[Epidemiological and evolutionary profile of tuberculosis under the influence og HIV]. / Profil épidémiologique et évolutif de la tuberculose sous l'influence de l'infection par le VIH dans un centre de prise en charge ambulatoire au Gabon.

INTRODUCTION: We conducted this study to understand the impact of HIV infection on the epidemiology of tuberculosis (TB) in an outpatient care center. PATIENTS AND METHODS: This is a retrospective and comparative study between subjects infected or not infected with HIV, using TB case notification data registered from October 2017 to September 2019 in the intermediate care facility (CDT) of the University Hospital of Libreville. Comparisons were made by bivariate analysis; proportions were compared using the Chi2 or the Fisher Exact test. Variables of significant interest were included in a binary logistic regression model for multivariate analysis. RESULTS: Prevalence of HIV infection was 30.4%. Average age was 35.2 years with extremes at 15 and 83 years. In the results of the multivariate analysis, female patients were more frequently infected with HIV (p=0.002; OR=1.960, 95% CI [1.275 - 3.015]) and HIV infection was associated with a reduction in the proportion of PTB (+) (p=0.001; OR=0.483, 95% CI [0.311 - 0.752]). HIV infection was also associated with an increased proportion of new cases (P=0.007; OR=2.987, 95% CI [1.353 - 6.597]), EPT (p<0.001; OR=1.084, 95% CI [1.054 - 1.131] and an unfavorable therapeutic outcome (p=0.016; OR=2.744, 95% CI [1.208 - 6.233]). CONCLUSION: TB/HIV co-infection remains high. It continues to negatively impact outpatient management of TB.

Profil épidémio-clinique, fonctionnel et de sensibilisation aux allergènes chez les asthmatiques suivis en consultation en milieu Africain à Libreville, Gabon / Epidemiological-clinical, functional profile and sensitization to allergens in asthmatics followed in consultation in an African environment in Libreville, Gabon

Introduction : La prévalence de l'asthme au niveau national est inconnue. L'objectif était de déterminer la prévalence hospitalière de l'asthme et la sensibilisation aux pneumallergènes standards.Patients et Méthodes : Il s'agit d'une étude transversale, rétrospective qui a consisté en l'analyse descriptive de 164 dossiers de patients asthmatiques reçus pour consultation au CHU de Libreville sur une période d'activité de 36 mois. La mesure du VEMS pré et post-bronchodilatateur ainsi que les prick-tests ont été réalisés. Les extraits standardisés suivants étaient testés : Dermatophagoïdes pteronyssinus et farinae, les phanères (chien et chat), les plantes vertes (Cynodon dactylon) et les moisissures (Alternaria sp). Résultats : Des 2798 patients reçus en consultation de pneumologie, 164 l'étaient pour un asthme soit une fréquence 5,8%. Parmi les 164 patients asthmatiques 59,8%(n=98) étaient des femmes avec un sex-ratio à 0,67. La moyenne d'âge de la population d'étude était de 31±18,1 ans, des extrêmes de 5 et 81 ans. Plus de la moitié des patients résidait en milieu urbain (59,7%), et était sans revenu (50,7%). L'asthme était associé à la rhinite allergique dans 72,6%. Seuls 45 patients avaient réalisé les prick tests parmi lesquels la sensibilisation aux acariens (n=37/45 ; 82,2%) était fréquente et dominée par Dermatophagoïdes pteronyssinus (n=32/37 ; 86,5%). La sensibilisation à Blomia tropicalis était de 73,0% (n=27/37). La sensibilisation aux phanères d'animaux (chiens et chats) était observée chez 9 patients (n=9/45 ; 20,0%). Aucune sensibilisation à l'Alténaria sp n'a été relevée. Le déficit ventilatoire obstructif proximal et distal a été observé dans 45,8% des cas (n=60/131).Conclusion : La prévalence de l'asthme est relativement élevé dans notre contexte d'exercice. Le taux sensibilisation révélé est le témoin d'une forte pression allergénique exercée par l'environnement domestique

Introduction: The national prevalence of asthma is unknown. The objective was to determine the hospital prevalence of asthma and sensitization to standard airborne allergens. Patients and Methods: This is a cross-sectional, retrospective study which consisted of the descriptive analysis of 164 records of asthmatic patients received for consultation at the University Hospital of Libreville over a period of activity of 36 months. Measurement of pre- and post-bronchodilator FEV1 as well as prick-tests were performed. The following standardized extracts were tested: Dermatophagoides pteronyssinus and farinae, skin appendages (dog and cat), green plants (Cynodon dactylon) and molds (Alternaria sp).Results: Of the 2798 patients seen in a pulmonology consultation, 164 were for asthma, i.e. a frequency of 5.8%. Among the 164 asthmatic patients 59.8% (n=98) were women with a sex ratio of 0.67. The average age of the study population was 31 ± 18.1 years, extremes of 5 and 81 years. More than half of the patients lived in urban areas (59.7%), and had no income (50.7%). Asthma was associated with allergic rhinitis in 72.6%. Only 45 patients had performed prick tests,among which sensitization to house dust mites (n=37/45; 82.2%) was frequent and dominated by Dermatophagoides pteronyssinus (n=32/37; 86.5%). Sensitization to Blomia tropicalis was 73.0% (n=27/37). Sensitization to animal dander (dogs and cats) was observed in 9 patients (n=9/45; 20.0%). No sensitization to Altenaria sp was noted. Proximal and distal obstructive ventilatory deficit was observed in 46.5% of cases (n=60/130).Conclusion: The prevalence of asthma is relatively high in our exercise context. The sensitization rate revealed is the witness of a strong allergenic pressure exerted by the domestic environment.

Pregnancy in autoimmune diseases in the sub-Saharan zone: the experience of the University Hospital of Libreville Department of Internal Medicine.

Autoimmune diseases are a group of heterogeneous conditions responsible for polymorphic clinical and biological manifestations. Because pregnancy activates them and promotes gestational complications, it is difficult for women with these diseases. Pregnancy and autoimmune diseases have rarely been studied in sub-Saharan Africa. We report the experience of the Internal Medicine Department of the University Hospital of Libreville. Conducted retrospectively for 2008 through 2011, and prospectively from 2012 through August 31, 2018, this descriptive and analytical study examined the records at the Department of Internal Medicine of the University Hospital Center of Libreville of women with a known autoimmune disease, receiving regular care there, and who became pregnant after the diagnosis. During pregnancy, women were monitored and manÂged simultaneously in the departments of obstetrics and internal medicine. Data considered for this study were demographic data (Âge, sex, social status), type of autoimmune disease, including the diagnosis, the therapies used, extent of disease control, and time from diagnosis to each pregnancy. Obstetric data include the number of fetuses, obstetric complications, gestational Âge at and route of delivery, fetal sex, and Apgar score to 5 minutes (normal ≥ 7). Women had the following autoimmune diseases : systemic lupus erythematosus (SLE) (n = 16), Sjögren's disease (n = 3), inflammatory myopathy (n = 2), rheumatoid arthritis (n = 1), primary antiphospholipid syndrome (APS) (n = 1), and Still disease (n = 1).The overall averÂge Âge at diagnosis was 26.6 years (range : 13-40). The 24 women had 32 pregnancies. The mean interval from diagnosis to first pregnancy was 3.3 years, to the second pregnancy also 3.3 years (n = 6), and to the third (n = 2), 5 years. Disease was controlled for at least 2 years (n = 23) except for one woman with primary APS. Therapeutically, corticosteroids were used alone (n = 2) or combined with other immunomodulatory therapies (n = 32). Gestational complications included spontaneous abortions in the first trimester (n =2), in utero deaths (n = 2), perinatal death on day 12 (n = 1), and eclampsia (n = 2), one of which was complicated by a pulmonary embolism in the first pregnancy. The mean gestational Âge at delivery was 37 weeks. Intrauterine growth restriction affected 11 fetuses, and preterm delivery 18. There were 11 cesarean deliveries and 16 vaginal. Mean birth weight was 2353.3 grams, Apgar was ≥ 7 for all neonates except in one case of dermatomyositis complicating a neonatal death. The sex ratio was 13 male infants per 17 females. Women with optimal disease control can become pregnant and have positive pregnancy outcomes. This possibility has been little explored in sub-Saharan Africa; mystical-religious notions of conceptions persist and can prevent women from attempting to become prégnant . This experience with a short series of viable fetuses of women with autoimmune diseases is therefore encouraging and deserves to be continued.

[Behavior and attitudes towards smoking among student midwives in Libreville]. / Comportements et attitudes des élèves sages-femmes de Libreville vis-à-vis du tabagisme.

BACKGROUND: The midwife, in taking on a public health role, is one of the most important resources for the prevention of smoking and in helping smoking cessation among women of childbearing age thanks to their numerous contacts with pregnant women. With this in mind, we conducted a study among student midwives to examine their smoking behavior, their attitudes towards smoking, and their participation in prevention. METHOD: This was a descriptive cross-sectional study conducted from 15 January to 15 February 2018 using a self-administered questionnaire and included the student midwives of the University of Health Science at Libreville (Gabon). RESULTS: A total of 188 student midwives completed the questionnaires (70.7% of students of the 1st year, 15.0% of students of the 2nd year and 14.3% of students of the 3rd year). Gaps exist in the knowledge of student midwives regarding the risks of cigarette smoking in pregnancy and its role in the development of complications for the mother and foetus. Overall, 17.1% of student midwives think that smoking is responsible for the occurrence of ectopic pregnancies, 20.3% believe it is responsible for retro-placental haematoma, 17.6% for premature rupture of the membranes. The prevalence of smoking was 11.1% and was most frequent in 2nd year students (25.0%) and 3rd year students (14.8%) (P<0.023). The mean age of beginning smoking was 19.0±4.4 years. The main initiating factors were peer influence (28.6%), pleasure (19.0%) and stress (14.3%). Nicotine dependence was weak to moderate among 48.8% of smokers and absent in 52.2%. CONCLUSION: Gaps exist in the knowledge of student midwives regarding the risks of cigarette smoking to complications of pregnancy. There is need therefore to include formal training on tobacco control strategies at an early stage in the medical curriculum.

[DRESS syndrome secondary to pyrazinamide: An uncommon complication of tuberculosis treatment]. / DRESS syndrome au pyrazinamide : complication rare et grave du traitement antituberculeux.

INTRODUCTION: The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe drug-induced reaction. CASE REPORT: We report the case of a 35-year-old man treated by RHEZ for a first episode of a smear positive pulmonary tuberculosis and who developed a DRESS syndrome due to pyrazinamide after twenty days of treatment, associated with a viral reactivation to Human Herpes Virus 6 (HHV6). He had a skin eruption, liver involvement and hypereosinophilia. He fully recovered after drug withdrawal, associated with local and general corticosteroids. He died two weeks after discharge. CONCLUSIONS: Discovery of DRESS syndrome during tuberculosis treatment is an uncommon complication and requires a searching for the responsible drug. That should be difficult because tuberculosis drugs are often given as fixed-dose combination. Physicians have to bear in mind the potential role of pyrazinamide.

[Clinical and radiological characteristics of pulmonary tuberculosis in tobacco smokers]. / Particularités cliniques et radiologiques de la tuberculose pulmonaire chez le tabagique.

INTRODUCTION: Tobacco smoke alters lung defense mechanisms against infections and so increases the risk of mycobacterium tuberculosis infection. OBJECTIVE: To determine the particular clinical features of tuberculosis in smokers and identify risk factors. METHODS AND PATIENTS: We conducted a prospective, cross-sectional study over a period of nine months in Dakar, Senegal. The Chi-square test and multiple logistic regression were used to identify differences between smokers and non-smokers and to identify factors associated with clinical outcomes. RESULTS: We included 165 patients with active pulmonary tuberculosis (59 smokers versus 106 never-smokers). The average age of smokers was 43.8±12.7 versus 32.1±13.1 years (P<0.0001). Smokers were overwhelmingly male (98.3% versus 1.8%, P<0.0001). The average delay to consultation was longer among smokers (90 days [30-120] versus 60 days [30-90] ; P<0.0001). In multivariate analysis, alcohol abuse, increasing age, male sex, and an unknown retroviral status were independent risk factors for pulmonary tuberculosis. Haemoptysis was observed more frequently in smokers (49.1% versus 31.1%, P=0.017). With regards to chest X-ray features, smokers presented with more advanced, bilateral and cavitating lung lesions. CONCLUSION: Diagnostic delay and haemoptysis are important characteristics of the pulmonary tuberculosis in tobacco smokers.

[Therapeutic itinerary and radiological features of positive microscopy tuberculosis patients at Centre Hospitalier National Universitaire de Fann (CHNUF), Dakar]. / Itinéraire thérapeutique et caractéristiques radiologiques des patients tuberculeux bacillifères dépistés au centre hospitalier national universitaire de Fann (CHNUF), Dakar.

INTRODUCTION: The long diagnostic delay is responsible for the extension of radiological lesions and spread of TB in the community. These radiological lesions can leave significant scars responsible for respiratory disability. OBJECTIVE: The aim of the study is to characterize radiologic features according to tuberculosis diagnostic delay. METHODS: We conducted a prospective cross-sectional study, about 66 patients with positive sputum. RESULTS: The average diagnostic delay was 16 (±15) weeks; whether 22 (±14.1) weeks in the female gender versus 14.6 (±14.3) weeks in the male gender (P=0.10). The first care use was respectively health centers (62.1%), drugstores (51.9%), and traditional medicine (28.7%). Only 27.2% of patients used the marabouts care. Bilateral radiographic abnormalities in bivariate analysis were associated with consultation at the health center (66.7% versus 33.3%; P<0.031), as is the extension of the lesions (70.2% versus 29.8% RP=1.66 [1.05 to 2.91]; P<0.03). Lake of knowledge of the symptoms of TB was associated with the use of marabouts care (12.5% versus 87.5; PR=0.35 [0.11 to 1.08], P<0.04). CONCLUSION: These results should prompt consideration in an emergency, appropriate control interventions, advocacy, patient information and medical personnel on the reality of tuberculosis to prevent its spread often causing respiratory disability with radological effects.

Hepatic cytolysis and bicytopenia after 15 days of four-drug tuberculosis treatment in Senegal.

We report the case of a 31-year-old immunocompetent woman residing in Senegal, with localized microscopy-proved pulmonary tuberculosis, complicated by macrophage activation syndrome and associated with viral hepatitis B, identified due to hepatic cytolysis and a bicytopenia.

Non-adherence to antiretroviral therapy in patients infected with HIV and cryptococcal meningitis: two cases at the Lambaréné Hospital Center in Gabon.

Cryptococcal meningitis is a serious infection occurring mainly in immunodepressed patients, especially those with AIDS. Its incidence is growing among people living with HIV/AIDS who interrupt their antiretroviral treatment. We report two cases that occurred in this situation and had lethal outcomes in the short term. Testing for cryptococcal antigen in serum (serum CRAG test) enables a reliable and early diagnosis, and its use should be promoted in rural areas of sub-Saharan Africa.

[Tuberculosis of the breast: four cases report at the Armies Instruction's Hospital Omar Bongo Ondimba (HIAOBO) in Libreville (Gabon)]. / Tuberculose mammaire : à propos de quatre cas à l'hôpital d'instruction des armées Omar Bongo Ondimba (HIAOBO) de Libreville (Gabon).

Mammary tuberculosis is a rare localization of extra pulmonary tuberculosis. Its frequency increases proportionally with the HIV pandemic. We report four cases of breast tuberculosis diagnosed in the general medicine department of HIAOBO including two with positive HIV serology. It is necessary to know this extra pulmonary form/feature as the differential diagnosis with breast tumors is sometimes difficult.

Caractéristiques cliniques de la bronchopneumopathie chronique obstructive à l'Hopital d'Instruction des Armées Omar Bongo Ondimba

Il s'agit d'une étude rétrospective menée sur cinq ans à l'hôpital d'instruction des armées Omar Bongo Ondimba au cours de laquelle nous avons obtenu les résultats suivants : une prévalence de 0,78.Une prédominance masculine (68,9%), avec un âge moyen de 66 ans chez des patients présentant des co-morbidités à type de diabète (6,6%) et d'HTA (36,34%). La majorité des patients était des sans-emploi (31,45%). Les antécédents tabagiques (principale étiologie) étaient retrouvés dans 85% des cas avec 70% de fumeurs actifs et une consommation moyenne de 24±18 paquets/année.Le motif de consultation le plus fréquent était la dyspnée (50,8%) alors que le facteur favorisant prédominant était le tabac (83,6%). Mais les infections (surtout tuberculeuse) vienaient en seconde position (9,84%). L'anomalie radiologique la plus fréquente était l'emphysème centro lobulaire (30,51%). Les patients étaient pour la plupart au stade II (57,4%). Ils avaient quasiment tous bénéficié de beta 2 mimétiques (95,08%) et de corticothérapie inhalées (91,80%).La BPCO est une maladie chronique évolutive dont la principale cause reste le tabac (surtout en Occident). Mais la pollution et les infections post tuberculeuses ne doivent pas être négligées dans les pays en voie de développement. Ceci nécessite de la part des pouvoirs publics une mobilisation des ressources humaines et financières avec intégration de la BPCO dans le programme de santé publique. Le dépistage (peak Flow dans les salles de consultation) et la prise en charge des patients doivent être assurés. Il faut élaborer un cadre législatif anti-tabac et renforcer les moyens préventifs et thérapeutiques de la lutte contre la tuberculose

Apport du Crag-Test serum dans le diagnostic de la cryptococcose neuroméningée en milieu rural. A propos de deux observations

Introduction : La cryptococcose neuro-méningée est la plus commune des affections mortelles du Système Nerveux Central chez les patients immuno-déprimés en Afrique Subsaharienne. Il s'agit alors d'une véritable urgence diagnostique et thérapeutique, d'où la mise en œuvre des tests diagnostiques rapides et efficace. Le Crag-Test serum (Antigénémie cryptococcique) pourrait alors se révéler utile sur ces terrains particuliers en milieu rural africain. Observation : Nous rapportons deux cas de cryptococcose neuro-méningée chez deux patientes âgées respectivement de 48 et 38 ans au regard du terrain d'immuno-dépression acquis, la présence de levure encapsulée à l'examen du liquide cérébro-spinal à l'encre de Chine dans un cas et la positivité du Crag-test serum dans les deux cas. La présence d'emblée de facteurs de mauvais pronostic expliquaient l'issue fatale. Conclusion : Compte tenu de la gravité potentielle de cette affection, le Crag-test serum devrait être facilement accessible et disponible pour un diagnostic rapide et une prise en charge précoce et efficace afin de limiter la morbi-mortalité

[Breast cancer in men: about 3 cases at the l'Hôpital d'instruction des armées Omar Bongo Ondimba (HIAOBO) (Gabon)]. / Cancer du sein chez l'homme: à propos de trois observations à l'Hôpital d'instruction des armées Omar Bongo Ondimba (HIAOBO) (Gabon).

We report three cases of breast cancer in men observed at Military Teaching Hospital Omar Bongo Ondimba between January 2008 and December 2009, under varying circumstances, with all unfavorable evolution.