[Contribution of the Xpert MTB / Rif test in the diagnosis of tuberculosis of any form in Saint-Louis]. / Apport du test Xpert MTB/Rif dans le diagnostic de la tuberculose toute forme a Saint-Louis.

INTRODUCTION: The Xpert MTB / RIF assay has a dual advantage on the one hand, the rapid diagnosis of even difficult cases by the standard technique of direct microscopic examination and on the other hand by the detection of resistance to rifampicin. Our objective was to determine the contribution of the Xpert test in the diagnosis of tuberculosis of all forms. MATERIALS AND METHOD: retrospective, descriptive and analytical study carried out in the Pneumophtisiology department of the CHRU of Saint-Louis. All suspected tuberculosis cases who had received an Xpert test from 2018 to 2020 were included. The parameters studied were socio-demographic, clinical and biological data. RESULTS: 524 patient records included in the study with a sex ratio of 1.3. The mean age of the patients was 37 +/-15 years. There were 285 positive GeneXpert samples, of which 224 were of pulmonary origin and 61 of extra-pulmonary origin. The number of rifampicin resistant samples was five, all of respiratory origin. CONCLUSION: the Xpert test is a new molecular technique recommended by the WHO in the diagnosis of pulmonary tuberculosis.

INTRODUCTION: le test Xpert MTB/RIF présente un double avantage d'une part le diagnostic rapide des cas mêmes difficiles par la technique standard de l'examen direct à la microscopie et d'autre part par la détection de la résistance à la rifampicine. Notre objectif était de déterminer l'apport du test Xpert dans le diagnostic de la tuberculose toutes formes confondues. MATÉRIELS ET MÉTHODE: étude transversale, descriptive à collecte rétrospective menée dans le service de Pneumophtisiologie de CHRU de Saint-Louis. Tous les cas suspects de tuberculose qui avaient bénéficié d'un test Xpert de 2018 à 2020avec un dossier médical accessible et exploitable ont été inclus. Les paramètres étudiés étaient les données sociodémographiques, cliniques et biologiques. RÉSULTATS: Nous avions colligés 524dossiers de malades avec un sex-ratio de 1,3. L'âge moyen des patients était de 37 ans+/-15 ans. Il y'avait 285 prélèvements positifs au GeneXpert dont 224 d'origine pulmonaire et 61d'origine extra pulmonaire. Le nombre d'échantillons résistants à la rifampicine était de cinq, tous d'origine respiratoire. CONCLUSION: le test Xpert est une nouvelle technique moléculaire recommandée par l'OMS dans le diagnostic de la tuberculose pulmonaire. Toutefois il doit être évaluer dans le diagnostic de la tuberculose extra pulmonaire.

[Epidemiology of primary lung cancer among non-smokers in Senegal]. / Épidémiologie des cancers bronchopulmonaires primitifs des non-fumeurs au Sénégal.

INTRODUCTION: According to global data for 2002, one quarter of new cases of primary bronchopulmonary cancer were non-smokers. We undertook this study with the aim of describing the epidemiological characteristics of non-smokers with primary bronchopulmonary cancer in the Dakar region of Senegal. METHODS: A multicenter descriptive study that included all non-smokers who presented with primary bronchopulmonary cancer between January 1st 2014 and December 31st 2015. The data were captured on an Excel file and then transferred to Epi InfoTM 7 software for analysis. RESULTS: The rate of diagnosis for primary bronchopulmonary cancers was 72.1 %. The prevalence of non-smokers was 33.3 %. The sex ratio was 1.27. The average age was 54.6 years. More than a third of the sample were housewives. Carpenters and craftsmen exposed to metals predominated. Exposure to cooking oils was reported in one case. Three patients presented sequelae of pulmonary tuberculosis. Adenocarcinoma was the most common histological type and predominated in young subjects. CONCLUSION: The proportion of primary bronchopulmonary cancers diagnosed among non-smokers is increasing in Dakar. An analytical study of suspected risk factors would be helpful for prevention.

Hepatic cytolysis and bicytopenia after 15 days of four-drug tuberculosis treatment in Senegal.

We report the case of a 31-year-old immunocompetent woman residing in Senegal, with localized microscopy-proved pulmonary tuberculosis, complicated by macrophage activation syndrome and associated with viral hepatitis B, identified due to hepatic cytolysis and a bicytopenia.

[Contribution of the Xpert MTB/RIF to the etiological diagnosis of tuberculous pleurisy]. / Apport de l'Xpert MTB/RIF dans le diagnostic étiologique des pleurésies tuberculeuses.

INTRODUCTION: Performance of the Xpert MTB/RIF for the detection of Mycobacterium tuberculosis in pleural liquid is poorly described. The aim of this study was to determine its usefulness for the etiological diagnosis of a tuberculous pleurisy. PATIENTS AND METHOD: We performed a descriptive cross-sectional study, with analytical design, including all the patients having a unilateral serofibrinous pleurisy, exudative, lymphocytic, and sterile. The diagnosis of pleural tuberculosis was considered based on epidemiological, clinical, paraclinical and therapeutic arguments. The Xpert MTB/RIF of the pleural fluid was carried out among all patients. RESULTS: Pleural tuberculosis was confirmed in 301 patients. The median age was 32years. Our study has included 217 men (72.1%) with a final sex ratio of 2.6. The cost of the pleural biopsy coupled with histology made it practicable in only 90 patients (29.9%) with a yield of 80%. The Xpert MTB/RIF of the pleural liquid was positive in only 10 patients (3.3% of the cases). CONCLUSION: Gene amplification by Xpert MTB/RIF of the pleural liquid is much less effective in establishing the diagnosis of tuberculous pleurisy than pleural biopsy, which remains the gold standard.

[Contribution of fiberoptic bronchoscopy in the diagnosis of pulmonary dragging]. / Apport de la fibroscopie bronchique dans le diagnostic des pneumopathies traînantes.

INTRODUCTION: Bronchoscopy is recommended into the exploration of chronic lung diseases. This one is expensive and invasive. We conducted this study in order to assess the benefit of the bronchoscopy in the etiologic diagnosis of chronic lung diseases. PATIENTS AND METHODS: This study was retrospective, descriptive and analytical, using medical records of outpatients and in patients who has done the bronchoscopy in Pneumology Clinic, Fann hospital, Dakar from January 2010 to December 2014. RESULTS: We have reported 159 cases. The sex ratio was 2.2. Middle age was 44 years. Fever was found in 32.7%. Alveolar syndrome was found in 64.8%. The white blood cells (WBC) were normal in 80.7%. Bronchoscopy was contributive in 74.1%. Specimen analysis isolated banals germs in 69.2%, mainly bacteria in 51.6%. Parasitology of the fluid of broncho-alveolar lavage was positive in 28.6%. CONCLUSION: Bronchoscopy stills a use full exploration while diagnosing chronic lung diseases. It should be systematic in chronic lung diseases with or not fever, this, when sputum microscopy a sputum PCR are negative.

Molecular detection of CTX-M-15-type ß-lactamases in Escherichia coli strains from Senegal.

We aimed to detect the extended-spectrum ß-lactamases (ESBLs) secreted by clinical strains of Escherichia coli at Fann University Hospital in Dakar and to characterize them molecularly. We identified 32 isolates producing ESBLs. The CTX-M-15 gene was the most frequently detected ESBL gene, detected in 90.63% of the isolates studied.

Pediatric invasive pneumococcal disease in Senegal.

OBJECTIVES: We aimed to describe the clinical, epidemiological, and outcome characteristics of IPD case patients hospitalized at the Albert-Royer National Children's Hospital (French acronym CHNEAR) to evaluate the disease burden of IPDs in a pediatric hospital of Dakar (Senegal). PATIENTS AND METHODS: All children aged 0-15 years hospitalized at the CHNEAR between January 1st, 2008 and December 31st, 2013 for a documented IPD were included in the study. Medical history, risk factors, clinical, bacteriological, and outcome data was collected. Data was then analyzed using the SPSS software, version 16 (Pearson's Chi(2) test: a P-value<0.05 was considered statistically significant). RESULTS: A total of 218 IPD patients were hospitalized at the CHNEAR during the study period (hospital prevalence: 0.79%). The mean age was 36.1 months. The male to female ratio was 1.27 (122 boys and 96 girls). Infants<2 years of age represented 61.46% of patients. Prior antibiotic therapy was found in 54% of patients but details were lacking. Infection sites were mostly meningeal (61%) and pleuropulmonary (28.9%). The main isolated serotypes were 1, 6A, 14, 5, and 23F. Case fatality was 17.4% and it was five times higher for pneumococcal meningitis. CONCLUSION: IPDs are very common in children in Senegal. Infants<2 years of age are particularly affected. The very high case fatality (17%) was significantly associated with meningeal infection sites hence the need for better access to pneumococcal vaccines.

First report of gastroenteritis by genotype G12 rotavirus in Dakar, Senegal.

The genotype G12 rotavirus was isolated from the stool of children 5 years old or younger with acute gastroenteritis during 1 year in three Dakar hospitals. The G12 genotype was the most common (58.25%). VP4 genotyping revealed mixed genotypes (1.94%).

[Prevalence of tobacco smoking in primary and secondary schools in the Department of Dakar, Senegal]. / Prévalence du tabagisme dans l'enseignement moyen et secondaire dans le Département de Dakar, Sénégal.

INTRODUCTION: Tobacco smoke is a global health problem, and the largest avoidable cause of death in the world. The objective of our study was to determine the prevalence of tobacco smoking in schools in Dakar area (Senegal). MATERIEL AND METHODS: This descriptive and analytical cross-sectional study was performed from September 2011 to June 2012 in 27 schools of the Dakar area. RESULTS: We questioned 1654 students over a 9-month school period. The mean age was 15±2.5years (range 11-22). The sample included 848 boys (51.3 %), therefore a sex ratio of 1.05. There were 68 smokers (4.1 %) and 60 ex-smokers (3.6 %). The mean age of the smokers was 16.9±2.2years (range 11-22) with a male preponderance of 70.6 % (n=48). Smoking in family members was the initiating factor most frequently reported by smokers (25 %). The average age of ex-smokers was 16.4±2years. Fear of parents' reactions was the most frequently invoked reason for stopping smoking (41.7 %). CONCLUSION: This study confirms the reality of smoking among school children in Senegal and highlights the urgency of the installation of a prevention policy near the young people.

[Smoking among health workers at four large hospitals in Dakar (Senegal)]. / Le tabagisme chez le personnel médical et paramédical dans quatre grands hôpitaux de Dakar.

INTRODUCTION: The addiction to tobacco remains a significant problem in the context of medical practice in African in general and in Senegal in particular. It is an important cause of morbidity and mortality. The main purposes of this study were to establish the smoking habits of hospital staff as a step towards elaborating a strategy for an anti-smoking campaign within the hospital environment. PATIENTS AND METHOD: The study was a cross-sectional, prospective, descriptive going study conducted between 1st March 2007 and May 15th, 2008. We recovered 662 out of 750 questionnaires collected representing a 75% participation rate. RESULTS: Eighty-five respondents reported that they were smokers (12.8%). The sex-ratio was 7.5 times more common in men. The paramedical staff were more likely to smoke than doctors (14% versus 12.2%). The average age of the smokers was of 37.4 years. Women had begun to smoke at an earlier age (17.4 years against 20.5 years). According to the Fagerström test, 87% were averagely or strongly dependent on nicotine. It was mainly the pleasure (41.2%) and the influence of their circle of acquaintances (36.5%) that prompted the staff to smoke. Smoking cessation was most commonly achieved through the use of willpower alone (44.4%). CONCLUSION: The mortality and morbidity arising from the addiction to smoking is entirely avoidable in contrast to other pandemics. Consequently, engagement in the fight against smoking must constitute a major priority for health workers who must set an example for their patients.

[Miliary tuberculosis: a report of 49 cases]. / Miliaire tuberculeuse: à propos de 49 cas.

INTRODUCTION: Miliary tuberculosis is a severe, acute form of tuberculosis due to lymphohaematogenous dissemination of tubercle bacilli from a focal lesion. PATIENTS AND METHODS: A prospective study of was undertaken at the Pneumology Clinic of the National University Hospital Centre (CHUN) of Fann, over a period of 30 months (January 2007-June 2009), in order to assess the epidemiological, clinical, paraclinical and evolutionary aspects of miliary tuberculosis. RESULTS: Miliary tuberculosis accounted for 3.8% (n=49) of all diagnosed cases of tuberculosis. The sex-ratio was 1.7. The average age of patients was 37.5 years with a range of 15 to 70 years. The typical radiological appearances were present in 88% of cases whereas only 10% were positive on direct smear. HIV serology was positive in 29%. In the hospital environment, the mortality was 12.2%. CONCLUSION: Miliary tuberculosis is a severe form of the disease. The prognosis depends on early diagnosis and treatment.

[Pédiatric haemophilus influenzae b meningitis in Dakar]. / Méningite pédiatrique à haemophilus influenzae b à Dakar.

OBJECTIVE: This study had for aim to determine the etiology of Haemophilus b pediatric meningitis. DESIGN: A retrospective study of 216 biologically confirmed cases was carried out during 6 years (January 1995- December 2000) on children 0 to 15 years of age, hospitalized at the Albert Royer Children Hospital Center. RESULTS: Haemophilus influenzae b is the first cause of pediatric meningitis (19.7%) followed by Nesseria meningitidis (14.5%), and Streptococcus pneumoniae (13.6%). The Haemophilus influenzae b meningitis cases are distributed all year round with a peak between January and March, that is to say, during the dry and cool season. They affect children at an average age of 11.7 months, with a sex ratio of 1.1 for boys. Almost all of the patients live in the low-socio-economic areas of the Dakar suburbs (92.8%). More than 90% of the H. influenzae b isolates are sensitive to ceftriaxone (96%) chloramphenicol (93%), and to ampicillin (91%). Clinical evolution is marked by death (17.8%) and recovery with psychological, sensory, and motor sequels (19.9%). CONCLUSION: This report should help to include the combined vaccine Antihaemophilus influenzae b in the Senegalese Broad Vaccination Program. The final aim is the reduction of morbidity and mortality of infections due to Haemophilus influenzae b.

[Antibiotic resistance of the most frequently isolated germs at the Fann University Teaching Hospital between January 1999 and December 2000]. / Résistances aux antibiotiques des principaux germes isolés au CHU de Fann entre Janvier 1999 et Décembre 2000.

Bacterial infections take up an important place in tropical pathology and have an increased death-rate. Among the causes of this strong mortality, the resistance of bacteria to antibiotics keeps a dominant part. We carried out, between January 1999 and December 2000 a study aiming to establish the distribution of the most frequently isolated germs at the Laboratory of Bacteriology of Fann Hospital, their sensibility to antibiotics and the different phenotypes of resistance. We noticed a predominance of enterobacteria (69.30%), notably Escherichia coli (56.76%) and Klebsiella pneumoniae (47.69%), but also Staphylococcus aureus (13.91%). Enterobacteria present 39.7% of resistant phenotypes to beta-lactams (E. coli: 61.75% and K. pneumoniae: 47.69%). Only the third generation cephalosporins and fluoroquinolons are constantly actives on enterobacteria, and 69% of S. aureus strains are resistant to methicillin, and so to all beta-lactams. Pseudomonas aeruginosa become difficult to overcome: 51.13% of the strains produce beta-lactamase. The quinolons are the most active antibiotics on this germ. It is very important to settle network that will be in charge to survey the evolution of these bacterial resistances.

Molecular characteristics and susceptibility to antibiotics of serogroup A Neisseria meningitidis strains isolated in Senegal in 1999.

A total of 22 strains of Neisseria meningitidis isolated from cerebrospinal fluid samples of patients in Dakar, Senegal, in the course of an epidemic of meningococcal meningitis in 1999 were studied. All the strains were serogroup A, serotype 21:P1.9 and belonged to clonal subgroup III-1. The strains were resistant to sulphonamide, but were susceptible to ampicillin, ceftriaxone and chloramphenicol, which are used in the treatment of cerebrospinal meningitis in Senegal.

[Urinary tract infections in Dakar: etiologies, therapeutic basis]. / Infections du tractus urinaire à Dakar: etiologies, bases thérapeutiques.

This prospective study, performed in Fann University Teaching Hospital from January 1st to December 31st 1998, concern 1446 samples of urine. Enterobacteria (87.56%) were the most frequent aetiology, and Escherichia coli (48.7%) was the leading species in this family. The strains of E. coli present more resistant profil to beta-lactams (70.27%). Fluoroquinolons are active on more than 80% of the strains responsible of urinary tract infection in Dakar.