[Post-circumcision tetanus in Dakar, Senegal]. / Le tétanos post-circoncision a Dakar, Sénégal.

This study aimed at describing the epidemiology, clinical features and prognosis of post-circumcision tetanus at the infectious diseases clinic in Fann Hospital in Dakar. Data were collected retrospectively for analysis from patients' files recorded from January 1, 1999 to December 31, 2006. 54 cases were included, accounting for 4% of all tetanus cases admitted to the clinic during the study period (54 cases/1291). The patients' average age was 9 +/- 3.7 years old (range = 1-17 years) and 52% of them were schoolboys. In most cases (76%), tetanus symptoms occurred beyond 7 days after circumcision. The average delay from onset of the disease to admission was 2.3 days (range = 0-6 days). The circumcision took place at home in 39% of cases, in health center in 35% of cases and in unspecified area in 26% of cases. The majority of patients (85%) had never received tetanus vaccine and, in 72% of the cases, the circumciser was designated as a male nurse. Generalized tetanus was observed in all cases, most of which was a mild form of the disease (63%). During hospitalisation, thirteen patients (24%) had complications among which diaphragmatic and intercostal muscle spasms (3 cases), bacteraemia (5 cases), respiratory infection (4 cases), urinary tract infection (4 cases), and fracture of the vertebrae (1 case). The case fatality rate was 7.4% (4 deaths). Vaccination together with health education of the population as well as a better sensitization of the practitioners are necessary to eradicate tetanus after circumcision.

[Observance of antiretroviral treatments: African specificities]. / L'observance aux traitements antirétroviraux: particularités Africaines.

Since the Durban conference in 2000, the initiatives of access to antiretroviral therapy (ART) have expanded in sub-Saharan Africa. It is of high interest to monitor observance to HAART, in a context of increasing ART use, a rapid increase of patients under HAART, and the sociocultural specificities in Africa. In sub-Saharan Africa the concept of disease without cure does not exist and a disease always has or is attributed an external cause. Optimizing observance is a key element for the success of implementation programs for which we recommend a light monitoring to follow-up patients and the use of first line and effective antiretroviral drugs, with a low genetic barrier (efavirenz, nevirapine). The consequences of non-adherence are extremely negative for a patient in Africa, for whom we have few assessment tools and a limited number of ART. Improvement of adherence requires the involvement of all health care actors including traditional healers.

L'epidemie de cholera de 2004 a Dakar : aspects epidemiologiques; cliniques et therapeutiques

Ce travail decrit l'epidemie de cholera qui a touche Dakar en 2004; au cours de laquelle 593 cas confirmes ou probables ont ete pris en charge dans notre service. Il se fixe pour objectif de decrire les aspects epidemiologiques; cliniques; bacteriologiques et les strategies de prise en charge de cette epidemie. Pour atteindre cet objectif; nous avons mene une etude prospective a la clinique des maladies infectieuses du 11 octobre au 20 decembre 2004. L'age moyen des patients etait de 30 ans; et le sexe ratio de 1;33. La source probable de contamination a ete alimentaire et/ou hydrique dans 92des cas. La duree de l'epidemie a ete courte (75 jours). Le debut a ete brutal dans 98des cas; et la symptomatologie clinique dominee par la diarrhee aqueuse (95) et les vomissements (78). Le delai moyen d'hospitalisation etait de 11 heures et le nombre de selles emises avant l'admission superieur a 10 dans 23des cas. A l'admission; 119 malades (20;1) ont presente une deshydratation severe. Au total 250 coprocultures ont ete effectuees; dont 145 positives (58); mettant en evidence Vibrio cholerae O1 dans 112 cas (44). Les 36 souches testees aux antibiotiques ont montre une excellente sensibilite a la doxycycline et a la pefloxacine; mais aussi une resistance au cotrimoxazole; a l'amoxicilline et au chloramphenicol. La rehydratation par voie orale a ete la regle (61). La letalite a ete de 0;5. Le cholera est une urgence medicale dont le pronostic peut etre favorable a condition que l'organisation de la prise en charge soit bonne

[Cryptococcal meningitis and positive syphilitic serology in a patient infected by HIV]. / Cryptococcose neuroméningée associée à une sérologie syphilitique positive chez un sujet infecté par le VIH.

Co-infection of Cryptococcal meningitis and syphilis is rare. We report the first case of coinfection with cryptococcus neoformans and treponema pallidum in Dakar. There was a 41 yearold senegalese man with HIV2 infection despite a CD4 count of 50 /mm3. The patient have had the history of precedent genital ulcerations and trush. Finally he died on eigth day of treatment with Fluconazol and Penicillin G.