Amplification of blood smear DNA to confirm disseminated histoplasmosis.

BACKGROUND: The prevalence of the Histoplasma capsulatum var. capsulatum (Hcc) histoplasmosis may be underestimated West Africa, both because the diagnosis is not mentioned in the early stages of the disease and due to limited biological resources available. CASE REPORT: We report a case of disseminated histoplasmosis due to Hcc in a Senegalese HIV patient. The diagnosis was suspected following the demonstration of small encapsulated yeasts within neutrophils on a thin blood smear. It was further confirmed using a specific real-time PCR applied on a DNA specimen extracted from the thin blood smear. CONCLUSION: To the best of our knowledge, this is the first case of Hcc infection diagnosed in Senegal. Blood smear may be a valuable screening tool in the case of bloodstream dissemination and can be used for further molecular approaches to confirm the diagnosis.

[Evaluation of the efficacy and safety of three 2-drug combinations for the treatment of uncomplicated Plasmodium falciparum malaria in Senegal: artesunate-amodiaquine, dihydroartemisinin-piperaquine, and artemether-lumefantrine]. / Évaluation de l'efficacité et de la tolérance des combinaisons artésunate-amodiaquine, dihydroartémisinine-pipéraquine et artéméther-luméfantrine pour le traitement du paludisme à Plasmodium falciparum non compliqué au Sénégal.

BACKGROUND: Since 2006, artemisinin-based combination therapies (ACT) have been used to treat uncomplicated Plasmodium falciparum malaria in Senegal, as recommended by WHO. Recently, decreased parasite clearance with artemisinin derivatives has been reported in Cambodia and Thailand. The effectiveness of artemisinin derivatives in Africa must be monitored. This study was conducted to evaluate the efficacy and the tolerability of three ACT widely used in Senegal. METHODS: From October 2010 to February 2011, a descriptive and analytical sequential study was conducted in adults and children to evaluate these three combinations: artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ), and dihydroartemisinin-piperaquine (DHAPQ). The study took place at the health posts of Deggo and Pikine and the health center of Guédiawaye, in the suburbs of Dakar. The primary endpoint was the PCR-corrected adequate clinical and parasitological response (ACPR) at day 28 (D28); the secondary endpoints included ACPR at D42, clearance times for parasites, fever, and gametocytes, and the incidence of adverse events. RESULTS: The study included 393 patients: 139 in the AL group, 130 in the ASAQ group, and 124 in the DHAPQ group. In the intent-to-treat population, PCR-corrected ACPR at day 28 was 92.8% in the AL, 89.2% in the ASAQ, and 91.1% in the DHAPQ (p = 0.58) groups, and in the per-protocol population, 98.4%, 98.3%, and 100% respectively (p = 0.39). At D42, ACPR was 99.2% in the AL, and 99.1% in each of the ASAQ and DHAPQ arms (p = 1). No early therapeutic failure (ETF) was observed. The combinations were well tolerated, with no serious adverse events reported during the follow-up period. CONCLUSION: These combinations are still effective and well-tolerated. Continued monitoring is nonetheless essential to detect early artemisinin resistance in Africa.

[Cryptosporidiosis in Senegalese children: prevalence study and use of ELISA serologic diagnosis]. / La cryptosporidiose de l'enfant au Sénégal : étude de la prévalence et apport du diagnostic sérologique par ELISA.

This is a prospective, descriptive and analytic study conducted from July 2011 to September 2011 at the Children National Hospital Albert Royer of Dakar and at the Vélingara Health District. It was focused on children under 15 without reference to HIV status. For each child, a sample of stool was examined by the Ziehl-Neelsen modified staining and by ELISA using the "Cryptosporidium Antigen Detection Microwell ELISA kit" designed to detect Cryptosporidium spp antigens. The aim of our study was to determine the prevalence of cryptosporidiosis in rural and hospital areas and to measure the performance of the ELISA kit that we used. Out of the 375 stool examinations performed with the Ziehl-Neelsen modified staining, 17 had revealed the presence of Cryptosporidium spp (4.53%). The prevalence in rural areas was 2% while the hospital prevalence was 7.4%, of which 1.8% (1/57) were from urban areas and 9.8% (12/122) from suburban areas. No positive case was observed in children over 10 years. By ELISA, 23 positives cases were reported corresponding to a prevalence of 6.13% (1.8% in children living in urban areas, 13.1% in children from suburban areas and 3%living in rural areas).The correlation of this assay with the Ziehl-Neelsen modified staining, considered as the reference method, found that this assay had a sensitivity of 58.82% and a high specificity reaching 96.37%. The positive predictive value (PPV) was 43.4% while the negative predictive value was 98%. Cryptosporidiosis is a significant cause of parasitic infection among children in Senegal. Antigen detection of Cryptosporidium spp by ELISA in stool can be a complementary tool in the diagnosis of cryptosporidiosis.

[Effect of intermittent presumptive treatment with sulfadoxine-pyrimethamine on the acquisition of anti-VAR2CSA antibodies in pregnant women living in a hypoendemic area in Senegal]. / Influence du traitement présomptif intermittent par la sulfadoxinepyriméthamine sur l'acquisition d'anticorps anti-VAR2CSA chez la femme enceinte vivant en zone hypoendémique au Sénégal.

The impact of intermittent presumptive treatment (IPT) on the immunity of pregnant women in Senegal is still not very well known. We conducted a prospective study at the Roi-Baudouin maternity of Guediawaye in Senegal to assess IgG antibodies production against MSP1, GLURP and DBL5 in pregnant women under IPT. Blood samples were collected from the participating women at inclusion and delivery. Samples were analyzed after centrifugation for the detection of IgG antibodies in sera by Elisa. Informed consent was given by each study participant prior to their inclusion. A total of 101 eligible women aged from 18 to 44 were included in this study. Multigravidae women represented 70.3% of the study population, whereas primigravidae accounted for 29.7%. The IgG level decreased slightly from inclusion to delivery for the women with regard to anti-MSP1 (83.1at inclusion versus 79.5 at delivery, p = 0.52) as well as anti-GLURP-R2 (84.1 at inclusion versus 75.9 at delivery, p = 0.16). After adjustment for number of pregnancies, there was a significant decrease in the production of anti-VAR2CSA between inclusion and delivery (p < 0.05). By reducing the incidence of malaria during pregnancy, IPT reduced the acquisition of placental parasites antibodies suppressors which could delay the development of protective immunity against malaria. The application of IPT in pregnant women would thus be more appropriate in hypoendemic areas where malaria exposure is lower.

[Epidemiological study on lymphatic filariasis (Wuchereria bancrofti) in Sénégal]. / Evaluation de l'epidemiologie de la filariose lymphatique au Sénégal.

The purpose of this descriptive study conducted in an area endemic for lymphatic filariasis was to update information on the prevalence, clinical aspects, and awareness of this parasitic disease. All consenting inhabitants over 10 years old in three selected sectors were included. An entomological investigation was carried out to estimate the rate of vector infection. Out of a total of 3.359 subjects examined, 57.3% reported familiarity with the disease and provided an accurate description. The prevalence of clinical manifestations, i.e., mainly adenopathy, attributable to the disease was 14.11%. The overall prevalence rate of parasites was 4.7% with significant variations between sectors. The only parasite species found was Wuchereria bancrofti. Parasite load was low with 68.8% of subjects having less than 10 microfilariae per microliter of blood. Data analysis identified the following risk factors: age with 77.2% of microfilariae carriers over the age of 45 years, sex with 61.4% of carriers being female, and duration of residence in endemic area with 80.4% of carriers living in the area for more than 10 years. Differences were statistically significant. Dissection of 511 female culicidae showed no microfilariae carriers. These data indicate a declining ten-dency in this endemic zone in Senegal.

[Interaction between malaria and intestinal helminthiasis in Senegal: influence of the carriage of intestinal parasites on the intensity of the malaria infection]. / Interaction paludisme et helminthiases intestinales au Sénégal: influence du portage de parasites intestinaux sur l'intensite de l'infection plasmodiale.

Co-infection between intestinal parasites and Plasmodium falciparum is very frequent in inter tropical zone. Our study carried out in the North of Senegal (zone of high prevalence of schistosomiasis) aimed at measuring the influence of the carriage of intestinal parasites on the intensity of malaria infection. The Plasmodium falciparum densities were significantly higher during Plasmodium falciparum/Schistosoma mansoni and Plasmodium falciparum/Ascaris lumbricoides co-infection in children under 14 years old. Other intestinal parasites did not seem to have negative influence on the intensity of Plasmodium falciparum infection.