Toxicité hématologique sévère du linezolide au cours du traitement de la tuberculose pharmacorésistante : A propos de deux(2) cas au service de Pneumo-Phtisiologie du CHU de Conakry

Introduction : Le linezolide est un médicament potentiellement efficace pour le traitement des patients atteints de tuberculose pharmaco-résistante. En dépit de son efficacité et sa bonne biodisponibilité, il présente des toxicités, dont celle hématologique demeure l'une des plus graves. Nous rapportons deux cas de toxicité hématologique du linézolide au cours du traitement de la tuberculose pharmacorésistante. Le premier cas concernait un patient de 65 ans traité pour une tuberculose multi-résistante avec un schéma thérapeutique contenant du linézolide. L'évolution fut marquée par la survenue d'une pancytopénie avec anémie sévère à 5,4 g et un tableau d'insuffisance rénale. L'issue fut favorable après arrêt du médicament et transfusion sanguine. Le second cas concernait un patient de 33 ans, pré XDR qui lutte contre la tuberculose depuis 10 ans avec cinq cures de chimiothérapie antituberculeuse qui se sont soldées par des échecs et résistances. Au cours de son suivi, il a présenté une bonne évolution clinique et bactériologique initiale mais rapidement était survenue une anémie sévère à 5g/dl, à cette anémie était associées des neuropathies périphériques. Le Linezolide avait été retiré du schéma thérapeutique, suivi de transfusions sanguines. La suite avait été favorable sous traitement antituberculeux et le patient fut guéri de sa tuberculose. Conclusion Le linézolide est efficace dans le traitement de la tuberculose pharmacorésistante mais présente une toxicité hématologique

[Investigation of epidemiology of neurotrauma in the Republic of Guinea].

The paper focuses on analysis of incidence of neurotrauma in economically underdeveloped country such as Republic of Guinea. It is found that leading etiology of central nervous system injuries are road accidents and indoor traumatism. Investigation of system of medical care revealed its poor condition and severe defects which prevent practical application of evidence-based recommendations for management of traumatic brain injury in underdeveloped countries including Republic of Guinea. Development of multiplanar strategy of control of neurotrauma is required which can be achieved only in case of massive governmental and international aid.

[Impact of snakebites in rural environment: community survey in the rural development community (DRC) of Frilguiagbe, Republic of Guinea]. / Incidence des morsures de serpent: enquête communautaire dans la collectivité rurale de développement (CRD) de Frilguiagbe (République de Guinée).

An exhaustive study has been carried out in the rural development community (DRC) of Frilguiagbe, located at 115 km from Conakry in the Conakry-Kindia highway. It concerns a population of 23,442 inhabitants divided into 3,047 households. The survey was carried out at three levels:--community level;--health centres;--traditional healers. In the household survey made between 2002 and 2003, 175 snakebites cases were recorded. In health centres, only two (2) cases were recorded from 1993 to 2003. On the other hand, 80% (=140) of the cases registered in the households have consulted a traditional healer. On the whole, there were 9 deaths (5%). Such a result shows that the collect of information from the consultation registers is not appropriate to appraise the importance of envenomations in our country.

[Problems with envenomations in Guinea]. / Problématique des envenimations en Guinée.

Only a few years after its creation, the Kindia Pasteur Institute (currently Institut de Recherche de Biologie Appliquée de Guinée, IRBAG), owing to its geographical situation, began regularly supplying the Paris Pasteur Institute with snake venom for manufacturing antivenom. The diversity of the biotopes in Guinea due mainly to the diversity of vegetation (savannah, forest, mangrove) and altitudes (coastal zone, mountains of Fouta-Djalon and mountain of High Guinea), induces a wide variety of the herpetological fauna. Envenomations are consequently a significant cause of morbidity and mortality in a country where agriculture is an important economic activity. Unfortunately, precise statistics for envenomations are unavailable. A retrospective study was performed based on IRBAG registers (1980-1990). A total of 584 snakebites were reported with a 2.2% case fatality rate. Between 1997 and 1999, 379 cases of snakebites were reported with 18.2% death, mainly due to the lack of antivenom, and 2.1% amputations. By combining the fang marks and victim or relative assessments, we were able to identify most of the snakes involved in the envenomations: Naja (21.3%), Bitis (15%), Dendroaspis (12.4%) and Causus (12.9%). In 38.2% of the cases, the snake was not identified. This survey confirmed that envenomations are a problem in Guinea. However, more studies are necessary to appreciate the real importance of the herpetological Guinean fauna and its consequences on morbidity and mortality in order to improve the management of envenomations.

[Malaria prevalence survey in 24 Guinean villages in the Kindia area]. / Etude de la prévalence du paludisme dans 24 villages de la Guinée.

The authors report the results of a survey of malaria prevalence carried out from October to December 1998 in 24 villages located upstream of the Garafiri dam, in the Kindia area. The parametre used for the assessment of prevalence was the Plasmodium index. The gametocyte and spleen indexes were also recorded. The prevalence observed (34,7%) confirms the presence in this area of stable malaria mostly transmitted by Anopheles gambiae in tropical Africa. This prevalence rate is compatible with the epidemiological data of the Ministry of Health.