Effects of Age, Level of Education and HIV Status on Cognitive Performance in West African Older Adults: The West Africa IeDEA Cohort Collaboration.

An in-depth understanding of the impact of aging, cognitive reserve, and HIV status on cognitive function is needed in older West African adults. Ninety-nine HIV-negative and 334 HIV-positive adults aged ≥ 50 years were enrolled in three clinics (Senegal and Côte d'Ivoire) participating in the IeDEA West Africa collaboration. All subjects underwent the Free and Cued Selective Reminding Test (FCSRT) and the Isaacs Set Test (IST). Age (both linear and quadratic), education level, and HIV status effects on Z-scores were assessed using multivariate linear regression models. Interactions between HIV status and age or educational level were tested. In the present cohort of older West African adults, the role of age and educational level on episodic memory and verbal fluency was observed without revealing an interaction between HIV status and age effect. As age had quadratic effects, older HIV-positive adults should not be considered as a unique group irrespective of their age. Low-educated HIV-positive patients had the lowest verbal fluency performance compared to others. Further studies are needed to duplicate these results. In clinical settings, screening and adapted programs focusing on improving cognition in those patients are needed.

[Pseudo-tumoral invasive fungus infection of the maxillary sinus in Abidjan]. / Infection invasive à champignon filamenteux pseudotumorale du sinus maxillaire à Abidjan.

INTRODUCTION: The invasive fungal infection of the maxillary sinus is a rare and serious disease generally favored by immunosuppression. We report an exceptional case of pseudotumoral invasive fungal infection of the maxillary sinus in an immunocompetent patient. OBSERVATION: A 32-year-old patient consulted for labial and left temporal swelling associated with proptosis and chemosis that has been developing for 18 months. The scanner objectified a filling of the left maxillary sinus, and the ipsilateral orbital cavity, and the surrounding muscles. Histological examination of the surgical specimen revealed invasive fungal infection of the left maxillary sinus. The relevant antifungal therapy, namely voriconazole, could not be administered due to the unavailability of the medicine. However, the patient has received 200mg of itraconazole every 12hours for three weeks. The change proved disappointing with recurrence and significant sequelae, sort of sagging of the right hemifacial, severe limitation of mouth opening and functional loss of the right eye. CONCLUSION: The invasive fungus infections of the maxillary sinus and the orbit are exceptional in immunocompetent patient. Healing is based on early diagnosis and administration of the reference antifungal to face the risk of recurrence.

[Fluconazole 1200mg or 800mg for cryptococcal meningitis treatment in Ivory Coast]. / Fluconazole 1200mg ou 800mg dans le traitement de la cryptococcose neuroméningée en Côte d'Ivoire.

OBJECTIVE: Assessing the use of high-dose fluconazol monotherapy (1200mg or 800mg) in the treatment and prognosis of HIV-associated cryptococcal meningitis in Ivory Coast. PATIENTS AND METHODS: A retrospective study carried out from August 2008 to August 2011 based on patients charts suffering from CM in the Abidjan Tropicals and Infectious Disease Unit. Mortality rate and associated factors were analyzed. RESULTS: Forty-six cases of cryptococcal meningitis (2.5% of hospitalizations) were included. The sex-ratio was of 1.2. The median age was 40.5 [35-47] years. The symptomatology was subacute (93.5%). The main clinical symptoms were syndrome of pure meningeal irritation (65%), fever (100%); 35% of patients had encephalomeningits. Twenty-one (45.7%) was ART-naïve patients. Fluconazole 1200mg was prescribed to 29 (63%) patients. Therapeutic lumbar punctures were performed in 42 (91.3) patients. The mortality rate was 50%. Significant predictors of mortality were encephalomeningitis and therapeutic lumbar puncture. CONCLUSION: Cryptococcal meningitis associated mortality remains high despite the use of high-dose fluconazole monotherapy. Therapeutic lumbar punctures help to improving the prognosis.

Pratique du dépistage du cancer du col au Service des Maladies infectieuses et tropicales, Abidjan

Le dépistage systématique du cancer du col de l'utérus chez les femmes infectées par le Vih est recommandé par l'oMS et effectif en Côte d'ivoire depuis 2009. l'objectif était de partager l'expérience de cette pratique en routine chez les femmes infectées par le Vih suivies dans un service d'infectiologie à abidjan. il s'est agit d'une étude rétrospective des dossiers de patientes âgées de 25 à 65 ans, infectées par le Vih, suivies au SMiT entre 2010 et 2014. la technique d'inspection visuelle à l'acide acétique (iVa) a été utilisée pour le dépistage. les données socio-démographiques, cliniques et thérapeutiques recueillies ont été analysées à l'aide des logiciels excel 2007 et STaTa version 13.0. le test statistique utilisé pour comparer les pourcentages était le khi deux ou le test exact de Fischer. les différences observées ont été considérées comme significatives en dessous de 5 %. la variable d'intérêt était la réalisation d'au moins un test iVa en routine. Selon le résultat du test iVa, le profil clinique et immunovirologique des patientes a été analysé en précisant la conduite à tenir selon l'indication. enfin la poursuite du dépistage a été notifiée dans le temps spécifiquement chez les femmes négatives au test initial. entre 2010 et 2014, 4 368 femmes infectées par le Vih étaient éligibles au dépistage du cancer du col. Parmi elles, 301 femmes (6,9 %) en ont bénéficié. l'âge médian était de 38 ans [25 - 58 ans]. la médiane des Cd4 au bilan de suivi lors du test iVa était de 291 cellules/mm3 [2 ­ 1 876 cellules/mm3]. le dépistage était positif pour 24 femmes (8 %) et selon les indications, 6 femmes étaient éligibles à la cryothérapie (26 %), 6 à la résection à l'anse diathermique (26 %) et 10 à la réalisation d'un frottis cervico-vaginal, pour une suspicion de cancer invasif (44 %). les patientes positives au test iVa étaient relativement plus jeune (35 vs 38 ans ; p = 0,03). aucun contrôle ultérieur n'a été effectué chez 90 % (n = 249) de celles qui ont eu un test iVa négatif au premier dépistage. le dépistage systématique est peu réalisé en routine au cours du suivi des femmes Vih. les défis opérationnels doivent être relevés pour une optimisation des soins en afrique

[Antiretroviral prophylaxis after non-occupational exposure to HIV in Abidjan (Cote d'Ivoire)]. / Prophylaxie antirétrovirale après expositions non professionnelles au VIH à Abidjan (Cote d'Ivoire).

OBJECTIVE: The aim of this study was to assess the tolerability and adherence to all non-occupational post-exposure prophylaxis (PEP) for cases of HIV exposure in Abidjan. METHOD: We retrospectively studied all post-exposure prophylaxis for non-occupational exposures to HIV prescribed from January 1st, 2000 to December 31st, 2007 in the Abidjan infectious diseases department. We analyzed the types of exposure, socio-demographic characteristics of patients, antiretroviral therapy regimens, adherence and tolerability, duration of the treatment, and post-exposure follow-up. RESULTS: Over these eight years, we managed 128 consultations for non-professional exposures to HIV (50 male [39%], 78 female patients [61%]), average age 24.8 years (four-54 years). The most frequent exposures were due to rape (n=74), condom rupture (n=29), and occasional unprotected sex (n=21). The average delay before consultation was 20.8 hours. The antiretroviral chemoprophylaxis included a protease inhibitor in 93% of the cases; 80.5% of patients completed 28 days of chemoprophylaxis, while 8.6% interrupted the treatment, and 10.9% were lost to follow-up. The most frequent adverse effects were gastrointestinal, reported by 79 patients (61.7%). Only 34 patients (26.6%) returned for clinical and biological post-exposure follow-up with HIV control at third month, without documented seroconversion. CONCLUSION: Cases of sexual exposure to HIV are the main indication for post-exposure prophylaxis in Abidjan, except for occupational exposure to blood. However, post-exposure prophylaxis should be available in the units of primary care, such as emergencies departments.

Patient safety and systematic reviews: finding papers indexed in MEDLINE, EMBASE and CINAHL.

OBJECTIVE: To develop search strategies for identifying papers on patient safety in MEDLINE, EMBASE and CINAHL. METHODS: Six journals were electronically searched for papers on patient safety published between 2000 and 2006. Identified papers were divided into two gold standards: one to build and the other to validate the search strategies. Candidate terms for strategy construction were identified using a word frequency analysis of titles, abstracts and keywords used to index the papers in the databases. Searches were run for each one of the selected terms independently in every database. Sensitivity, precision and specificity were calculated for each candidate term. Terms with sensitivity greater than 10% were combined to form the final strategies. The search strategies developed were run against the validation gold standard to assess their performance. A final step in the validation process was to compare the performance of each strategy to those of other strategies found in the literature. RESULTS: We developed strategies for all three databases that were highly sensitive (range 95%-100%), precise (range 40%-60%) and balanced (the product of sensitivity and precision being in the range of 30%-40%). The strategies were very specific and outperformed those found in the literature. CONCLUSION: The strategies we developed can meet the needs of users aiming to maximise either sensitivity or precision, or seeking a reasonable compromise between sensitivity and precision, when searching for papers on patient safety in MEDLINE, EMBASE or CINAHL.

[Efficiency and safety of antiretroviral treatment among the elderly in Abidjan]. / Efficacite et tolerance du traitement antiretroviral chez les sujets ages a Abidjan.

OBJECTIVE: To evaluate the efficacy of antiretroviral treatment in elderly people followed at the Unit for Infectious and Tropical Diseases at the University Hospital in Abidjan. MATERIAL AND METHODS: We performed a retrospective descriptive study of the files of people aged at least 60 years, infected by HIV who were treated and followed-up in the Unit between 1 January 1999 and 31 December 2006. We analysed sociodemographic (age, sex), clinical (weight, Karnofsky scale, CDC, opportunistic infections), biological (HIV, CD4, haemogram, glycaemia, creatininaemia, transaminasaemia) and therapeutic (antiretroviral regimens, evolution, side-effects) parameters. The efficacy of treatment was evaluated as the percentage of patients with < 200 CD4/ml, and its safety was based on deleterious effects. RESULTS: We studied 62 patients (44 men, 18 women), of whom 13 had been treated (21%), 46 had not been treated (74.2%) and 48 (77.4%) were undergoing chemoprophy-laxis with cotrimoxazole. Most were infected with HIV1 (93.6%), 3.2% with HIV2 and 3.2% with both HIV1 and HIV2. The majority (93.3%) was symptomatic, and 67.8% had AIDS. During 34 months of follow-up, 48 patients (77.4%) received first-line treatment, 13 (21%) received second-line and only one patient (1.6%) had third-line treatment. The percentage of patients with more than 200 CD4/ml increased from 20% at baseline to 36% at 6 months and 39% at 12 months. The main clinical side-effect was peripheral neuropathy (30.5%), and the main biological effect was hypertransaminasaemia > 2N (32.3%). The median rate of loss to follow-up was 17.7%, and two patients (3.2%) died. CONCLUSION: Antiretroviral treatment is effective in the elderly, with few biological disorders. A prospective study of a larger sample would elucidate the differences from younger people in the efficacy of such treatment.

Efficacite et tolerance du traitement antiretroviral chez les sujets ages a Abidjan

Objectif : Evaluer l'efficacite du traitement antiretroviral chez les sujets ages suivis dans le service des Maladies Infectieuses et Tropicales a Abidjan. Materiel et Methodes : Il s'agit d'une etude retrospective; descriptive et portant sur l'analyse des dossiers de sujets ages d'au moins 60 ans; infectes par le VIH; traites et suivis dans le service des Maladies Infectieuses et Tropicales entre le 1er janvier 1999 et le 31 decembre 2006. L'analyse a porte sur les parametres sociodemographiques (age; sexe); cliniques ARV; (poids; score Karnofsky; stade CDC; affections opportunistes); biologiques (type de VIH; CD4; hemogramme; glycemie; creatininemie; transaminasemie) et therapeutiques (regimesA RV; evolution; effets secondaires). L'efficacite du traitement etait basee sur le pourcentage de patients ayant un taux de CD4 200 / ml et la tolerance basee sur les effets deleteres. Resultats : L'etude a concerne 62 sujets ages (44 hommes / 18 femmes); dont 13 pretraites (21); 46 naifs (74;20) et 48 (77;42) sous chimioprophylaxie au cotrimoxazole. La majorite de l'effectif etait infectee par le VIH1 (93;60) contre 3;20pour le VIH2 et 3;20pour le VIH 1+2. Ils etaient symptomatiques a 93;3avec 67;8au stade SIDA. En trente quatre mois de suivi; 48 patients ont recu un regime de premiere ligne (77;4) ; 13 de deuxieme ligne (20;96) et un seul patient avait un regime de troisieme ligne (1;6). L'analyse des resultats a montre que le pourcentage des patients ayant un taux des CD4 200 etait croissant; passant de 20a M0 a 36a M6 puis 39a M12. Quant aux effets secondaires; ils etaient cliniquement domines par les neuropathies peripheriques (30;5) et biologiquement par l'hypertransaminasemie 2N (32;3). Le taux median de perdus de vue etait de 17;7; et 2 patients (3;22) sont decedes. Conclusion : Le traitement ARV est efficace chez les personnes agees avec peu d'anomalies biologiques; aussi; une etude prospective sur un plus grand echantillonnage permettrait-elle de mieux percevoir les differences avec le sujet jeune

[Hyperactive malarious splenomegaly: diagnosis and therapeutic problems in adults]. / Splénomégalie palustre hyperactive: problèmes diagnostiques et thérapeutiques chez l'adulte.

The chronic forms of malaria are scarce. We report a case of an hyperactive malarious splenomegaly. This case concerns a 69 year-old man residing in a village of Côte d'Ivoire. He had massive splenomegaly type IV. He was admitted in hospital for progressive loss of weight and moderate fever He presented also asthenia, anaemia and regular hepatomegaly. The haematological, biochemical, immunological and radiological exams ruled out trypanosomiasis, visceral leishmaniasis, tuberculosis, bilharziasis diseases and neoplasia process. His age, the massive splenomegaly, the anaemia, the high antimalarial IgM antibodies in immunofluorescence and the favourable response to the prolonged administration of antimalarial treatment led to the diagnosis of hyperactive malarious splenomegaly despite the detection of Plasmodium falciparum in blood. This observation allows to underline the frequency of this possible underestimated chronic form of malaria in Africa and shows the necessity to consider it seriously when facing massive splenomegaly.

[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.

[Three new cases of visceral leishmaniasis in Côte d'Ivoire]. / Trois nouveaux cas de leishmaniose viscérale autochtone en Côte d'Ivoire.

The objective of this work is to report three cases of visceral leishmaniasis in non-HIV infected native patients in Côte d'Ivoire. The three observations concerned adults aged of 31 and 65 and a five years old child without particular medical or surgery histories. Factors associated with visceral leishmaniasis regarding the younger and the older adults were respectively young age, chronic lymphoid leukaemia and Burkitt lymphoma. Clinical features in the three cases were chronic fever a myeloproliferative syndrome with wasting syndrome and pancytopenia. The diagnosis was confirmed by the existence of Leishmania in bone marrow, ganglionic juice and splenic samples. The species of Leishmania was not identified. Specific treatment was based on intravenous amphotericin B (Fungizone) relayed by Glucantim in one case because of side effects; however the treatment has been unsuccessful. These three new cases show that visceral leishmaniasis is a reality in Côte d'Ivoire therefore an epidemiological survey is requested in order to identify Leishmania species, reservoirs and vectors.

[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.

[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.