Postpartum infections in a tropical environment: The experience of the infectious diseases department at Fann Teaching Hospital of Dakar (Senegal).

To describe the epidemiology, clinical characteristics, and outcomes of infections in postpartum women admitted to the infectious diseases department at Fann Teaching Hospital. This retrospective descriptive study examined the records of women admitted for infectious diseases within 42 days after childbirth during the five-year period (2007-2011). Data were collected from medical files and analyzed with Sphinx plus2 V5 software. In all, 54 women were admitted for infections during the postpartum period. Their mean age was 27.4 ± 6.2 years. Fifty women (93%) had had vaginal deliveries. The average interval from delivery to admission was 15.4 ± 11.0 days. Tuberculosis (14 cases), vaginitis (13 cases), and severe malaria (7 cases) were the most frequent infectious diseases. The average duration of hospitalization was 12.1 ± 9.0 days. The mortality rate was 30%, with the main causes of death tuberculosis (25 %) and severe pneumonia of unknown causes (25 %). Tropical diseases remain frequent during the postpartum period, with a high lethality rate, as this study shows. Early diagnosis during pregnancy and better follow-up after delivery should be the best ways of reducing morbidity and mortality from these infections.

Cryptococcose neuro-méningée : mortalité et facteurs associés au décès chez les patients hospitalisés au service des Maladies Infectieuses du CHNU de Fann

Introduction : La Cryptococcose Neuro-Méningée (CNM) survient souvent sur terrain d'immunodépression et surtout au cours de l'infection à VIH.Objectif : Déterminer la prévalence de la mortalité et les facteurs associés au décès. Patients et méthodes : Etude rétrospective descriptive et analytique, sur des patients hospitalisés de 2011 à 2014, des deux sexes, d'âge supérieur à 18 ans avec une CNM confirmée.Résultats : Trente-quatre cas colligés, dont 31 chez des patients VIH+ (91,1%). L'âge moyen était de 43,17 ans et la majorité avait un âge compris entre 40 et 49 ans. Le sex-ratio était de 1,26 en faveur des hommes. Ils présentaient des maladies chroniques sous-jacentes dans 11,7% des cas. Sur le plan clinique, céphalées (81,8%), fièvre au long cours (76,5%), vomissements (57,6%) et troubles de la conscience (44,1%) étaient notés. Des infections opportunistes étaient objectivées (97%) avec une prédominance de la candidose digestive. Sur le plan biologique, le taux moyen de LT CD4+ était de 117,42/mm3. L'examen direct à l'encre de Chine positif dans 11/23 cas. L'antigène cryptococcique positif dans LCR dans 16/24 cas et l'antigénémie positive pour 20/22 cas. Sur le plan évolutif, la létalité était de 57,6%. La durée de l'infection à HIV< 20 mois et les patients sans traitement ARV étaient les facteurs associés au décès.Conclusion : Dans nos régions elle est l'une des principales causes de méningo-encéphalite chez les sujets VIH+ immunodéprimés. Sa létalité est importante du fait de la non- disponibilité des antifongiques majeurs et du diagnostic tardif de l'infection à VIH

[Evaluation of tolerance of zidovudine-lamivudine-nevirapine combination in HIV 1 patients in Fann Teaching Hospital in Dakar]. / Évaluation de la tolérance de l'association zidovudine-lamivudine-névirapine chez les patients VIH-1 au Centre hospitalier de Fann à Dakar.

We conducted a study to evaluate the tolerance of the zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving AZT-3TC-NVP combination between 2008 and 2011. Seventy patients were included. Two thirds of the patients presented at least one side effect (44 cases). The digestive disorders (15 cases) and neuropsychiatric (14 cases) were the most frequent. Epigastralgia (20%), headaches (20%) and arthralgias (13%) were main side effects. A maculo-papular exanthema was noted in three cases. During the follow-up, five patients presented with anemia. No patient presented hepatic cytolysis due to NVP. All the patients followed for more than six months presented a side effect against 29.7% when the duration of treatment was equal to or less than 6 months (p=10(-5)). Most of the side effects due to the association AZT/3TC/NVP are minor. The evaluation of the clinical and biological tolerance must be maintained during all the follow-up.

[Elimination of maternal and neonatal tetanus in Senegal: evolution of survey indicators of 2003-2009]. / Élimination du tétanos maternel et néonatal au Sénégal : évolution des indicateurs de surveillance de 2003 à 2009.

OBJECTIVES: This study aimed to estimate the evolution of the maternal and neonatal tetanus in Senegal from the tetanus vaccination coverage among pregnant women, the proportion of deliveries attended by trained medical personnel and the number of cases of tetanus declared by respective districts, helping to identify districts at high risk of neonatal tetanus (NNT). METHOD: Data analysis of the epidemiological surveillance realized from 2003 to 2009 in 65 districts of Senegal. Data were collected from the reports of vaccination usage and from the Statistical Directories of the National Health Information Services of the Ministry of Health & Prevention. A district is at high risk when the incidence of NNT is ≥1 case per 1 000 Live births (LB). RESULTS: There were 153 reported cases of NNT in Senegal between 2003 and 2009. National incidence decreased from 0.08 to 0.03 case per 1 000 LB (p = 0,0008). The vaccination coverage of the pregnant women by at least two doses of tetanus vaccine (VAT2+) increased from 66% in 2003 to 78% in 2009. The percentage of districts that had reached a vaccination coverage ≥80% was 20% in 2003 compared to 60% in 2009 (p = 0.009). The proportion of deliveries attended by qualified medical staff evolved from 53% in 2003 to 67% in 2009 (p = 0,02). By 2009, the incidence of NNT was less than 1 case per 1,000 LBs in all districts. CONCLUSION: Assessing the elimination of maternal and neonatal tetanus in Senegal shows that progress has been made from 2003 to 2009. This was made possible through the organization of vaccination campaigns for women of childbearing age and the improvements in the conditions of deliveries.

Trends of HIV-1, HIV-2 and dual infection in women attending outpatient clinics in Senegal, 1990-2009.

We assessed trends in the relative prevalences of HIV-1, HIV-2 and dual HIV-1/HIV-2 infection in 10,321 women attending outpatient clinics in Senegal between 1990 and 2009. The relative prevalence of HIV-1 (defined as the proportion of seropositive subjects having HIV-1) rose sharply from 38% in 1990 until 1993 (P < 0.001), whereupon it continued to rise, but at a slower rate, reaching 72% of HIV infections in 2009. As compared with HIV-1, the relative prevalence of HIV-2 decreased sharply from 54% in 1990 until 1993 (P < 0.001) and continued to decrease at a slower rate through 2009. The relative prevalence of dual infection, as compared with HIV-1, was stable from 1990 to 1993, but decreased slightly thereafter (P < 0.001). These study findings indicate that during the early 1990s, the relative prevalence of HIV-1 increased markedly, while the relative prevalence of HIV-2 decreased and the relative prevalence of dual infection remained stable in Senegal. From 1993 to 2009, the relative prevalence of HIV-1 increased at a slower rate, while the relative prevalences of HIV-2 and dual infection decreased. These results confirm trends in HIV prevalence observed in other West African populations and provide a critical update on HIV transmission risk among women in Senegal.

[Current profile of HIV-infected patients hospitalized in Dakar (Senegal)]. / Profil actuel des patients infectés par le VIH hospitalisés à Dakar (Sénégal).

Ten years after the introduction of the Senegalese Antiretroviral Drug Access Initiative in 1998, we conducted a retrospective study of the epidemiological and clinical profiles and outcome of HIV-infected patients hospitalized in the Infectious Diseases Clinic of Fann Teaching Hospital in Dakar between 2007 and 2008. During these 2 years, 527 HIV-positive patients were included. The average age of the patients was 41 ± 10 years, and the sex-ratio (F/M) was 1.1; 56% of patients were married. The average interval before admission was 40 ± 57 days. Fever (83%), loss of weight (83%) and cough (54%) were the principal symptoms. Tuberculosis (40.9%) and gastrointestinal candidiasis (38.9%) were the commonest opportunistic infections. Most patients were diagnosed at the AIDS stage (88%) and the CD4+ T lymphocyte count was ≤ 200/mm3 in 86% of cases. Hospital fatality was 44% (231/527). Tuberculosis (36%), bacterial pneumonia (18%) and encephalitis (12%) were the most frequent causes of death. Despite the availability of and free access to antiretroviral drugs in Senegal, the mortality associated with HIV infection remains very high due to late diagnosis. The population must be educated to boost early screening and care.

[Epidemiological and clinical features of HIV-2 infection in Dakar]. / Aspects épidémiologiques et cliniques de l'infection par le VIH-2 à Dakar.

OBJECTIVE: The aim of this article was to describe the epidemiological and clinical aspects of HIV-2 infection in Dakar. DESIGN AND METHODS: This retrospective study was made on 217 HIV-2 infected patients hospitalized between 1986 and 2003; the epidemiological, clinical, and paraclinical data was collected and analyzed using the Epi-Info software version 6.04. RESULTS: The mean age was 40 years+/-9.6 and the male to female sex ratio was 1.33. The mode of transmission was primarily heterosexual. Some risk factors (travel abroad, heterosexual multi-partners, and unprotected sexual intercourse) were more frequently observed in men while others (blood transfusion, HIV positive partners) were noted among HIV-2 infected women. The most frequent symptoms were weight loss (88%), diarrhea (77%), fever (72.4%), asthenia (70.5%), chronic cough, and dermatosis (50.7%). The main opportunistic infections were oral candidiasis (61.8%), tuberculosis (26.3%), intestinal parasitosis (20.3%). The lethality rate was 33.2% and it was correlated with a low CD4 rate. Meningoencephalitis and bacterial infections were associated with a high lethality rate. CONCLUSIONS: The epidemiological and clinical aspects of HIV-2 infection were the same as in HIV-1 infected patients. However the lethality rate remained high among patients hospitalized with a low CD4 cell count. Early HIV testing and improving the diagnostic approach for opportunistic infections remains a high priority.

[Cholera epidemic of 2004 in Dakar, Senegal: epidemiologic, clinical and therapeutic aspects]. / L'épidémie de choléra de 2004 à Dakar: aspects épidémiologiques, cliniques et thérapeutiques.

During the cholera epidemic that occurred in Dakar, Senegal in 2004, we treated a total of 593 confirmed or suspected cases in our department. The purpose of this report is to describe epidemiologic, clinical, bacteriologic and therapeutic aspects of these cases. Study was conducted at the infectious diseases clinic from October 11 to December 20, 2004. Mean patient age was 30 years and the sex ratio was 133. The likely source of contamination was food or water intake in 92% of cases. The duration of the epidemic was short (75 days). Onset was sudden in 98% of cases and the main clinical manifestations were watery diarrhoea (95%) and vomiting (78%). The mean delay between symptoms and hospitalization was 11 hours and the number of stools before admission to the hospital was greater than 10 in 23% of cases. At the time of admission 119 patients (20.1%) were severely dehydrated. A total of 250 coprocultures were performed. Results were positive in 145 cases (58%) including 112 (44%) for Vibrio cholerae 01. Antibiotic testing carried out on 36 strains demonstrated excellent sensitivity to doxycycine and pefloxacine but resistance to cotrimoxazole, amoxicilline and chloramphenicol. Oral rehydration therapy was used in most cases (61%). The mortality rate was 0.5%. Cholera is a medical emergency that can have a favourable prognosis with properly organized management.

L'epidemie de cholera de 2004 a Dakar : aspects epidemiologiques; cliniques et therapeutiques

Ce travail decrit l'epidemie de cholera qui a touche Dakar en 2004; au cours de laquelle 593 cas confirmes ou probables ont ete pris en charge dans notre service. Il se fixe pour objectif de decrire les aspects epidemiologiques; cliniques; bacteriologiques et les strategies de prise en charge de cette epidemie. Pour atteindre cet objectif; nous avons mene une etude prospective a la clinique des maladies infectieuses du 11 octobre au 20 decembre 2004. L'age moyen des patients etait de 30 ans; et le sexe ratio de 1;33. La source probable de contamination a ete alimentaire et/ou hydrique dans 92des cas. La duree de l'epidemie a ete courte (75 jours). Le debut a ete brutal dans 98des cas; et la symptomatologie clinique dominee par la diarrhee aqueuse (95) et les vomissements (78). Le delai moyen d'hospitalisation etait de 11 heures et le nombre de selles emises avant l'admission superieur a 10 dans 23des cas. A l'admission; 119 malades (20;1) ont presente une deshydratation severe. Au total 250 coprocultures ont ete effectuees; dont 145 positives (58); mettant en evidence Vibrio cholerae O1 dans 112 cas (44). Les 36 souches testees aux antibiotiques ont montre une excellente sensibilite a la doxycycline et a la pefloxacine; mais aussi une resistance au cotrimoxazole; a l'amoxicilline et au chloramphenicol. La rehydratation par voie orale a ete la regle (61). La letalite a ete de 0;5. Le cholera est une urgence medicale dont le pronostic peut etre favorable a condition que l'organisation de la prise en charge soit bonne

[Efficacy and tolerance of non nucleosidic reverse transcriptase inhibitors containing tritherapy in HIV-1 infection]. / Efficacite et tolerance des tritherapies antiretrovirales comprenant un inhibiteur non nucleosidique de la transcriptase inverse du VIH-1.

INTRODUCTION: Antiretroviral therapy has dramatically changed the natural history of HIV infection. The aim of this study was to evaluate the effectiveness and tolerance of Non Nucleosidic Reverse Trancriptase Inhibitors containing regimens in HIV-1 infection. PATIENTS AND METHODS: This is a retrospective chart review of 257 HIV-1 infected patients followed in the infectious clinic ward of fann, from august 1998 to February 2002. RESULTS: Overall 195 patients (75.87%) were on efavirenz and 62 (25.2%) on nevirapine, with a male predominance (sex-ratio = 1.44). Baseline HIV-1 viral load was higher in efavirene group (p = 0.03). The two groups were comparable for immune restoration, tolerance, rate of treatment discontinuation and letality. The viral suppression was greater in efavirenz group at month 6 (p = 0.04). CONCLUSION: Non nucleosidic reverse transcriptase inhibitor containing regimens are effective and well tolerated. Those results make them suitable for first line therapy in HIV-1-infection.