[Perception of the population in the fourth municipality of Bamako-Mali, on the COVID-19 vaccine]. / Perception de la population de la commune iv de Bamako-Mali, sur le vaccin contre la COVID-19.

INTRODUCTION: In response to the COVID-19 pandemic, various candidate vaccines has been approved to be used by WHO. However, there is low adherence to the vaccination campaign, especially in Mali. The goal was to study the perception of fourth municipality's population of the district of Bamako, about the COVID-19 vaccine. METHODS: It was a cross-sectional descriptive and analytic study conducted from May to August 2021. A rational selection of two wards of the fourth municipality of Bamako was carried out. The Chi-square test of Pearson was used to test association between variables. RESULTS: In total 179 people from two wards were surveyed. The average age was 37.73 years (SD=13.67), 34.6% (n=62) we'renot in school, and 7.8% (n=62) had received at least the first dose of a COVID-19 vaccine. 37.4% (n=67) did not believe in the existence of COVID-19; while 84.9% (n=152) didn't know at least the name of the vaccine in use in Mali. 65.4% (n=117) didn't trust the vaccine, while 78.1% (n=25) would have preferred other vaccines from AstraZeneca. Knowledge of the vaccine was associated with education level (OR=18.86; 95% CI [7.16-49.64]; p=0.00). CONCLUSION: The population of the fourth municipality of Bamako have a few knowledge about the vaccine in use in Mali. So it's necessary to strengthen awareness campaigns.

INTRODUCTION: Face à la pandémie de la COVID-19, plusieurs vaccins candidats ont reçu l'accord de l'OMS d'être utilisés. Cependant on assiste à une faible adhésion à la campagne de vaccination, surtout au Mali. L'objectif était d'étudier la perception de la population de la commune IV du district de Bamako sur le vaccin contre la COVID-19. MÉTHODE: Il s'agissait d'une étude transversale descriptive et analytique, réalisée du mois de Mai au mois d'Août 2021. Un choix raisonné de deux quartiersde la commune IVa été réalisé. Le test de Khi-deux de Pearson a été utilisé pour vérifier l'association entre les variables. RÉSULTATS: Au total179 personnes de deux quartiers de la commune IV ont été enquêtées. L'âge moyen était 37,73 ans (SD=13,67), 34,6% (n=62) n'étaient pas scolarisées, et 7,8% (n=62) avaient reçu au moins la première dose d'un vaccin contre la COVID-19.37,4% (n=67) ne croyaient pas à l'existence de la COVID-19 ; pendant que 84,9% (n=152)ne connaissaient,ne seraitce que le nom du vaccin en usage au Mali. 65,4% (n=117) ne faisaient pas confiance au vaccin, pendant que 78,1% des enquêtés (n=25) auraient préféré autres vaccins différents d'AstraZeneca. On pouvait voir que La connaissance du vaccin étaitassociée au niveau d'étude (OR=18,86 ; 95% IC [7,16-49,64] ; p=0,00). CONCLUSION: La population de la commune IV du district de Bamako a très peu de connaissance sur le vaccin utilisé au Mali, d'où la nécessité de renforcer les campagnes de sensibilisation.

[Evaluation of the quality-of-life of patients with pacemakers : experience of Burkina Faso about 120 patients paired with the collaboration of doctors from AUVERGNE (France)]. / Évaluation de la qualité de vie des patients porteurs d'un stimulateur cardiaque (pacemaker) : expérience du Burkina Faso à propos de 120 patients appareillés avec la collaboration des médecins d'Auvergne (France).

INTRODUCTION: In Burkina Faso, cardiac stimulation was introduced in October 2000 has grown over time.In orderto evaluate the effectiveness of stimulation on life, we proposed to evaluate the quality of life of patients with a pacemaker. GENERAL OBJECTIVE: to study the effect of the pacemaker on the quality of life of patients PATIENTS AND METHODS: This was a cross-sectional study aimed at describingthe wearers of a pacemaker for at least six months at the Yalgado OUEDRAOGO University Hospital and the Schiphramedical center.The AQUAREL questionnaire has been adapted to our context to establish a quality-of-life score. RESULTS: The mean age of the study population was 68 years with a female predominance (53.3%). Complete atrioventricular block was the main indication of stimulation in 55%. The average duration of implantation was 41.6 months with extremes of 8 and 128 months. The primo implantation was found in 79.1 % of patients against 18.3 % for a first change of case and2.5 % for a second change of housing. Double chamber stimulation was performed in 65% of cases. DDD mode was the most used followed by VVIR. The average quality of life score was 90.12. Negative predictors of quality of life were age and female.A correlation between quality-of-life score and age, hypertension and dyslipidemia was found (p< 0.05). On the other hand, no correlation between the number of implantation, the duration of implantation and the mode of stimulation was found (p> 0.05). CONCLUSION: patients with a pacemaker have a good quality of life. However, quality-of-life is not correlated with the number of pacemakers, nor the duration and mode of stimulation.

[Comparison of the performance of viral load screening from plasma and from the oneblotting paper (Oudried Blood Spot), protocol in people living with the human immunodeficiency virus (PLHIV) in Bamako]. / Comparaison des valeurs de charges virales realisees sur plasma et sur goutte de sang seche Oudried Blood Spot(DBS) chez les personnes vivant avec levirus de l'immunodeficience humaine (VIH) a Bamako.

INTRODUCTION: The use of blotting paper as a support for quantification of viral load could improve the virological monitoring of patients on Human Immunodeficiency Virus treatment in Mali. The urgency is obvious to us that the coverage in charge is only 10% for the achievement of the 3rd 90. OBJECTIVE: To assess the performance of viral load screening (sensitivity, specificity, concordance) of DBS from the one spot DBS protocol according to plasma in people living with the human immunodeficiency virus (PLHIV) in Bamako. METHODS: A total of 130 blotting papers were made from blood samples received from five sites for monitoring live persons with HIV. These blotting papers thus made were analyzed with the Abbott m2000 apparatus for the purpose of quantifying the viral load with plasma as reference sample. The extraction was done with the m2000SP automatic extractor, following the protocol 1.0 mL HIV-RNA DBS Protocol for paper. Furthermore, the extraction of plasma RNA on the m2000SP was done according to the 0.6 mL HIV-1 RNA protocol. RESULTS: With 130 samples with detectable viral loads, we obtained a correlation of r = 0.837 (p <0.001). In addition, the average difference between the viral load on blotting paper and plasma was 0.512 log / virological copies with a kappa coefficient = 0.708. The threshold of 1000 copies / mL defined as virological success in our study allowed us to obtain a sensitivity of 87% and a specificity of 100%. CONCLUSION: Decentralized zones or virological plasma monitoring is not accessible, the new Protocol one spot of Abbott laboratory offers an interesting opportunity for the follow-up of these patients with good performance at the threshold of 1000 copies. The use of DBS as a virological support can contribute effectively to the achievement of the 3rd 90.

INTRODUCTION: L'utilisation du papier buvard comme support de quantification de la charge virale pourrait améliorer le suivi virologique des patients sous traitement antirétroviral (ARV) au Mali. L'urgence s'impose à nous vula couverture en charge faible(10%) pour l'atteinte du 3ème 90. OBJECTIF: Evaluer les performances de dépistage de la charge virale (sensibilité, spécificité, concordance) des DBS issus du protocole one spot DBS en fonction du plasma chez les personnes vivant avec le virus de l'immunodéficience humaine (PVVIH) à Bamako. MÉTHODES: Au total, 130 papiers buvards ont été confectionnés à partir d'échantillons sanguin reçus de cinq sites de suivi des personnes vivant avec le virus de l'immunodéficience humaine. Ces papiers buvards ainsi confectionnés ont été analysés avec l'appareil Abbott m2000 en vue de la quantification de la charge virale avec comme échantillon de référence le plasma. L'extraction a été faite avec l'extracteur automatique m2000SP, suivant le protocole 1.0 mL HIV-RNA DBS Protocol pour le papier buvard. Par ailleurs, l'extraction de l'acideribonucléique (ARN) plasmatique sur le m2000SP a été faite selon le protocole 0.6 mL HIV-1 RNA. RÉSULTATS: Avec les 130 échantillons avec des charges virales détectables, nous avons obtenu une corrélation de r= 0.837(p<0,001). Par ailleurs, la différence moyenne entre la charge virale sur papier buvard et sur plasma était de 0,512 log/copies virologique avec un coefficient kappa= 0,708. Le seuil de 1000 copies/mL défini comme succès virologique dans notre étude nous a permis d'obtenir une sensibilité de 100% et une spécificité de 87%. CONCLUSION: Dans les zones décentralisées où le suivi virologique sur plasma n'est pas accessible, le nouveau Protocol one spot du laboratoire Abbott offre une opportunité intéressante pour le suivi de ces patients avec de bonne performance au seuil des 1000 copies. Aussi, l'utilisation du DBS comme support virologique peut contribuer efficacement à l'atteinte du 3ème 90.

Effet de la formation sur la qualité de la prise en charge des cas de paludisme dans les centres de santé de premier contact de la commune V de Bamako

Le programme national de lutte contre le paludisme avec ses partenaires a entrepris des formations des prestataires sur les nouvelles directives de prise en charge des cas de paludisme dans les formations sanitaires du pays. Cette étude visait à mesurer l'effet desdites formations sur les pratiques des prestataires formés. Elle s'est déroulée dans les structures de premier contact de la commune V du district de Bamako. Il s'agissait d'une étude transversale portant sur les données de 3 mois avant et après la formation à partir des registres de consultation. La fièvre était le symptôme le plus fréquent avec 34,7 % avant la formation et 33,6 % après la formation. La majorité des patients a bénéficié d'un examen biologique soit 57,9 % avant la formation et 60,5 % après la formation. Le paludisme simple a représenté 35,4% avant la formation et 37,9 % après la formation contre respectivement 34,8 % et 34,3 % pour le paludisme grave. Cependant, 29,8 % des patients avant la formation et 27,8 % après la formation n'ont pas été classés conformément aux normes nationales. Parmi les cas de paludisme simple, 45,3 % ont été traités correctement avant la formation contre 57,6 % après la formation. Pour le paludisme grave, les taux de traitement correct étaient de 75,5 % avant la formation contre 72,1 % après la formation. La formation des prestataires a eu un effet modéré sur la qualité de la prise en charge des cas de paludisme dans les structures concernées. La supervision postformation ou la formations des prestataires à la tâche pourrait améliorer la situation

Pidolate de magnésium dans la prévention des AVC. A propos de 60 cas à l'Institut Cœur de Grâce en Côte d'Ivoire

L'hypertension artérielle (HTA) représente une cause fréquente de consultation dans les pays en voie de développement. Elle est pourvoyeuse de complications neurologiques de type encéphalopathie hypertensive et accident vasculaire cérébral ischémique transitoire (AIT).L'objectif de cette étude était de d'évaluer l'efficacité synergique de l'association Pidolate de Magnésium et traitement antihypertenseur chez les patients hypertendus suivis à l'institut cœur de grâce (ICG) à Cocody Danga.Patients et méthodes : Il s'agit d'une étude randomisée, prospective portant sur 60 patients hypertendus tirés au sort. Le premier groupe de patients concernait ceux qui avaient reçu du pidolate de magnésium en association à un traitement antihypertenseur, le second groupe servant de témoin n'avait reçu que le traitement antihypertenseur. Le test de Chi carré et le test de Fisher exact ont été appliqués. Le seuil de signification (p < 0.05) ; l'odds ratio, les valeurs de tendance centrale et l'écart-type ont été calculés. Le logiciel EPI-INFO a permis d'analyser les données.Résultats : Dans cette étude, il n'y a pas de différence significative au niveau du sexe (p = 0,398) entre les deux groupes de population. Globalement la moyenne d'âge était de 51,7 ans ± 11 (extrêmes 32 et 76 ans). Spécifiquement dans le groupe 1 avec la supplémentation magnésique, la moyenne d'âge était de 51,9 ans ± 11 (extrêmes 36 et 73 ans) et dans le groupe 2 sans magnésium la moyenne d'âge était de 51,5 ans ± 11 (extrêmes 32 et 76 ans). Il n'y avait pas de différence significative (p = 0,889). Les tranches d'âges étaient harmonieusement réparties (Chi2 = 0,309 et p = 0,856). La répartition des patients en fonction des étiologies était équitable entre les deux groupes (Test de Fischer exact p = 0,397) avec distribution harmonieuse des patients ayant présenté une encéphalopathie hypertensive (12 patients versus 14) et une HTA sévère (18 patients versus 16) et aucune différence significative n'a été observée entre les deux groupes (OR = 0,7619 ; IC 95% [0,2737­2,12] p = 0,39). Nous constatons dans cette étude que la supplémentation magnésique au traitement anti-hypertensif a eu un effet bénéfique, donc un rôle protecteur contre la survenue d'accident vasculaire cérébral ischémique. Le bénéfice cardiovasculaire s'est avéré supérieur à celui que l'on pouvait imputer à la baisse de la pression artérielle (Test de Fischer exact p = 0,000003).Conclusion : Ces résultats plaident fortement pour l'importance du pidolate de magnésium dans la prise en charge de l'hypertension artérielle

Diversity of Sand Flies (Diptera: Psychodidae: Phlebotominae) in Two Different Eco-Climatic and Endemic Zones of Cutaneous Leishmaniasis in Mali, West Africa.

Being the only established vectors of the protozoan parasites of the genus Leishmania, sand flies have become very important in all countries where leishmaniasis exists. To better understand the sand fly fauna, a taxonomic inventory study was carried out between January and March 2012 in Soudan savannah (Boundioba, Sikasso) and Sahelian (Tieneguebougou, Koulikoro) areas of Mali. CDC light traps were used to collect the sand flies. Collected sand flies specimens were cleaned with lacto-phenol and examined under a light microscope for species identification. In total, 14 species belonging to the genera Phlebotomus and Sergentomyia were identified. The genus Sergentomyia constituted 98.05% of collected sand flies versus 1.95% for the genus Phlebotomus. The most abundant species were Sergentomyia dubia Parrot, Mornet, & Cadenat, Sergentomyia shwetzi, Sergentomyia clydei Sinton, and Sergentomyia antennata Newstead. In Boundioba, the genus Phlebotomus was represented by two species (Phlebotomus duboscqi Neveu-Lemaire and Phlebotomus rodhaini Parrot), whereas only one species, Ph. duboscqi, was captured in Tieneguebougou. For the first time, three new species, Sergentomyia madagascariensis, Sergentomyia congolensis, and Sergentomyia dureni, were identified in Mali. More investigations are needed for a better entomological assessment of the transmission of cutaneous leishmaniasis in the different eco-climatic zones of Mali.

Quelle strategie de depistage et de prise en charge des hepatites virales en entreprise ?

Introduction. Les hepatites virales posent un veritable probleme de sante publique en Cote d'ivoire. Le but de ce travail etait de rapporter la strategie de depistage et de prise en charge des hepatites virales au sein d'une entreprise financiere de la Cote d'Ivoire. Methodes. Il s'agissait d'une etude transversale qui s'est deroulee selon un chronogramme en trois phases du 18 aout 2014 au 12 septembre 2014 au sein des differentes agences de l'entreprise. La campagne de depistage avait ete precedee d'une conference de sensibilisation des agents de l'entreprise. Les marqueurs de depistage etaient l'Ag HBs et les AC anti HBc totaux pour l'hepatite B et l'Ac anti VHC pour l'hepatite C. Les patients dont les Ac anti VHC etaient positifs avaient eu un dosage de l'ARN viral C. Les travailleurs qui avaient deja ete vaccines; sans avoir ete depistes et qui apres depistage n'etaient pas porteurs les marqueurs de l'hepatite B positifs avaient eu un dosage quantitatif de l'Ac anti HBs. La serologie retrovirale; de meme que les anticorps anti VHD totaux avaient ete systematiquement recherches chez les travailleurs dont l'antigene HBs etaient positifs. De meme tous ceux qui etaient porteurs de l'ARN viral C ont ete systematiquement depistes pour le VIH. Les parametres d'etude etaient : le taux de participation; la prevalence de l'antigene HBs; la prevalence des Ac anti VHC; le nombre d'agents eligibles a la vaccination; le nombre de patients eligibles a un traitement anti viral; le nombre de patients non eligibles a un traitement mais sous surveillance. Resultats. 1025 agents sur un effectif de 1137 avaient participe a la campagne de depistage soit un taux de participation de 90;14%. La prevalence des marqueurs de l'hepatite B et C etaient respectivement de 6;34% et de 1;46%. Sur 80 personnes depistees positives a l'hepatite B et C; seules 67 ont ete prises en charge (83;75%) les 11 autres (16;25%) n'avaient pas repondu a la convocation du medecin. 224 agents avaient ete proposes pour la vaccination. La mise en route du traitement antiviral B avait concerne 07 patients soit 12;96% des patients porteurs de l'hepatite B et 01 seul patient pour l'hepatite C. Conclusion. La strategie de lutte contre les hepatites virales au sein de cette entreprise a ete favorablement accueillie par les travailleurs de celle -ci; avec un taux de participation de 90;14% pour le depistage. La prevalence de l'hepatite B reste elevee (6;34%). Un plaidoyer pour une meilleure accessibilite au Tenofovir et aux DASS merite d'etre fait

[Complications of digestive ostomies in pediatric surgery]. / Complications des stomies digestives en chirurgie pediatrique.

AIMS: To determine the frequency and factors of complications of intestinal stomas. METHODS: This was a retrospective study over a 7 year period from January 2004 to December 2010, covering all children aged 0-15 years, who received a stoma and hospitalized in the period of study. Excluded from this study, alimentary ostomy and urological ostomy, and children whose medical records were incomplete. RESULTS: We examined 192 cases of stoma or 27 cases/year. We noted a complication in 91 (48%) of our patients. The average age was 3.64 ± 5.03 years ranging from 6 hours and 15 years. The complicating factors were: the indication for surgery, type of stoma, the variety of stoma, surgical technique and equipment. CONCLUSION: The achievement of good technique and appropriate equipment would be needed to reduce some complications of the stoma.

OBJECTIFS: Déterminer la fréquence et les facteurs de complications des stomies digestives. MATÉRIEL ET MÉTHODE: Il s'agissait d'une étude rétrospective de 7 ans allant de Janvier 2004 à Décembre 2010, portant sur tous les enfants âgés de 0­15ans, ayant bénéficié d'une stomie et hospitalisés dans le service pendant la période d'étude. N'ont pas fait partie de cette étude, les stomies d'alimentations et urologiques, ainsi que les enfants dont le dossier médical était incomplet. RÉSULTATS: Nous avons colligé 192 cas de stomies soit 27 cas/an. Nous avons noté une complication chez 91 patients (48%) de nos patients. L'âge moyen a été de 3,64±5,03 ans avec des extrêmes de 6 heures et 15ans. Les facteurs de complications ont été: l'indication opératoire, le type de stomie, la variété de la stomie, la technique chirurgicale et l'appareillage. CONCLUSION: La réalisation d'une bonne technique et un appareil adéquat seraient nécessaires pour réduire certaines complications des stomies.

[Typhoid peritonitis in children: Evaluation of morbi-mortality at the Gabriel Touré teaching hospital in Bamako]. / Peritonites typhiques chez l'enfant: Evaluation de la morbi-mortalité au CHU Gabriel Touré, Bamako.

AIMS: To determine related factors of complications typhoid perforations in the small intestine in children. MATERIAL AND METHOD: A retrospective study was conducted between June 1st, 2005 to June 30th, 2010 in all children aged 0 to 14 years treated for peritonitis by ileal perforations in the service of paediatric surgery at the Gabriel Touré teaching hospital. Traumatic perforations and patients with incomplete files were not included in this study. RESULTS: In 5 years time we gathered 105 cases of ileal typhoid perforation. After surgical treatment early outcomes were simple in 70 patients (66.6%), a parietal suppuration had been noted in 15 patients (14.3%) and fistula in 4 (3.9%). Sixteen patients (15.2%) died. Complications were related to patient's age, ASA Score, time frame of care, quantity of peritoneal fluid, number and site of perforation, surgical techniques and the duration of surgery P(<0.05). Sex, anaemia, surgeon, and perforation diameter did not significantly influence the rate of complications. CONCLUSION: Reduction of morbi-mortality happens through prevention, earlier diagnosis and appropriate management of typhoid fever.

OBJECTIFS: Déterminer les facteurs liés aux complications post-opératoires des perforations typhiques du grêle chez l'enfant. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude rétrospective réalisée du 1er juin 2005 au 30 juin 2010 chez tous les enfants âgés de 0 à 14 ans traités pour péritonite par perforation iléale dans le service de chirurgie pédiatrique du CHU Gabriel Touré. Les perforations traumatiques et les patients à dossier incomplet n'ont pas été inclus dans l'étude. RÉSULTATS: En 5 ans nous avons colligé 105 cas de perforations iléales typhiques. Après le traitement chirurgical les suites immédiates ont été simples chez 70 malades (66,6%), une suppuration pariétale a été notée chez 15 patients (14,3%) et une fistulisation chez 4 autres (3,9%). Le décès était survenu chez 16 malades (15,2%). Les complications ont été fonctions de l'âge du patient, du Score ASA, du délai de prise en charge, de la quantité du liquide intraabdominal, du nombre et siège de la perforation, de la technique chirurgicale et de la durée de l'intervention (P<0,05). Le sexe, la présence d'une anémie, le chirurgien et le diamètre de la perforation n'ont pas eu d'influence sur la survenue des complications. CONCLUSION: La réduction de la morbi-mortalité passe par la prévention, un diagnostic précoce et une prise en charge adéquate des fièvres typhoïdes.

Pharmacovigilance et impact du traitement preventif intermittent a la Sulfadoxine-pyrimethamine chez la femme enceinte a Selingue au Mali

Cette etude avait pour but d'evaluer l'impact du traitement intermittent preventif (TPi) et les effets adverses associes chez la femme enceinte vivant en zone hyperendemique de Selingue sur l'issue de grossesse. La pharmacovigilance a pour objet; la surveillance du risque d'effet indesirable resultant del'utilisation des medicaments et produits a traitements a la S-P aux femmes enceintes a des intervalles definis apres environ 18-20 semaines de grossesse. L'enquete sur le comportement et les attitudes pratiques (CAP) nous a permis d'interviewer 210 femmes enceintes vues en consultation prenatale au niveau des centres de sante du district sanitaire de Selingue. La quasi-totalite de nos femmes (99) affirme connaitre le paludisme et 84;8connaitre les signescliniques du paludisme (tableau 1). L'automedication etait pratiquee par 40des femmes enceintes. Une faible proportion des femmes affirment posseder des moustiquaires (8;6) tandis que 14;3affirment utiliser des moustiquaires impregnees d'insecticides. Le taux d'anemie severe etait de 30;5(Hb 7 g/dl) apres la premiere dose et de 13;3apres la seconde dose de S-P. Parallelement; le taux d'anemie moderee (Hb 7-9g /dl) a diminue de 54;8apres la premiere dose a 26;2apres la seconde dose. Ce taux d'anemie etait plus eleve chez les multigestes (32;1) comparees aux primigestes (21;7). Nous n'avons observe aucun cas d'echec therapeutique a la S-P ni d'infection placentaire dans notre etude. Le taux de prematurite etait de 3tandis que le taux du petit poids a la naissance etait de 17;6. Les effets secondaires etaient essentiellement des nausees et embarras gastrique (1;9a la 1e dose S-P et 1apres la 2e dose de S-P). Nous n'avons note aucun cas d'effets secondaires severes ni de malformations a la naissance des nouveau-nes. En conclusion; le TPi a la S-P a ete bien tolere par les femmes enceintes vivant a Selingue et presente tres peu de reactions secondaires mineures. La S-P est actuellement le seul antipaludique a dose unique qui possede un effet prolonge et qui a des proprietes ideales (cout faible; assez de donnees disponibles sur sa tolerance et sa facilite d'utilisation) pour une meilleure utilisation au cours de la grossesse.) affirme connaitre le paludisme et 84;8connaitre les signescliniques du paludisme (tableau 1). L'automedication etait pratiquee par 40des femmes enceintes. Une faible proportion des femmes affirment posseder des moustiquaires (8;6) tandis que 14;3affirment utiliser des moustiquaires impregnees d'insecticides. Le taux d'anemie severe etait de 30;5(Hb 7 g/dl) apres la premiere dose et de 13;3apres la seconde dose de S-P. Parallelement; le taux d'anemie moderee (Hb 7-9g /dl) a diminue de 54;8apres la premiere dose a 26;2apres la seconde dose. Ce taux d'anemie etait plus eleve chez les multigestes (32;1) comparees aux primigestes (21;7). Nous n'avons observe aucun cas d'echec therapeutique a la S-P ni d'infection placentaire dans notre etude. Le taux de prematurite etait de 3tandis que le taux du petit poids a la naissance etait de 17;6. Les effets secondaires etaient essentiellement des nausees et embarras gastrique (1;9a la 1e dose S-P et 1apres la 2e dose de S-P). Nous n'avons note aucun cas d'effets secondaires severes ni de malformations a la naissance des nouveau-nes. En conclusion; le TPi a la S-P a ete bien tolere par les femmes enceintes vivant a Selingue et presente tres peu de reactions secondaires mineures. La S-P est actuellement le seul antipaludique a dose unique qui possede un effet prolonge et qui a des proprietes ideales (cout faible; assez de donnees disponibles sur sa tolerance et sa facilite d'utilisation) pour une meilleure utilisation au cours de la grossesse

A natural asymptomatic herpes B virus infection in a colony of laboratory brown capuchin monkeys (Cebus apella).

Herpes B virus (BV) infection of macaques persists in the natural host, but is mainly asymptomatic. However, BV can cause fatal disease in humans and in several non-macaque species such as capuchin monkeys (Cebus apella). The BV infection described here in a colony of capuchin monkeys was persistent but asymptomatic. Initially the infection was detected serologically in five out of seven animals. However, using polymerase chain reaction (PCR) developed specifically for BV, we found the virus in all seven clinically healthy animals. It is probable that the infection was transferred from BV-infected macaques housed in different cages but in the same room for several years. We have no evidence to indicate that similar asymptomatic infections may occur in other New World species but the possibility should not be discounted. We recommend that the housing of capuchin monkeys in close proximity to macaques should be avoided and that greater caution should be used when handling capuchin monkeys and possibly other New World species that have been in contact with macaques. All may act as a source of BV infection in humans, hence routine, repeated testing of all primates is essential.

A spontaneous uterine sarcoma in a rhesus monkey (Macaca mulatta).

In primates, little has been reported about malignant mesenchymal uterine tumours. A case of a spontaneous metastasising uterine sarcoma in a 17-year-old rhesus monkey is presented. Clinically, transient abdominal pain, spasms, nausea, anaemia, a firm uterus and bloody vaginal discharge were noted. In a diagnostic laparoscopy, both massive adhesions in the lesser pelvis and 10 ml of ascites fluid were detected. In necropsy, in addition to peritonitis with massive adhesions, a cauliflower-shaped, irregular, tough, greyish-white uterine tumour was seen. Two cherry-sized tumour metastases were noticed in the greater omentum. In histology, both in the uterus and the metastases, a sarcoma with a low amount of connective tissue and well-differentiated cell nuclei was identified.

Virus safety in xenotransplantation: first exploratory in vivo studies in small laboratory animals and non-human primates.

For xenotransplantation, the transplantation of animal cells, tissues and organs into human recipients, to date, pigs are favored as potential donors. Beside ethical, immunological, physiological and technical problems, the microbiological safety of the xenograft has to be guaranteed. It will be possible to eliminate all of the known porcine microorgansims in the nearby future by vaccinating or specified pathogen-free breeding. Thus, the main risk will come from the porcine endogenous retroviruses (PERVs) which are present in the pig genome as proviruses of different subtypes. PERVs will therefore be transmitted, with the xenograft, to the human recipient. PERVs can infect numerous different types of human primary cells and cell lines in vitro and were shown to adapt to these cells by serial passaging on uninfected cells. Furthermore, PERVs have high homology to other retroviruses, such as feline leukemia virus (FeLV) or murine leukemia virus (MuLV), which are known to induce tumors or immunodeficiencies in the infected host. To evaluate the potential risk of a trans-species transmission of PERV in vivo, naive and immunosuppressed rats, guinea pigs and minks were inoculated with PERV and screened over a period of 3 months for an antibody reaction against PERV proteins or for the integration of proviral DNA into the genomic DNA of the host's cells. Furthermore, we inoculated three different species of non-human primates, rhesus monkey (Macaca mulatta), pig-tailed monkey (Macaca nemestrina) and baboon (Papio hamadryas) with high titers of a human-adapted PERV. To simulate a situation in xenotransplantation, the animals received a daily triple immunosuppression using cyclosporine A, methylprednisolone and RAD, a rapamycin derivative, presently under development by Novartis. None of the small laboratory animals or the non-human primates showed production of antibodies against PERV or evidence of integration of proviral DNA in blood cells or cells of several organs, 3 months after virus inoculation, despite the observation that cells of the animals used in the experiment were infectible in vitro. This apparent difference in the outcome of the in vitro and the in vivo data might be explained by an efficient elimination of the virus by the innate or adaptive immunity of the animals.

Productive infection of a mink cell line with porcine endogenous retroviruses (PERVs) but lack of transmission to minks in vivo.

Porcine endogenous retroviruses (PERVs) are considered a special risk for xenotransplantation because they are an integral part of the porcine genome and are able to infect cells of numerous species including humans in vitro. Among these cells, the mink lung epithelial cell line Mv1Lu could be productively infected with PERV. Provirus integration was detected by PCR, expression of viral proteins was shown by immunostaining and reverse transcriptase was detected in cell supernatants. PERV produced from mink cells could infect both, uninfected mink Mv1Lu cells and uninfected human 293 cells, with considerably higher virus production by human cells. Typical type C retroviruses were observed in PERV-infected mink cells using electron microscopy together with numerous multivesicular body (MVB)-like structures containing small virus-like particles, not present in uninfected mink cells. These MVBs could be stained with PERV-specific serum. In an attempt to establish a small animal model, PERV grown on mink cells was inoculated into adult and newborn American minks. Neither antibody production against PERV nor integration of viral DNA or production of viral proteins in tissues of different organs could be detected 12 weeks post virus inoculation, indicating that PERV infection had not occurred.

Simian immunodeficiency virus (SIV) from sun-tailed monkeys (Cercopithecus solatus): evidence for host-dependent evolution of SIV within the C. lhoesti superspecies.

Recently we reported the characterization of simian immunodeficiency virus (SIVlhoest) from a central African l'hoest monkey (Cercopithecus lhoesti lhoesti) that revealed a distant relationship to SIV isolated from a mandrill (SIVmnd). The present report describes a novel SIV (SIVsun) isolated from a healthy, wild-caught sun-tailed monkey (Cercopithecus lhoesti solatus), another member of the l'hoest superspecies. SIVsun replicated in a variety of human T-cell lines and in peripheral blood mononuclear cells of macaques (Macaca spp.) and patas monkeys (Erythrocebus patas). A full-length infectious clone of SIVsun was derived, and genetic analysis revealed that SIVsun was most closely related to SIVlhoest, with an amino acid identity of 71% in Gag, 73% in Pol, and 67% in Env. This degree of similarity is reminiscent of that observed between SIVagm isolates from vervet, grivet, and tantalus species of African green monkeys. The close relationship between SIVsun and SIVlhoest, despite their geographically distinct habitats, is consistent with evolution from a common ancestor, providing further evidence for the ancient nature of the primate lentivirus family. In addition, this observation leads us to suggest that the SIVmnd lineage should be designated the SIVlhoest lineage.

Simian immunodeficiency virus of African green monkeys is apathogenic in the newborn natural host.

Several studies have demonstrated that newborn animals are more susceptible to disease development following infection with retroviruses than adults. Adult African green monkeys (AGMs) infected with SIVagm do not develop AIDS-like disease and the objective of the study was to determine whether experimental infection of newborn AGMs with SIVagm would result in pathogenesis. Neonatal AGMs were found to have a higher percentage of circulating CD4+ lymphocytes than adults (62% versus 14%) and therefore a higher potential pool of target cells for SIVagm infection. However, no differences in the in vitro replication kinetics of SIVagm in peripheral blood mononuclear cells of adult or neonatal AGMs could be observed. In vivo, the neonatal AGMs became viremic at the earliest two months after inoculation whereas the adult AGMs had evidence of virus replication already 2 to 6 weeks after infection. None of the animals developed AIDS-like symptoms upon infection. In the heterologous cynomolgus macaque host, a newborn infected with SIVagm developed early high virus loads and died two months after birth with AIDS-like histopathologic features. It would therefore appear that in contrast to the situation with many other retroviruses, newborn AGMs are no more permissive to SIVagm infection than are adults.

The effect of simian immunodeficiency virus infection in vitro and in vivo on the cytokine production of isolated microglia and peripheral macrophages from rhesus monkey.

Microglia are the major target for human immunodeficiency virus (HIV) infection within the central nervous system. Because only a few cells are productively infected, it has been suggested that an aberrant cytokine production by this cell population may be an indirect mechanism leading to the development of neurological disorders in HIV-infected patients. Therefore we decided to study the secretion pattern of several interleukins (IL) by microglial cells and peripheral blood macrophages isolated from uninfected and simian immunodeficiency virus (SIV)-infected Rhesus monkeys. We found that uninfected, unstimulated primate microglia produce more IL-6 and less TNF alpha than peripheral blood macrophages, but generate comparable levels of IL-1 beta and IL-8. After infection with SIV in vitro, synthesis of all cytokines tested is increased compared to uninfected cultures and to peripheral blood macrophages. Microglia isolated from infected animals produce more IL-8 and TNF alpha than the uninfected cultures and display a strongly increased capacity to secrete TNF alpha upon stimulation with lipopolysaccharide. In addition, production of IL-6 by in vivo-infected microglia increases with time in culture to very high levels despite the fact that only a few cells contained replicating virus. These findings clearly show that the cytokine production of microglia is impaired after SIV infection both in vitro and in vivo and that a low level of viral replication is sufficient for these alterations to occur. In conclusion, the results of this study further support a possible role of cytokines in the pathogenesis of neuro-AIDS.

Simian immunodeficiency virus (SIV) gp130 oligomers protect rhesus macaques (Macaca mulatta) against the infection with SIVmac32H grown on T-cells or derived ex vivo.

The efficacy of three SIVmac32H gp130 vaccines was compared in rhesus monkeys. Three rhesus monkeys were each immunized over a period of 20 weeks with a total of 600 microgram virion-derived gp130 oligomers (O-gp130) mixed with keyhole limpet hemocyanin and emulsified with incomplete Freund's adjuvant. Three other monkeys were infected with 5 x 10(8) PFU of vaccinia virus wild type (VV-wt) while three additional animals received an equivalent dose of VV expressing the gp130 of SIVmac (VV-gp130). At Week 8, the two VV-wt animals received an additional immunization with 100 microgram O-gp130 each. All VV-infected animals then received booster immunizations at Weeks 12, 16, and 20 with a total of 300 microgram O-gp130 per animal. All animals along with two controls were challenged iv with 50 MID50 of T-cell-grown SIVmac32H at Week 22. Four weeks after the challenge and thereafter, both controls and one animal from either VV group were infected as demonstrated by polymerase chain reaction (PCR), virus isolation, and antibody response. In contrast, all O-gp130 animals and one animal each from the VV-wt and the VV-gp130 group were completely protected as shown by negative PCR and virus reisolation. One animal of the VV-gp130 group was partially protected, since it remained virus isolation negative but became PCR positive. All protected animals did not develop a secondary antibody response. Six months after the first challenge, the five completely protected animals were reimmunized twice 4 weeks apart with a total of 200 microgram O-gp130 per animal. Two weeks later, all animals were challenged with 5 MID50 of the SIVmac32H/spI prepared from the spleen of an immunized, but unprotected SIV-infected rhesus monkey. After the second challenge, all three control animals and one of the vaccinees become productively infected. In contrast, two animals were completely protected, one from the former O-gp130 and one from the former VV-gp130 group. One animal from the former VV-wt group was only DNA-PCR positive and thus partially protected. Therefore, immunization with virion-derived gp130 oligomers of SIVmac32H can confer protection against the infection with T-cell-grown SIVmac32H as well as the ex vivo isolate SIVmac32H/spI.

vpr deletion mutant of simian immunodeficiency virus induces AIDS in rhesus monkeys.

In previous experiments, animals infected with SIVmac239 containing a point mutation in the vpr and nef genes developed AIDS-like symptoms after early reversion of the vpr and nef genes. Here we show that two animals in which the nef gene but not the vpr gene had reverted in the first few months did not develop disease during a 3-year observation period even after reversion to a functional vpr gene 70 weeks postinfection. To study the influence of a stable vpr mutation on virus load and pathogenesis, a 43-bp deletion was introduced into the vpr gene of SIVmac239on, a nef-open mutant of SIVmac239. Four rhesus monkeys were inoculated with the vpr deletion mutant (SIV delta vpr), and two control animals were infected with SIVmac239on. Both control animals had persistent antigenemia, high cell-associated virus loads, and elevated neopterin levels. They had to be euthanized 20 and 30 weeks postinfection because of AIDS-related symptoms. However, all four rhesus monkeys inoculated with SIV delta vpr showed only transiently detectable antigenemia. The cell-associated virus loads were high in three of the four animals. Two animals with AIDS-like symptoms had to be euthanized 71 and 73 weeks postinfection. The two remaining monkeys infected with SIV delta vpr were still alive 105 weeks postinfection. In contrast to the SIVmac239on-infected animals, SIV delta vpr-infected animals had strong humoral immune responses and intermittent cellular immune responses to SIV antigens. Our data show that a functional vpr gene is not necessary for pathogenesis. However, vpr-deficient SIVmac239 variants might be slightly attenuated, allowing some animals to resist progression to disease for an extended period of time.

Repeated exposure of rhesus macaques to low doses of simian immunodeficiency virus (SIV) did not protect them against the consequences of a high-dose SIV challenge.

As part of an in vivo titration study of the macaque simian immunodeficiency virus (SIVmac) strain 251/spl, macaques were inoculated intravenously with various dilutions of this infectious SIVmac. Seven animals received dilutions from 10(-3) to 10(-6) of SIVmac251/spl. Two monkeys infected with the 10(-3) dilution of SIVmac exhibited a productive infection as indicated by seroconversion, detection of genomic RNA and proviral DNA and positive virus isolation. These animals showed a cytotoxic T cell (CTL) response against different SIVmac proteins without any measurable T cell proliferation. The five macaques receiving higher virus dilutions did not seroconvert and were negative for both viral RNA and for infectious virus, although proviral DNA was detected in their peripheral blood mononuclear cells. In contrast to the animals receiving the 10(-3) virus dilution, these five silently infected monkeys developed an SIV-specific proliferative T cell response but SIV-specific CTL could not be observed. The SIV-specific T cell proliferation of the silently infected animals could be boosted by a second low-dose exposure with a 10(-4) or 10(-5) dilution of SIVmac251/spl. The virological status of the animals was not changed following this second virus inoculation. Four months later these macaques were challenged intravenously with 2 ml of a 10(-4) dilution of SIVmac251/32H containing 10 monkey ID50. After this challenge all SIV-pre-exposed animals and three naive controls became productively infected. In addition, all infected animals developed typical signs of an immunodeficiency within 6 months after infection. These observations indicate that macaques infected silently by a low-dose exposure to infectious virus generated a virus-specific cellular immune response. However, SIV-specific T cell proliferation alone could not protect the monkeys against an intravenous challenge with SIVmac and the subsequent development of AIDS-like symptoms.