Emergence de souches d'entérobactéries résistantes aux fluoroquinones dans les cultures des plaies diabétiques compliquées d'ostéites à Abidjan (Côte d'Ivoire)

Objectif. Décrire les caractéristiques épidémiologiques et microbiologiques des pieds diabétiques compliqués d'ostéite à Abidjan. Méthodes. Il s'agit d'une étude transversale, rétrospective ayant concerné 71 prélèvements bactériologiques (écouvillonnage) suivis d'une culture en présence d'un pied diabétique avec ostéite, colligés dans le service d'endocrinologie ­ Diabétologie du CHU de Yopougon (Abidjan) de 2002 à 2012. Résultats. La population d'étude était constituée de 71 patients dont 92,2% diabétiques de type 2, d'âge moyen 56,6± 12,6 ans, de durée moyenne d'évolution du diabète 10,4±8 avec une moyenne glycémique à 3,33±1,54 g/l et au stade de multiples complications du diabète. Le facteur déclenchant de la plaie était souvent un traumatisme (21,1%), une phlyctène spontanée (21,1%) ou un pied d'athlète (12,2%). Parmi les 71 patients avec pieds diabétiques compliqués d'ostéite ayant bénéficié d'un prélèvement, 51 cultures ont été positives soit 71,83 % des cas. Elles ont été le plus souvent monomicrobiennes 42 soit 82,3% des cas. A l'issue des examens microbiologiques 61 germes ont été isolés repartis selon les familles, les espèces et sous espèces. Parmi ces germes 60,65% étaient des bacilles Gram négatif, dont 86,5 % d'Entérobactéries, et 39,35% des Cocci Gram positif. La recherche de germes anaérobies n'a pas êté réalisée. En fonction des espèces, Escherichia coli a été isolé dans 35,13% des cas et les staphylocoques aureus ont été isolés dans 18% des cas. Au total 52,7% dessouches d'entérobactéries étaient résistantes aux quinolones et 22,7 des souches de Staphylocoque étaient méticillino-résistants. Conclusion. L'écologie bactérienne des pieds diabétiques compliqués d'ostéite est dominée par des souches d'entérobactéries résistantes aux antibiotiques usuels

[Nephrogenic diabetes insipidus during lithium acute intoxication]. / Diabète insipide néphrogénique au cours d'une intoxication aiguë au lithium.

Acute lithium intoxication may occur in circumstances causing kidney failure, when using lithium chronically. This situation may lead to neurological symptoms with coma, gastrointestinal disorders with diarrhea, cardiovascular symptoms with hypotension and metabolic symptoms with hypercalcemia. Nephrogenic diabetes insipidus may also develop. We report the case of a 69-year-old woman suffering from unipolar manic-depressive psychosis and treated by lithium for 10 years. This case highlights the need to monitor serum lithium levels in patients on long-term lithium regimens, especially in circumstances involving dehydration.

[Diabetes in Ivory Coast: special epidemiological features]. / Le diabète sucré diagnostiqué en Côte d'Ivoire: des particularités epidémiologiques.

Within less than a quarter century diabetes has become a health problem in developing countries. In Africa this metabolic disorder is found in a wide variety of sometimes atypical forms. The purpose of this study was to highlight the special epidemiological features of medically diagnosed diabetes in Ivory Coast. Data from the files of 10320 African patients who presented at a major national outpatient care centre between January 1, 1991 and December 31, 2000 were compiled and analyzed. Findings showed that morbidity gradually increased from 30 to 49 years then stabilized from 50 to 69 years with a higher rate in males between 30 and 49 years. One of the five national ethnic groups appeared to be most affected and two appeared to be relatively unaffected. On the basis of several criteria, 5968 patients were classified as type 1 in 11.8% of cases, type 2 without excess body weight in 48.7% and type 2 with excess body weight in 39.5%. The second of these identified groups was characterized by intermediate-discovered glycaemia and older age at diagnosis. Epidemiological features included age of occurrence and higher morbidity in young male patients, probable higher premature mortality, likely links with socio-cultural environmental factors and existence of two type 2 subgroups. This profile underlines the challenges of screening, management and prevention of diabetes in Ivory Coast.

Clinical classification of diabetes in tropical west Africa.

The objective of this work was to classify and describe the different types of diabetic patients detected in West Africa. In four health centres (three in Ivory Coast, one in Niger) 310 new cases were detected and followed up over 1 year. Classification was based on age at diagnosis, BMI, ketonuria, basal and stimulated C-peptide levels at inclusion, and response to antidiabetic therapy. In this population, males were predominant (sex ratio = 2.40), and random blood glucose levels very high at screening (mean +/- SE, 18.6 +/- 0.4 mmol/l). Only one case of fibrocalculous pancreatic diabetes and one possible case of diabetes mellitus related to malnutrition were detected. IDDM was diagnosed in 11.3% of the patients, half of them above 35 years. Leanness was observed in 59% of the patients with NIDDM. A dramatic decrease of fasting blood glucose was observed in all groups after 2 months of treatment, especially in NIDDM. As IDDM and non-obese NIDDM presented great similarities before treatment, even for C-peptide levels, a point score system is proposed to classify these two groups at baseline. In conclusion, it is confirmed that the form of diabetes previously defined as related to malnutrition is a very rare entity in black African populations. In contrast, African diabetes is characterised by the high proportion of NIDDM patients with low BMI, and reduced beta-cell function, rarely associated to ketonuria. This form of diabetes seems to be adequately controlled with oral hypoglycaemic drugs and/or diet in the year following diagnosis.

L'insulinotherapie conventionnelle optimisee en Cote d'Ivoire : resultats preliminaires

"L'insulinotherapie de ""survie""; basee sur l'injection quotidienne unique d'une insuline d'action retard; est certes commode mais peu efficace en general. De ce fait; en depit des difficultes reelles liees aussi bien aux ressources materielles qu'humaines; les auteurs ont entrepris ce travail sur l'insulinotherapie conventionnelle optimisee. Le desequilibre glycemique principalement du a l'injection; represente la principale indication du traitement intensif. Celui-ci n'est efficace que dans 51 pour cent des cas au prix d'une hospitalisation longue (de duree superieure a 30 jours 28 pour cent des cas) et couteuse (119171;70 F CFA) en moyenne). Par ailleurs les effets collateraux et notamment l'hypoglycemie (30 pour cent de cas) sont nombreux et constituent l'ineluctable rancon du traitement"

[Turner syndrome: mosaic and isochromosome q in a young African woman]. / Syndrome de Turner: mosaïque et isochromosome q chez une jeune Africaine.

The authors describe the first case reported in Ivory Coast of an 18-year-old African girl for a small size and amenorrhea and failure to reach puberty. There was no dysmorphism. The uterus was infantile. X-ray examination of the skeleton revealed early osteoporosis and KOSOWICZ sign. Hormonal evaluation demonstrated hypertrophic hypogonadism. Diagnosis of TURNER's syndrome was confirmed by karyotype obtained by culture of peripheral blood and which was 46,Xi (Xq)/45,X, associating a mosaic and isochromosome q. Hormonal therapy induced menstruation and led to normal breast development. This case report confirms that these syndromes occur in Black Africa where diagnosis remains difficult due to the sophisticated facilities required.

Hypertension et grossesse

Les auteurs rapportent les aspects cliniques biologiques et therapeutiques actuels de l'hypertension arterielle au cours de la grossesse

[Lupus disease in Abidjan. Apropos of 3 new case reports]. / La maladie lupique à Abidjan. A propos de 3 nouvelles observations.

Three new cases of systemic lupus erythematosus, all observed en 1986, are reported. So the incidence of this disease seems to be increased. Clinical features do not show any particularity and hyperthermia; cutaneous manifestations, arthralgia and renal impairment must be emphasized. Urinary infection is frequent. Among the biological features, antinuclear antibodies are positive in the three cases. Glucocorticosteroid therapy was efficient at short term, with unfortunately side effects which lead to stop the treatment.

[Acute disseminated lupus erythematosus in Ivory Coast (apropos of 9 cases)]. / Le lupus érythémateux aigu disséminé en Côte-d'Ivoire (a propos de 9 observations).

Nine cases of systemic lupus erythematosus (S.L.E.) among ivoirian Africans seen over a period of eleven years were studied. The pattern of clinical presentations is similar of that seen elsewhere. Photo-sensitivity is not described as in american Negroes. Death is usually due to severe infection. The incidence of the disease among populations of different african countries are compared. The low prevalence 0,18 p. mille may be a function of failure to diagnose the more mild cases.

[Pericarditis in adults in Abidjan. Study of one hundred observations (author's transl)]. / Les péricardites de l'adulte a Abidjan. Etude à propos de cent observations.

The goal of this work is to precise the respective aetiologic prevalence and the bases of diagnosis of pericarditis in Ivory Coast. The epidemiologic study has been done about 197 cases diagnosed between march 1972 and april 1978. These results are comparable to those collected previously in West Africa: the pericarditis is present in 1% of the patients admitted in the hospital and in 5.6% of the cardiovascular diseases of the unit of internal medicine in the Treichville Hospital (Abidjan). The semeiologic and evolutive study has been done with the 100 best documented records, with 90 acute and sub-acute pericarditis and 10 chronic pericarditis. The usual bases of diagnosis are used; the frequency of chest pain and signs of adiastole is emphasized. The aetiologic repartition is as follows: tuberculous 33%, septic 18%, benign acute pericarditis 15%, rheumatic 5%, uremic 13%, malignant 3%, undetermined 12%. These numbers are comparable to other author's numbers in West Africa. They confirm the important number of tuberculous and septic infections. These infections processus explain probably the frequency of constrictive pericarditis. However, the aetiology of constrictive pericarditis is often difficult to state precisely.U