Efficacy and Safety of Manual Partial Red Cell Exchange in the Management of Severe Complications of Sickle Cell Disease in a Developing Country.

INTRODUCTION: The realization of red cell exchange (RCE) in Africa faces the lack of blood, transfusion safety, and equipment. We evaluated its efficacy and safety in severe complications of sickle cell disease. PATIENTS AND METHOD: Manual partial RCE was performed among sickle cell patients who had severe complications. Efficacy was evaluated by clinical evolution, blood count, and electrophoresis of hemoglobin. Safety was evaluated on adverse effects, infections, and alloimmunization. RESULTS: We performed 166 partial RCE among 44 patients including 41 homozygous (SS) and 2 heterozygous composites SC and 1 S/ß0-thalassemia. The mean age was 27.9 years. The sex ratio was 1.58. The regression of symptoms was complete in 100% of persistent vasoocclusive crisis and acute chest syndrome, 56.7% of intermittent priapism, and 30% of stroke. It was partial in 100% of leg ulcers and null in acute priapism. The mean variations of hemoglobin and hematocrit rate after one procedure were, respectively, +1.4 g/dL and +4.4%. That of hemoglobin S after 2 consecutive RCE was -60%. Neither alloimmunization nor viral seroconversion was observed. CONCLUSION: This work shows the feasibility of manual partial RCE in a low-resource setting and its efficacy and safety during complications of SCD outside of acute priapism.

[Evaluation of the efficacy of medical screening of blood donors on preventing blood transfusion-transmitted infectious agents]. / Évaluation de l'efficacité de la sélection médicale des donneurs de sang dans la prévention des agents infectieux.

BACKGROUND: The aim of this study was to evaluate the efficacy of medical screening to retain blood donors in window period by comparing the seroprevalence of infectious agents (HIV, hepatitis B and C, syphilis) in deferred versus accepted blood donors. MATERIALS AND METHODS: This prospective and transversal study was performed during 4 months in the National Blood Transfusion Center in Dakar (Senegal). We conducted a convenience sampling comparing the seroprevalence of infectious agents (HIV, HBsAg, HCV and syphilis) in deferred versus accepted blood donors after medical selection. RESULTS: In total, 8219 blood donors were included. Medical selection had authorized 8048 donors (97.92%) and deferred donors were 171 (2.08%). The prevalence of HIV was higher in the deferred than in accepted blood donors (1.75% vs. 0.05%) (P=0.0003; OR=35.91), as well as for HBsAg (12.87% vs. 7.35%) (P=0.006; OR=1.86). HCV antibodies were present in 0.71% of accepted blood donors and 0.58% in deferred blood donors (P=0.65; OR=0.82). Only accepted donors had brought the infection of syphilis (0.34%) (P=0.56; OR=0). CONCLUSION: Medical selection is efficient to exclude blood donors at high risk of HIV transmission and to a lesser extent of HBV. However, current medical screening procedures do not allow us to exclude donors asymptomatic carriers of HCV and syphilis.

Inbreeding within human Schistosoma mansoni: do host-specific factors shape the genetic composition of parasite populations?

The size, structure and distribution of host populations are key determinants of the genetic composition of parasite populations. Despite the evolutionary and epidemiological merits, there has been little consideration of how host heterogeneities affect the evolutionary trajectories of parasite populations. We assessed the genetic composition of natural populations of the parasite Schistosoma mansoni in northern Senegal. A total of 1346 parasites were collected from 14 snail and 57 human hosts within three villages and individually genotyped using nine microsatellite markers. Human host demographic parameters (age, gender and village of residence) and co-infection with Schistosoma haematobium were documented, and S. mansoni infection intensities were quantified. F-statistics and clustering analyses revealed a random distribution (panmixia) of parasite genetic variation among villages and hosts, confirming the concept of human hosts as 'genetic mixing bowls' for schistosomes. Host gender and village of residence did not show any association with parasite genetics. Host age, however, was significantly correlated with parasite inbreeding and heterozygosity, with children being more infected by related parasites than adults. The patterns may be explained by (1) genotype-dependent 'concomitant immunity' that leads to selective recruitment of genetically unrelated worms with host age, and/or (2) the 'genetic mixing bowl' hypothesis, where older hosts have been exposed to a wider variety of parasite strains than children. The present study suggests that host-specific factors may shape the genetic composition of schistosome populations, revealing important insights into host-parasite interactions within a natural system.

Implementing haemophilia care in Senegal, West Africa.

Despite significant progres on haemophilia care in developed world, this disease remains unknown in many sub-Saharan African countries. The objectives of this article were to report Senegalese experience on the management of haemophilia care through 18 years of follow-up. This cohort study included 140 patients (127 haemophilia A, 13 haemophilia B), followed in Dakar's haemophilia treatment centre from 1995 to 2012. Our study reported a prevalence of 2.3/100,000 male births, accounting for 11.6% of what is expected in Senegal. From the period 1995-2003 to 2004-2012, significant progress was seen including 67.9% increase in new patient's identification, 11.3 years reduction in mean age at diagnosis (from 15.5 to 4.2 years), lower mortality rate (from 15.3% to 6.8%) and age at death evolved from 6.5 to 23.3 years. Of the 50 haemophilia A patients who were tested for inhibitor presence, 10 were positive (eight severe and two moderate) that is prevalence of 20%. All patients were low responders since inhibitor titre was between 1.5 and 3.8 BU. Disabilities were seen in 36.5% of patients above 20 years old who had musculoskeletal sequels and 39% had no scholar or professional activities in our setting. Implementing haemophilia care in sub-Saharan Africa is a great challenge as this disease is not yet counted in national health problems in many countries. Lessons learned from this study show a significant improvement in diagnosis and prognosis parameters. This emphasizes the needs to set up such follow-up initiatives and to enhance medical and lay cooperation for better results.

Schistosome infection is associated with enhanced whole-blood IL-10 secretion in response to cercarial excretory/secretory products.

Infection of the human host by schistosome parasites follows exposure of skin to free-swimming cercariae and is aided by the release of excretory/secretory (E/S) material, which is rich in proteases and glycoconjugates. This material provides the initial stimulus to cells of the innate immune system. The study presented here is the first to examine human innate/early immune responsiveness to cercarial E/S in subjects from an area co-endemic for Schistosoma mansoni and S. haematobium. We report that in infected participants, stimulation of whole-blood cultures with cercarial E/S material (termed 0-3 hRP) caused the early (within 24 h) release of greater quantities of regulatory IL-10, compared with uninfected controls. Elevated levels of IL-10 but not pro-inflammatory TNFα or IL-8 were most evident in participants co-infected with S. mansoni and S. haematobium and were accompanied by a higher 0-3 h RP-specific IL-10: TNFα ratio. We also report that glycosylated components within 0-3 h RP appear to be important factors in the stimulation of IL-8, TNFα and IL-10 production by whole-blood cells.

Association between herpes simplex virus type 2 and HIV-1 in a population of married couples from Dakar, Senegal.

Numerous studies suggest that herpes simplex virus type 2 (HSV-2) increases the risk of HIV-1 infection but recent clinical trials of HSV-2 suppressive therapy failed to show an effect. We assessed the putative association between HSV-2 and HIV-1 in a population of HIV-concordant-negative, HIV-1-discordant and HIV-1-concordant-positive married couples from Dakar, Senegal. In agreement with previous studies, we observed a strong overall association between HSV-2 and HIV-1 (odds ratio 4.61; P < 0.001). However, this association was mainly determined by a low HSV-2 prevalence in HIV-concordant-negative couples compared with HIV-1-discordant and HIV-1-concordant-positive couples (23% versus 59% and 66%, respectively; P < 0.001). We observed no further differences in HSV-2 prevalence between HIV-1-discordant and HIV-1-concordant-positive couples (59% and 66%, respectively; P = 0.483). Neither the index (59% versus 62%, P = 1.000) nor recipient partners (41% versus 63%, P = 0.131) in HIV-1-discordant and HIV-1-concordant-positive couples showed significant differences in HSV-2 prevalence. HSV-2 does not constitute a clear risk factor for HIV-1 infection in this population.

[Predictive factors of chronic complications in adult sickle cell anemia patients in Dakar, Senegal]. / Facteurs prédictifs des complications chroniques de la drépanocytose homozygote chez l'adulte à Dakar (Sénégal).

PURPOSE: Chronic complications of sickle cell disease (SS) usually involve irreversible organ damage. Several genetic factors have been shown to have predicative value for chronic complications but these data are not always available. The purpose of this study was to assess the value of sociodemographic and clinicobiological features in predicting chronic complications. METHODS: This study included a total of 229 adult SS patients who underwent quarterly follow-up examinations for at least 10 years (range, 10 - 16). All sociodemographic and clinicobiological data were recorded. Screening for complications was performed at least once every three years. The risk of developing chronic complications was analyzed in function of patient follow-up data. RESULTS: Mean patient age was 28.6 years (range, 20 - 57) and sex ratio was 1.3. Prevalence of chronic complications was 34.9% (80/229). The most common complication was bone necrosis in 27 cases (11.7%) followed by gallstones in 24 (10.4%). The only sociodemographic factor with predictive value was patient age (p=0.0008). Multivariate analysis identified two clinicobiological factors with predictive value. History of transfusion was associated with a 3-fold higher risk while hemoglobin F level was associated with decreased risk. CONCLUSION: In this study, age and low hemoglobin F level were the only predictive factors of chronic complications in SS patients.

[Residual risk of transmission of HIV and HBV, in Senegalese national blood bank from 2003 to 2005]. / Risque résiduel de transmission du VIH et du VHB par transfusion sanguine entre 2003 et 2005 au Centre national de transfusion sanguine de Dakar (Sénégal).

BACKGROUND AND AIM: Using of safety blood products did not stop improving these last years. The use of effective methods as well immunologicals as virologicals ones really reduces risk associated to blood transfusion. However, it persists residual risk (RR) of transfusion transmitted viral diseases. The aim of our study was to detect cases of seroconversion for HIV,and HBV among donors in the Senegalese national blood bank. And then, we estimated the RR of these virus. METHODS: We led a transverse retrospective study from 2003 (January 1st) to 2005 (December 31st). Had been included donors with at least two donations of blood during the period of study. They had to be seronegative for HIV and HBV after the first donation. All donors with only one donation had been excluded. RR was estimated by multiplying incidence rates by the durations of the window periods. RESULTS: During 3 years, we collected 425,503 donations; 388 were positive for HIV and 4240 for HBV. But we noted only two cases of seroconversion for HIV and 23 for HBV. So, RR estimated was 3,5 in 100,000 donation for HIV and 102,45 in 100,000 donations for VHB. CONCLUSION: It emerges from this study that the risk of blood transmitted virus is always high. Introduction of more sensitive tests (as nucleic acid testing) would allow us to deliver more safety products.

[Prevention of transfusion transmitted malaria in endemic area]. / Prévention du paludisme post-transfusionnel en zone d'endémie.

BACKGROUND: Malaria is a real public health problem in Africa; more than 300 million new cases and approximately two million deaths arise every year. In spite of the blood transfusion is a potential way of Plasmodium transmission, there is no consensus for measures to prevent post-transfusion malaria in endemic area. This work aimed at comparing some tools and to discuss various strategies to be implemented. MATERIAL AND METHODS: The study concerned 3001 blood donors recruited in seven blood transfusion centers in Senegal during two periods: dry season (June-July, 2003) and rainy season (October-November, 2003). We evaluated the efficiency of the selection questionnaire for the blood donors to exclude those who are potentially asymptomatic carriers of the Plasmodium. Every donation was screened for pLDH antigen and antibodies against Plasmodium by Elisa technique (DiaMed, Cressier sur Morat, Suisse), morphological tests was also performed, as well as the screening of HIV, HBs Ag, HCV Ab and syphilis. RESULTS: Median age of blood donors was of 27.7 years. Anti-Plasmodium antibodies prevalence was 65.3% and pLDH antigen was of 0.53%, all positivity was confirmed by microscopy. The prevalence of the other infectious markers was 11.7% for HBs Ag; 0.83% for syphilis; 0.49% for HCV Ab and 0.46% for HIV Ab. The risk factors associated with an asymptomatic carrier of Plasmodium were: the rainy season, irregular character of the blood donations, high frequency of malaria attacks in the past, and absence of treatment during the last episode. CONCLUSION: Plasmodium represents the third risk of blood transmitted infectious agents after hepatitis B virus, syphilis, and before HCV and HIV in Senegal. The medical questionnaire is not useful enough for asymptomatic carriers deferral, and we propose to introduce Plasmodium screening. The screening for Plasmodium pLDH by Elisa technique seems to be the best tool in endemic area and the strategy of systematic screening is the most suited in terms of blood transfusion safety.

[Decentralization of the immunological monitoring of people living with HIV/AIDS in a limiting setting with a low HIV seroprevalence: the experience of Senegal]. / Décentralisation du suivi immunologique des personnes vivant avec le VIH dans un pays à ressources limitées et à prévalence faible: expérience du Sénégal.

Our work aimed to propose a manual method of counting CD4 T lymphocytes which is an alternative magnetic immunoseparation followed by a reading with a fluorescence microscope as an alternative to the automated flow cytometry. This alternative technique is easier for use, less expensive and could answer the difficulties encountered for the monitoring CD4 T cells count in developing countries. The specific objectives were: 1) to train the technicians of the peripheral sites in order to make the numeration of the CD4 T lymphocytes more accessible at the peripheral level; 2) to equip the sites with necessary facilities for the T lymphocytes CD4 count; 3) to put in place a system of quality control permitting the reliability of the results. A hundred and fifty patients have been enrolled in three care services for people living with HIV/AIDS in Dakar. This population was constituted of 119 seropositive and 31 seronegative patients acting as control group to have some patients with high rates of T lymphocytes CD4. For the follow-up at peripheral level, the patients were constituted of the active line of the patients living with HIV/AIDS supported in the targeted sites. The measurements allowed studying concordances for different rates of lymphocytes: 0 to 199, 200 to 499 and over 500 cells by mm3. The results showed also a very good correlation (r = 0.97 or r = 0.98 according to the operator) between the two methods for CD4 rates inferior to 500 cells by mm3 among both the negative group and the HIV positive patients. We also discussed the profit of decentralization for the program and the patient, as well as the setting up of an external quality control to validate the alternative technique. According to the results, the Dynabeads is well correlated with the Facscount. It is a technique that can be used as an alternative in the zones with limited resources, low prevalence and for a small number of samples.

[Monoclonal gammapathy of undetermined significance and autoimmune disease: description of three cases in Senegal]. / Gammapathies monoclonales de signification indéterminée et maladies auto-immunes: étude de trois observations sénégalaises.

Monoclonal gammapathy of undetermined significance (MGUS) has rarely been reported in African literature. The purpose of this article is to describe 3 cases of MGUS observed in women aged 63, 54, and 44 years in Senegal. All three patients had previously documented autoimmune disease, i.e., auto-immune thrombopenia, multiple auto-immune disease (comprising Sjögren's syndrome, polymyositis and vitiligo), and Sjögren's syndrome. Diagnosis of MGUS was made thanks to routine protein electrophoresis that demonstrated a monoclonal peak in the gammaglobulin area in all patients. Serum protein binding showed the IgG lambda subtype in one case and IgG kappa subtype in two cases. Medullogram findings were unremarkable with nondystrophic plasma cell rates ranging from 1 to 4%. Bisphophonate therapy was undertaken along with the recommended treatments for the associated autoimmune diseases, i.e., prednisone, hydroxychloroquine, and methotrexate. Treatment was successful in all three patients with stabilization of the associated diseases and of the monoclonal peak on subsequent electrophoresis. As of this writing, the mean duration of follow-up was 3 years. MGUS that has been uncommon in the African hospital setting should be screened for in all older patients or in patients presenting infection (especially due to virus) or autoimmune disease (as in the three cases presented herein). More systematic use of serum protein electrophoresis should reveal an increased incidence of MGUS. Diagnosis of MGUS requires regular clinical and laboratory surveillance due to the risk for complications of malignant hemopathies, especially multiple myeloma.

[Diffuse infiltrative lymphocytosis syndrome (DILS) associated with HIV-1 infection: first Senegalese case report]. / Syndrome d'infiltration lymphocytaire diffuse ou DILS associé a une infection par le VIH -1: premier cas Sénégalais.

INTRODUCTION: The "Diffuse Infiltrative Lymphocytosis Syndrome" [DILS] is a seldom complication and even very particular case of HIV-1 infection, characterized by a merely syndrome and a systemic symptomatology superimposable to the figure met during the Gougerot-Sjögren Syndrome. GSS is nevertheless underlied by a lymphocyte infiltrate composed mainly of TCD8+ lymphocytes, while in the Gougerot-Sjögren syndrome (GSS), the lymphocyte infiltrate is essentially composed of TCD4+ lymphocytes. Despite the antiquity and significance of the HIV/AIDS pandemic, the DILS is not according to our knowledge individualized in the African literature. OBSERVATION: We are reporting a case revealed by a polyarthritis associated among others with a merely syndrome and a HIV-1 infection in a 32 years old Senegalese patient. Her CD4 rate was 327/mm3 and her viral load 17052. The biopsy of the accessory salivary glands showed a 4 grade lymphocite sialoadenitis according to Chisholm classification. The investigation of rheumatoid factors et anti-nuclear antibodies was negative. Under prednisone, hydroxychloroquine, methotrexate and tritherapy treatment, the evolution was favourable with a current return of 2 years. The rarity of DILS has pushed us to study its epidemiological, clinical, paraclinical, physiopathological and therapeutical aspects.

[Von Willebrand disease and menorrhagia]. / Maladie de Willebrand et ménorragie.

INTRODUCTION: Known since over than seventy years, von willebrand disaese is the most common herediary bleeding disorder. This condition was first described by Pr. Willebrand in 1926 in a family with (positive) history of excesive bleeding tendency. Von Willebrand desease is characterized by a lifelong tendency toward easy spontaneous mucosal or post operative bleeding. In females, excessive or prolonged menorrhagia could be a sign of von willebrand desease; symptoms that are often misunderstood to be gynecologic rather than hematologic problem. In the present work, we have tried to screen for this anomaly in females with menorrhagia, following a simple anamnestic, clinical and biological protocol. PATIENTS AND METHOD: In a seventeen month study, fifty two procreating females with menorrhagia were recruited in the haematology laboratory of Aristide le Dantec hospital with the cooperation of gynecology and obstetric departements of Aristide Le Dantec, Abass Ndao and grand yoff Hospitals. RESULTS: Eight patients were revealed to be von willebrand positive (prevalence: 15%). The diagnosis was retained on the basis of epidemiological, clinical and biological data. CONCLUSION: These simple and accessible criteria should allow better handling of patients with hemorragic disorders.

Maladie de Willebrand et menorragie

Introduction : Connue depuis plus de 70 ans; la maladie de Willebrand (MW) est la plus frequente des pathologies hemorragiques hereditaires. Decrite depuis 1926 par le Pr Von Willebrand au sein d'une famille dont plusieurs membres presentaient un syndrome hemorragique; la MW se manifeste surtout par des hemorragies muqueuses et post operatoires. Chez la femme; la MW est a l'origine de menorragies d'abondance variable. Nous nous sommes propose au cours de ce travail de rechercher la maladie de Willebrand chez des femmes presentant une menorragie en suivant une demarche simple anamnestique; clinique et biologique. Patients et methode : Cinquante deux femmes en age de procreer presentant des menorragies ou des menometrorragies ont ete recrutees au sein durant 17 mois au sein du laboratoire d'hematologie de l'hopital Aristide le Dantec; des services de gynecologie et obstetriques des hopitaux Aristide le Dantec; Abass Ndao et Grand Yoff. Resultats : Parmi 52 femmes recrutees 8 ont presentes une maladie de willebrand ; soit une prevalence de 15.Le diagnostic de maladie de willebrand a ete retenu sur la base de faisceaux d'arguments : anamnestiques; cliniques et biologiques. Conclusion : Ces arguments simples accessibles devrait permettre une meilleurs prise en charge des patients souffrant de maladie hemorragique aussi bien sur le plan diagnostic que therapeutique

[Seroprevalence of hepatitis C virus (HCV) in Senegalease blood donors]. / Seroprevalence du virus de l'hepatite C (VHC) chez les donneurs de sang au Senegal.

INTRODUCTION: Hepatitis C virus (HCV) is an important problem of public health in the world according to its transmission mode and its pathogenesis. The risk of blood transmission has led to be the systematic screening of blood donors in the world. In Senegal no study about HCV prevalence on the general population and also has been done. The aim of our study was to determine HCV prevalence in blood donors and the rate of co-infection with hepatitis B (HCV/HBV) or with HIV infection (HCV/HIV). MATERIALS AND METHODS: This study had been done in the National Blood Transfusion Centre (CNTS) in Dakar. Two different techniques has been used for the assessment HCV: 1/ ELISA technique and 2/ Immunoblot RIBA as confirmation test. RESULTS: Our study relates to 1565 blood donors recruited in CNTS during 2002. 369 of them were new blood donors with 365 females and 1200 males. The mean average was 30.5 +/- 9.5 years, ranged from 18 to 59 years. HCV ELISA test were positive in 22 plasma samples and one of them were co-infected with hepatitis B (HCV/HBV). Four out of these 22 samples have been confirmed positive to RIBA test and three of them were not determined. HCV seroprevalence were 1.4% after ELISA and 0.25% after RIBA testing. This seroprevalence were similar in male and in female and higher in new blood donors than in regular blood donors. CONCLUSION: Our results reinforce the necessity to screen hepatitis C virus in all Senegalese blood transfusion centres.

[Relation between lupus-antiphospholipids antibodies and heart disorders]. / Relation lupus-anticorps antiphospholipides et cardiopathie lupique.

BACKGROUND AND AIM: Antiphospholipids antibodies (APL) are autoantibodies found in lupus erythematosus and disorders like. Their frequency varies between 2 and 62% according to the literature. An increased frequency of cardiac disorders in antiphospholipids (APL) positive lupus has been reported. The aim of our study was to evaluate the role of APL as an independent risk factor of cardiac disorders in patients with systemic lupus erythematosus. MATERIAL AND METHOD: A prospective study during 14 months has been designed with the cooperation of dermatologic, internal medicine and cardiology departments of the Aristide Le Dantec hospital of Dakar. Platelets count (Beckmann Coulter analyzer), activated partial thromboplastin time (Diagnostiga stago analyzer) and antiphospholipids antibodies (Elisa) were determined. RESULTS: 37 patients affected by lupus were included in this study with a net feminine prevalence (89%); 8 (14.6%) had APL's significant results and 20 presented an echographic heart abnormality. The analysis of our data did not reveal an increased risk of cardiac diseases among APL positive lupic patients as compared to the negative group (p = 1). CONCLUSION: The presence of APL in patients with systemic lupus does not so seem to be an independant risk factor of heart diseases.

[Maternal anaemia: effect on the newborn]. / Anémie par carence en fer maternelle: retentissement sur le nouveau-né.

Pregnancy increases considerably iron needs in mother and her foetus. The purpose of our study is to measure the effect of maternal anaemia on the foetus and the effect of iron supplementation on the maternal and foetal reserves. Therefore, we conducted a three-month cross sectional study at the gynaecological and obstetrics clinics of Aristide Le Dantec Hospital. Ninety-five women aged 16 to 43 years old and having an haemoglobin rate < 11 g/dl were recruited. Most of them were primipares. Among them 69 had a low ferritinemia (< 50 ng/ml), 36, a ferritinemia collapsed (< 30 ng/ml) and 13 virtually non-existent reserves (< 12 ng/ml). All newborns were born in terms with an apgar score >/= in 93 of them. Among them 24 had anemia (rate of haemoglobin < 14 g/dl) and 54.7% a low ferritinemia. There is no relationship between the maternal and foetal rates of haemoglobin; 74% of newborn had a normal rate of haemoglobin. Among 36 women with low ferritinemia only two gave birth to a newborn without iron reserves. In our study, among 68 women who received iron regularly, 41 had normal reserves and 43 gave birth to a newborn with high ferritinemia. There is significant difference between the women having received iron during their pregnancy and those not supplemented as regards the effect on newborn (p = 0.00001). The prevention of iron deficiency and anaemia can be done by the iron systematic and premat supplementation.