[Drug-resistant tuberculosis with rifampicin in children co-infected with HIV in Bamako]. / Tuberculose resistante a la rifampicine chez un enfant co-infectepar le VIH a Bamako, Mali.

Drug-resistant tuberculosis, especially in children, is a major public health challenge. We report a case with rifampicin resistance diagnosed in an HIV co-infected in Bamako. The history of the disease suggests possible father-to-child transmission. After confirmation, MDR-TB treatment was initiated. Global improvement and normalization of biological parameters and X-Ray was obtained. The identification of this case highlights the need to improve diagnosticand treatment algorithms for rapid confirmation and better management.

La tuberculose pharmaco-résistante surtout de l'enfant représente un défi majeur de santé publique. Nous rapportons un cas avec résistance à la rifampicine chez un enfant séropositif au VIHà Bamako. L'histoire de la maladie suggère une possible transmission du père à l'enfant. Après la confirmation, l'enfant a été mis sous traitement de TB-MR. Une amélioration de son état général et une normalisation des paramètres biologiques et radiologiques a été observée. L'identification de ce patient met en évidence la nécessité d'améliorer les algorithmes de diagnostic et de traitement pour une confirmation rapide et une meilleure prise en charge.

[Multidrug-resistant tuberculosis (MDR-TB) in a black African carceral area: Experience of Mali]. / Tuberculose multi-résistante (TB-MR) en milieu carcéral noir africain : expérience du Mali.

INTRODUCTION: Prison constitutes a risk factor for the emergence of multi-drug resistance of tuberculosis (MDR-TB). The aim of this work was to study MDR-TB in a black African carceral center. MATERIAL AND METHODS: Prospective study from January to December 2016 at the central house of arrest for men, Bamako. The study population was composed of tuberculous detainee. The suspicion of MDR-TB was done in any tuberculosis case remained positive in the second month of first-line treatment or in contact with an MDR-TB case. RESULT: Among 1622 detainee, 21 cases of pulmonary tuberculosis were notified (1.29%), with an annual incidence of 13 cases/1000 detainee, they were 16 cases of SP-PTB (microscopy smear positive tuberculosis) and five cases of microscopy smear negative tuberculosis. The mean age was 28±7 years, extremes of 18 and 46 years. A negative association was found between the notion of smoking and occupation in the occurrence of tuberculosis (OR=0.036, [95% CI: 0.03-0.04], P=0.03. Among the 21 tuberculosis cases notified, one confirmed case of MDR-TB was detected (4.7%). In the first semester of 2016 cohort, we notified a cure rate of 87.5% (7/8 SP-PTB cases), and the confirmed MDR-TB case on treatment (21-month regimen), evolution enameled of pulmonary and hearing sequelae at seven months treatment. CONCLUSION: It was the first case of MDR-TB detected in a prison in Mali. Late diagnosis, evolution is enameled of sequelae and side effects.

[Respiratory diseases in black African carceral area]. / Pathologies respiratoires en milieu carcéral noir africain.

INTRODUCTION: The measures for people in specific situations such as prisoners are part of the Millennium Development Goals (MDGs). The objective of this study was to assess respiratory pathologies in a black African carceral center. METHODS: Retrospective study about the prevalence of respiratory pathologies in the arrest central house for men in Bamako (Mali), from May 2012 to April 2013. The admission records have served as data checking support on detainee's records. Statistical significance was investigated by the SAS 9.3 software with a threshold of 5%. RESULTS: Of 2740 admissions, 207 concerned respiratory pathologies (7.5%). All men, were of mean age 30±13 years (range 19-71). The respiratory diseases found were: pneumonia (33.8%), chronic bronchitis (26.6%), acute respiratory infection (14%), asthma (13.5%) and tuberculosis (5.3%). A definite diagnosis was made in 42% of cases. A tobacco intoxication was found in all age groups (CI 95%, R-square=0.01), without significant difference between the occurrence of cough in smoking and non-smoking men. CONCLUSION: According to their relative frequencies, the management of respiratory diseases requires collaboration between carceral health facilities and pneumological specialized services.

[How I treat a poisoning with tricyclic antidepressants : potential role of a treatment with lipid emulsion]. / Comment je traite l'intoxication aux antidépresseurs tricycliques : efficacité potentielle d'un traitement par émulsion lipidique.

Poisoning with tricyclic antidepressants is common and can be life-threatening. The classic management is well known (chelating gastrointestinal, sodium bicarbonate, benzodiazepine, norepinephrine). A few years ago, a treatment with lipid emulsion, previously used in local anesthetics poisoning, has been successfully tested in tricyclic poisoning with cardiac arrest. We are currently unable to explain the exact mechanism of this treatment but it could have a place in the treatment of severe tricyclic poisoning with hemodynamic instability in addition to the conventional treatment.

L'intoxication aux antidépresseurs tricycliques n'est pas rare et peut engager le pronostic vital du patient. La prise en charge classique est bien connue (chélateurs gastrointestinaux, bicarbonate de sodium, benzodiazépines, amines vasoactives). Il y a quelques années, un traitement par émulsion lipidique, jusque-là utilisé dans les intoxications aux anesthésiques locaux, a été testé avec succès dans les intoxications aux tricycliques en arrêt cardio-respiratoire. Nous sommes, actuellement, incapables d'expliquer le fonctionnement exact de ce traitement, mais il pourrait avoir une place dans la prise en charge des intoxications aux tricycliques avec instabilité hémodynamique échappant au traitement conventionnel.