Hémoglobinurie au cours du paludisme grave de l'enfant: Attention au déficit en G6PD à propos de 5 observations

Le paludisme reste un problème majeur de santé publique en Afrique subsaharienne, notamment au Niger où il sévit sur un mode endémique. Un des éléments de gravité est la survenue d'une hémoglobinurie et/ou une anémie. Nous rapportons 5 observations d'anémie par déficit en glucose-6-phosphatase (G6PD) de diagnostic tardif, car mis dans le compte du paludisme grave. Il s'agissait de cinq enfants d'âge moyen de 8,2 ans. 3 des patients étaient de sexe masculin. Tous les cinq patients étaient admis en urgence, référés pour anémie sévère dans un contexte de fièvre. Le nombre moyen d'hospitalisations antérieures était de 4. Les principaux signes à l'admission étaient la pâleur, les douleurs abdominales et des urines couleur porto. La bandelette urinaire a révélé une hémoglobinurie chez tous les patients et une bilirubinurie dans 4 cas. Une notion d'ictère a été retrouvée chez 2 patients, les 3 autres présentaient un ictère clinique. Le taux d'hémoglobine moyen était de 4,4 g/dl. Le taux des plaquettes et le taux de réticulocytes étaient normaux. La goutte épaisse était positive chez tous les patients. Le profil électrophorétique de l'hémoglobine était hétérozygote AS dans 2 cas et homozygote AA dans 3 cas. L'activité enzymatique de la G6PD, dosée à distance de la crise, était effondrée chez tous les patients. Le déficit en G6PD constituant une cause fréquente d'hémoglobinurie et/ou d'anémie chez l'enfant, le bilan étiologique, surtout devant la récurrence de ces signes, devrait en outre comporter un dosage de l'activité enzymatique de la G6PD

Leucémie lymphoïde chronique au Niger: une étude de 99 cas au service d'onco-hématologie de l'hôpital national de Niamey

Introduction. Le but de l'étude est de décrire les caractéristiques épidémiologiques et cliniques de la leucémie lymphoïde chronique (LLC) au Niger. C'est la première étude nigérienne spécifiquement consacrée à cette maladie. Méthodologie. Nous avons mené une étude rétrospective couvrant la période de janvier 2000 à décembre 2011 (12 ans) dans le service d'Onco-Hématologie de l'HNN. Le diagnostic de LLC était retenu sur la base d'une hyper lymphocytose sanguine > 15 000/mmᶾ associée à une infiltration médullaire de plus de 40% de lymphocytes mâtures. Les données ont été recueillies dans les dossiers de malades. Nos variables d'étude étaient les aspects épidémiologiques, cliniques et évolutifs de la maladie. Résultats. Au cours de la période d'étude, 99 patients ont été colligés soit une fréquence d'environ huit cas par an. Le sex ratio était de 0,47 et la moyenne d'âge des patients de 53,25 ans (extrêmes: 30 à 82 ans). L'échantillon était constitué de 89 % de paysans (cultivateurs, éleveurs femmes au foyer). La durée moyenne des troubles avant la première consultation était de 24 mois. Les principaux motifs de consultation étaient: la splénomégalie (81,8%), les adénopathies (38,4%) et l'anémie (21,2%). Les principaux signes physiques étaient: les adénopathies (84,8%); la splénomégalie (80,8%); la pâleur cutanéo-muqueuse (31,3%); la fièvre (29,3%) et l'hépatomégalie (25,3%). Selon la classification anatomo-clinique de Binet, 39 patients (39,4%) étaient au stade A, 16 cas (16,2%) au stade B et 44(44,4%) au stade C. Conclusion. À Niamey, la LLC est une maladie de l'adulte jeune diagnostiquée souvent à un stade avancé du fait du retard de la première consultation

Leucémie aigue lymphoblastique néonatale : À propos d'un cas au CHU Hassan II de Fès au Maroc

La leucémie aiguë lymphoblastique (LAL) néonatale est une affection exceptionnelle et est de mauvais pronostic. Nous décrivons l'observation d'un nouveau-né à Jo de vie, atteint d'une LAL de type B, révélée par un syndrome hémorragique et tumoral en service de réanimation néonatale du CHU Hassan II de Fès, dont l'évolution a été marqué après 25 jours de vie par le décès du patient dans un tableau de lyse tumoral, quelques jours après une chimiothérapie d'induction

[Geophagy associated with severe anemia in non-pregnant women: A case series of 12 patients]. / Géophagie associée à une anémie sévère chez la femme non gravide : à propos de 12 cas.

INTRODUCTION: Geophagy or soil eating is mostly described in pregnant women from Sub-Saharan Africa, South America. Here, we report 12 cases of geophagy associated with severe anemia in non-pregnant Nigerian women. RESULTS/CASE REPORTS: The median age at diagnosis was 34.5 years. The socioeconomic level was average for all patients. The median hemoglobin level at admission was 6.9g/dL (3.3-8.6), median corpuscular volume was 78.3fL (63-106) and median serum ferritin was 9.2ng/mL (3.6-11.2). The reasons of this practice were "desire" (5/12) and tradition (4/12). All patients received psychotherapy and supplementation with intravenous iron. CONCLUSION: Geophagy is an underestimated practice in developed countries and in non-pregnant women. It can be the cause of severe iron deficiency and must be discussed in patients with anemia, including non-pregnant patients, and in Africa as well as in migration areas, where the practice can be exported.

[Focusing of Schistosoma haematobium transmission in irrigated perimeters of the Niger valley (Niger): importance of malacological factors]. / Focalisation de la transmission de Schistosoma haematobium au sein des périmètres irrigués de la vallée du Niger (Niger): importance des facteurs malacologiques.

BACKGROUND: Currently, the control of urinary schistosomiasis is mostly based on mass treatment. Characterization of Schistosoma haematobium transmission could lead to adding new methods to the control strategy. METHODS: We carried out malacological and cercariometrical surveys in irrigated perimeters of the Niger River valley. A semi-monthly follow-up was performed in three main sites of human-water contact in a village located at the border of the irrigated perimeter. Bulinids were collected during 20 min; after identification based on the shell morphology, their parasites were characterized by isoelectrofocalisation. The cercariometrical technique by differential filtration was used to evaluate the density of cercariae in every site with two 20-litre samples of water collected at various periods of the day (9, 12, 15 and 18 h). RESULTS: In the arm of the river, the cercariometry never showed cercariae whereas only some Bulinus truncatus, all negative, were collected. In the channels, B. truncatus and B. globosus were observed and highest density was found during the dry season. Only B. truncatus was naturally infested. Homozygote BB phenotype (characteristic of S. haematobium) was observed in all positive molluscs. Using cercariometry, more than two third of cercariae were collected at 3:00 PM. CONCLUSION: Transmission of S. haematobium was primarily focused in the irrigating channels during the dry hot season at the beginning of afternoon. These results should lead to improve the output of S. haematobium control methods within irrigated areas.

Bulinus forskalii: a new potential intermediate host for Schistosoma haematobium in Niger.

Malacological monitoring of two irrigated areas in Niger highlighted the natural susceptibility of Bulinus forskalii to infection with Schistosoma haematobium when the parasitic load is high. This first report of S. haematobium infection in B. forskalii, which is an abundant snail in irrigated areas, has been confirmed experimentally.

ELISA study of oocyst-sporozoite transition in malaria vectors.

Intrinsic vector characteristics and environmental factors affect the sporogonic development of P. falciparum in Anopheles mosquitoes. We tested for the presence of the circumsporozoite protein, as a marker of the oocyst to sporozoite transition in naturally infected Anopheles gambiae s.l. and Anopheles funestus. Malaria vectors were collected in a village in the Sahel of Niger during the rainy and dry seasons. ELISA-CSP was carried out on abdomen and head/thorax portions from more than 2000 samples. No significant difference was found in the overall rates of infection of An. gambiae s.l. (4.13%) and An. funestus (3.58%). Given the differences in duration of the two parasite stages, P. falciparum CSP antigen prevalence was nearly as high in the abdomen as in the head/thorax, and did not differ significantly between An. gambiae s.l. and An. funestus. These preliminary results suggest that development from oocysts to salivary gland sporozoites is similar in the two vectors. However, these developmental indices varied as a function of the season in which samples were collected, particularly for An. gambiae s.l. This simple method may be useful for field studies assessing the effect of environmental and genetic factors on parasite survival.

[Heterogeneity of Schistosoma haematobium transmission in irrigated fields]. / Hétérogénéité de la transmission de Schistosoma haematobium dans les périmètres irrigués du Niger.

Heterogeneity of Schistosoma haematobium transmission in irrigated fields. Although irrigated areas exist since a long time in the Niger Valley the distribution of the urinary schistosomiasis does not appear homogeneous, testifying to the existence of limiting or favourable factors. The identification of these factors could lead to a better definition of the distribution of the schistosomiasis risks and to optimise control programmes. The population of five villages about 1,900 inhabitants living in the same irrigated area (Sébéri) was examined at the end of 1999 before treatment and surveyed two and ten months after treatment by praziquantel in order to investigate re-infections. In parallel, the transmission sites were subject to a semi-monthly malacological follow-up from 1998 to 2001 and the water contacts were quantified in the sites of the main village during 2000. Before treatment, schistosomiasis risks appeared related to the proximity between habitat and lateral canals: the infections concerning youngers were all the more intense that the dwellings were close to the canal. The parasitological indices were the highest in the village lacking of other water sources. The morbidity indices followed a similar distribution with maximum values in the children of the 3 villages located to less than 1 km from the canal; however, morbidity was mainly observed in the adult population, in particular male, of the 2 villages which were the most distant from the canal. After treatment, the incidence of the re-infection between 2 and 10 months was comparable in the 3 villages close to the canal (28%) but was significantly weaker in the 2 villages far from the transmission sites (5%). In the villages bordering the canal, the incidence in the children was all the more high since the habitat was close to the canal. Between 1999 and 2000, the collected number of Bulinus truncatus decreased from 1.4 to 0.6 individuals per survey; moreover, no mollusc harbouring parasites was found, representing the decrease of the parasite burden. The abnormal weakness of re-infection, regarding this type of focus, could be explained by the repeated stop of water supply inducing a complete drying out of the canal for 2 months during the year preceding the study. These repeated drying out also resulted in a reduction of the exposure. Whereas the average frequentation of the sites of the canal remained rather comparable between January (cold dry season) and May (dry hot season), it decreased dramatically in September (rainy season but canals were not irrigated this year) from 99 to 11 daily contacts. The use of the lateral canal when filled represented 80% of the contacts. In the event of drying out, 80% of the contacts were transferred in the ponds but not in the river (5% of the contacts whatever the season). These results confirmed (1) that the presence of canals reduced the use of natural sites and (2) that the drying out of the canals induced a total reduction of the contacts.

[Transmission of Schistosoma haematobium in the town of Niamey, Niger]. / Transmission de Schistosoma haematobium dans la ville de Niamey, Niger.

Located in an area where Schistosoma haematobium is hyperendemic, the town of Niamey is a focus of hypoendemicity. The aim of the malacological follow-up studies undertaken over a one year period was the determination of the mollusc species present in the water bodies, the appreciation of their space-time distribution of the snail and to find out the potential seasons of transmission. The investigation applied to 22 sites of transmission in the urban community. Four molluscs species (Bulinus truncatus, B. forskalii, B. globosus and B. senegalensis) are collected. The first three species are present all the year long, with a peak of density in the dry season. The last species (B. senegalensis) is found only during the rainy season. B truncatus and B. senegalensis are the two naturally infested species. The main site of transmission is the river Niger. The ponds play a secondary role in the peripheral districts. The main intermediate host of S. haematobium is B. truncatus.