Aspects cliniques et IRM de l'endométriose pelvienne à Abidja: à propos de 68 cas / Clinical and MRI findings of pelvic endometriosis in Abidjan: A study of 68 patients

Introduction.L'endométriose est une pathologie mal connue et sous explorée en Afrique en particulier en Côte d'Ivoire. L'objectif de notre étude était d'étudierles caractéristiques épidémio-cliniques et à l'imagerie par résonnance magnétique(IRM)de l'endométriose pelvienne à Abidjan.Méthodologie. Il s'agissait d'une étude prospective et descriptive qui s'est déroulée à Abidjan sur une durée 15 mois. Les examens ont été réalisés sur une IRM 1,5 T avec les séquences conventionnelles. Les patientes retenues ont réalisé une IRM du pelvis pour suspicion d'endométriose pendant la période. N'ont pas été retenues les patientes qui ont réalisés l'examen pour d'autres affections gynécologiques. L'ensemble des données ont été recueillies à partir des comptes rendus d'IRM des patientes. Les paramètres épidémio-cliniques; les paramètres IRM des lésions endométriosiques ont été étudiés. Nous avons utilisé le test de khi carré pour vérifier le lien entre certains facteurs.Résultats.Nous avons enregistré 68 patientes dont l'âge moyen était de 38,61 ans. L'adénomyose représentait la localisation la plus fréquente (67,65%) suivi de l'atteinte ovarienne (35,29%). Dans l'adénomyose, la zone jonctionnelle était inférieure à 20 mm dans 44,19%. L'endométriose ovarienne a été objectivée chez 24 patientes, soit 35,29% des cas. Une endométriose sous péritonéale a été objectivée dans 19,12% des cas. L'atteinte tubaire était de 10,29%. L'association endométriose et fibrome a été observé chez 44,12% des patientes. Le risque d'adénomyose était élevé après 40 ans p < 0,005.Conclusion.L'IRM apparait comme l'examen d'imagerie de référence dans le diagnostic et le bilan d'extension de l'endométriose pelvienne. A Abidjan, le diagnostic d'endométriose se fait à un âge avancé.

Introduction.Endometriosis is a poorly understood and under-explored condition in Africa, particularly in Ivory Coast. The aim of our study was to investigate the epidemiological and clinical characteristics, as well as magnetic resonance imaging (MRI) features of pelvic endometriosis in Abidjan. Methodology.This was a prospective and descriptive study conducted in Abidjan over a period of 15 months. The examinations were performed on a 1.5 T MRI machine using conventional sequences. Patients who underwent pelvic MRI for suspected endometriosis during the study period were included, while those who underwent the examination for other gynecological conditions were excluded. All data were collected from the MRI reports of the patients. Epidemiological and clinical parameters, as well as MRI parameters of endometriotic lesions, were analyzed. The chi-square test was used to verify the association between certain factors. Results.We included 68 patients with a mean age of 38.61 years. Adenomyosis was the most common localization (67.65%), followed by ovarian involvement (35.29%). In adenomyosis, the junctional zone was less than 20 mm in 44.19% of cases. Ovarian endometriosis was documented in 24 patients, accounting for 35.29% of cases. Subperitoneal endometriosis was observed in 19.12% of cases. Tubal involvement was seen in 10.29% of cases. The co-occurrence of endometriosis and fibroids was observed in 44.12% of patients. The risk of adenomyosis was higher after the age of 40 (p < 0.005). Conclusion.MRI appears to be the imaging modality of choice for diagnosing and assessing the extent of pelvic endometriosis. In Abidjan, endometriosis is diagnosed at an older age.

[Morbidity and mortality from infectious diseases at the Military Hospital of Abidjan, Côte d'Ivoire]. / Morbimortalité des pathologies infectieuses à l'hôpital militaire d'Abidjan, Côte d'Ivoire.

OBJECTIVES: To determine the proportion of infectious diseases and their lethality at the Abidjan Military Hospital. PATIENTS AND METHODS: This cross-sectional study examined the medical files of patients hospitalized in the internal medicine unit of the hospital during 2004. RESULTS: The study included 668 patients with 855 diseases, 579 of them infectious (67.7%). The prevalence of HIV in this population was 41.3%. The main diseases observed were pneumonia (150 cases; 17.5%), malaria (82 cases; 9.6%), oropharyngeal candidiasis (83 cases; 9.7%), and tuberculosis (54 cases; 6.3%). The immediate causes of death were cerebral toxoplasmosis (27 cases; 39%), pneumopathy (25 cases; 36%), severe malaria (7 cases; 10%), tuberculosis (6 cases; 9%), and bacterial meningitis (5 cases; 7%). The prevalence of HIV infection prevalence among those who died of an infectious disease was 74.3%. CONCLUSION: Infectious diseases are the main pathologies seen in the internal medicine department of the in Abidjan Military Hospital. They were mainly opportunistic infections linked to AIDS. The creation of a laboratory of infectious microbiology and of a medical intensive care unit appears necessary to optimize management of these infectious diseases.

[Clinical and developmental aspects of care-related tetanus in the reference service of the teaching hospital of Abidjan]. / Aspects cliniques et évolutifs du tétanos lié aux soins dans le service de référence du CHU d'Abidjan.

A cross-sectional descriptive study was conducted from medical data of inpatients with tetanus in the Department of Infectious and Tropical Diseases of the University Hospital of Treichville in Abidjan from January 2003 to December 2007. In five years, 221 cases of tetanus have been hospitalized. The tetanus gateway was found in 188 patients (85%). Tetanus gateway linked to care was found in 22 patients (11.7%). Acts of care in question were intramuscular injections (10 cases) and operative procedures (12 cases). Concerning medical care by intramuscular injection, quinine (four cases), sulfadoxine-pyrimethamine (one case), and long-acting penicillin (one case) were the identified drugs. The operative procedures mainly involved were skin sutures (nine cases), cures of hernia (two cases), and flattening of Fournier's gangrene (one case). The average incubation period was 9.5 days. The invasion lasted for an average of 1.8 days. On admission, tetanus was immediately generalized for all patients with the presence of paroxysms in 20 patients (90.9%). The lethality of tetanus related care was 54.5%. The death rate in the first 48 hours of hospitalization was estimated at 83.3%. The average length of hospital stay was 14.6 days. Health workers should be involved in the prevention of tetanus in improving the quality of care and especially in reducing intramuscular injections. Also, any patient not immunized against tetanus should receive anti-tetanus serum and an update of its tetanus vaccine before any invasive procedures.

[Morbidity and mortality of military personnel at the Abidjan Military Hospital (AMH) in Côte d'Ivoire]. / Morbi-mortalité des militaires à l'hôpital militaire d'Abidjan, Côte d'Ivoire.

The purpose of this retrospective study was to document morbi-mortality in soldiers at the Abidjan Military Hospital (AMH). The medical files of soldiers treated at Abidjan Military Hospital from January 1 to December 31, 2004 were reviewed. During the study period, a total of 155 soldiers were treated for 259 pathologies including 208 infectious diseases (80.5%). The most common diseases were HIV infection (85 cases; 42%), pneumopathy (40 cases; 19%), cerebral toxoplasmosis (22 cases; 10.5%), malaria (18 cases; 9%) and tuberculosis (11 cases; 5%). Direct causes of death were cerebral toxoplasmosis (32%), pneumopathy (28%), tuberculosis (16%) and severe malaria (12%). The prevalence of HIV infection in soldiers who died was 76%. Morbi-mortality in military personnel at the AMH is due mainly to HIV infection and related complications. Specific prevention measures should be implemented for an effective control of this epidemic.

[Efavirenz versus indinavir among HIV-1 naive patients in Abidjan (Ivory Coast)]. / Efavirenz versus indinavir chez les patients naïfs infectés par le VIH-1 à Abidjan (Côte d'Ivoire).

OBJECTIVE: The authors had for aim to compare the therapeutic efficiency and tolerance of 2 NRTI+efavirenz (EFV) versus 2 NRTI+indinavir (IDV) in HIV infected adults in Abidjan. METHODS: A retrospective and multicentric study was made on 327 HIV-1 naive patients, 142 in the EFV group and 185 in the IDV group followed in Abidjan from November 1998 to December 2003. The analysis concerned clinical advents (opportunistic infections) and immunovirological parameters (CD4, viral load). Patients received 2 NRTI such as AZT+3TC or D4T+3TC combined either with EFV or IDV. The principal judgement criterion was therapeutic failure. We assessed the percentage of patients with undetectable viral load and the frequency of grade 3-4 adverse effects after 24 months of follow-up. RESULTS: Clinical improvement of patients' state and regression of opportunistic infections were identical in the two groups. The average gain of CD4 was superior to 177 in EFV versus +219 in IDV (p=0.004). The percentage of patients with undetectable viral load was 66% for EFV versus 59% for IDV (p=0.04). The frequency of adverse effects was more elevated with EFV than IDV, 39% versus 23% (p=0.002) initially, but seemed to decrease later. CONCLUSION: HAART with EFV is at least as efficient as with IDV in terms of reduction of viral load and increased CD4 count and is an excellent low-cost first line treatment.

Morbi-mortalite des militaires a l'hopital militaire d'Abidjan; Cote d'Ivoire

L'objectif etait de preciser la morbi-mortalite des militaires a l'HMA. Il s'agit d'une retrospective realisee sur dossiers des patients hospitalises au service de medecine interne de l'Hopital Militaire d'Abidjan (HMA) du 1er janvier au 31 decembre 2004. Les 155 militaires inclus dans l'etude ont developpe 259 pathologies dont 208 pathologies medicales infectieuses (80;5); 48 medicales non infectieuses (18;5) et 3 pathologies chirurgicales (1). Les principales pathologies observees etaient l'infection a VIH (85 cas ; 42); la pneumopathie (40 cas ; 19); la toxoplasmose cerebrale (22 cas ; 10;5); le paludisme (18 cas ; 9) et la tuberculose (11 cas ; 5). Les causes directes de deces etaient la toxoplasmose cerebrale (32); une pneumopathie (28); la tuberculose (16) et le paludisme grave (12). La prevalence de l'infection a VIH chez les decedes etait de 76. La morbi-mortalite de militaires a l'HMA est essentiellement du fait de l'infection a VIH et ses complications. Des mesures de prevention specifiques devraient etre mises en oeuvre pour un controle efficace de cette epidemie

[Generalized tetanus complicating a traditional medicine applied for snakebite]. / Tétanos généralisé compliquant un traitement traditionnel instauré après une morsure de serpent.

In many of Africa's rural areas, snakebite victims often resort to traditional healers for first line treatment. This may be source of infectious complications. We report a case of generalized tetanus which occured after 15 days in a 13-years old boy who had applied a traditional, plant-based concoction on a snake bite. He presented with trismus, generalized contractures and fever extended musculo-aponevrotic necrosis of the right upper limb, without loss of consciousness. The only accompanying biological sign was an increased leukocyte count (11,200/mm3) with a predominance of neutrophils (84%). Platelets count, creatinin and AST/ALT titers and haemostasis were all normal, as was the radiogram of the right hand. The clinical outcome was favourable after 3 weeks hopital care (antibiotic, muscle relaxants, antitetanus serotherapy and local wounds care). This clinical observation shows that traditional care for snake bite wounds can be an entry point for tetanus. Appropriate treatment of snake bites in a hospital setting is of the utmost importance, in addition to vaccination against tetanus, in order to reduce the incidence of tetanus in African countries.

[First case of Stevens-Johnson syndrome in a patient treated by Triomune in Abidjan, Côte d'lvoire]. / Premier cas de syndrome de Stevens-Johnson chez un patient traité par association de stavudine, lamivudine et névirapine à Abidjan, Côte d'Ivoire.

The authors report the first case of Stevens-Johnson syndrome which has occurred in a 45 year old patient treated by Triomune containing névirapine. Triomune is used within the context of the African antiretroviral initiative access. It was a mild form whose evolution was favourable when nevirapine was stopped. The prevalence of this affection should increase with the larger use of nevirapine in our countries and the attention of both prescriber and patient must be requested.

[Management of accidental exposure to blood in the Treichville teaching hospital, Abidjan (Côte-d'Ivoire)]. / Prise en charge des accidents d'exposition au sang au CHU de Treichville, Abidjan (Côte-d'Ivoire).

OBJECTIVE: The aim of this study was to assess care and preventive measures for accidental exposure to blood (AEB) in Abidjan. METHODS: A retrospective study of all AEB reported in the Infectious and Tropical Diseases Center of the Treichville University Hospital was made between January 2000 and December 2005. Epidemiology, management, clinical and biological post-exposure follow-up were analyzed. RESULTS: One hundred eighty-two AEB were managed over 6 years (151 needlesticks, 14 ocular projections of blood, 12 cuts, and 5 mucocutaneous exposure to blood). 94 men (51.6%) and 68 women (48.4%) were included [sex ratio 1.4] mean age 33.8 years+/-7.4 years. Physicians (29.1%), nurses (19.8%), assistant nurse (12.1%), and medical students (11.4%) were the professional categories which declared most accidents. Among them, only 51.1% was correctly vaccinated against hepatitis B. The average delay of consultation was 26.5 hours (1-240 hours), and 82.9% of victims consulted before the 48th hour. Antiretroviral prophylaxis was prescribed to 151 patients among whom 45% with bitherapy (Zidovudine and Lamivudine), and 55% with HAART including an antiprotease. Only 60 patients had one actual month of treatment. Despite the weak follow-up, no case of HIV seroconversion was reported 6 month after exposure. CONCLUSION: This work underlines once again the high frequency of AEB in Abidjan despite a under reporting, and calls for the implementation of a policy to train health care workers on AEB preventive measures.

[Medical emergencies related to HIV/AIDS in tropical zones: a prospective study in Cote d'Ivoire (1999-2000)]. / Urgences médicales liées au VIH/SIDA en zone tropicale: étude prospective en côte d'ivoire, 1999-2000.

At the beginning of the HIV epidemic, the incidence of the complications considered as emergencies was high in developed countries but with the advent of new therapeutic strategies the frequency of such complications and the associated need for emergency treatment decreased drastically. In developing countries where management resources remain limited, HIV/AIDS patients are still exposed to the risk of serious complications. However few studies have documented exact implication of HIV/AIDS in medical emergencies hospitals in developing countries. The purpose of this prospective study was to describe medical emergencies related to HIV infection in adult patients admitted at Treichvilie University Hospital Center. Evaluation of prevalence was carried out in the infections disease and internal medicine emergency units between May 1999 and January 2000. All patients over the age of 15 years were included after informed consent to undergo pre-testing and HIV serology. A total of 400 patients were recruited including 312 that were HIV positive (78%). Mean patient age of patients was 35 years. The male-to-female sex ratio was 1. The most frequent motives for emergency consultation were deterioration of general condition (62%), diarrhea (39.1%) and cough (20.5%). Illness was chronic in 54% of cases. Physical signs were severe weight lost (84%), fever (50%), pale conjunctivas (29%), respiratory signs (19.2%) and dehydration (19%). The most frequent organic involvement causing admission was digestive (39.7%), neurological (24.4%) and pulmonary (20.5%). No deaths were observed. Most medical emergencies related to the HIV infection in the adult involved opportunistic diseases. They pose a challenge for therapeutic management.

Urgences medicales liees au VIH/SIDA en zone tropicale : etude prospective en Cote d'Ivoire; 1999-2000

Dans les pays developpes; au debut de l'epidemie du VIH; l'incidence des complications decrites comme des urgences etait tres elev e e. Mais l'avenement de nouvelles strategies therapeutiques; a fait considerablement reduire la frequence de ces complications et des consultations qu'elles imposaient en urgence. Par contre; dans les pays en developpement ou les moyens de prise en charge sont encore limites; on constate avec amertume; que les patients continuent d'etre exposes a ces complications graves. Mais a defaut d'etudes; on ignore la place du VIH/SIDA parmi les problemes rencontres chez les patients en situation d'urgence dans ces hopitaux. L'objectif de notre etude etait de decri re les urgences medicales liees a l'infection a VIH chez l'adulte au CHU de Treichville. Il s'agit d'une etude pro s p e c t ive sous fo rme d'enquete de prevalence realisee entre mai 1999 et janvier 2000; dans les unites d'urgences d'infectiologie et de medecine. Ont ete inclus dans l'etude les sujets admis aux urgences ages de plus de 15 ans et ayant accepte de participer a l'enquete en se soumettant au pre-test et a la serologie du VIH. Nous avons recrute 400 patients parmi lesquels 312 etaient infectes par le VIH (78). L' age moyen des patients etait de 35 ans. Le sex - ratio H/F etait de 1. Les motifs de consultation les plus frequents :l'alteration de l'etat general (62); la diarrhee (39;1) et la toux (20;5) ; 54des pathologies avaient une evolution chronique. Les signes physiques etaient l'amaigrissement important (83;6); la fievre (50); la paleur des conjonctives (29); les signes respiratoires (19;2) et la deshydratation (19). Les atteintes organiques les plus frequentes etaient digestives (39;7); neurologiques (24;4) et pulmonaires (20;5) et ont necessite plus d'hospitalisation. Aucun cas de deces n'a ete observe. Les urgences medicales liees a l'infection par le VIH chez l'adulte concernent essentiellement les affe ctions opportunistes. Elles posent le pro bleme de leur prise en charge therapeutique.). L' age moyen des patients etait de 35 ans. Le sex - ratio H/F etait de 1. Les motifs de consultation les plus frequents: l ' alteration de l'etat general (62); la diarrhee (39;1) et la toux (20;5) ; 54des pathologies avaient une evolution chro n i q u e. Les signes physiques etaient l'amaigrissement important (83;6); la fi e v re (50); la paleur des conjonctives (29); les signes re s p i rat o i res (19;2) et la deshydratation (19). Les atteintes organiques les plus frequentes etaient digestives (39;7); neurologiques (24;4) et pulmonaires (20;5) et ont necessite plus d'hospitalisation. Aucun cas de deces n'a ete observe. Les urgences medicales liees a l'infection par le VIH chez l'adulte concernent essentiellement les affe ctions opportunistes. Elles posent le pro bleme de leur prise en charge therap e u t i q u e.). L' age moyen des patients etait de 35 ans. Le sex - ratio H/F etait de 1. Les motifs de consultation les plus frequents: l ' a l t e ration de l'etat general (62); la diarrhee (39;1) et la toux (20;5) ; 54des pathologies avaient une evolution chronique. Les signes physiques etaient l'amaigrissement important (83;6); la fievre (50); la paleur des conjonctives (29); les signes respiratoires (19;2) et la deshydratation (19). Les atteintes organiques les plus frequentes etaient digestives (39;7); neurologiques (24;4) et pulmonaires (20;5) et ont necessite plus d'hospitalisation. Aucun cas de deces n'a ete observe. Les urgences medicales liees a l'infection par le VIH chez l'adulte concernent essentiellement les affe ctions opportunistes. Elles posent le pro bleme de leur prise en charge therapeutique

[Morbidity and mortality of tetanus in the infectious and tropical diseases department in Abidjan 1985 - 1998]. / Morbidité et mortalité du tétanos dans le service des maladies infectieuses et tropicales d'Abidjan (1985-1998).

UNLABELLED: In spite of the increase of the antitetanus immunization coverage, tetanus is still one of the main causes of morbidity and mortality in Côte d'Ivoire hospitals. OBJECTIVE: The purpose of this study was to analyse the epidemiological, clinical and prognosis aspects of tetanus in the department of infectious diseases in Abidjan. METHODS: A retrospective analysis was carried out from patients files admitted for tetanus in this department from 1985 to 1998. Tetanus diagnosis was based on clinical arguments. RESULTS: Within a period of fourteen years, 1870 cases of tetanus representing 3% of hospitalised cases were admitted in the infectious diseases department. For 1387 patients answering to the inclusion criteria of the study the ratio MIF was 2.5. The median age was 28 years old (1-85 years). The entrance doors were dominated by cuts (49.3%) and intramuscular injections of drugs (18.7%). Despite the complete vaccination, 7 patients have presented tetanus (0.5%). About 17% have presented progressive complications especially cardio-respiratory complications (41.5%). The total lethality was 31.9% and the after- effects rate 2.3%. The factors of poor prognosis were the age > 60 years old, IM injections, generalised aspect, group III of severity and presence of complications. CONCLUSION: Tetanus frequency certainly drops in infectious and tropical diseases department, but the lethality remains high therefore a reinforcement of the vaccination efforts and a management of patients are recommended.

[Severe malaria in native adults in Abidjan (Côte d'Ivoire)]. / Paludisme grave de l'adulte autochtone à Abidjan (Côte d'Ivoire).

Our retrospective study carried out from 1985 to 1998 in the Unit of Infectious Diseases in Abidjan aimed at describing the epidemiological, clinical and prognosis features of severe malaria among native adults. Within 14 years, we have listed 274 cases of severe malaria for 54 098 hospitalizations (0.5%). 164 men and 110 women were recorded (sex-ratio = 1.5), aged of 33 years (16-86), among them 48% were HIV positive. 23% of the patients had already received an antimalarial treatment. The main clinical presentation was cerebral malaria (78%). The other manifestations were respiratory symptoms (13%), kidney failure (11%), anaemia (11%), macroscopic haemoglobinuria (6%), hypoglycaemia (9%), cardiovascular shock (4%). The average parasite load in blood was 27 222 plasmodium/microl (25 000 - 180200). The treatment used was quinine IV (172 patients), and arthemeter (102 patients). The outcome was favourable in 232 cases (84%) and 42 patients died. Prognosis factors identified were age > 65 years, Glasgow coma score < 7, convulsions, cardio-vascular shock, macroscopic haemoglobinuria. HIV infection has not been identified as a pejorative factor Our results confirm that severe malaria in native adult is a reality in tropical area. This study shows how difficult it is to have an adequate care management regarding this pathology in our context.

[Localized tetanus in Abidjan: clinical and prognostic features (1976-1997)]. / Le tétanos localisé à Abidjan: particularités cliniques et évolutives (1976-1997).

UNLABELLED: Localised tetanus, rarely described in Africa, was examined retrospectively in Abidjan, over a period of 22 years (1976-97). Forty-five patients--representing an incidence rate of 2% of tetanus cases--were reported in this time span. The mean age was 23 years, and none of the patients had had prior access to adequate immunoprophylaxis. Three clinical forms were observed: tetanus of the limbs (32 cases, 71%), cephalic tetanus (11 cases, 25%), and abdominal tetanus (2 cases, 4%). Infection had occurred via wounds of the limbs (38%), intramuscular injections (33%), craniofacial wounds (25%), and abdominal wounds (2%). No portal of entry was identified for 2% of the cases. 37 patients were cured (82%) of whom 5 retained sequelae (11%). 7 deaths were observed (16%). In terms of prognosis, the only risk was secondary generalisation of tetanus (27%). CONCLUSION: Localised tetanus is far from being mild and incurs significant rates of sequelae. The only efficient treatment is immunisation-based prophylaxis.

[Adult non-viral lymphocytic meningitis in Abidjan (Côte d'Ivoire)]. / Méningites lymphocytaires non virales de l'adulte à Abidjan (Côte d'Ivoire).

Our prospective and longitudinal study aimed to analyse the aetiologies, clinical features and prognostic of non viral lymphocytes meningitis (NVLM). We recruited 131 patients, 77 males (59%) and 54 females (41%) sex-ratio 1.4. The mean age was 35 years [15-67]. 117 patients were HIV positive (89%) and 14 (11%) were HIV negative. Feverish meningoencephalitis was present in 85% of cases, with 7 days for mean delay of admission into hospital. 80 germs were found in the C.S.F. 70 Cryptococcus neoformans, 4 Mycobacterium tuberculosis, 3 Streptococcus pneumoniae, 1 Candida albicans, 1 Neisseria meningitis and 1 Trypanosoma gambiense. 63 aetiologies were linked to lymphocytes meningitis by indirect deduction: 41 cases of tuberculous meningitis with lung X-ray anomalies and M. tuberculosis in sputum (11 times), 11 cases of cerebral malaria with Plasmodium falciparum in blood, 11 cases of cerebral toxoplasmosis by significant features with cerebral tomodensitometry. Letality was 53%, 35% of patients improved and 12% were lost to follow-up. Our study shows the difficulties in the management of the NVLM, due to the delay of diagnosis, particularly for tuberculous meningitis.

Tuberculin skin testing to assess the occupational risk of Mycobacterium tuberculosis infection among health care workers in Abidjan, Côte d'Ivoire.

SETTING: Tuberculin skin test (TST) survey of health care workers (HCWs) in selected clinical services in Abidjan, Côte d'Ivoire. OBJECTIVE: To assess whether HCWs in Abidjan are at increased risk for occupationally acquired Mycobacterium tuberculosis infection. DESIGN: From October 1996 to January 1997, consenting HCWs from four services where tuberculosis (TB) prevalence among patients was high and two services where it was low were evaluated with a questionnaire, TST (including evaluation of anergy) and chest radiograph. RESULTS: Of the 512 participants, 405 (79%) had a TST reaction of > or =10 mm, eight (2%) were anergic, five (1%) had a radiograph compatible with TB, and two had confirmed TB. Using a cut-off of 10 mm, we found a higher prevalence of TST positivity in services with high TB prevalence than in those with low TB prevalence (92% vs 72%; odds ratio [OR] 4.3; 95% confidence interval [CI] 2.3-8.0]) and among HCWs with direct (87%; OR 2.9; 95%CI 1.6-5.1) and indirect patient contact (80%, OR 1.7; 95%CI 1.0-2.3) than among those with minimal patient contact (69%). CONCLUSION: These findings indicate that TST positivity among HCWs is related to level of exposure to TB patients, and suggest that HCWs in Abidjan are at risk for the nosocomial transmission of TB.

[Neurosurgical complications of purulent meningitis in the tropical zone]. / Complications neurochirurgicales des méningites purulentes en zone tropicale.

Our retrospective study concerned 35 cases of surgical complications related to bacterial meningitis in 16 adults and 19 children. The mean age was 28 years for adults (15-56 years), and 6 months for children (1-12 months). Portal of entry for meningitis was found in 12 cases (35%): 8 sinusitis and 4 otitis. Delay to appearance of complications was 4.5 days, and to diagnosis confirmation 9 days with CT scan (17 cases), and transfontanellar ultrasonography (19 cases). The complications were: hydrocephalus, 19 cases (54%), brain empyemas, 7 cases (20%), abscesses, 10 cases (28.5%), ventriculitis, 2 cases (6%). Twenty-two bacteria were isolated from the CSF: Streptococcus pneumoniae (15 cases), Haemophilus influenzae (5 cases), Neisseria meningitidis (1 case), and Escherichia coli (1 case). Fourteen patients underwent neurosurgical treatment based on aspiration in case of suppuration and external drainage in case of hydrocephalus. The associated medical treatment was antibiotics combining third-generation cephalosporins, fluoroquinolone, and metronidazol, with a mean duration of 12 days. Recovery rate was 89%, letality 11%, and after effect rate were 33%. Our results confirm the low frequency of neurosurgical complications related to bacterial meningitis, but it emphasizes the role of an early CT-scan for diagnosis and prognosis.

Efficacy of trimethoprim-sulphamethoxazole prophylaxis to decrease morbidity and mortality in HIV-1-infected patients with tuberculosis in Abidjan, Côte d'Ivoire: a randomised controlled trial.

BACKGROUND: There is a high incidence of opportunistic infection among HIV-1-infected patients with tuberculosis in Africa and, consequently, high mortality. We assessed the safety and efficacy of trimethoprim-sulphamethoxazole 800 mg/160 mg (co-trimoxazole) prophylaxis in prevention of such infections and in decrease of morbidity and mortality. METHODS: Between October, 1995, and April, 1998, we enrolled 771 HIV-1 seropositive and HIV-1 and HIV-2 dually seroreactive patients who had sputum-smear-positive pulmonary tuberculosis (median age 32 years [range 18-64], median CD4-cell count 317 cells/microL) attending Abidjan's four largest outpatient tuberculosis treatment centres. Patients were randomly assigned one daily tablet of co-trimoxazole (n=386) or placebo (n=385) 1 month after the start of a standard 6-month tuberculosis regimen. We assessed adherence to study drug and tolerance monthly for 5 months and every 3 months thereafter, as well as rates of admission to hospital. FINDINGS: Rates of laboratory and clinical adverse events were similar in the two groups. 51 patients in the co-trimoxazole group (13.8/100 person-years) and 86 in the placebo group (25.4/100 person-years) died (decrease In risk 46% [95% CI 23-62], p<0.001). 29 patients on co-trimoxazole (8.2/100 person-years) and 47 on placebo (15.0/100 person-years) were admitted to hospital at least once after randomisation (decrease 43% [10-64]), p=0.02). There were significantly fewer admissions for septicaemia and enteritis in the co-trimoxazole group than in the placebo group. INTERPRETATION: In HIV-1-infected patients with tuberculosis, daily co-trimoxazole prophylaxis was well tolerated and significantly decreased mortality and hospital admission rates. Our findings may have important implications for improvement of clinical care for such patients in Africa.

[Problems produced by the use of antitubercular agents in a reference service for HIV/AIDS in Abidjan (Côte d'Ivoire)]. / Problèmes engendrés par l'utilisation des antituberculeux dans un service de référence pour VIH/SIDA à Abidjan (Côte d'Ivoire).

This study reports on the experience using antituberculosis drugs in a HIV/AIDS reference service in Abidjan during a 64 month period. Prevalence of tuberculosis is 1.9% out of a total of 23,957 patients. The annual incidence rate increased slowly from 0.9% in 1990 to 3.5% in 1995. Seropositivity to HIV is 90.8%. Predominant locations of tuberculosis are pulmonary (60.3%), extrapulmonary (19.7%) and multifocal or disseminated (20%). The average period of diagnosis (9.9 days) and average duration of antituberculosis treatment in hospital (11.8 days) are similar whatever the serological status and the location of the infection may be. However, the mortality rate is more important in HIV positive patients (39.7%) than in HIV negative (17.6%) p = 0.01. The decision to treat is taken by infectiologists only in 88% of the cases, by pneumologists only in 2.5%, and both by infectiologists and pneumologists in 9.5%. Side-effects due to antituberculosis drugs were noticed in 19 patients leading to an interruption of the treatment in 10 cases. The authors recommend that health personnel be trained for the management of tuberculosis.