicting results of other studies that did not relay upon molecular aspects