[Abdominal tuberculosis: contribution of ultrasonographyin the diagnosis and problematic of treatment in a country of sub-Saharan African]. / Tuberculose abdominale : apport de l'echographie dans le diagnostic et problematique de prise en charge dans un pays d'Afrique subSaharienne.

OBJECTIVE: To determine the contribution of ultrasonography in the diagnosis of abdominal tuberculosis (TB) in HIV- infected children at the University TeachingHospital Sourô-Sanou of Bobo-Dioulasso, Burkina Faso. METHODS: In children infected with HIV and suspected to develop tuberculosis (TB) on the basis of epidemiological and clinical evidence, the following were performed at inclusion, at 2, 6, and 9 months of follow-up: a chest x-ray and abdominal ultrasound. A bacteriological investigation of the Koch bacillus (BK) was made. All children diagnosed with TB were put on treatment. RESULTS: Sixty-three (63) children with suspected TB were included. Thirty one children (42.86%) had been diagnosed with tuberculosis. Tuberculosis with abdominal lesions accounted for 29.03% (9/31) of TB cases, divided as follows: 4 cases (12.9%) of abdominal tuberculosis without radiographic lung lesions; 5 (16.13%) cases of multifocal TB associating pulmonary involvement with ultrasound abdominal lesions. Bacteriological confirmation was 55.55%. The main ultrasound lesions were abdominal lymph nodes (88.89%). A spleen miliary and hepatosplenic miliary were noted in 33.33% and 11.11% of the cases respectively. The evolution under antituberculous treatment was favorable in 88.88% of the cases. CONCLUSION: Ultrasonography is a significant contributor in the diagnosis and monitoring of treatment of abdominal TB in HIV-infected children.

OBJECTIF: Déterminer l'apport de l'échographie dans le diagnostic de la tuberculose (TB) abdominale chez l'enfant infecté par le VIH au Centre Hospitalier Universitaire Sourô-Sanou de Bobo-Dioulasso, Burkina Faso. MÉTHODE: Chez des enfants infectés par le VIH et suspects de développer une TB sur la base d'arguments épidémiologiques et cliniques, étaient réalisées une radiographie pulmonaire et une échographie abdominale à l'inclusion, à 2, 6, et 9 mois de suivi. Une recherche bactériologique du bacille de Koch (BK) était effectuée. Les enfants dépistés tuberculeux étaient mis sous traitement. RÉSULTATS: 63 enfants suspects de TB étaient inclus. Trente un (42,86%) étaient diagnostiqués tuberculeux. La TB avec lésions abdominales était de 29,03% (9/31), répartie en 4 cas de tuberculose abdominale sans lésions radiographiques pulmonaires, 5 cas associant une atteinte pulmonaire et les lésions abdominales échographiques. La confirmation bactériologique était de 55,55%. Les principales lésions échographiques étaient des adénopathies profondes (88,89%). Une miliaire splénique et hépatosplénique était notée dans 33,33% et 11,11% des cas respectivement. L'évolution sous traitement antituberculeux était favorable dans 88,88% des cas. CONCLUSION: l'échographie est d'un apport majeur dans le diagnostic et le suivi du traitement de la TB abdominale chez l'enfant infecté par le VIH.

Fecal Carriage of Enterobacteriaceae Producing Extended-Spectrum Beta-Lactamases in Hospitalized Patients and Healthy Community Volunteers in Burkina Faso.

Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) have been described worldwide, but few reports focused on Burkina Faso. To assess the prevalence of digestive carriage of such bacteria in the community and in the hospital, 214 fecal samples, 101 from healthy volunteers and 113 from hospitalized patients without digestive pathology, were collected in Bobo Dioulasso, Burkina Faso economic capital, during July and August 2014. Stool samples were screened using ESBL agar plates. Strains were identified by mass spectrometry using the Biotyper MALDI-TOF. ESBL production was confirmed with the double-disc synergy test. Susceptibility was tested using the disk diffusion method on Müller-Hinton agar. The main ESBL genes were detected using multiplex PCR and bidirectional gene sequencing. Escherichia coli phylogenetic groups were identified using a PCR-based method. During the study period, prevalence of subjects with fecal ESBL-PE was 32% (69/214), 22% among healthy volunteers and 42% among inpatients. All but two ESBL, CTX-M-15 and ESBL-PE, were mostly E. coli (78%). Among the 60 ESBL-producing E. coli strains, 26% belonged to phylogenetic group D, 23.3% to group A, 20% to group B1, 6.6% to group B2, and 3.3% to the ST131 clone. Univariate analysis showed that history of hospitalization and previous antibiotic use were risk factors associated with ESBL-PE fecal carriage. In Burkina Faso, the prevalence of both healthy subjects from the community and hospitalized patients with fecal ESBL-PE is alarmingly high. This feature should be taken into consideration by both general practitioners and hospital doctors with regard to empirical treatments of infections, notably urinary tract infections.

Preterm birth: Case definition & guidelines for data collection, analysis, and presentation of immunisation safety data.

Preterm birth is commonly defined as any birth before 37 weeks completed weeks of gestation. An estimated 15 million infants are born preterm globally, disproportionately affecting low and middle income countries (LMIC). It contributes directly to estimated one million neonatal deaths annually and is a significant contributor to childhood morbidity. However, in many clinical settings, the information available to calculate completed weeks of gestation varies widely. Accurate dating of the last menstrual period (LMP), as well as access to clinical and ultrasonographic evaluation are important components of gestational age assessment antenatally. This case definition assign levels of confidence to categorisation of births as preterm, utilising assessment modalities which may be available across different settings. These are designed to enable systematic safety evaluation of vaccine clinical trials and post-implementation programmes of immunisations in pregnancy.

High Nasal Carriage Rate of Staphylococcus aureus Containing Panton-Valentine leukocidin- and EDIN-Encoding Genes in Community and Hospital Settings in Burkina Faso.

The objectives of the present study were to investigate the rate of S.aureus nasal carriage and molecular characteristics in hospital and community settings in Bobo Dioulasso, Burkina Faso. Nasal samples (n = 219) were collected from 116 healthy volunteers and 103 hospitalized patients in July and August 2014. Samples were first screened using CHROMagar Staph aureus chromogenic agar plates, and S. aureus strains were identified by mass spectrometry. Antibiotic susceptibility was tested using the disk diffusion method on Müller-Hinton agar. All S. aureus isolates were genotyped using DNA microarray. Overall, the rate of S. aureus nasal carriage was 32.9% (72/219) with 29% in healthy volunteers and 37% in hospital patients. Among the S. aureus isolates, only four methicillin-resistant S. aureus (MRSA) strains were identified and all in hospital patients (3.9%). The 72 S. aureus isolates from nasal samples belonged to 16 different clonal complexes, particularly to CC 152-MSSA (22 clones) and CC1-MSSA (nine clones). Two clones were significantly associated with community settings: CC1-MSSA and CC45-MSSA. The MRSA strains belonged to the ST88-MRSA-IV or the CC8-MRSA-V complex. A very high prevalence of toxinogenic strains 52.2% (36/69), containing Panton-Valentine leucocidin- and EDIN-encoding genes, was identified among the S. aureus isolates in community and hospital settings. This study provides the first characterization of S. aureus clones and their genetic characteristics in Burkina Faso. Altogether, it highlights the low prevalence of antimicrobial resistance, high diversity of methicillin-sensitive S. aureus clones and high frequency of toxinogenic S. aureus strains.

High prevalence of extended-spectrum ß-lactamase producing enterobacteriaceae among clinical isolates in Burkina Faso.

BACKGROUND: Nothing is known about the epidemiology and resistance mechanisms of extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) in Burkina Faso. The objective of this study was to determine ESBL-PE prevalence and to characterize ESBL genes in Burkina Faso. METHODS: During 2 months (June-July 2014), 1602 clinical samples were sent for bacteriologic investigations to the microbiology laboratories of the tree main hospitals of Burkina Faso. Isolates were identified by mass spectrometry using a matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) BioTyper. Antibiotic susceptibility was tested using the disk diffusion method on Müller-Hinton agar. The different ESBL genes in potential ESBL-producing isolates were detected by PCR and double stranded DNA sequencing. Escherichia coli phylogenetic groups were determined using a PCR-based method. RESULTS: ESBL-PE frequency was 58 % (179 strains among the 308 Enterobacteriaceae isolates identified in the collected samples; 45 % in outpatients and 70 % in hospitalized patients). The CTX-M-1 group was dominant (94 %, CTX-M-15 enzyme), followed by the CTX-M-9 group (4 %). ESBL producers were more often found in E. coli (67.5 %) and Klebsiella pneumoniae (26 %) isolates. E. coli isolates (n = 202; 60 % of all Enterobacteriaceae samples) were distributed in eight phylogenetic groups (A = 49, B1 = 15, B2 = 43, C = 22, Clade I = 7, D = 37, F = 13 and 16 unknown); 22 strains belonged to the sequence type ST131. No association between a specific strain and ESBL production was detected. CONCLUSIONS: This report shows the alarming spread of ESBL genes in Burkina Faso. Public health efforts should focus on education (population and healthcare professionals), surveillance and promotion of correct and restricted antibiotic use to limit their dissemination.

Diagnostic Path of a Genetic Disease: A Case of Williams-Beuren Syndrome in Burkina Faso.

Williams-Beuren syndrome (WBS) is a rare neurodevelopmental disorder characterized by a set of somatic, psychological, and behavioral abnormalities, which is caused by a deletion of several genes. Herein we report a 6 year-old boy, who presented with mental retardation and psychological disorders. The result of the first clinical examination was poor, since it didn't detect any dysmorphic feature which is a major component for the clinical diagnosis of WBS. Despite the multidisciplinary and the multicenter approaches used, the diagnosis of WBS (deletion of chromosome band 7q11. 23) was established more than 3 years after the first medical consultation. Rare partial forms of WBS have been recently described and they are both clinically and genetically difficult to diagnose. Unfortunately, this disorder is still little known by health professionals.

[Epidemiology, microbiology, and outcomes of septicemia in children treated at the Charles de Gaulle University Pediatric Hospital in Burkina Faso]. / Aspects Épidémiologiques, Microbiologiques et Évolutifs des Bactériémies de L'enfant, au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Burkina, Faso. abdousal2000@yahoo.fr

The aim of this study is to describe the epidemiological and microbiological characteristics and outcome of children with septicemia at the Charles de Gaulle University Pediatric Hospital of Ouagadougou to help improve probabilistic antibiotic therapy in this type of infection. This retrospective descriptive study covered all the children from 0 to 15 years old seen over a period of 7 years in any hospital department with suspected bacteriemia and for whom the bacteriology laboratory performed a blood culture. During the study period, the laboratory received 842 requests for blood cultures and found 154 (18.3%) of them to be positive. Files for 81 of the 154 patients could be found and examined. The distribution according to age showed septicemia was most frequent among those aged 6-15 years (61.7% of the cases). Microbial identification showed the dominant species to be Salmonella enterica (serovars paratyphi and typhi) (58%) followed by Staphylococcus aureus (12.3%). The salmonella isolates had a high rate of resistance to amoxicillin, chloramphenicol and cotrimoxazole. Staphylococci were always sensitive to the antibiotics with which they were tested, although to a lesser extent for penicillin G. All patients routinely received antibiotic treatment, and 81.5% (n=66) were cured (5 children died and 10 left the hospital against medical advice). This study shows that the bacterial epidemiology of septicemia in our setting is dominated by salmonella. Trends in bacterial resistance to antibiotics showed that common antibiotics such as amoxicillin and cotrimoxazole are no longer acceptable as probabilist therapy here. They should be replaced in this type of infection by injectable third generation cephalosporin alone or combined with aminoglycosides.