[Guillain-Barré syndrome in hospitals in Togo]. / Syndrome de Guillain-Barré en milieu hospitalier au Togo.

Introduction: In sub-Saharan Africa characterized by limited resources especially in health facilities and a relatively higher frequency of infectious diseases, studies on Guillain-Barré syndrome (GBS) are rare. Objectives: The objectives of this work are to describe the characteristics of GBS in Togo through a cohort of patients followed in the neurology unit of the Campus University Hospital of Lomé. Methodology: The study took place from May 2015 to July 2019. Patients with GBS of levels 1 to 3 of the Brighton criteria for diagnostic certainty were included consecutively and assessed at admission, at 6 months and at 1 year with the GBS disability score and the MRC sum score. Qualitative and quantitative variables were expressed, respectively, in frequency and median (interquartile range). Results: Out of 7012 hospitalized patients, 28 (0.39%) including 20 women (71%) with a median age of 40 (27-53) years, presented GBS. The clinical presentation mainly consisted of bilateral sensory-motor disorders predominantly in the lower limbs associated with facial diplegia and preceded by an infectious event. On admission, 39% of patients (n=11) were able to walk (GBS score 0 to 3) and the median MRC sum score was 28 (12-38). Cytoalbuminologic dissociation was present in 654% of patients (13 of 20 patients who underwent lumbar puncture). The demyelinating and axonal subtypes each accounted for 47% (9 of 19 patients who underwent an electroneuromyography examination). Immunoglobulins and intravenous corticosteroid therapy were administered in 18% (n=5) and 50% (n=14) of patients, respectively. Lethality rate during hospitalization was 11% (n=3). The median MRC sum score at 6 and 12 month-outcome were 40 (38-49) and 51 (46-58), respectively. After one year of evolution, case fatality rate was 18% (n=5), and 78% of survivors (n=14) could walk without assistance, of which 17% (n=3) were asymptomatic. Conclusion: In Togo, GBS, with a low hospital prevalence, remains a serious condition due to its high morbidity and lethality related to non-optimal treatment and delayed management.

[Brown Sequard syndrome revealing a cervical pott's disease associated with a retropharyngeal abscess]. / Mal de pott cervical associe a un abces retropharynge revele par un syndrome de Brown Sequard.

A 37-year-old patient was admitted for a left progressive left-hand hemiparesis associated with left C4-C5 neuralgia preceded by inflammatory neck pain for 04 months and dysphagia for 02 weeks. Magnetic resonance imaging showed C3-C5 spondylodiscitis lesions with epidural abscess and predominantly left lateralized compression of the spinal cord and retropharyngeal abscess. The patient was operated for incision and drainage of the retropharyngeal abscess through the oral cavity and Koch bacillus was demonstrated from the aspirate by molecular technique GeneXpert. The patient was treated anti-tuberculosis drug therapy and we noted a fully neurological and extraneurological recovery.

Un patient de 37 ans a été admis pour un déficit hémicorporel gauche d'installation progressive associé à des névralgies C4 etC5 gauches précédés de cervicalgies inflammatoires depuis 04 mois et de dysphagie depuis 02 semaines. L'imagerie par résonance magnétique a montré des lésions de spondylodiscite C3-C5 avec épidurite et une compression médullaire latéralisée à gauche en regard ainsi qu'un abcès retropharyngé. Le patient a bénéficié d'une incision-drainage de cet abcès à travers la cavité buccale et le bacille de Koch a été isolé dans le pus par la technique moléculaire GeneXpert. Sous traitement médical, l'évolution clinique neurologique et extraneurologique a été favorable.

Neuromyelitis optica in Sub-Saharan Africa: the first case report from Togo.

Neuromyelitis optica (NMO) appears to affect blacks disproportionately in mixed populations. We report the first case of documented NMO in Togo (West Africa). A 26-year-old Togolese woman was admitted for progressive tetraplegia, acute urine retention, and dyspnea. Magnetic resonance imaging of the cervical spinal cord demonstrated an extensive longitudinal lesion, and an ophthalmologic examination found bilateral optic neuritis. Antibody testing for AQP4-IgG was positive. The patient died of severe respiratory distress despite high doses of intravenous corticosteroids. Epidemiological data about NMO in sub-Saharan Africa would improve our understanding of the role of genetic and environmental risk factors in this disease.

[Amyotrophic Lateral Sclerosis (ALS) in the 10 last years in CHU Campus of Lomé (TOGO)]. / Sclerose Laterale Amyotrophique (SLA): Rapport de 10 ans d'activites en service de neurologie du CHU Campus de Lome (TOGO).

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that causes damage of upper motor neuron and lower motor neuron. Our objective was to describe the incidence and demographic characteristics of ALS and to analyze its diagnosis and management in Togo. MATERIALS AND METHODS: A retrospective and descriptive study of patient's observations was conducted in the department of neurology of the teaching hospital in Lomé during a 10 years period (2000 to 2009). The diagnosis of ALS was made according to the clinical classification of El Escorial. RESULTS: 5 cases of ALS were diagnosed, representing 0.049% of the hospitalizations in the department of neurology. The average age of patients was 49 years [range: 24 - 67 years] and the average evolution of the disease was 17.6 months [range: 6 - 36 months]. All the patients were men. The treatment was symptomatic in every case. Treatment with Riluzole was not delivered. During the follow-up, one patient died from respiratory complications. CONCLUSION: The El Escorial criteria should be made more accessible for a larger audience, as the availability and classification of care management relies heavily on diagnosed cases, namely early diagnosis.

La sclérose latérale amyotrophique (SLA) est une maladie dégénérative du motoneurone qui atteint les deux neurones de la voie motrice volontaire et qui est cliniquement définie. BUT: Avoir des données préliminaires au Togo concernant la SLA. MATÉRIEL ET MÉTHODES: Il s'agit d'une étude rétrospective et descriptive sur les observations de patients en service de neurologie du CHU campus de Lomé sur une durée de 2000 à 2009. Sont inclus, les patients répondant aux critères de SLA certaine selon les critères d'El Escorial. RÉSULTATS: Cinq (5) cas de SLA ont été diagnostiqués, représentant 0,049% des hospitalisations du service. L'âge moyen était de 49 ans [24; 67 ans] avec une durée moyenne d'évolution de 17,6 mois [6; 36 mois]. Tous les patients étaient de sexe masculin. Le traitement a été symptomatique dans tous les cas. Le traitement au Riluzole n'a pas pu être institué. Un patient était décédé plus tard de complications respiratoires. CONCLUSION: Les critères d'El Escorial doivent être vulgarisés, car la disponibilité et la codification de la prise en charge dépendent du nombre des cas diagnostiqués et surtout de la précocité du diagnostic.

Causes of mortality associated with HIV/AIDS in health-care facilities in Togo: a six-month prospective study.

In order to determine the rate and the different causes of mortality associated with HIV/AIDS in health-care facilities we conducted a prospective study between 1 April and 30 September 2010 in the six health regions of Togo. We rationalized the choice of the healthcare facilities in order to cover the entire national territory. During the study period, 24,054 patients were hospitalized. HIV serology was positive in 1065 (18.2%) of the 5865 tested patients. Of the 24,054 patients, we recorded 2551 deaths (10.6%), including 309 HIV-infected patients (5.2%). The mortality rate associated with HIV/AIDS was 1.3% of the total number of inpatients and 5.3% of the number of patients tested for HIV. The mortality rate among HIV-infected patients was 29%. The causes of death in patients infected with HIV/AIDS were mainly anaemia and cerebral toxoplasmosis. This study shows that mortality associated with HIV/AIDS in health-care facilities in Togo remains relatively high.

[Knowledge, attitudes and practices about prevention of mother to child transmission of HIV (PMTCT) among pregnant women in antenatal clinic at 2010 in Togo]. / Connaissances, attitudes et pratiques en matière de prévention de la transmission mère-enfant du VIH chez la femme enceinte vue en consultation prénatale en 2010 au Togo.

PURPOSE: The purpose of this study carried out among pregnant women in antenatal clinics in Togo was to evaluate knowledge, attitudes and practices related to prevention of mother-to-child transmission of HIV (PMTCT). METHODS: A qualitative cross-sectional study was conducted in 22 antenatal clinics. Data were collected by interviewing all pregnant women examined from January 18th to February 4th, 2010. RESULTS: A consecutive series of 210 pregnant women was compiled. The women identified sexual relations (93.8%), objects soiled with blood (80.5%) and transmission from mother to child (27.1%) as routes of HIV transmission. A large majority (77.1%) agreed that unprotected sexual relations raised the risk of HIV transmission to the child and most (61%) expressed willingness to use condoms during pregnancy or breastfeeding, A high percentage (68.1%) believed that contamination during pregnancy increased the risk of HIV transmission to the child, and 61% knew that the risk of HIV transmission to the child was higher for mixed breastfeeding than for exclusive breastfeeding. The acceptance rate for HIV testing was 92.4%. The percentage of women who never used condoms (male or female) was 51% and the percentage considering that HIV-positive woman should not have children was 29.5%. CONCLUSION: The results of this study indicate that pregnant women in Togo have fairly good knowledge about HIV/AIDS. Attitudes towards PMTCT were generally positive but some behaviors such as condom use still require improvement.