Arrêt cardio-respiratoire de l'enfant. Aspects épidémiologiques, thérapeutiques et pronostiques au Sénégal

Introduction : L'Arrêt Cardio-Respiratoire (ACR) est un évènement fréquent dans les services d'urgences et de réanimation pédiatrique. Bien que de nombreuses données soient rapportées dans plusieurs régions du monde, peu sont disponibles en Afrique subsaharienne. L'objectif de cette étude était d'évaluer les aspects épidémiologiques, thérapeutiques et le pronostic des enfants victimes d'ACR au CNHEAR.Patients et méthodes : Il s'agissait d'une étude prospective sur 1 an, concernant les enfants âgés de 0 à 15 ans, ayant présenté un ACR et bénéficié de manœuvres de réanimation au CNHEAR. Les données ont été saisies et analysées avec le logiciel Epi info 3.5.4 et SPSS 24.0. Résultats : Cent-soixante-dix-neuf (179) cas d'ACR ont été enregistrés. Les motifs de consultation les plus fréquents étaient la fièvre et la détresse respiratoire (38,5% chacun). Le délai de consultation moyen était de 3,5 jours. Quarante-neuf virgule sept pour cent (49,7%) avaient consulté dans une structure périphérique avant d'atteindre le niveau central et 13,9% étaient transportés par un transport médicalisé. Les principales circonstances ayant conduit à l'ACR étaient la détresse respiratoire (45,2%), la défaillance hémodynamique (48,7%), et les troubles métaboliques (19,6%). Les pathologies sous- jacentes étaient dominées par le sepsis 20,1%. Au plan thérapeutique, 71,5% avaient eu un massage cardiaque externe. Au décours de la réanimation initiale, le retour à une activité cardio-circulatoire spontanée était de 60,9%. L'évolution secondaire était marquée par la récidive de l'ACR chez 71,6% et finalement le décès de 85,3%. Au final, sur les 179 enfants ayant fait un ACR et bénéficié d'une réanimation, 16 (8,9%) ont survécu et ont été suivis en ambulatoire.Conclusion : La survie après ACR pédiatrique au Sénégal est faible. Des efforts importants restent à faire, notamment une amélioration des ressources matérielles ainsi que des compétences et la formation continue des praticiens en vue d'une meilleure prise en charge des enfants gravement malades

Simulation training for emergency obstetric and neonatal care in Senegal preliminary results.

To describe a new training approach for emergency obstetric and neonatal care (EmONC) introduced in Senegal to strengthen the skills of healthcare providers. The approach was based on skills training according to the so-called "humanist" method and on "lifesaving skills". Simulated practice took place in the classroom through 13 clinical stations summarizing the clinical skills needed for EmONC. Evaluation took place in all phases, and the results were recorded in a database to document the progress of each learner. This approach was used to train 432 providers in 10 months and to document the increase in each participants' technical achievements. The combination of training with the "learning by doing" model ensured that providers learned and mastered all EmONC skills and reduced the missed learning opportunities observed in former EmONC training sessions. Assessing the impact of training on EmONC indicators and introducing this learning modality in basic training are the two major challenges we currently face.

Amplification of blood smear DNA to confirm disseminated histoplasmosis.

BACKGROUND: The prevalence of the Histoplasma capsulatum var. capsulatum (Hcc) histoplasmosis may be underestimated West Africa, both because the diagnosis is not mentioned in the early stages of the disease and due to limited biological resources available. CASE REPORT: We report a case of disseminated histoplasmosis due to Hcc in a Senegalese HIV patient. The diagnosis was suspected following the demonstration of small encapsulated yeasts within neutrophils on a thin blood smear. It was further confirmed using a specific real-time PCR applied on a DNA specimen extracted from the thin blood smear. CONCLUSION: To the best of our knowledge, this is the first case of Hcc infection diagnosed in Senegal. Blood smear may be a valuable screening tool in the case of bloodstream dissemination and can be used for further molecular approaches to confirm the diagnosis.

Mortalité pédiatrique au Centre Hospitalier Régional de Saint-Louis (Sénégal)

Introduction : La mortalité infantile notamment la mortalité infanto-juvénile demeure encore élevée en Afrique sub-saharienne malgré une baisse considérable. Les objectifs de notre étude étaient d'évaluer la mortalité hospitalière globale et spécifique en fonction des tranches d'âge (nouveau-né, enfants de moins de 5 ans et enfants âgés de 5 ans et plus) et d'identifier les principaux facteurs de mortalité dans ces différents âges. Matériel et méthodes : Il s'agissait d'une étude rétrospective, descriptive et analytique allant du 1er janvier 2015 au 31 décembre 2015. Elle portait sur l'exploitation des registres de consultation, d'hospitalisation et sur l'analyse des dossiers des enfants décédés âgés de 0 à 15 ans Résultats : Durant l'année 2015, le service avait enregistré 6487 consultations et le nombre d'hospitalisations s'élevait à 2458 enfants. Le nombre de décès enregistré était de 212, mais seuls 193 dossiers d'enfants décédés ont été colligés, le reste des dossiers n'a pas été retrouvés. La mortalité hospitalière globale était de 8,6% et la mortalité spécifique en fonction des tranches d'âge montrait une surmortalité néonatale de 13,9%, une mortalité infanto-juvénile de 8,6% et une mortalité chez les enfants de plus de 5 ans de 3,5%. Les facteurs de mortalité chez les nouveau-nés étaient dominés par la prématurité 32,5%, suivie par la Souffrance Néonatale (SNN) 27,1% et les infections néonatales (INN) 22,4%. Chez les enfants d'un mois à 5 ans, les facteurs de mortalité prédominants étaient la Malnutrition Aiguë Sévère (MAS) compliquée 30%, les Infections Respiratoires Aiguës (IRA) 30% et les méningites purulentes 14%. Conclusion : La réduction de la mortalité néonatale et infanto-juvénile dans notre contexte doit passer par le recrutement en personnels qualifiés (pédiatres, obstétriciens, sages-femmes…), la création d'unité de néonatologie au niveau des EPS de niveau 1, le relèvement du plateau technique des structures hospitalières et la lutte contre la pauvreté et l'amélioration du niveau de vie des populations

[Pneumocystis pneumonia biological diagnosis at Fann Teaching Hospital in Dakar, Senegal]. / Diagnostic biologique de la pneumonie à Pneumocystis au centre hospitalier universitaire de Fann, Dakar, Sénégal.

BACKGROUND: Data relative to Pneumocystis pneumonia in sub-Saharan Africa are not well known. Weakness of the technical material and use of little sensitive biological tools of diagnosis are among the evoked reasons. The objective of this study is to update the data of the disease at the Fann Teaching Hospital in Dakar and to estimate biological methods used in diagnosis. MATERIALS AND METHODS: A descriptive longitudinal study was carried out from January 5th, 2009 to October 31st, 2011 in the parasitology and mycology laboratory of the Fann Teaching Hospital in Dakar. The bronchoalveolar lavages received in the laboratory were examined microscopically for Pneumocystis jirovecii by indirect fluorescent assay or after Giemsa or toluidine blue O staining. RESULTS: One hundred and eighty-three bronchoalveolar lavages withdrawn from 183 patients were received in the laboratory. Sixteen were positive for P. jirovecii at 9% frequency. Four among these patients were HIV positive. Indirect fluorescent assay allowed finding of P. jirovecii among 16 patients while Giemsa staining discovered P. jirovecii only in a single patient. No case was diagnosed by toluidine blue O staining. CONCLUSION: Pneumocystis pneumonia in Parasitology and Mycology Laboratory of Fann Teaching Hospital at Dakar was mainly diagnosed among HIV patients.

[Evaluation of the efficacy and safety of three 2-drug combinations for the treatment of uncomplicated Plasmodium falciparum malaria in Senegal: artesunate-amodiaquine, dihydroartemisinin-piperaquine, and artemether-lumefantrine]. / Évaluation de l'efficacité et de la tolérance des combinaisons artésunate-amodiaquine, dihydroartémisinine-pipéraquine et artéméther-luméfantrine pour le traitement du paludisme à Plasmodium falciparum non compliqué au Sénégal.

BACKGROUND: Since 2006, artemisinin-based combination therapies (ACT) have been used to treat uncomplicated Plasmodium falciparum malaria in Senegal, as recommended by WHO. Recently, decreased parasite clearance with artemisinin derivatives has been reported in Cambodia and Thailand. The effectiveness of artemisinin derivatives in Africa must be monitored. This study was conducted to evaluate the efficacy and the tolerability of three ACT widely used in Senegal. METHODS: From October 2010 to February 2011, a descriptive and analytical sequential study was conducted in adults and children to evaluate these three combinations: artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ), and dihydroartemisinin-piperaquine (DHAPQ). The study took place at the health posts of Deggo and Pikine and the health center of Guédiawaye, in the suburbs of Dakar. The primary endpoint was the PCR-corrected adequate clinical and parasitological response (ACPR) at day 28 (D28); the secondary endpoints included ACPR at D42, clearance times for parasites, fever, and gametocytes, and the incidence of adverse events. RESULTS: The study included 393 patients: 139 in the AL group, 130 in the ASAQ group, and 124 in the DHAPQ group. In the intent-to-treat population, PCR-corrected ACPR at day 28 was 92.8% in the AL, 89.2% in the ASAQ, and 91.1% in the DHAPQ (p = 0.58) groups, and in the per-protocol population, 98.4%, 98.3%, and 100% respectively (p = 0.39). At D42, ACPR was 99.2% in the AL, and 99.1% in each of the ASAQ and DHAPQ arms (p = 1). No early therapeutic failure (ETF) was observed. The combinations were well tolerated, with no serious adverse events reported during the follow-up period. CONCLUSION: These combinations are still effective and well-tolerated. Continued monitoring is nonetheless essential to detect early artemisinin resistance in Africa.

La détresse respiratoire du nouveau-né à terme au service de néonatologie du Centre hospitalier d'enfants Albert Royer de Dakar, Sénégal

Introduction : La Détresse Respiratoire (DR) est fréquente en néonatalogie, souvent liée à des difficultés d'adaptation ou à l'infection. Objectifs : Décrire les aspects épidémiologique, clinique, thérapeutique et pronostique de la détresse respiratoire du nouveau-né à terme au service de néonatologie Centre hospitalier National d'Enfants Albert Royer de Dakar (CHNEAR).Patients et méthode : Etude rétrospective, descriptive du 1er janvier au 31 décembre 2014, concernant les nouveau-nés à terme hospitalisés pour détresse respiratoire. Résultats : Nous avons colligé 214 cas de DR, soit une fréquence de 34,8% des nouveau-nés à terme. Le sex-ratio était de 1,06 et l'âge moyen de 8,5 jours. L'accouchement était fait par césarienne dans 39 cas (18,2%) et 132 nouveau-nés (61,5%) étaient eutrophiques. Une réanimation en salle de naissance avait été nécessaire pour 86 nouveau-nés (40,2%). La DR était précoce en salle de naissance dans 75 cas (35,0%) et 107 nouveau-nés (50%) étaient admis avant 48 heures de vie. Le transfert était fait par transport en commun dans 92 cas (42,8%). La DR était sévère chez 102 nouveau-nés (47,7%). La SpO2 moyenne était de 78% sous oxygène à l'admission. Les principales étiologies étaient l'infection néonatale (118 cas ; 55,1%), l'asphyxie périnatale (53 cas ; 24,8%), l'inhalation méconiale (30 cas ; 14,0%), les cardiopathies congénitales (29 cas ; 13,5%), la bronchiolite aiguë 20 cas ; (9,3%), l'atrésie des choanes (9 cas ; 4,2%). Une ventilation artificielle était réalisée pour 45 nouveau-nés (21,0%). La létalité était de 31,8% (68 décès). Cette létalité était significativement associée à l'existence d'une détresse respiratoire en salle de naissance (p = 0,007 ; OR 2,2), d'une hypertension artérielle pulmonaire (p <0,001 ; OR 5,1), d'un pneumothorax (p < 0,001 ; OR 3,3), d'une inhalation méconiale (p = 0,006 ; OR 4,0), et d'une cardiopathie congénitale (p = 0,004 ; OR 3,7). Conclusion : Les détresses respiratoires néonatales sont fréquentes et sont associées à une létalité élevée. La prise en charge en salle de naissance, pendant le transfert et en néonatologie doit être améliorée

Maladie de Caroli à révélation précoce. A propos d'un cas au service de néonatologie du Centre Hospitalier Abass Ndao de Dakar

Introduction : La maladie de Caroli est une maladie hépato-biliaire d'origine génétique rarement diagnostiquée en pédiatrie. Nous en rapportons un cas observé au service de néonatologie du centre hospitalier Abass Ndao de Dakar. Observation : Il s'agissait d'un nourrisson de 6 mois, de sexe féminin, hospitalisé pour une cholestase évoluant depuis la période néonatale. Une notion de consanguinité était notée chez les parents. L'échographie abdominale et l'IRM ont permis de confirmer le diagnostic de maladie de Caroli en montrant une dilatation kystique des voies biliaires intra-hépatiques. L'évolution a été défavorable chez notre patiente qui est décédée à domicile dans un tableau de sepsis sévère et d'hémorragie.Conclusion : La maladie de Caroli est une des affections à ne pas méconnaître devant une cholestase du nourrisson

Drépanocytose chez l'enfant. Profils clinique et évolutif à propos de 138 cas suivis au Service de Pédiatrie de l'Hôpital Abass Ndao de Dakar

Introduction : La drépanocytose est une maladie héréditaire autosomique récessive de l'hémoglobine. C'est l'hémoglobinopathie la plus répandue dans le monde. Elle touche particulièrement l'Afrique subsaharienne. Sa révélation est souvent précoce chez le jeune nourrisson et son évolution chronique est émaillée de complications altérant la qualité de vie.Objectif : Caractériser le profil clinique et évolutif des enfants suivis pour syndrome drépanocytaire majeur, afin d'améliorer leur qualité de vie et de prolonger leur survie.Patients et méthodes : Il s'agissait d'une étude rétrospective, descriptive ayant concerné tous les patients suivis dans notre service pour une drépanocytose du 1er janvier 2010 au 31 avril 2015.Résultats : Cent trente-huit patients étaient suivis avec un sex-ratio (H/F) de 1,42, un âge moyen de 8,26 ans (DS = 4,06). La majorité provenait de Dakar (65,1%) suivie de la région de Diourbel, puis de Matam avec respectivement 10,3% et 8,7% des cas. Les aînés étaient plus représentés avec 35,8% des cas et la fratrie moyenne était de 3,4 enfants par famille (DS 2,09). Une consanguinité parentale était retrouvée dans 50% et concernait le premier degré dans 46,7% des cas. L'âge moyen au diagnostic était de 52,61 mois (DS 39,8). Les circonstances de découverte étaient dominées par les douleurs ostéo-articulaires (34,8%), le syndrome pieds-mains (14,5%) et l'anémie (10,2%). A l'admission, 62,9% des patients avaient un index de masse corporelle insuffisant par rapport à l'âge. Trois types de profil d'hémoglobine ont été retrouvés : SS (94,7%), SC (4,5%) et un cas de S bêta thalassémie. Le traitement était essentiellement une supplémentation en acide folique (98,6%) et en fer (20,4%) et seulement deux patients étaient sous hydroxyurée.Une antibioprophylaxie par la pénicilline V orale était administrée dans 74,1% des cas. Pendant les phases de crises, la prise en charge était basée sur les antalgiques (81,9%), l'hydratation avec des solutés glucosés 5% (71%), des antibiotiques surtout les bêtalactamines et les quinolones (60,9%), la transfusion (30,4%) et la chirurgie (1,7%). Les complications étaient la crise vaso-occlusive (83,3%), les infections (54,3%) et la déglobulisation aiguë (26,1%). Un décès était noté. Les perdus de vue concernaient 41,7% des cas.Conclusion : Les complications de la drépanocytose chez l'enfant restent dominées par les crises vaso-occlusives et les infections. Il est alors capital de mettre l'accent sur la prévention primaire et secondaire afin d'améliorer la qualité de vie de ces patients

[Profile of cytokines associated with protection against malaria episodes during pregnancy in hypo-endemic area in Senegal]. / Profil des cytokines associées à la protection contre les accès palustres au cours de la grossesse en zone hypo-endémique au Sénégal.

BACKGROUND: Malarial infection in non immune pregnant women is a major risk factor for pregnancy failure. However in malaria endemic areas, intermittent preventive treatment (IPTp) have been adopted to prevent malaria in pregnancy women since 2003 in Senegal. The impact of IPT on the development of immunity is not very well documented. We conducted a prospective study at the Roi-Baudouin maternity hospital of Guediawaye in Senegal to assess IL10, IL12, TNFα and IFNγ cytokines production in pregnant women under IPTp. Cytokines were analyzed in 82 sera at inclusion and delivery. P. falciparum HRP2 antigen was detected in 17% of women included by rapid diagnostic test (RDT). At inclusion the mean of IL10 response was higher in P. falciparum negative women (8 UA) compare to RDT-positive women (7 UA) p=0.069 while in delivery the opposite was found p=0.014. Low production of inflammatory cytokines IL12, IFNγ and TNFα was noted in both groups. Between inclusion and delivery, a significant increase of IL-10 production was noted while a decrease of IFNγ and TNFα cytokine was noted. Thus, IL12 and IFNγ responses may synergistically associate as malaria immune response during pregnancy.

[Cryptosporidiosis in Senegalese children: prevalence study and use of ELISA serologic diagnosis]. / La cryptosporidiose de l'enfant au Sénégal : étude de la prévalence et apport du diagnostic sérologique par ELISA.

This is a prospective, descriptive and analytic study conducted from July 2011 to September 2011 at the Children National Hospital Albert Royer of Dakar and at the Vélingara Health District. It was focused on children under 15 without reference to HIV status. For each child, a sample of stool was examined by the Ziehl-Neelsen modified staining and by ELISA using the "Cryptosporidium Antigen Detection Microwell ELISA kit" designed to detect Cryptosporidium spp antigens. The aim of our study was to determine the prevalence of cryptosporidiosis in rural and hospital areas and to measure the performance of the ELISA kit that we used. Out of the 375 stool examinations performed with the Ziehl-Neelsen modified staining, 17 had revealed the presence of Cryptosporidium spp (4.53%). The prevalence in rural areas was 2% while the hospital prevalence was 7.4%, of which 1.8% (1/57) were from urban areas and 9.8% (12/122) from suburban areas. No positive case was observed in children over 10 years. By ELISA, 23 positives cases were reported corresponding to a prevalence of 6.13% (1.8% in children living in urban areas, 13.1% in children from suburban areas and 3%living in rural areas).The correlation of this assay with the Ziehl-Neelsen modified staining, considered as the reference method, found that this assay had a sensitivity of 58.82% and a high specificity reaching 96.37%. The positive predictive value (PPV) was 43.4% while the negative predictive value was 98%. Cryptosporidiosis is a significant cause of parasitic infection among children in Senegal. Antigen detection of Cryptosporidium spp by ELISA in stool can be a complementary tool in the diagnosis of cryptosporidiosis.

[Identification of three Candida africana strains in Senegal]. / Identification de trois souches de Candida africana au Sénégal.

JUSTIFICATION: The frequency of candidiasis has increased dramatically in recent years. Candida albicans is the most common species. However, other species which are pathogenic and resistant to usual antifungal agents beginning to emerge. These include Candida dubliniensis and Candida africana, which share morphological similarities with Candida albicans. Thus, it is of interest to correctly identify the fungal isolates. OBJECTIVE: To seek these new species among Candida strains isolated in Dakar. MATERIAL AND METHODS: Oropharyngeal and vaginal swabs were performed at Fann Universitary Hospital in Dakar. The strains were identified by the germ tube test, the chlamydospore production test and an auxanogram. Then identification by PCR targeting the hyphal wall protein 1(hwp1) gene, was performed for the discrimination between Candida albicans, Candida dubliniensis and Candida africana. RESULTS: In total, 243 yeasts were isolated from samples including 231 in vaginal swab and 12 in oropharyngeal swab. Species identified by phenotypic methods are Candida albicans, which is the most frequent, Candida tropicalis, Candida glabrata, Candida dubliniensis, Candida kefyr and Candida lusitaniae. PCR performed on the 150 strains germ tube test positive identifies three Candida africana, 109 Candida albicans and no strain of Candida dubliniensis. CONCLUSION: This study isolates Candida africana for the first time in Senegal. Further studies on a larger sample will better know the actual proportion of these three species among the isolated yeasts.

[Effect of intermittent presumptive treatment with sulfadoxine-pyrimethamine on the acquisition of anti-VAR2CSA antibodies in pregnant women living in a hypoendemic area in Senegal]. / Influence du traitement présomptif intermittent par la sulfadoxinepyriméthamine sur l'acquisition d'anticorps anti-VAR2CSA chez la femme enceinte vivant en zone hypoendémique au Sénégal.

The impact of intermittent presumptive treatment (IPT) on the immunity of pregnant women in Senegal is still not very well known. We conducted a prospective study at the Roi-Baudouin maternity of Guediawaye in Senegal to assess IgG antibodies production against MSP1, GLURP and DBL5 in pregnant women under IPT. Blood samples were collected from the participating women at inclusion and delivery. Samples were analyzed after centrifugation for the detection of IgG antibodies in sera by Elisa. Informed consent was given by each study participant prior to their inclusion. A total of 101 eligible women aged from 18 to 44 were included in this study. Multigravidae women represented 70.3% of the study population, whereas primigravidae accounted for 29.7%. The IgG level decreased slightly from inclusion to delivery for the women with regard to anti-MSP1 (83.1at inclusion versus 79.5 at delivery, p = 0.52) as well as anti-GLURP-R2 (84.1 at inclusion versus 75.9 at delivery, p = 0.16). After adjustment for number of pregnancies, there was a significant decrease in the production of anti-VAR2CSA between inclusion and delivery (p < 0.05). By reducing the incidence of malaria during pregnancy, IPT reduced the acquisition of placental parasites antibodies suppressors which could delay the development of protective immunity against malaria. The application of IPT in pregnant women would thus be more appropriate in hypoendemic areas where malaria exposure is lower.

[Parasitic and bacterial etiologies of diarrhea among people living with HIV hospitalized in Fann hospital (Senegal)]. / Etiologies Bacteriennes Et Parasitaires De Diarrhees Chez Les Personnes Vivants Avec Le VIH/SIDA Au Chnu De Fann (Senegal).

Diarrhea is the most common opportunistic infection in AIDS. We conducted at the Fann National University Hospital in Dakar, a study of all patients living with HIV, hospitalized in the the Clinical service of Infectious Diseases from 1 January 2003 to December 31, 2006, with diarrhea and having received an bacteriological and / or a parasitological examination of stools. The aim of this study was to identify the various pathogens isolated in the laboratory and responsible for those diarrhea. In total, 351 patients were collected, their average age was 39.93 years and the extreme ages 15 and 72 years. HIV1 serological profile was found in 90.77% of patients; 34.42% of patients received a dosage of CD4 count, among them 21.09% had a rate <200/mm3. Fifteen stool cultures were positive with the following breakdown: - Shigella (10 strains): 7 strains of Shigella flexneri, 2 of Shigella sp, one of Shigella sonnei; antibiotics most active on the Shigella strains were third generation cephalosporins and quinolones. - Salmonella (5 strains) with Salmonella Typhimurium and Salmonella Enteritidis, strains sensitive to an association of amoxicillin + clavulanic acid, to cephalosporins and to ciprofloxacin. 289 patients received a parasitological examination of the stools (KOP) and the positive number of KOP was 90 a 30,14% rate. The parasites most frequently found were: Cryptosporidium parvum, representing 10.38% of positive KOP, Isospora belli 6.23%, and Entamoeba coli 5.19%. These parasites were found predominantly in patients infected with HIV1 (61 cases/90). Cases of cobacterial and parasitic co-infections were also found. Diarrhea is one of the leading causes of death among people living with HIV. The etiologies of diarrhea, multiple, are yet to be identified and this should go through an improvement of the technical capacity and quality of our laboratories.

[Parasitic and fungal neuroinfections at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar]. / Neuro-infections parasitaires et mycosiques a la clinique des maladies infectieuses du Chu de Dakar.

OBJECTIVES: This retrospective study was carried out to describe the epidemiological, clinical and aetiological profile of parasitic and fungal neuroinfections at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar. PATIENTS AND METHODS: Data were collected for analysis from patients files recorded from January 1, 2001 to December 31, 2003. RESULTS: We found 126 cases of parasitic and fungal neuroinfections, representing 62% of the total of neuroinfections cases (126/203) and 27% of cerebro-meningeal diseases encountered at the clinic during the study period (126/470). Sex ratio M/F was 1.7 and the mean age of patients was 32 years +/- 14.4. Thirty seven patients (30%) were HIV seropositive. Aetiologies were represented by cerebral malaria (85 cases), neuromeningeal cryptococcosis (37 cases) and toxoplasmosis (4 cases). The overall case fatality rate was 38% (48 deaths/126). The fatality rate varied according to aetiologies: 27% in cerebral malaria, and 59.5% in neuromeningeal cryptococcosis that was found mainly among HIV positive patients (34 cases/37). CONCLUSION: These results give evidence of the frequency and the gravity of the adult's cerebral malaria in Dakar, but also the growing place of the neuromeningeal cryptococcosis in the neuromeningeal opportunist pathology of HIV positive patients.

[The place of malaria in an infectious disease department in Dakar, Senegal]. / Place du paludisme dans un service de pathologie infectieuse a Dakar (Sénégal).

The aims of this study were to determine the place of malaria at the Infectious Disease Clinic in Dakar, Senegal, to identify diseases associated with malaria, and to assess malaria mortality with or without co-morbidity. The files of all patients hospitalized from 2001 to 2003 in whom at least one test for malaria (thick films/spears) was performed to detect malaria parasites were reviewed. Malaria was diagnosed in patients presenting fever and positive thick films demonstrating asexual blood stages of Plasmodium. Data were collected from hospital charts. A total of 416 patients presented malaria (prevalence rate, 25.9%). The male-to-female sex ratio was 1:7 and mean age was 33 +/- 18 years. Of the 416 patients diagnosed with malaria, 273 (65.6%) presented severe forms. The overall mortality rate of malaria with or without co-morbidity was 25.7% (107/416). There was not a statistically significant difference between mortality due to isolated malaria and malaria associated with tuberculosis (23.4% versus 18.5%) (p = 0.7) or tetanus (23.4% versus 17.6%) (p = 0.34). Conversely mortality of malaria in HIV-positive patients was higher (58% versus 19%) (p = 10(-6)). Thus, malaria is of major concern in our department.

[Clear-fluid meningitis in HIV-infected patients in Dakar]. / Les méningites à liquide clair chez les patients infectés par le VIH à Dakar.

This retrospective study was carried out to describe the epidemiological, clinical and aetiological aspects of clear-fluid meningitis among HIV-positive patients admitted at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar Data were collected for analysis from patients files recorded from January 1, 2001 to December 31, 2003. Forty-six cases of clear-fluid meningitis were found among HIV-infected patients, representing 51.7% of cerebro-meningeal diseases and 92% of meningitis encountered in those patients. Sex ratio MIF was 1.5 and the mean age of patients was 40.7 years [range 23-61 years]. Clinical presentations comprised headache (80%), fever (67%), meningeal syndrome (74%), coma (28%), convulsions (9%), focal neurological deficits (11%), cranial nerves dysfunction (9%). Aetiologies were represented by neuromeningeal cryptococcosis (29 cases) and tuberculous meningitis (5 cases). In 26% of cases no aetiology was found. The case fatality rate was 63% overall (29 deaths) and 83.3% among cases with unknown aetiology. It did not vary significantly according to epidemiological and clinical variables studied. Neurological sequelae were found in 4 patients who recovered. A better management of clear-fluid meningitis among HIV-positive patients should benefit from the reinforcement of our diagnostic capacities, the availability of effective systemic antifungal drugs and the prevention of opportunistic infections in the course of HIV/AIDS infection.

[Epidemiological, clinical, etiological features of neuromeningeal diseases at the Fann Hospital Infectious Diseases Clinic, Dakar (Senegal)]. / Profil épidémiologique, clinique et étiologique des affections cérébroméningées observées à la clinique des maladies infectieuses du CHU de Fann à Dakar.

OBJECTIVES: This retrospective study was carried out to determine the prevalence of cerebromeningeal diseases at the Fann Teaching Hospital Infectious Diseases Clinic, in Dakar, and to describe their epidemiological, clinical, and etiological features. PATIENTS AND METHODS: Data was collected for analysis from patients files recorded from January 1, 2001 to December 31, 2003. RESULTS: Four hundred seventy cases were identified (11.4% of total admissions) with a M/F sex ratio of 1.38 and a mean age of 33 years. Eighty-nine patients were infected by HIV and clinical presentations included fever (78%), meningeal syndrome (57.4%), coma (64.9%), convulsions (19%), focal neurological deficits (15.5%), and cranial nerves dysfunction (7.2%). Etiologies presented as cerebral malaria (85 cases), purulent meningitis (51 cases), neuromeningeal cryptococcosis (37 cases), tuberculous meningitis (11 cases), intracranial abscess (10 cases), toxoplasma encephalitis (4 cases), cerebrovascular attack (11 cases), and cerebromeningeal hemorrhages (3 cases). In as many as 248 cases (52.8%) no etiology could be found. The case fatality rate was 44.5% overall (209 deaths) and 68.5% among HIV-infected patients. Neurological sequels were found in 22 survivors (8.8%), consisting in focal neurological deficit (12 cases), deafness (5 cases), diplopia (2 cases), dementia (2 cases), postmeningitic encephalitis (1 case). CONCLUSION: These results show the need to improve our technical capacities in our diagnostic laboratories, the prevention of opportunistic infections in the course of HIV/AIDS infection, and the involvement of various specialists in the management of cerebromeningeal diseases.