[Antibacterial Susceptibility Patterns of Bloodstream Isolates in 74 HIV-Infected Patients Hospitalized at the Clinic of Infectious and Tropical Diseases of Fann University Hospital, Dakar from 2013 to 2016]. / Profils de Sensibilité aux Antibactériens des Isolats Sanguins Chez 74 Patients Infectés Par le VIH Hospitalisés à la Clinique des Maladies Infectieuses et Tropicales du Chu de Fann, Dakar de 2013 à 2016.

Introduction: Bacteremia is associated with high lethality in HIV-infected patients. The widespread use of cotrimoxazole prophylaxis and misuse of antibiotics promote antibacterial resistance. Only few studies have considered this issue in HIV-infected patients. Thus, the objective of this study was to describe the etiology and antibacterial susceptibility patterns of bloodstream isolates in patient living with HIV. Material and methods: This is a retrospective cross-sectional and descriptive study conducted at the clinic of Infectious and Tropical Diseases of Fann university hospital from March 2013 to December 2016. Data were collected from patients' files according to a pre-establish survey form made of demographic, clinical, bacteriological and biological parameters. Results: Seventy-four cases of bacteremia were registered, 51.4% of which in women. Participants' median age was 45 years old [18-73 years old] and average CD4 count 83.3 cells/µl. The most commonly isolated bacteria were coagulase negative staphylococci (14%) followed by Escherichia coli (10%) and Klebsiella pneumoniae (10%). Rates of methicillin resistance for coagulase negative staphylococci and Staphylococcus aureus were 35.7% (5/14) and 22% (2/9), respectively. The most frequent ESBL producing germs were Escherichia coli 50% (5/10), Klebsiella pneumoniae 40% (4/10) and Enterobacter sp 25% (2/8). Pseudomonas sp were the most (22.2%) germs resistant to carbapenems. Conclusion: The result of this study advocates the need for ongoing surveillance of antibacterial resistance in HIV-infected patients and empirical antibiotic therapy based on surveillance data.

Cerebral venous thrombosis in a sub-saharan African country: A preliminary monocentric study of a 70 case series at the neurology department of Fann teaching hospital in Dakar - Senegal.

INTRODUCTION: Cerebral venous thrombosis (CVT) are underdiagnosed in sub-saharan Africa where publications are uncommon. Our study aim was to describe the CVT diagnostic and therapeutic features through a senegalese case series. PATIENTS AND METHOD: A monocentric retrospective and prospective study was conducted at the adult Neurology department of Fann Teaching Hospital in Dakar (Senegal), between January 01, 2013 and April 30, 2020. It had included all CVT cases diagnosed by neurovascular imaging. RESULTS: Seventy CVT cases were collected including 48 women (68.6%). The average age of the patients was 35.2±14 years. The main neurological signs were headache (92.8%) and motor deficit (41.4%), with subacute onset in 67.2% of cases. The superior sagittal sinus (54.3%) and the transverse sinus (38.6%) were the most affected with multiple involvements in 27 patients (38.6%). Thirty patients (42.8%) had indirect parenchymal signs such as venous infarction (15.7%), cerebral edema (11.4%) or intracerebral hemorrhage (12.8%). The etiological factors were mostly infectious (41.4%) with meningoencephalitis (12.8%) and otorhinolaryngological infection (10%). Gyneco-obstetric factors (27%) and Behçet's disease (7%) were the main aseptic factors. In the short-term clinical course, curative anticoagulation (98.6%) had enabled a favourable outcome (mRS 0-1) in half of the patients. CONCLUSION: Our study, the largest series in sub-saharan Africa to this date, confirms that CVT is a young women disease. Infectious etiology is the most frequent at the Fann national teaching hospital (41.4% in Dakar against 6.5% in Germaine Bousser's series) even if the etiological assessment is limited by financial constraints (no coagulopathy/thrombophilia check-up).

[Neuro-Behçet in a Sub-Saharan Africa Country: a Series of Sixteen Patients in Fann Teaching Hospital, Dakar, Senegal]. / Neuro-Behçet dans un pays d'Afrique subsaharienne : une série de 16 patients au centre hospitalier national universitaire de Fann de Dakar, Sénégal.

Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.

Les études africaines sur le neuro-Behçet (NB) sont majoritairement maghrébines, mais l'Afrique noire n'est pas en reste. L'objectif de l'étude était de décrire les particularités diagnostiques et thérapeutiques du NB dans une série sénégalaise colligée à Dakar. Il s'agit d'une étude rétrospective à visée descriptive menée à la clinique de neurologie du centre hospitalier universitaire de Fann de Dakar, au Sénégal. Tous les patients répondant aux critères diagnostiques de NB ont été inclus. Seize patients ont été colligés, 14 hommes et deux femmes avec un âge moyen de 40 ans [18­71]. Les principaux signes neurologiques étaient un déficit moteur (13 cas), des céphalées (10 cas) et un trouble du langage (4 cas). Les signes extraneurologiques étaient dermatologiques (14 cas), oculaires (2 cas) et articulaires (2 cas) à type de gonarthrite unilatérale aseptique. Une fièvre était présente chez neuf patients. L'atteinte neurologique était majoritairement parenchymateuse isolée (8 cas) ou mixte (6 cas). Les principales formes cliniques de NB étaient la rhombencéphalite (8 cas) et la névrite optique rétrobulbaire (4 cas). Sept patients avaient un angio-Behçet cérébral à type de thromboses veineuses cérébrales (3 cas), d'infarctus cérébraux (2 cas) et d'hématomes intracérébraux (2 cas). Sous prednisone (16 cas) et azathioprine (3 cas), l'évolution clinique à court terme était majoritairement favorable (14 cas) avec un score de Rankin modifié de 2 au moment de l'exeat. Le NB est une maladie de l'homme adulte sous-diagnostiquée en Afrique noire. Des études ultérieures multicentriques nationales et sous-régionales sont souhaitables.

Postpartum infections in a tropical environment: The experience of the infectious diseases department at Fann Teaching Hospital of Dakar (Senegal).

To describe the epidemiology, clinical characteristics, and outcomes of infections in postpartum women admitted to the infectious diseases department at Fann Teaching Hospital. This retrospective descriptive study examined the records of women admitted for infectious diseases within 42 days after childbirth during the five-year period (2007-2011). Data were collected from medical files and analyzed with Sphinx plus2 V5 software. In all, 54 women were admitted for infections during the postpartum period. Their mean age was 27.4 ± 6.2 years. Fifty women (93%) had had vaginal deliveries. The average interval from delivery to admission was 15.4 ± 11.0 days. Tuberculosis (14 cases), vaginitis (13 cases), and severe malaria (7 cases) were the most frequent infectious diseases. The average duration of hospitalization was 12.1 ± 9.0 days. The mortality rate was 30%, with the main causes of death tuberculosis (25 %) and severe pneumonia of unknown causes (25 %). Tropical diseases remain frequent during the postpartum period, with a high lethality rate, as this study shows. Early diagnosis during pregnancy and better follow-up after delivery should be the best ways of reducing morbidity and mortality from these infections.

[Post-circumcision Tetanus: Epidemiological, Clinical, Prognostic and Evolutionary Aspects of 16 Cases Collected at the Department of Infectious and Tropical Diseases in Fann Hospital (Dakar)]. / Tétanos postcirconcision : à propos de 16 cas colligés à la Clinique des maladies infectieuses du CHNU de Fann (Dakar).

This retrospective, descriptive study carried out in the Infectious Diseases Department of CHNU, Fann from 1st January 2012 to 3st December 2016 aimed to describe the epidemiological aspects and the course of post-circumcision tetanus and to formulate public health recommendations. During our study period, 16 cases of post-circumcision tetanus were collected out of a total of 452 patients with tetanus, equivalent to a rate of 3.5%. The median age was 8 years (3-40). None of the patients had a vaccination card. In 63% of cases, circumcision was performed at home, by a practitioner whose qualification was not documented in 63% of cases. All signs of tetanus were found with trismus (100%), dysphagia (63%) and paroxysms (88%). These were mostly Mollaret stage II forms in 14 cases, and grade 3 Dakar score in 7 cases. The median duration of hospitalization was 10 days [6-15]. Mechanical or infectious complications were noted in two cases, with a lethality rate of 13%. Post-circumcision tetanus is a reality in Senegal. Good community awareness, continuous training of staff and implementation of vaccination catch-up strategies for children of circumcised age should eradicate this form of tetanus.

Cette étude rétrospective descriptive, réalisée à la Clinique des maladies infectieuses du CHNU de Fann du 1er janvier 2012 au 31 décembre 2016 avait pour but de décrire les aspects épidémiologiques et évolutifs du tétanos postcirconcision et de formuler des recommandations en termes de prévention. Durant la période d'étude, 16 cas de tétanos postcirconcision ont été colligés sur un total de 452 patients atteints de tétanos, soit une fréquence hospitalière de 3,5 %. L'âge médian était de huit ans (3­40). Aucun des patients ne disposait de carnet de vaccination. Dans 63 % des cas, la circoncision a été effectuée à domicile, par un praticien dont la qualification n'a pas été documentée dans 63 % des cas. Tous les signes du tétanos ont été retrouvés avec le trismus (100 %), la dysphagie (63 %) et les paroxysmes (88 %). Il s'agissait surtout de formes de moyenne gravité classées au stade II de Mollaret dans 14 cas, et au score 3 de Dakar dans sept cas. La durée médiane d'hospitalisation était de dix jours [6­15]. Des complications mécaniques ou infectieuses ont été notées dans deux cas, avec une létalité de 13 %. Le tétanos postcirconcision est une réalité au Sénégal. Une bonne sensibilisation de la communauté, la formation continue du personnel et la mise en place de stratégies de rattrapage vaccinal des enfants en âge d'être circoncis devraient permettre d'éradiquer cette forme de tétanos.

[Tuberculosis Abscess of the Chest Wall on an Immunocompetent Patient in the Teaching Hospital of Dakar (Senegal)]. / Abcès tuberculeux de la paroi thoracique chez une patiente immunocompétente au centre hospitalier universitaire de Dakar (Sénégal).

Tuberculosis remains a problem of public health, in spite of the numerous significant advances noted in the diagnosis in recent years. The involvement of the thoracic wall is a rare extra lung shape. Its clinical presentation is not specific and a collected thoracic tumefaction is the main clinical demonstration. The diagnosis is improved by the use of non-invasive tools such as the Xpert MTB/Rif® test with a good sensibility on the pus. Medical care is based on medical treatment and sometimes associated with surgical treatment.

La tuberculose demeure un problème de santé publique, malgré les nombreuses avancées significatives notées dans le diagnostic ces dernières années. L'atteinte de la paroi thoracique est une forme extrapulmonaire rare. Sa présentation clinique est non spécifique, et une tuméfaction thoracique collectée en est la principale manifestation clinique. Le diagnostic est amélioré par l'utilisation d'outils non invasifs tels que le test Xpert MTB/Rif® avec une bonne sensibilité sur le pus. La prise en charge repose sur le traitement médical quelquefois associé à un traitement chirurgical.

Cryptococcose neuro-méningée : mortalité et facteurs associés au décès chez les patients hospitalisés au service des Maladies Infectieuses du CHNU de Fann

Introduction : La Cryptococcose Neuro-Méningée (CNM) survient souvent sur terrain d'immunodépression et surtout au cours de l'infection à VIH.Objectif : Déterminer la prévalence de la mortalité et les facteurs associés au décès. Patients et méthodes : Etude rétrospective descriptive et analytique, sur des patients hospitalisés de 2011 à 2014, des deux sexes, d'âge supérieur à 18 ans avec une CNM confirmée.Résultats : Trente-quatre cas colligés, dont 31 chez des patients VIH+ (91,1%). L'âge moyen était de 43,17 ans et la majorité avait un âge compris entre 40 et 49 ans. Le sex-ratio était de 1,26 en faveur des hommes. Ils présentaient des maladies chroniques sous-jacentes dans 11,7% des cas. Sur le plan clinique, céphalées (81,8%), fièvre au long cours (76,5%), vomissements (57,6%) et troubles de la conscience (44,1%) étaient notés. Des infections opportunistes étaient objectivées (97%) avec une prédominance de la candidose digestive. Sur le plan biologique, le taux moyen de LT CD4+ était de 117,42/mm3. L'examen direct à l'encre de Chine positif dans 11/23 cas. L'antigène cryptococcique positif dans LCR dans 16/24 cas et l'antigénémie positive pour 20/22 cas. Sur le plan évolutif, la létalité était de 57,6%. La durée de l'infection à HIV< 20 mois et les patients sans traitement ARV étaient les facteurs associés au décès.Conclusion : Dans nos régions elle est l'une des principales causes de méningo-encéphalite chez les sujets VIH+ immunodéprimés. Sa létalité est importante du fait de la non- disponibilité des antifongiques majeurs et du diagnostic tardif de l'infection à VIH

Risk factors for maternal mortality: a case-control study in Dakar hospitals (Senegal).

This study was conducted in the three main hospitals of Dakar, the capital city of Senegal. Each case of 152 maternal deaths identified over a 12-month period was matched with two controls: a safe delivery in the same clinic, and a safe delivery in the same neighbourhood of residence. Controls were matched on age, birth order, place, and time of delivery. The leading causes of death were: puerperal sepsis and other infections (51 cases), haemorrhage (32 cases), eclampsia (29 cases), ruptured uterus (11 cases), and anaemia (7 cases). Results of the case-control study revealed the major risk factors associated with health system failures: medical equipment failure (odds ratio [OR] = 55.0), late referral (OR = 23.2), lack of antenatal visit (OR = 16.9), and lack of available personnel at time of admission (OR = 6.6). Various indicators of maternal status at time of admission (complications, blood pressure, temperature, oedema, haemoglobin level) and of health history prior to admission (previous complications, previous C-section, lack of treatment) were also strong predictors of survival. Lastly, socio-demographic factors also appeared as correlates of maternal mortality, in particular: first pregnancy (OR = 2.3), pregnancy of high birth order (OR = 1.9), rainy season (OR = 2.4), being unmarried (OR = 2.5), and low level of education (OR = 1.6). Implications for policy are discussed.

[Poverty, ignorance and inefficiency of the health systems]. / Pauvrete, ignorance et inefficacite des systemes de sante.

PIP: Maternal mortality (MM) rates are very high in Senegal, and these have been badly underestimated in past studies. A retrospective study done by UNDP in 1986 estimated MMR between 530-780/100,000 while a prospective study in the rural areas done by ORSTROM between 1983-84 estimated MMR to be 576/100,000. In 1977 a study done at Le Dantec Hospital found an MMR of 500/100,000. This new study,funded by the World Health Organization, is an effort to address the misinformation coming from previous studies partly due to weaknesses in the health system and to the socioeconomic and demographic characteristics of Senegalese women. This study establishes the principal determinants leading to MM. Done between 1986-87, it included all MM in the 3 principal maternities in Dakar because the majority of high-risk women are referred to these hospitals. 2 samples were done: 1) a local sample of women in the same maternities of approximately similar ages, same parity, same diagnosis for admission and normal deliveries of live babies during the same period; 2) a regional sample that included women of approximate ages, same parities, and from the same residential areas, normal deliveries of a live infant during the same period. A detailed medical questionnaire was given to each of the women in the 2 samples. In 12 months 152 MM were identified of which 118 were in Dakar; while 6217 live births were recorded during the same period making MMR 750/100,000 live births in the maternities. The principal causes of death were puerperal infections, hemorrhages, hypertension, and uterine ruptures. Results demonstrated that the most significant factor in the survival of women was the length of time between the 1st signs of complication and admission to the hospital. The MMR was higher during the rainy season (4 months), and single women were more at risk of dying than women in union and those without prenatal consultations.^ieng

[Echography in comparing the fetal growth of infants of African and European mothers]. / Comparison, par échographie, de la croissance foetale des enfants de mères africaines et européennes.

Ethnic differences after delivery between babies of black or white origin are well know. However, until now, fetal growth during pregnancy has not been studied in relation to ethnic factors. In this study, two groups of 201 women, one of african origin, the other of european origin, were compared for their ultrasonic measurements of fetal abdominal transverse diameter (ATD), biparietal diameter (BPD) and femoral length. The two groups were matched by hospital, date of delivery, parity and socio-economic status. Multiple pregnancies were excluded. ATD was not different between the two groups, whereas BPD was significantly smaller among african fetuses mainly during late pregnancy and femur was greater during the entire pregnancy. Ethnic factor remained significant when taking into account confounding factors. Observed differences appeared to be more probably related to a racial factor than to hypotrophy. These findings have to be considered in order to appreciate fetal growth among african fetuses during pregnancy.