New diagnostic tools for neonatal sepsis: the role of a real-time polymerase chain reaction for the early detection and identification of bacterial and fungal species in blood samples.

Early diagnosis and treatment of neonatal sepsis are essential to prevent severe and life threatening complications. Consequently, rapid diagnostic tests capable to differentiate infected from non-infected newborns have the potential to make a significant impact on neonatal care. A new real-time polymerase chain reaction (PCR; LightCycler SeptiFast test M GRADE) has been proposed in the routine assessment of neonatal sepsis for the detection and identification of bacterial and fungal DNA from microorganisms which cause approximately 90% of all blood stream infections. The LightCycler SeptiFast test can detect and identify simultaneously the 25 most important bacterial and fungal species causing bloodstream infections within few hours by using a small volume of a single whole blood sample. Real-time PCR can be easily incorporated into the hospital setting for term or near-term infants admitted to the neonatal intensive care unit for sepsis evaluation.

[Results of active surveillance of acute flaccid paralysis in the Central African Republic and Chad from 1995 to 2000]. / Bilan de la surveillance active des paralysies flasques aigues en Republique Centrafricaine et au Tchad de 1995 a 2000.

The threefold purpose of this report is to describe the epidemiology of acute flaccid paralysis (AFP), to determine the impact of the National Immunization Days (NID), and evaluate the quality of active surveillance in the Central African Republic (CAR) and Chad. The data in this study was obtained from the Enterovirus Division of the Pastear Institute in Bangui (National WHO Inter-country Reference Laboratory for the CAR and Chad and Regional Poliovirus Reference Laboratory in Africa). An increase in the number of AFP cases was observed in the CAR between 1995 and 2000 and in Chad between 1997 and 2000, mainly as a result of enhancement of the surveillance system. The goals set by the WHO in terms of the proportion of AFP cases with 2 specimens collected within 14 days of onset of paralysis and the number of cases with 60-day follow-up have not been reached in either country. The presence of 2 strains of wild poliovirus (types 1 and 3) and several genotypes (West African 13 and West African 7 for type 1 and Central African and Nigeria-P3 for type 3) not only show that Central Africa is still a significant reservoir for poliovirus transmission but also raise serious doubts about the quality of the NID organized over the last 3 years. The priority of the next NID round must be to reach unimmunized children who have been missed by routine immunization coverage.

Enterohaemorrhagic Escherichia coli in Central African Republic.

PIP: A dysentery outbreak in the Central African Republic village of Zemio was diagnosed as "Shigella flexneri" by the Pasteur Institute in Bangui (IPB) in February 1996; 2 months later there was an outbreak of hemorrhagic colitis. 108 patients presented with bloody diarrhea; cramping abdominal pain, fever, nausea, and vomiting were uncommon. The illness lasted between 5 days and 3 weeks (average, 8 days). Antibiotics were ineffective. Four patients died and several developed hemolytic-uremic syndrome. Stool cultures done at IPB tested negative. PCR was used to detect enterohemorrhagic Shiga-like toxin (SLT) 1 and 2, the invasivity gene ipaH, and the attaching and effacing gene eaeA. DNA fragments of 130 and 494 nucleotides corresponding to amplified SLT1 and eaeA were found in 80% of the specimens tested. No amplification was obtained for SLT2 or for ipaH in specimens collected during the second epidemic. These results suggest the presence of enterohemorrhagic Escherichia coli and the absence of Shigella. The number of reported cases of acute bloody diarrhea in infants and adults in Bangui has increased since 1996. E. coli O157:H7 was isolated from two fatal adult cases. Smoked zebu meat was suspected in several hospital cases (bloody diarrhea, hemolytic anemia, and renal insufficiency) in which non-fermenting sorbitol E. coli O157:H7 was not isolated. In two cases of acute diarrhea, other serotypes of E. coli were indicated by retrospective PCR on stools which were positive for SLT1 and for eaeA and negative for invasivity. A study was conducted in Bangui on 290 cases (33 with bloody diarrhea) and 140 controls. Patients were not paired because of civil unrest in the city. The questionnaire included demographic and socioeconomic characteristics, environmental factors, and habitual food consumption. The major contributing factor was consumption of locally made meat pies (kanda), which were made with smoked zebu meat. Kanda is stored at ambient temperature, often for days, before it is sold in markets or along roads. Before 1996, E. coli was not reported as a cause of bloody diarrhea in the Central African Republic.^ieng

The epidemic of HIV/AIDS in Abidjan, Côte d'Ivoire: a review of data collected by Projet RETRO-CI from 1987 to 1993.

We present a review of epidemiologic data collected by Projet RETRO-CI between 1987 and 1993 on trends in human immunodeficiency virus type 1 (HIV-1) and HIV-2 infections and on cases of AIDS in Abidjan, Côte d'Ivoire. Overall rates of HIV infection in pregnant women had already reached 10% in 1987, and have increased only modestly since then. In contrast, in 1992-1993, rates in men with sexually transmitted diseases and in female commercial sex workers reached 27 and 86%, respectively. The increases in infection rates have been largely due to transmission of HIV-1, whereas rates of HIV-2 have remained stable or have declined. Among persons with tuberculosis and hospitalized patients, rates of 46-71% have been reached, increases in recent years again being largely attributable to HIV-1. Among the 15,245 AIDS cases reported by Projet RETRO-CI, a steady decline in the male:female sex ratio has occurred over time, from 4.8:1 in 1988 to 1.9:1 in 1993. It is likely that AIDS cases were initially concentrated among a core group of female commercial sex workers and their male clients. A substantial proportion of sex workers and their clients originate from neighboring countries, and migration is likely to have contributed to the spread of HIV infection in West Africa. Including HIV-associated pulmonary tuberculosis as an AIDS-defining illness increased AIDS cases reported by Projet RETRO-CI by 13% in 1993. Despite a need for interventional research, careful description of the evolution of HIV/AIDS in this region remains essential.

[The pathogenicity of the human immunodeficiency virus HIV-2 as seen by epidemiologists]. / La pathogenicite du virus de l'immunodeficience humaine VIH2 vue par des epidemiologistes.

The purpose of this study is an evaluation of HIV-2 pathogenicity through an epidemiological analysis, specially in Africa. It is acknowledged that the incubation, or more specially the lapse of time between the infection and the AIDS disease, is longer with HIV-2 than with HIV-1. More over, a certain number of surveys done in Africa show that the average age is higher with HIV-2 than with HIV-1; this is a regular sign of lower pathogenicity. It appears that the sexual transmission of the virus is the same for the HIV-2 and the HIV-1, but it is less effective from mother to baby. Furthermore this type of virus is less prevalent with AIDS patients or AIDS suspects than the HIV-1; and the follow-up of HIV-2 seropositives show that fewer people fall ill than with the HIV-1. A few signs of AIDS standard diagnosis are less frequent among HIV-2 infected patients than among HIV-1 infected patients. Opportunist or associated infections, like tuberculosis or malnutrition, are less often found in HIV-2 patients.

Tuberculosis and HIV infection in sub-Saharan Africa.

OBJECTIVES: To review the epidemiologic, clinical, and pathological characteristics and the public health implications of human immunodeficiency virus (HIV)-associated tuberculosis in sub-Saharan Africa. DATA SOURCES: Published medical literature (English and French) and proceedings of international and African conferences on the acquired immunodeficiency syndrome (AIDS). STUDY SELECTION: Selection by the authors of articles most pertinent to HIV infection and tuberculosis in Africa and internationally. DATA EXTRACTION: Direct reporting of quantitative data (eg, HIV seroprevalence levels) and of qualitative descriptions and conclusions from selected literature. DATA SYNTHESIS: High rates (20% to 67%) of HIV infection in patients with tuberculosis have been reported from East, West, Central, and Southern Africa. An increase in tuberculosis cases has been reported at the same time as the emergence of AIDS in several countries. Autopsies in Abidjan, Ivory Coast (Côte d'Ivoire), have shown tuberculosis as the most frequent opportunistic infection in patients dying of AIDS. Clinical differences in patients with tuberculosis who were HIV-positive and HIV-negative are reviewed, the most important being a greatly increased mortality rate in HIV-associated disease. Access to HIV testing is required for firm diagnosis, for clinical care and counseling, and for public health surveillance. CONCLUSIONS: The epidemiology of tuberculosis has been profoundly influenced by the epidemic of HIV infection in sub-Saharan Africa. Greatly increased human and material resources are required for this neglected problem in international health.

[Prevalence of Chlamydia trachomatis in genital samples from Abidjan]. / Prévalence de Chlamydia trachomatis dans des prélèvements génitaux à Abidjan.

A study of direct genital swabs achieved in Abidjan, on 116 men and 131 women consulting for urogenital complaints, has revealed that the men show a prevalence of 28.4% Chlamydia trachomatis, and of 18.1% Neisseria gonorrhoeae. Concerning the women the prevalence of the same germs are 13.7% for Chlamydia trachomatis, and 4.6% for Neisseria gonorrhoeae. These results show the importance of Chlamydia trachomatis as a sexually transmitted disease in Abidjan (Côte-d'Ivoire). No differences were observed according to age in the two groups.

The present and future course of the AIDS epidemic in Côte d'Ivoire.

An assessment of the current and future mortality and morbidity from acquired immunodeficiency syndrome (AIDS) in Côte d'Ivoire was made using the results of the 1989 national survey of the prevalence of human immunodeficiency (HIV) infection in the country and the AIDS projection model developed by WHO. For 1989 it was estimated that about 25,000 AIDS cases in adults and children had occurred, although the total number of cases reported for 1989 (up to 1 July 1991) was about 13% (1:6.9) of this estimated total. It is projected that by 1994 in Côte d'Ivoire the cumulative number of cases of AIDS in adults will be 89,000, and that for infants and children the corresponding number will be 41,000. It was also projected that about 371,000 uninfected children will have been born to HIV-infected mothers in Côte d'Ivoire by 1994 and that many of these children will have been orphaned by the deaths of their mothers from AIDS.

[Analysis of new criteria for increasing the specificity of commercial Western blots]. / Analyse de nouveaux critères pouvant accroître la spécificité des western blots commerciaux.

We examined the frequency of serum cross-reactivity on Western blot for HIV1 and HIV2. 661 patients with tuberculosis in Abidjan, and 4,899 asymptomatic persons for HIV1 and HIV2 infections were tested. All specimens positive on ELISA for HIV1 or HIV2 were further characterized by synthetic peptide based tests. Confirmed positive samples were tested by HIV1 and HIV2 specific Western blot criteres utilisis. Dual serologic reactivity on synthetic peptide tests was significantly more frequent in HIV positive patients with tuberculosis than asymptomatic subjects. Positive HIV1 Western blots were seen in 61%-86% of specimens positive for HIV2 only on synthetic peptide tests. [Cross-reactivity, to HIV2 Western blots by HIV1 positive specimens was significantly more frequent in patients with tuberculosis than in asymptomatic subjects.] Using recently recommended criteria for HIV1 and HIV2 Western blot interpretation (presence of 2 env bands) reduced the overall proportion of HIV1 positive specimens having a positive HIV2 Western blot from 39% to 14% and HIV2 positive specimens having a positive HIV1 Western blot from 31% to 8%.

The present and future course of the AIDS epidemic in Côte d'Ivoire

An assessment of the current and future mortality and morbidity from acquired immunodeficiency syndrome (AIDS) in Côte d'Ivoire was made using the results of the 1989 national survey of the prevalence of human immunodeficiency (HIV) infection in the country and the AIDS projection model developed by WHO. For 1989 it was estimated that about 25,000 AIDS cases in adults and children had occurred, although the total number of cases reported for 1989 (up to 1 July 1991) was about 13% (1:6.9) of this estimated total. It is projected that by 1994 in Côte d'Ivoire the cumulative number of cases of AIDS in adults will be 89,000, and that for infants and children the corresponding number will be 41,000. It was also projected that about 371,000 uninfected children will have been born to HIV-infected mothers in Côte d'Ivoire by 1994 and that many of these children will have been orphaned by the deaths of their mothers from AIDS

[Difficulties in the epidemiological surveillance of measles in Africa: exemplified by the Ivory Coast]. / Difficultés de la surveillance épidémiologique de la rougeole en Afrique: exemple de la Côte d'Ivoire.

In tropical areas measles cases often are under-reported but the authors comment here two epidemics which had at first been considered as outbreaks of measles but were not. The first epidemic resembled a Chikungunya virus outbreak with important rashes, hyperthermia and pain attacks and was due to Igbo-Ora arbovirus. In the second epidemic children were having rashes with hyperthermia and adenopathy evoking rubella. The authors consider the possibility of over-reporting in view of the surveillance of measles, the target-disease in EPI (Expanded Programme on Immunization). This hypothesis is confirmed by the distribution of reported cases at national level with a high rate of out-season cases and among adults.

[The transmission of maternal measles antibodies to newborn infants in the Ivory Coast]. / Transmission des anticorps maternels antirougeoleux au nouveau-ne Ivoirien.

Authors studied the disappearance of mothers measles antibodies among 286 babies from Ivory Coast 250 of which were living in Adzopé, a town with 30,000 inhabitants at 100 km up North from Abidjan and the 36 other babies in Abidjan. The study of antibodies by IHA showed a higher serum incidence rate of mother antibodies among 4 months aged babies in Abidjan. The more sensitive study of antibodies by the Mann serum neutralisation, shows that when 6 months aged, 60% babies from Adzope still have antibodies and when 10 months aged, none of the babies is positive. Serum negativation is late compared to Brazzaville when antibodies level is lower.