La co-infection tuberculose-VIH chez l'enfant au Sénégal

Objectifs : Décrire les aspects épidémiologique, diagnostique, thérapeutique et évolutif de la co-infection tuberculose-VIH au Centre National d'Enfants Albert Royer (CHNEAR) de Dakar. Patients et méthode : Etude rétrospective, analytique et descriptive menée du 1er janvier 2000 au 31 décembre 2014. Tous les enfants âgés de 0 à 15 ans co-infectés par le VIH et tuberculose étaient inclus au CHNEAR. Les antécédents, les facteurs de risque, les données cliniques, bactériologiques et évolutives ont été recueillis et analysés grâce au logiciel SPSS version 16 (test du Chi2 : p < 0,05 était considérée comme statistiquement significative).Résultats : Un total de 99 cas de co-infection tuberculose-VIH ont été colligés parmi les 705 enfants infectés par le VIH au CHNEAR (soit une de fréquence de 14%). L'âge moyen des enfants était de 6,8 ans. Le sex-ratio de 1.3 était en faveur des garçons. La majorité (60,2%) des enfants étaient orphelins d'au moins un parent. Un contage tuberculeux était retrouvé chez 26 enfants. Les principaux terrains retrouvés étaient la malnutrition dans 48 cas, la dermatose dans 32 cas, la candidose dans 18 cas, l'otite dans 13 cas, la gastro-entérite aiguë dans 6 cas, la pneumonie dans 4 cas et la drépanocytose A/S dans 3 cas. La localisation pulmonaire était la plus fréquente dans 67 cas, suivie des atteintes ganglionnaires dans 28 cas et abdominales dans 11 cas et des formes multifocales dans 9 cas. La recherche de bacille acido-alcoolo-résistant était positive dans 15,5%. Tous les patients avaient bénéficié d'un traitement (antituberculeux, antirétroviraux (ARV), prophylaxie au cotrimoxazole). La létalité était de 16,2%. Les principaux facteurs de risque de décès retrouvés étaient l'âge (p = 0,0278), le sexe (p = 0.0018), et la localisation de la tuberculose (p = 0,0170). Conclusion : La co-infection tuberculose-VIH est très fréquente chez l'enfant au Sénégal, ceci malgré un accès gratuit aux ARV. Nous recommandons une vulgarisation de la chimioprophylaxie à l'isoniazide chez les enfants infectés par le VIH

[Epidemiological and clinical aspects of paediatric HIV infections in Albert-Royer Paediatric Hospital (Dakar, Senegal)]. / Aspects épidémiologiques et cliniques de l'infection à VIH de l'enfant au centre hospitalier national d'enfants Albert-Royer à Dakar.

UNLABELLED: Human Immunodeficiency Virus (HIV) infection prevalence rate is estimated at 1.4% in Senegal, and about 3,000 children could be infected. HIV positive children are followed up since 2000 in Albert Royer Hospital (Dakar, Senegal). OBJECTIVES: To describe clinical and epidemiological aspects of HIV paediatric infection, and to evaluate the implementation of high active antiretroviral therapy in HIV positive children in our country. POPULATION AND METHODS: Over a period of three years, the medical reports of 98 infected patients have been collected, 96% with HIV 1 infection. RESULTS: Most of the patients had a maternally transmitted HIV infection (99%). At their enrollment, the median age was 60 months; malnutrition (79%), persistent lymphadenopathy (65%) and skin lesions (64%) were the common clinical manifestations. Thirty-nine percent of the patients were in class C (CDC) and 81% had CD4 cell count< or =25%. Median viral load were 421,852 copies/ml at presentation. Seven infants had a rapid progressive disease with encephalopathy. Thirty-six patients received high active antiretroviral therapy with high observance and good tolerance. CONCLUSION: This study allowed to define clinical and biological profile of paediatric HIV infection in our country and to update the implementation of high active antiretroviral therapy.

[Management of children with sickle cell disease in Africa: experience in a cohort of children at the Royal Albert Hospital in Dakar]. / Prise en charge de la drépanocytose chez l'enfant en Afrique: expérience de la cohorte de l'Hôpital d'enfants Albert Royer de Dakar.

Management of major sickle hemoglobinopathies in industrialized countries has improved significantly over the last few years thanks to strict application of the preventive and curative measures developed as a result of a better understanding of the underlying pathophysiological mechanisms. However patients in Africa have benefited little from progress in the field due to the lack of human and physical resources in sharp contrast with the high prevalence of the disease. The purpose of this study was to analyze problems involved in management of childhood sickle cell disease in Africa based on our experience in a cohort of 556 cases treated over a period of 12 years. The main problems were the same as those encountered in other black African nations, i.e., delayed diagnosis due to a lack of routine neonatal diagnostic screening, difficulty implementing anti-infectious prophylaxis due not only to the high cost of recommended vaccinations not covered by the Expanded Program on Immunization but also to poor compliance with antiobioprophylaxis, and insufficient transfusion facilities hindering application of long-term transfusion protocols when indicated. In addition the high prevalence of digestive-tract parasitosis and malaria raise the need to combine standard preventive measures with routine parasiticidal treatment and malarial prophylaxis adapted to each geographical area. The high frequency of associated iron deficiency requires systematic laboratory testing to identify and treat resulting manifestations during follow-up. An important prerequisite for widespread implementation of appropriate preventive and curative measures in Africa is recognition of sickle cell disease as a priority in public health care policy.

[Management problems of malignant hemopathies among children in Senegal]. / Problèmes posés par la prise en charge des hémopathies malignes chez l'enfant au Sénégal.

Malignant hemopathies are not considered as public health priority in Senegal because of their infrequency in comparison with infections and malnutrition. However they remain usually lethal instead of a great improvement of their prognosis in suitable therapeutic conditions. The objective of this study was to determine the epidemiologic and evolutionnal profile of these pathologies, and identify practical management problems in a reference public pediatric service in Senegal. We retrospectively analysed hospitals registers and records of all patients followed up in Albert Royer Children Hospital of Dakar from january 1989 to december 1998. During this ten years period 25 cases of malignant hemopathies were diagnosed among 32,789 hospitalised children, representing an hospital prevalence of 0.08 per cent. Mean age at the desease diagnosis was 9.5 years and sex ratio 2.57 (18 boys and 7 girls). The malignant type was acute leukemia (AL) in 11 cases (44%) including 9 cases of of acute lymphoblastic leukemia (ALL) and 2 cases of acute myeloblastic leukemia (AML); chronic myeloid leukemia (CML) in 2 cases (8%), Hodgkin's desease (HD) in 9 cases (36%) and non hodgkinian lymphoma (NHL) in 3 cases. NHLwere Burkitt type in 2casesand lymphoblastic type in 1 case. Their was no maxillary or facial localisation in Burkitt type lymphoma. The mean duration between the first clinical symptomes and the diagnosis of the disease was 4 months and delayed diagnosis was mainly due to delayed transfer from peripheral health services to hospital. Among 19 patients whose records were available, 17 were subjected to chemotherapy. However reference protocols were completely applyed in only 2 cases, one with HD and an other with lymphoblastic lymphoma. Transfusion managementwas not sufficient because of the lack of blood derived products (packed platelets or leucocytes) when needed. Thirteen patients died while followed up and mean survival after first hospitalisation in these cases was 120 days in ALL, 38 days in AML, 2.5 years in HD and 18 months in NHL The other patients were lost of sight and presumed to be dead at home. Eventually, this study showed that, in our hospital, children with malignant hemopathies did not derive benefit of therapeutic progress enregistered long time ago in developed countries, since they remain constantly lethal. The main factors of lethality could be delayed transfer to hospital because of lack of knowledge about these pathologies in the peripheral health services and poor therapeutic conditions in reference hospitals. Creation of specialised clinical haematology department could enable us to improve the prognosis of these affections by an optimal use of available human and material ressources.

[Empyema caused by Staphylococcus aureus in children: the experience of the Albert Royer Children's Hospital at Fann University Hospital, Dakar]. / Pleurésies purulentes à staphylocoque doré de l'enfant. Expérience de l'hôpital d'enfants Albert-Royer du CHU de Fann à Dakar.

We report a retrospective study of 58 cases of empyema caused by Staphylococcus aureus at the Albert Royer Children's Hospital at the Fann University Hospital, between January 1st 1992 and December 31st 1995. Staphylococcus aureus is the principal bacterium responsible for pleural effusions in children (54%), way ahead of Streptococcus pneumoniae (19%). Most of the children affected (86%) are less than 30 months old. Theses infections are often serious due to the resistance of the bacterium to the usual antibiotics, the lack of solid research data and mechanical complications associated with the effusion. Treatment is based on the use of an appropriate bactericidal antibiotic treatment and pleural drainage.

[Sickle cell disease in children in Dakar, Senegal]. / Les syndromes drépanocytaires majeurs en pédiatrie à Dakar (Sénégal).

AIM OF THE STUDY: To determine the socioeconomic, clinical and biological aspects of sickle cell disease (SCD) in Senegalese children and adolescents, we retrospectively analysed all records of follow-up attending patients in the Albert Royer Children Hospital of Dakar (Senegal). RESULTS: Homozygous sickle cell (SS) was the most frequent genotype (307 cases). Sickle cell hemoglobin C (13 cases) and sickle cell beta-thalassemia (three cases) were uncommon. Patients were aged from five months to 22 years (mean age: eight years). Most of them came from poor families. The mean number of children was five in patients' families, with at least two cases of SCD in 60% of them. Immunization against hepatitis B virus (10.2%), Haemophilus influenzae b (8.4%), Salmonella (8.7%) and Streptococcus pneumoniae (21.4%) was insufficiently performed, because of its relatively high cost. Only 30% of the patients had received a blood transfusion. Painful crises occurred less than three times a year in 74% of the cases. Complications such as acute chest syndrome (1%), stroke (1%), cholelithiasis (9%), meningitis (0.4%), septicemia (2%) and osteomyelitis (6%) were rare. Mean steady state hemoglobin (Hb) and hemoglobin F(HbF) levels were 8.27 +/- 1.36 g/dL and 6.8 +/- 5.9% respectively among SS patients. No correlations were found neither between Hb and HbF nor between these parameters and the frequency of complications. Eleven patients (1.1% per year of follow-up) died, and infection was the main cause of death (73%). CONCLUSION: In comparison with published data, SCD seems to have mild severity in Senegalese children and adolescents in spite of poor follow-up conditions. In addition to genetic factors, environmental factors might have an important role in disease tolerance.

[Cholelithiasis and homozygote drepanocytosis in children in Dakar (Senegal)]. / Lithiase biliaire et drépanocytose homozygote en pédiatrie à Dakar (Sénégal).

BACKGROUND: Cholelithiasis is a well recognized complication of sickle-cell anemia (SCA) because of chronic hemolysis. It is usually asymptomatic but may result in acute cholecystitis or cholangitis. The aim of this study was to assess prevalence of cholelithiasis and its associated factors among Senegalese children and adolescents with SCA. PATIENTS AND METHODS: We analyzed the follow-up records and results of systematic clinical, biological and ultrasonographic examinations in 106 patients with SCA aged 11 months to 22 years (median: 10 years, 6 months), followed up in the Albert-Royer Children's Hospital (Dakar). RESULTS: Cholelithiasis was detected in 9.4% of the patients. Gender, ethnic group, geographic origin and socioeconomic conditions did not have any association with cholelithiasis frequency. The youngest patient with cholelithiasis was 7 years old, and prevalence of cholelithiasis increased with age. The mean age at the beginning of SCA follow-up was higher among patients with cholelithiasis. They were more frequently transfused and tended to present more frequent pain crises and other complications of SCA. We found no spontaneous clinical manifestations attributed to cholelithiasis. Nevertheless, provoked right upper quadrant pain was more frequently observed in patients with cholelithiasis. Fetal hemoglobin, steady-state hemoglobin, reticulocytes count, serum bilirubin, alkaline phosphatase and transaminase levels were not significantly different in these patients, compared to the others. However, those with cholelithiasis had significantly higher mean red cell volume. CONCLUSION: Prevalence of cholelithiasis appears relatively low in Senegalese patients with SCA, probably owing to the tolerance of the Senegal haplotype. Advanced age and severe chronic hemolysis are etiologic factors in evidence. We recommend systematic abdominal ultrasound at least once a year for patients older than 5 years, or when right upper quadrant pain is observed. Cholecystectomy should be performed in cases of cholelithiasis in order to prevent complications.

[Burkholderia cepacia isolation and characterization from hospital infections]. / Isolement et caractérisation de Burkholderia cepacia à l'origine d'infections hospitalières.

The evolution of reanimation and functional exploration techniques has led to and explosion of nosocomial infections. They are prevailing in Intensive Care and Neonatal Units. This study deals with B. cepacia strains isolated in 1996 in a pediatric hospital of the Dakar University Hospital Center, following the installation of tracheo-bronchial exhausters which are used for obstruction removal among children. The 44 B. cepacia strains examined come from 42 blood cultures done among 29 boys and 13 girls aged between 5 days and 7 years, and from 2 exhausters. After identification by API20 NE (bio Merieux), a standard antibiogram, a 3 characters biotyping (O.N.P.G., esculin, nitrate reductase) and a study of the polymorphism of the DNA enzymatic restriction profile obtained by an pulsed field electrophoresis are performed on the isolates. The contamination come from the exhausters. All the strains produce an orange-colored yellow pigment. Only an O.N.P.G. (+), nitrate reductase (+) biotype was identified. The antibiotic susceptibility profile is almost pathognomonic for the 44 tested strains: sensitivity (100%) to ceftriaxone, to ceftazidime, to aztreonam: to contrimoxazole (96%) and to chloramphenicol (91%). Search for widen spectrum beta-lactamses and antibiotics resistance plasmids was negative. However, those strains that are multiples resistant, discharge others 8.1. isofocal point beta-lactamases. The R.F.L.P. study demonstrated a unique profile. The B. cepacia transmission is the result of the installation of medical reanimation equipment that are not well taken care of. The nosocomial infections ascertained so far are ordinary bacteremias. Strain's phenotypical and genotypical identification shows the presence of only one clone. To overcome there nosocomial infections, hygienic measures have to be reinforced.

[Risk factors for low birth weight: influence of maternal age, parity, gestational age, nutritional status and maternal pathology]. / Facteurs de risque du petit poids de naissance: influence de l'âge maternel, de la parité, de la gestité, de l'état nutritionnel et de la pathologie maternelle.

A retrospective study carried on between april 1st and september 31st 1997 has helped in collecting. 69 cases of low birth weight new-born (weight < 2500 g) at Abass Ndao hospital center in Dakar. The above population has been compared to 79 eutrophic new-born of mean birth weight equal to 3047.7 +/- 311 g (witnesses). The goal of this study is to appreciate the relationship between the maternal age, the number of the gestation, the parity, the nutritional status, the maternal pathologies during pregnancy and the low weight at birth. There was no difference between both groups as regards to the mean age (p = 0.44), the mean number of gestation (p = 0.7) and the mean parity (p = 0.48). On the other hand, the weight of the mother is smaller as for the group of low birth weight but the mean body mass index stand at normal in both groups. The pathologies during pregnancy period were obviously more frequent in the group of low birth weight new-born. There is a real need to insist on the preventive measures to be taken and the treatment of the maternal pathologies during pregnancy.

[Staphylococcus aureus purulent pleurisy in children. Experience of the Albert Royer Hospital for Children of the Fann University Hospital Center in Dakar]. / Pleurésies purulentes à Staphylococcus aureus de l'enfant. Expérience de l'Hôpital d'Enfants Albert Royer du CHU Fann à Dakar.

The authors report here by a retrospective study 58 cases of Staphylococcus aureus empyema at Albert ROYER child hospital located in the Fann University Teaching Hospital of Fann between January 1st 1992 and December 31, 1995. In this study staphylococcus aureus is the bacterium involved in pleural effusions of the children (54%) a long way ahead Streptococcus pneumoniae (16%). Infant less than 30 month is more affected (86%). The average age of the patients is 16.8 month +/- 16.6. The resistance of the germ to usual antibiotics, the precariousness of the research field and mechanical complications linked to the outpouring explain their seriousness. The treatment lies upon an adapted antibiotic and bactericidal therapy associated to closed chest tube drainage.

[Facial nerve paralysis in the newborn infant: apropos of 8 cases]. / Paralysie faciale néonatale: à propos de 8 observations.

The authors report 8 cases of facial palsy collected in the Abass Ndao hospital center. Risk factors are dominated by the instrumental manipulations during delivery. Prognosis is however generally good.

[Purulent pleurisy in the child]. / Pleurésies purulentes de l'enfant.

We studied 122 cases of empyema in children. The mean age was 3 years. We found malnutrition in 33% of the patients. 60% of them had large pleural effusion and 56% associated pneumonia. Staphylococcus aureus (51%) and Streptococcus pneumoniae (18%) were the most frequently isolated bacterias in pleural fluid. The mortality rate was 6.5%. 53% of the children had closed chest tube drainage. There were minor abnormalities in pulmonary function tests. The best treatment of empyema in children is closed chest tube drainage and an antimicrobial therapy with antistaphylococcus antibiotic.

[Congenital adrenal hyperplasia apropos of 7 cases at the University Hospital Center of Dakar]. / L'hyperplasie surrénale congénitale à propos de 7 observations au CHU de Dakar.

The authors depict the main clinical tables relating to endocrine and cytogenetic study on 7 confirmed cases and stress the difficulties they faced taking care of these children. These were dominated by: the unavailability of sufficient suitable medicine; and the absence of complementary examinations indispensable for biologically checking the children treated and for their therapeutic readjustment.