Resistance profile of children and adolescents infected with HIV-1 in urban areas in Togo.

INTRODUCTION: Children and adolescents are more vulnerable than adults to virologic failure and the emergence of resistance. The objective of our study was to determine the resistance patterns in adolescents on antiretroviral therapy at Sylvanus Olympio University Hospital in Lome, Togo. METHODS: From June 1 to September 30, 2014, we included patients who had been on HAART for more than 12 months in the pediatric ward of Sylvanus Olympio University Hospital. Patients with an HIV viral load ≥ 1000 copies underwent resistance genotyping. RESULTS: Virologic failure was found in 36 of the 198 children and adolescents in the study (18.2%). Half were in WHO stage 3,72.2% were treated with a combination of two NRTIs (nucleoside reverse transcriptase inhibitors) and one NNRTI (non-nucleoside reverse transcriptase inhibitor). The mutations were mostly found in the NNRTI class with 100% mutations for EFV and NVP. The mutations associated with the most frequent NRTIs were M184V, Y181C, and T215Y. CONCLUSION: Our study shows the need to use PIs (boosted protease inhibitors) in most children treated with NNRTI. It is necessary to strengthen the virological monitoring of children on HAART.

[White blood cells counts and parasite density in malaria in children aged 6 to 60 months in urban areas of Togo]. / Numération leucocytaire et densité parasitaire dans le paludisme simple chez les enfants âgés de 6 mois à 5 ans en milieu urbain au Togo.

Rational use of the artemisinin-based combination therapies in Togo requires laboratory parasitemia values to confirm suspected malaria. This study was conducted to determine the impact of the measured white blood cell (WBC) count on the determination of malaria parasite density among children younger than 5 years old infected with uncomplicated Plasmodium falciparum in Togo. This cross-sectional study of 267 children from four pediatric centers diagnosed malaria with both thick and thin blood smears and counted WBCs with a hematology analyzer. The parasite densities, calculated with the number of WBCs and estimated with an assumed count of 8,000/µL, were compared with the Wilcoxon matched pairs signed-rank test. The children's median age was 35 months (interquartile range [24-48]), with a sex ratio of 1.32. The median WBC value was 8,300 cells/µL (range: 1,300-24,900 cells/µL). The median parasitemia value calculated with the absolute WBC count was 35,714 (range: 139-48,860 parasites/µL) was not statistically different from that estimated with the assumed value of 8,000 cells/µL - 33 125 parasites/µL (p = 0.564). This study shows that malaria parasite density obtained by assuming 8000 cells/µL does not result in overestimations for children aged 6-59 months.

[Tuberculosis in the newborn: recrudescence in areas with high endemic HIV infection]. / Tuberculose du nouveau-né: résurgence en milieu de forte endémie de VIH.

Despite the rising prevalence of tuberculosis due in part to the HIV pandemic in Africa, there have been few reports describing neonatal or congenital tuberculosis and its association with maternal HIV infection has been rare. The purpose of this study was to evaluate the clinical and epidemiological features of tuberculosis in newborns from areas with high endemic rates of both tuberculosis and HIV infection. During the 2-year study period all neonates admitted to the Campus Teaching Hospital in Lomé, Togo for differential diagnosis of symptoms compatible with tuberculosis were investigated. The clinical profile of tuberculosis in the newborn was correlated with that of the mother with or without HIV infection. Perinatal tuberculosis was diagnosed in 13 of the 79 newborns investigated including 8 whose mothers were co-infected by HIV and tuberculosis. Seven cases were classified as congenital tuberculosis. The predominant clinical features were respiratory distress (10/13), fever (9/13), hepatomegaly (9/13), intra-uterine growth retardation (8/13), stagnation or loss of weight (6/13), cough (4/13) and splenomegaly (4/13). Diagnosis of maternal HIV and tuberculosis infection was never made prior to newborn admission to our department. Four newborns and two mothers died within 3 months after childbirth. This study on perinatal tuberculosis in children born to mothers with or without HIV infection demonstrates the need for early diagnostic methods, consensual therapeutic protocols, and further study in larger geographical area to specify epidemiologic features and reduce high mortality.

[Post-hemolytic renal failure in children with glucose-6-phosphate dehydrogenase deficiency at the University Hospital Center in Lome]. / Insuffisance rénale post-hémolytique chez l'enfant déficient en glucose-6-phosphate déshydrogénase au Centre Hospitalier Universitaire de Lomé.

The purpose of the study was to identify predisposing factors for acute hemolysis and post-hemolytic renal failure in children with glucose-6-phosphate dehydrogenase deficiency (G6PD). Any child presenting hemoglobinuria during the study period was prospectively evaluated. Evaluation included detection of the presence of hemolytic agents, laboratory tests to measure hemolysis, G6PD activity, infection and renal failure, and assessment of outcome and management of hemolysis and renal failure. G6PD deficiency was documented in 32.1% of the 230 children admitted with hemoglobinuria. Anuric renal failure occurred during the hemolysis episode in 35.1% of patients with G6PD deficiency (21 boys and 5 girls between 30 months to 13 years old). Acute hemolysis associated with infection occurred before any treatment in 53.8% of cases and after beginning treatment in 46.1%. In 84.6% of cases, occurrence of acute hemolysis involved association of drugs considered as nonhemolytic either with themselves or with other drugs. Anuric renal failure occurred after beginning treatment in all cases and was most severe in patients with of multiple-germ infection (30.7%) and drug association (84.6%). Renal failure was reversible in 80.7% and fatal in 19.2%. Multiple-germ infection and drug association appeared as the main predisposing factors for post hemolytic anuric renal failure in patients with G6PD deficiency. The high frequency of these factors in tropical areas suggests implication of local endemic infections.