Performance of rapid tests and algorithms for HIV screening in Abidjan, Ivory Coast.

Seven rapid diagnosis tests (RDTs) of HIV were evaluated by a panel group who collected serum samples from patients in Abidjan (HIV-1 = 203, HIV-2 = 25, HIV-dual = 25, HIV = 305). Kit performances were recorded after the reference techniques (enzyme-linked immunosorbent assay). The following RDTs showed a sensitivity of 100% and a specificity higher than 99%: Determine, Oraquick, SD Bioline, BCP, and Stat-Pak. These kits were used to establish infection screening strategies. The combination with 2 or 3 of these tests in series or parallel algorithms showed that series combinations with 2 tests (Oraquick and Bioline) and 3 tests (Determine, BCP, and Stat-Pak) gave the best performances (sensitivity, specificity, positive predictive value, and negative predictive value of 100%). However, the combination with 2 tests appeared to be more onerous than the combination with 3 tests. The combination with Determine, BCP, and Stat-Pak tests serving as a tiebreaker could be an alternative to the HIV/AIDS serological screening in Abidjan.

[An uncommon complication of unsafe induced abortion: bowel prolapse through uterine perforation]. / Une complication rare mais grave des avortements provoqués clandestins : l'évisceration iléale per vaginum.

The authors report one case of bowel prolapse through uterus following induced abortion. The eviscerated bowel was completely gangrenous, devoided from its mesentery and entrapped in the uterus wall. The treatment was a bowel resection and ileo-ileum anastomosis; the uterus was evacuated of retained products of conception and then sutured. The patient recovered uneventfully; fertility prognosis is expected to be poor because of abortion sequelae. If the abortion law still remains in Ivory Coast, more effort should be directed at reducing the incidence of unwanted pregnancy. This could be best archived by a better information on contraception and better health education programs.

[Production lead time of coagulase in 180 Staphylococcus aureus strains collected at Abidjan]. / Delai de production de la coagulase chez 180 souches de Staphylococcus aureus isolees a Abidjan.

INTRODUCTION: The pathogenic capacity of S. aureus is related.to the production of many virulence factors of which the coagulase. Several genotypes of coagulase were described and are associated to various populations of S. aureus. According the susceptibility to methicillin, methicillin-resistant strains of S. aureus, are described. The aim of this subject was to study the coagulase expression of Staphylococcus aureus according to the site of infection, patient origin and the resistance against methicillin. MATERIAL AND METHODS: The study is related about 180 strains of S. aureus collected in the three University Teaching Hospital of Abidjan. S. aureus are identified with laboratory classical methods. Coagulase delay was determined by the test of the coagulase on citrated rabbit plasma at 2, 4 and 18 hours. The resistance against methicillin was researched by disc diffusion agar technique. RESULTS: In 60% of cases, the bacterial strains gave a coagulum at the end of four hours, fast coagulase, against 40% of strains whose coagulating activity appeared at 18 h, slow coagulase. Fast coagulase strains are isolated from the majority of infections (55% to 71%), in hospital patients (66%) and in paediatrics (58%). Fast coagulase strains are methicillin-resistant in 65% of cases against 48.5% of methicillin-susceptible and low coagulase strains (p < 0.0001). CONCLUSION: According to the production lead time of the coagulase, fast coagulase and slow coagulase variants of S. aureus coexisted. The expression of the coagulase is not related to the site of infection and the origin of the patients. On the other hand, the type of coagulase is associated to resistance of methicillin. However, the time of formation of the coagulum typed by the test of the coagulase, didn't constitute a sufficient discriminating factor in the medical following and the treatment of infections caused by S. aureus.

[Nasal carriage of meticillin-resistant Staphylococcus aureus among health care personnel in Abidjan (Côte d'lvoire)]. / Portage nasal de Staphylococcus aureus méticillino-résistant chez le personnel soignant hospitalier a Abidjan (Côte d'Ivoire).

To determine the prevalence of méticillino-résistant Staphylococcus aureus (MRSA) among health care personnel in Abidjan teaching hospitals as well as their resistance profile against other antibiotics, 592 health care personnel from various surgical and medical services: the intensive care unit, gynaecology and obstetrics and third-degree burns services of the Cocody, Treichville and Yopougon Teaching Hospitals were included. The previous nasal pits of each subject included were swabbed. The isolation of S. aureus strains was run in a Chapman medium followed by Identification based on morphological and biochemical characteristics. The resistance profile of the strains to antibiotics was determined by standard Kirby-Bauer disk diffusion method and a 1 microg disc of oxacillin was used for the detection of meticillin-resistance S. aureus strains according to NCCLS (National Committee for Clinical Laboratory Standards) guidelines. 269 members of the studied personnel were carriers of S. aureus, either a rate of portage of 45.4%. Among the 269 S. aureus isolates, 38.7% were MRSA strains and the carriage rate of MRSA in the population was 17.8%. The health care personnel working in surgery was the more colonized (36.7%) follow-up of those of the medical services (31.4%) and of the the intensive care unit (12.4%). A variable proportion of strains of MRSA also expressed resistances to the other families of antibiotics: 27% to aminosids of which 13.5% of phénotype kanamycine, tobramycine, gentamycine (KTG), 58.7% to macrolids and related (MLS), 37.5% to fluoroquinolons, 14.4% to cyclines and 40% to the cotrimoxazole. This confirms their multi-resistant character. The prevalence of MRSA carriage among health care personnel is high; this personnel constitutes an infectious risk for the hospitalized patients who are so exposed to nosocomial infections caused by MRSA.

[Detection and management of the yellow fever epidemic in the Ivory Coast, 2001]. / Detection et gestion de l'epidemie de fievre jaune en Cote d'Ivoire, 2001.

From March to December 2001, an outbreak of yellow fever was observed in Cote d'Ivoire. Sentinel surveillance for hemorrhagic fever allowed detection of the first case in the Duekoue health district in the heavily wooded western part of the country. A weekly reporting system was established. For each suspected case recorded and reported to the Epidemiological Surveillance Department at the National Institute of Public Hygiene, a sample was collected and sent for confirmation at the Pasteur Institute of the Cote d'Ivoire. The outbreak progressed from West to East reaching Abidjan, the economic capital of the country located in the southeast. The epidemic emergency plan consisted of setting up a crisis committee to implement epidemiological, entomological and virological surveillance, mass vaccination campaigns in areas around confirmed cases, and vector control. A total of 280 cases were reported including 32 confirmed cases and 6 deaths. Eleven out of 62 districts were affected with most cases occurring in cities with more than 10000 inhabitants. Over 3.7 million persons were vaccinated for an overall coverage of 92.2% in the areas where campaigns were carried out. As a result of this outbreak, surveillance for potentially epidemic diseases has been reinforced and surveillance of viral transmission is now being considered. A vaccination program for adults has also been established.

[Surveillance of the sensitivity of antibiotics to the principal germs responsible for purulent meningitis at the University Hospital Center in Treichville from 1986 to 1991]. / Surveillance de la sensibilité aux antibiotiques des principaux germes responsables des méningites purulentes au Centre Hospitalier Universitaire de Treichville de 1986 à 1991.

Between January 1986 and December 1991, the sensitivity of germs isolated from purulent meningitidis diagnosed at the Universitary and Hospital Center Treichville was tested with reference to the antibiotics utilized in the treatment of purulent meningitidis (Ampicillin, cefotaxime, amoxicillin+clavulinic acid, chloramphenicol, gentamicin and Trimethoprim-sulfamethoxazole)). Cefotaxime, cephalosporin of the third generation, keeps its effectiveness on the main germs as a whole (Pneumococcus, Meningococcus, haemophilus influenzae). On the contrary, the other antibiotics undergo some fluctuations, or their activities are declining year after year. As far as etiology is concerned, pneumococcus always takes the first place, then come Haemophilus influenzae and Meningococcus.