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.

[Healthcare associated infections in the neurosurgical department of Gabriel Touré teaching Hospital in Bamako]. / Les infections associees aux soins dans le service de neurochirurgie du CHU Gabriel Toure a Bamako.

INTRODUCTION: Healthcare-associated infections or nosocomial infections are a public health problem due to their frequency, severity and economic impact. They cause an increase of the morbidity, the mortality, the hospital stay and the expenses of taking care of the patients. According to the WHO, 7.1 million people are affected each year, of which about 100,000 die. AIM OF STUDY: The aim of this study was to determine the frequency of healthcare-associated infections in the Neurosurgery Department of Gabriel Touré University teaching Hospital and to identify the risk factors associated with these infections. MATERIAL AND METHODS: This was an epidemiological, descriptive, analytic, cross-sectional and prospective study lasting 6 months from May 29 to November 30, 2016. The study focused on patients who stayed more than 48 hours in the Neurosurgical department Gabriel Touré teaching hospital. The collected data focused on the clinical and biological characteristics of the patients during their hospitalization. The maximum size of the sample was 200 patients. A sample was taken for each type of infection. The criteria used for the diagnosis of Healthcare-associated infections were those of the CDC (Center for Disease Control) and the realization of a thick drop in our context. The chi-square test was used for the comparison of qualitative variables and Kruskal Wallis and Anova for quantitative variables. The materiality threshold has been set to a value of p less than 0.05. RESULTS: At the end of our study, we had 34 infected patients out of 200, a rate of 17%. The significant risk factors found in our study were: high age (p = 0.04), ASA class (p = 0.002), pre-surgical shaving (p = 0.02), long duration surgical intervention (p = 0.002) and long hospital stay (p = 0.004). The types of infections associated with the care found were: urinary in 18 (53%) cases, respiratory in 9 (26%) cases, operative site in 6 (18%) cases and 1 (3%) cases of bacteremia. The bacterial spectrum of these infections was dominated by Negative Gram Bacilli, among which Escherichia coli in 11 (32.3%) cases. The clinical course of patients treated for these infections was marked by healing in 31 (91.2%) cases, complications in 2 (5.9%) cases, and death in 1 (2.9%) case. CONCLUSION: The prevalence of Healthcare-associated infections in our department remains high compared to that found in developed countries. This study allowed us to identify the main risk factors associated with these infections. A stricter adherence to the rules of hygiene and prevention of Healthcare-associated infections is needed to reduce this rate.

INTRODUCTION: Les infections associées aux soins (IAS) ou infections nosocomiales constituent un problème de santé publique par leur fréquence, leur gravité et leur retentissement économique. Elles causent une augmentation de la morbidité, la mortalité, le séjour hospitalier et les frais de prise en charge des malades.Selon l'OMS, 7,1 millions de personnes seraient affectées par les IAS chaque année parmi lesquelles environ 100000 meurent de suites de ces ISA. BUT: Le but de cette étude était de déterminer la fréquence des infections associées aux soins dans le service de Neurochirurgie du CHU Gabriel Touré et d'identifier les facteurs de risque associés à ces infections. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude prospective d'une durée de 6 mois allant du 29 Mai au 30 Novembre 2016. L'étude a porté sur les patients ayant séjourné plus de 48 heures dans le service de Neurochirurgie du CHU Gabriel Touré.Les données collectées ont porté sur les caractéristiques cliniques et biologiques des patients au cours de leur hospitalisation.La taille maximum de l'échantillon a été de 200 malades. Un prélèvement a été fait pour chaque type d'infection.Les critères utilisés pour le diagnostic de l'IAS étaient ceux du CDC (Center for Disease Control) d'Atlanta ainsi que la réalisation d'une goutte épaisse dans notre contexte.Le test de khi2 a été utilisé pour la comparaison des variables qualitatives et Kruskal Wallis et Anova pour les variables quantitatives. Le seuil de signification a été fixé à une valeur de p inférieure à 0,05. RÉSULTATS: Au terme de notre étude nous avons eu 34 patients infectés sur 200, soit un taux de 17%. Les différents facteurs de risque significatifs retrouvés dans notre étude ont été : l'âge élevé (p=0,04), la classe ASA (p=0,002), le rasage pré-chirurgical (p=0,02), la longue durée de l'intervention chirurgicale (p=0,002) ainsi que la longue durée d'hospitalisation (p=0,004). Les types d'infections associées aux soins retrouvés ont été : urinaires dans 18 (53 %) cas, respiratoires dans 9 (26%) cas, site opératoire dans 6 (18%) cas et 1 (3%) cas de bactériémie. Le spectre bactérien de ces infections était dominé par les Bacilles Gram Négatifs parmi lesquels l'Escherichia coli dans 11 (32,3%) cas.L'évolution clinique des patients traités pour ces infections a été marquée par la guérison dans 31 (91,2%) cas, les complications dans 2 (5,9%) cas et le décès dans 1(2,9%) cas. CONCLUSION: La prévalence des infections associées aux soins dans notre service reste élevée par rapport à celle retrouvée dans les pays développés. Cette étude nous a permis d'identifier les principaux facteurs de risque associés à ces infections. Une observance plus stricte des règles d'hygiène et de prévention des IAS s'impose pour faire baisser ce taux.

La morbimortalité du tétanos à l'hôpital Sominé Dolo de Mopti

Introduction. Le tétanos est un problème de santé publique. La létalité qui lui est associée est très élevée. L'objectif de ce travail était de décrire les aspects cliniques, thérapeutiques et évolutifs du tétanos chez l'adulte. Méthodes. Il s'agissait d'une étude rétrospective des cas de tétanos à l'hôpital Sominé Dolo de Mopti. Les données ont été collectées à partir des dossiers des malades et portaient sur le nom, le sexe, l'âge, la profession, la provenance, le statut vaccinal, la porte d'entrée. Le score de Dakar a été utilisé pour évaluer le pronostic des patients. Résultats. Nous avons colligé 11 cas dont un tétanos obstétrical. La prévalence hospitalière était de 1,03% ; l'âge moyen de 41ans avec des extrêmes de 21 et 70 ans. La tranche d'âge de 20 - 30 ans était la plus affectée avec 36,36%. Aucun des patients n'avait été antérieurement vacciné contre le tétanos. La durée moyenne d'hospitalisation a été de 11,36 jours. Tous les patients ont présenté le trismus, dans plus de 50% des cas, la fièvre était associée aux paroxysmes. Nous rapportons un taux de létalité de 54,54% dont 83,33% sont survenus dans les quatre jours qui ont suivi l'hospitalisation. Le délai moyen de survenu du décès était de 4 jours. Conclusion. Le tétanos continue d'être une menace à l'atteinte de l'objectif de la couverture sanitaire universelle. Des efforts de sensibilisation et des programmes de vaccination plus inclusifs devraient permettre d'en réduire la morbimortalité

Depression and HIV: Epidemiological and clinical aspects at the Bamako University Hospital (Mali).

Depression plays an important role in clinical worsening, morbidity and mortality related to HIV/AIDS. To describe the epidemiological and clinical aspects of depressive disorders in people with HIV in Mali. This prospective study took place in the department of psychiatry and infectious diseases at the Bamako University Hospital from July 2004 through October, 2005 and included all HIV-positive antiretroviral-naive patients with depression, diagnosed according to ICD-10 criteria. The study included 84 HIV-positive patients with a depressive disorder; our total population of HIV-positive patients was 316 during the study period, for a prevalence rate of 26.7 % in this population. The mean age of these depressed patients was 36.7 ± 8.5 years (range: 20-57); 63.1% were women, 47.7% had not attended or at least not completed primary school; 66.6% were married, and 92.9% lived in urban areas. Sad mood, anxiety, and refusal to eat were reported by 27.7%, 10.9%, and 9.1%, respectively, as a reason for consultation. Depression was associated with an anxiety disorder in 33 (39.3%) and a delusional disorder in 14 (16.7%). Severe depression was associated with low BMI and at a CD4 count <200 cells/mm3. Depression was found at a high frequency in our study. Its detection, operational research about it, and improved management are recommended to improve the health of people living with HIV.

[Antiretroviral therapy with three nucleoside reverse transcriptase inhibitors in treatment-naive HIV-infected patients in Abidjan (Cote d'Ivoire)]. / Le traitement antirétroviral à base de trois inhibiteurs nucléosidiques de la transcriptase inverse chez les patients naïfs infectés par le VIH à Abidjan (Côte d'Ivoire).

This study assesses the results of initial antiretroviral therapy with 3 nucleoside reverse transcriptase inhibitors over the first 12 months of treatment. Patients' general health improved significantly during the year, with a significant mean weight gain (from 59.3 kg to 65.12 kg) and a strong regression in the frequency of opportunistic infections over the study period, from 38% to 2% (P<0.0001). The mean CD4 T-cell count rose from 242.8 to 390.5 cell/mm(3), for a mean increase of 147.7 cells/mm(3). Accordingly, antiretroviral treatment with three nucleoside reverse transcriptase inhibitors is effective and is a useful alternative in a country with limited resources.

Cryptoccocal meningitis and HIV in the era of HAART in Côte d'Ivoire.

OBJECTIVE: The authors had for aim to describe the management of cryptococcal meningitis in HIV infected adults, in Ivory Coast. PATIENTS AND METHODS: A retrospective study was made from January 1, 2005 to December 31, 2008 on the files of consecutive hospitalized patients presenting with cryptococcal meningitis, at the Treichville University Hospital, Infectious and tropical diseases department (Abidjan). The socio-demographic, clinical, and biological aspects as well as the outcome were analyzed. RESULTS: Eighty patients presenting with cryptococcal meningitis, (2.6% of hospitalized patients) were included: 41 men (51.25%) and 39 women (48.75%); mean age: 40 years (range 26 to 58 years). The delay before consultation was 5.4 days, range 2-12 days). The mains symptoms were headache (83.7%), fever (63.7%), and consciousness disorders (60%). Meningo-encephalitis accounted for 75% of the clinical presentations; 54 patients (67.5%) were naive of antiretroviral treatment (mean CD4: 45/mm(3) (range 5-103/mm(3)), while 26 (32.5%) had received antiretrovirals before presenting with cryptococcal meningitis (Nadir CD4=81/mm(3)). Amphotericin B relayed by fluconazole was prescribed to 86.2% of the patients, associated with a therapeutic lumbar puncture for 30 patients. The death rate was 41.2%. CONCLUSION: In spite of antiretroviral treatment availability in Ivory Coast, cryptococcal meningitis remains frequent with a high death rate. This study stresses the importance of early management to improve the prognosis.

[Cerebral toxoplasmosis during AIDS in the infectious diseases department of Point-G Teaching Hospital, Bamako, Mali]. / Toxoplasmose Cerebrale Au Cours Du Sida Dans Le Service Des Maladies Infectieuses Du CHU Du Point-G, Bamako-Mali.

Cerebral toxoplasmosis is common opportunistic infections of central nervous system in AIDS. It occurs most often in case of severe immunosuppression. The aim of this study is to investigate the general characteristics of cerebral toxoplasmosis during HIV infection and AIDS in hospital area in Bamako. It is a retrospective study of 5 years (form January 2001 to December 2005), conducted in the infectious diseases department of Point G Teaching Hospital of Bamako. It concerned all patients infected with HIV, hospitalized for cerebral toxoplasmosis. The diagnosis of cerebral toxoplasmosis was based on clinical, C T and therapeutic arguments. A total of 745 patients investigated, 26 met cerebral toxoplasmosis diagnostic criteria (14 men and 12 women). The rate of cerebral toxoplasmosis in the study population was 3.5%. The average age was 38.1 years (18-58 years). Focused neurological deficit (73.07%), intracranial hypertension signs (69.20%), meningeal syndrome (15.40%), seizures (57.69%) and consciousness disorders (30.80%) were the clinical characteristics. Hypodensity with or without peripheral enhancement images (93.75%) were found on CT. The average rate of CD4 T cells was 98.7cells/mm3 (5-473 cells/mm3). Oropharyngeal candidiasis in 61.53% of cases, intestinal cryptosporidiosis (11.53%), herpes zoster (3.84%) and Pott's disease (3.84%) were the opportunistic infections associated. Cotrimoxazole was used in 88.46% of patients and 3 patients (11.54%) received the standard treatment (Sulfadiazine-Pyrimethamine). Antitoxoplasmic treatment led to a clinical improvement in 84.61% and 4 deaths (15.39%). were recorded. The technical platform for etiological diagnosis of toxoplasmosis is not available at the Point-G Teaching Hospital, so in case of encephalitis signs in a HIV positive patient, CT should be urgently perform and a treatment trial must begin without delay.

[The psychiatric manifestations of people living with HIV in Mali]. / Les manifestations psychiatriques chez les personnes vivant avec le VIH au Mali.

HIV/AIDS related disorders have a negative impact on the assumption of responsibility of other Comorbidities and could lead to a highest lethality rate. The goal was to evaluate the prevalence of the psychiatric disorders during HIV/AIDS at infectious diseases service of "hôpital du Point G". We carried out an exploratory study and descriptive energy of July 1, 2004 to bearing 31 October 2005 out of 166 patients. The cases of HIV were defined on the basis of positivity of serology HIV by at least 2 fast tests associated or not with clinical signs with the AIDS according to CDC. Any disturbance of the higher functions was regarded as psychiatric demonstrations. The female sex was in a majority with a sex- ratio of 0.9. The ages bracket the most touched lay between 36 and 41ans. The housewives were 36.7%. The grooms accounted for 64.5%. The prevalence of the psychiatric disorders was 58.9%. The disorders were dominated by the depression (45.8%) followed confusional syndrome 31.9% and epilepsy 7.8%. All the patients with psychiatric antecedents developed a confusional syndrome. The subjects having presented a psychiatric disorder were infected by the HIV-1 in 93.4% of the cases.Occurred of the psychiatric disorders was inversely proportional to the rate of CD4. Lethality was very high is 56%.

Les manifestations psychiatriques chez les personnes vivant avec le VIH au Mali

Les troubles psychiatriques au cours de l'infection a VIH ont un impact negatif sur la prise en charge des autres co-morbidites et peuvent constituer en eux-memes une cause de mortalite. Le but de notre etude etait d'evaluer la prevalence des troubles psychiatriques au cours de l'infection par le VIH dans les services de maladies infectieuses et de psychiatrie du CHU du Point G. Nous avions realise une etude prospective et descriptive allant du 1er Juillet 2004 au 31 Octobre 2005 portant sur 166 patients. Les cas d'infection a VIH ont ete definis sur la base de la positivite de la serologie VIH par au moins 2 tests rapides associes ou non a des signes cliniques du SIDA selon la classification CDC. Toute perturbation des fonctions superieures etait consideree comme manifestations psychiatriques. Le sexe feminin etait majoritaire avec un sex- ratio de 0;9. La tranche d'age de 36 a 41 ans etait la plus touchee. Les menageres representaient 36;7de l'echantillon et les maries representaient 64;5. La prevalence des troubles psychiatriques etait de 58;9. Les troubles ont ete domines par la depression (45;8) suivis du syndrome confusionnel 31;9et de l'epilepsie 7;8. Les sujets etaient infectes par le VIH-1 dans 93;4des cas. La survenue des troubles psychiatriques etait inversement proportionnelle au taux de CD4. La letalite etait tres elevee soit 56

[Epidemiologic aspects of pulmonary tuberculosis with positive bacilloscopy in the decade of 1995-2004]. / Aspects epidemiologiques de la tuberculose pulmonaire a bacilloscopie positive au Mali pendant la decennie 1995-2004.

The purpose of this study is to make an epidemiological description of pulmonary tuberculosis with sputum smear positive in Mali. This is a retrospective study conducted from January 1st, 1995 to December 31st, 2004 by the National Program for fighting against tuberculosis (located at the National Department of health), and where data were centralized. From this ten years period, 33,000 cases of tuberculosis (all forms of TB) have been notified in Mali, which represented an annual rate of 2750. Of those, 22,275 cases (67.5%) were sputum smear positive (with Ziehl Nielsen), this represented 1856 as annual rate. The prevalence of pulmonary TB with sputum smear positive is 185/100,000. During the study period a total of 13,638 (61.22%) cases of 22,275 cases of pulmonary TB with sputum smear positive have been given ant tuberculosis drugs; From these patients under therapy 2371 cases (17.38% ) disappear before the end of treatment.; 5851 cases (42.90%) have been considered as cured; 161 (1.18%) cases of treatment failure and 523 (3.93%) cases of death. The sex-ratio was 3.57 with young adults representing the majority of cases. Pulmonary TB with sputum smear positive treatment remains a challenge for National Programs for fighting against TB as well as its prevention.

Aspects épidémiologiques de la tuberculose pulmonaire à bacilloscopie positive au Mali à la décennie 1995-2004

Dans le but de decrire l'epidemiologie de la tuberculose pulmonaire a bacilloscopie positive (TPM+) au Mali; une etude retrospective sur dix ans du 1er janvier 1995 au 31 decembre 2004; a ete menee au Programme National de Lutte contre la Tuberculose (TB) sis a la direction nationale de la Sante. Toutes les donnees de l'etendue du pays sont centralisees au niveau de ce programme. Durant cette periode de dix ans; 33 000 cas de TB toutes formes confondues ont ete notifies sur le territoire de la republique du Mali; soit 2750 cas de TB en moyenne par an ; et 22.275 cas (67;5) avaient une microscopie positive des crachats pour le BAAR soit 1856 cas de TPM+ en moyenne par an. Cette prevalence annuelle de TPM+ par rapport a la population nationale represente 185 cas pour 100.000 habitants par an. Au total pendant la periode d'etude 13.638 TPM+ sur 22275 cas au total (soit 61;22) ont ete soumis au traitement antituberculeux. Parmi ces patients sous traitements antituberculeux 2371 cas (17;38) ont ete perdus de vue pendant le suivi; 5851 ont ete declares gueris (42;90) ;161(1;18) en situation d'echec therapeutique et 523 (3;93) cas de deces. Avec un sex-ratio de 3;57 les adultes jeunes etaient majoritairement represente.La TPM+ reste la pierre angulaire de tout programme national de lutte anti-tuberculeux tant pour le traitement que la prevention

[AIDS related Kaposi's disease in Hospital area in Bamako]. / La Maladie de Kaposi au cours du VIH/Sida en milieu hospitalier de Bamako.

The goal of this prospective work were to describe the clinical, therapeutic and evolutionary aspects of Kaposi's disease occurring during AIDS in the infectious diseases service from October 1, 2004 to September 30, 2005. The diagnosis of the infection by the HIV was based on the positivity of serology with 2 fast tests. That of the Kaposi's disease was based on the clinical aspect and /or histological of the lesions. On these 2189 patients, 37 presented the Kaposi's disease that means a prevalence of 1.6%. They were 17 men and 20 women average age 39.5 years and heterosexuals in 97.30 % of the cases. Kaposi's disease limited on the skin and mucous were most represented within (48.65 %), followed by the skin limited (43.24 %) and mucous localization (8.11%). Papulo-nodulare feature was the major clinical founded to the physical examination in 54.05 %. The rate of average CD4 was 76 cellules/mm3 with the extreme one going from 1 to 512 cellules/mm3. It was favorable at 14 (43.75%) of the 32 patients having profited from antiretroviral treatment. The Kaposi's disease during the AIDS is relatively frequent with the service of the infectious diseases and the prognosis remains severe. However the antiretroviral therapy can improve the prognosis of the skin limited forms.

[Clinical and bacteriological profiles of the urinary infections associated the VIH/AIDS in hospital area of Bamako, Mali]. / Profils clinique et bactériologique des infections urinaires associées au VIH/SIDA en milieu hospitalier de Bamako, Mali.

The syndrome of immunodepression is the bed of multiple infections of which urinary infections. The goal of this study was to determine the aspects clinical and bacteriological urinary infections during the AIDS with the service of the infectious diseases of the hospital of the Point G of February 1, 2003 to June 30 2005. The diagnosis of the urinary infection was retained on the basis of bacteria number > or =10(4) bacteriury and or leucocytes count > or =10(5)/mm3. The prevalence of the urinary infection was estimated at 8.85%. The principal clinical aspects were a symptomatic pyelonephritis 73.5%, the leucocytiury 11.8%, the cystitis 8.8%, and acute prostatitis 5.9%. Escherichia coli was the most frequent bacterium (46.7%). The sensitivity of the germs was 91.7% with the aminosides, 90.9% with the fluoroquinolones, from 63.6 to 80% respectively with the cephalosporines of first and second generation. Resistance to ampicilline, chloramphenicol and sulfamides was about 72 and 80%. The systematic research of the urinary infection is necessary during the AIDS and the antibiotherapy of choice in first intention in absence of etiologic possibility of diagnosis should be the aminosides and or the fluoroquinolones.

Aspects épidémiologiques de la tuberculose pulmonaire à bacilloscopie positive au Mali pendant la décennie 1995-2004

Notre etude etait retrospective. Elle concernait l'evolution de l'incidence de la tuberculose pulmonaire a bacilloscopie positive au Mali pendant la decennie 1995 - 2004. Durant cette periode; la TPM+ representait plus de 67;27de l'ensemble des formes confondues de tuberculose sur le territoire malien. Les adultes jeunes etaient les plus touches. La letalite tuberculeuse variait entre 2;52 et 9;12. L'abandon du traitement; l'echec therapeutique; les perdus de vue; les transferts etaient des facteurs determinants de la letalite liee a la tuberculose. Une progression de l'incidence de la TPM+ a ete constatee

La Maladie de Kaposi au cours du VIH/Sida en milieu hospitalier de Bamako

Le but de ce travail prospectif etait de decrire les aspects clinique; therapeutique et evolutif de la maladie de Kaposi associee au VIH/SIDA au service des Maladies Infectieuses du 1er octobre 2004 au 30 septembre 2005. Le diagnostic de l'infection par le VIH etait base sur la positivite de la serologie a 2 tests rapides. Celui de la maladie de Kaposi etait base sur l'aspect clinique et /ou histologique des lesions. Sur ces 2189 patients; 37 ont presente la maladie de Kapozi soit une prevalence de 1;6. Il s'agissait de 17 hommes et 20 femmes d'age moyen de 39;5 ans et heterosexuels dans 97;30 des cas. La localisation cutaneo-muqueuse etait la plus frequente (48;65 ) suivie de la localisation cutanee (43;24 ) et muqueuse (8;11). L'aspect clinique le plus predominant a ete papulonodulaire dans 54;05 des cas. Le taux de CD4 moyen etait de 76 cellules/mm3 avec des extremes allant de 1 a 512 cellules/mm3. Elle a ete favorable chez 14 (43;75) des 32 patients ayant beneficie d'un traitement antiretroviral. La maladie de Kapozi au cours du VIH/SIDA est relativement frequente au service des Maladies Infectieuses et le pronostic reste severe. Toutefois les anti-retroviraux peuvent ameliorer le pronostic des formes localisees a la peau. Mots cles : Prevalence; Maladie Kaposi; VIH/SIDA; Mali