Description

Depuis sa création en 1908, la Société de pathologie exotique publie un Bulletin, recueil d'articles scientifiques et de compte-rendus de séances.

Publications in this journal

• [Epidemiological data on scorpion envenomation in Algeria.]

  Authors: H Hellal, M Guerinik, L Griene, Y Laid, S Mesbah, R Merad, B Alamir

  Bulletin de la Societe de pathologie exotique (1990).

  The scorpion envenomation is a major public health problem in Algeria. Given this fact, the Ministry of Health has developed a national strategy for prevention and control based on the training ofThe scorpion envenomation is a major public health problem in Algeria. Given this fact, the Ministry of Health has developed a national strategy for prevention and control based on the training of health personnel, information, education and communication, and standardization of care on the basis of a therapeutic consensus. The monitoring and evaluation activities are carried out by epidemiological indicators through the implementation of an information system based in the services of Epidemiology, INSP (National Institute of Public Health) and Prevention Department of the Health Ministry. The information carriers are report cards implemented in different health facilities that collect data on bites and deaths from scorpion envenomation. Summaries of notifications from the wilayas are collected monthly, and processed by the Epi info software using monitoring indicators. From 1991 to 2010, there has been a stagnation in the number of stings with an average of 50,000 cases per year, but mortality decreased from more than 100 deaths in the last fifty years to 50 nowadays. The higher proportion of stings was recorded during the summer period. The most affected group is from 15 to 49 years which constitute the workforce, but children from 5 to 14 years rank first in terms of mortality. But these rates vary across years and regions. Despite all these efforts, the scorpion envenomation in Algeria remains of concern and our main challenges are to strengthen cross-sectional actions at the local level and improving the quality of care.

• [Analysis of 18 Tunisian cases of mycetoma at the Sousse hospital (1974-2010).]

  Authors: A Aounallah, L Boussofara, Z Ben Saïd, N Ghariani, W Saidi, M Denguezli, C Belajouza, R Nouira

  Bulletin de la Societe de pathologie exotique (1990).

  Mycetoma are inflammatory pseudotumors, due to infection by bacterial (Actinomycetoma) or fungal (Eumycetoma) agent. A retrospective study was conducted during 34 years. Our aim was to studyMycetoma are inflammatory pseudotumors, due to infection by bacterial (Actinomycetoma) or fungal (Eumycetoma) agent. A retrospective study was conducted during 34 years. Our aim was to study epidemiologic, clinic, therapeutic and microbiologic characteristics. Eighteen patients were assessed. Sex-ratio H/F was 2. The mean age was 43.6 years. Principal localization was the feet. Our study was characterized by majority of actinomycetoma found in 15 cases (Actinomadura madurae in 14 cases and Nocardia sp. in one case). Eumycetoma were diagnosed in 3 cases (Madurella mycetomatis in twocases and Pseudallesheria in one case). All patients received medical treatment associated with surgical treatment in 11 cases.

• [Health of immigrant population of consultants at the Baudelaire outpatient clinic in Saint-Antoine hospital in Paris, France.]

  Authors: B Kaoutar, L Mathieu-Zahzam, J Lebas, P Chauvin

  Bulletin de la Societe de pathologie exotique (1990).

  Social and health data on the immigrant population remain scarce in France, especially concerning those in irregular situation. The Baudelaire outpatient clinic in Saint- Antoine hospital in ParisSocial and health data on the immigrant population remain scarce in France, especially concerning those in irregular situation. The Baudelaire outpatient clinic in Saint- Antoine hospital in Paris (PASS, i.e. specific free medicosocial care for the poor, the uninsured or the undocumented patients) treats a majority of immigrants, a lot of them being in an irregular residence status. The objectives of this study were to describe the social and health status of the immigrant consultants, to compare regular and undocumented migrants and to describe their main reasons for migration. A cross-sectional, descriptive, survey among the immigrant consultants has been performed among this outpatient clinic in April and May 2009. In total, 536 patients were included. Their age mean was 45 years, 62% are male, 49% are in an irregular situation and they have been in France for 12 years in average (19 years for the regular immigrants and 5 years for the undocumented). More than 20% had no health insurance. A majority (55%) of patients were suffering from a chronic disease. The more frequent ones were hypertension (20%), type 2 diabetes (11.6%), chronic infectious diseases - HIV, HBV, HCV - (7%). Reasons for immigration were mostly economical (39%), family (19%) and political (17%). Health reasons were at the 4th rank and concerned 9% of the patients. The main chronic diseases observed among this population are similar to those of the general population of consultants in primary health care, except for the chronic infectious diseases, which are more frequent. Immigration for health reasons represents only a small proportion of all immigration reasons. For this population, free clinics like the one investigated here constitute unique, irreplaceable, access points in the French healthcare system.

• [HIV/AIDS care and international migrations in the rural district of Nanoro, Burkina Faso.]

  Authors: B Autino, S Odolini, H Nitiema, D Kiema, A Melzani, V Pietra, M Martinetto, M Bettinzoli, J Simpore, G Sulis, E Focà, F Castelli

  Bulletin de la Societe de pathologie exotique (1990).

  West African Countries account for almost half of the estimated 20 000 000 international migrants in the continent. In the frame of the scaling up of HAART, our study aims to identify specificWest African Countries account for almost half of the estimated 20 000 000 international migrants in the continent. In the frame of the scaling up of HAART, our study aims to identify specific features and constraints of access to care for HIV migrant patients returning to Burkina Faso. From January 2007 to August 2011, the Nanoro District Hospital, serving a rural area in the Centre-West of Burkina Faso, followed 437 HIV/AIDS adult patients. Migrants were 139/437 (31.8 %), of whom 108/139 (77.7 %), declared they returned to Burkina Faso to seek care, because the area they migrated to did not offer specific HIV health assistance. At baseline, 113/139 (81,3 %) migrants and 181/298 (60,7 %) residents were in WHO clinical stages III or IV (p< 0.01). For every 100 patients/ year under HAART, 25.5 migrants (91.4 % of whom to foreign countries) and 5.7 Burkina residents were transferred to other centers (p<0.01). 21.8 migrants and 8.5 residents were dead or lost to follow up (p<0.05). For migrant patients, access to HIV screening and care seems to be delayed. The high frequency of migrants under HAART working abroad requires an improved cooperation among the health systems of the African Countries.

• [Genetic diversity and bone marrow transplantation.]

  Authors: E Marry

  Bulletin de la Societe de pathologie exotique (1990).

  The genetic origin of the patients, for whom a bone marrow transplantation has been proposed, is a key determinant in the possibility of identifying or not a compatible unrelated donor, andThe genetic origin of the patients, for whom a bone marrow transplantation has been proposed, is a key determinant in the possibility of identifying or not a compatible unrelated donor, and consequently in the possibility of performing the bone marrow transplantation. The required strict HLA compatibility, in the context of a bone marrow transplantation, increases the difficulty. A patient has one chance over four to have a compatible donor within his brothers and sisters, if any. This chance becomes one over a million, as an average, in the context of unrelated donor search. Taking into consideration the genetic history of the populations, their evolution and the large actual HLA diversity, the probability of finding an unrelated donor for a defined patient varies according to the frequency and the combination of the patient's HLA antigens, genetic markers inherited not only from his parents, but also from his ancestries. In the unrelated context, the HLA compatible donor most probably shares the same genetic history than the patient, and consequently belongs to the same population group. The study of the genetic of populations explains the difficulties in finding an unrelated compatible donor in the migrant populations, particularly those originated from Africa and from the middle east, due to their HLA specificities and to the small number of donors sharing the same origins registered on a volunteer bone marrow donors' file worldwide.

• [Improving malaria management through Rapid Diagnostic Tests: appropriation by providers communities (Sénégal).]

  Authors: S L Faye

  Bulletin de la Societe de pathologie exotique (1990).

  Introduced in the public health services in Senegal since 2007, Rapid Diagnostic Tests (RDTs) are a new technical opportunity for clinical diagnosis of malaria. We analyze how different categories ofIntroduced in the public health services in Senegal since 2007, Rapid Diagnostic Tests (RDTs) are a new technical opportunity for clinical diagnosis of malaria. We analyze how different categories of caregivers, who are the providers, assume appropriation of their professional practices. Similarly, we document, from the analysis of their application for care, attitudes of recipients towards RDTs. The results show a time lag between the uses of this tool and the recommendations. RDTs have a recognized epidemiological usefulness. However, their positive integration requires a change in behaviors that caregivers and recipients are not always willing to assume. Indeed, the architecture, working conditions and applications for care influence the modes of appropriation of this technical innovation.

• [High proliferation of An. gambiae and An. funestus larvae in irrigated and non-irrigated rice fields in the Western forest region of Côte-d'Ivoire.]

  Authors: A N Betsi, E S Tchicaya, B G Koudou

  Bulletin de la Societe de pathologie exotique (1990).

  Entomological surveys were conducted in the forest region of western Côte-d'Ivoire from November 1998 to December 1999 in order to study the ecology of mosquito breeding sites and bioecology ofEntomological surveys were conducted in the forest region of western Côte-d'Ivoire from November 1998 to December 1999 in order to study the ecology of mosquito breeding sites and bioecology of Culicidae. Three following agro-systems were considered: landscaped lowland (R0), the lowland with one growing season of rice per year (R1) and the lowland with two seasonal production of irrigated rice field per year (R2). Two villages were selected by agro-system, and cross-sectional entomological surveys were conducted every six weeks in each village. A total of 5,839 larvae of mosquitoes were collected in the different categories of breeding sites surveyed. From these larvae, 2,199 imagos emerged, giving an emergence rate equal to 37.7%. Nine species belonging to three genera were identified. The genus Anopheles with 1,828 larvae represented 83.1% of the total. Five anophelinae species were identified. An. ziemanni was the most abundant species with 751 larvae (32.5% of the total). An. funestus with 531 larvae represented 24.1% of the total. Larvae from this species were collected in river with raised vegetation and in irrigated rice field at transplanting and cut stages. About 559 larvae of An. gambiae representing 25.4% of the total were collected from artificial breeding sites, particularly in rice fields after the planting stage. Additionally, 38,626 anthropophilic mosquitoes were collected on 936 mannight catches in the study area. Thirty species belonging to seven genera were identified in the three agro-systems. In the villages of the agro-system R0, 2,675 mosquitoes were collected on landing catches. In the villages of the agro-ecosystem R1, 11,311 mosquitoes were collected, which was 4.2 higher than the number collected in the village of agro-system R0 for the same sampling effort. In the village of the agro-system R2, 24,640 mosquitoes were collected, which was 9.2 higher than the number collected in the agro-system R0 and 2.2 higher than the number collected in the agro-system R1. In the villages of agrosystems R0, R1 and R2, An. gambiae represented respectively 72.1%, 56% and 58.3% of anophelinae species collected, whereas An. funestus represented 25.6%, 40% and 31.9% of anophelinae species collected, in the same agrosystems, respectively. These results showed that areas of irrigated rice fields favoured the development of larvae from An. gambiae and An. funestus.

• [Reality of healthcare access for migrant children in Mayotte.]

  Authors: J Baillot, B Luminet, N Drouot, J F Corty

  Bulletin de la Societe de pathologie exotique (1990).

  The implementation of the social security system in 2005 in Mayotte has resulted in the end of free healthcare for all non-affiliated residents, primarily Comorians, due to the absence of the StateThe implementation of the social security system in 2005 in Mayotte has resulted in the end of free healthcare for all non-affiliated residents, primarily Comorians, due to the absence of the State Medical Aid (AME) in this department. Doctors of the World France opened a paediatric clinic in December 2009. The sociomedical data were collected during 5286 consultations in 2010. Analysis of these data demonstrates a link between access to healthcare for children and the residential status of their parents. The analysis concerns 2,350 patients met during consultations held by Doctors of the World France in Mayotte in 2010. The data have been electronically recorded and analysed by the Sphinx software. The results show that there are several obstacles to healthcare resulting in non-attendance. This situation is made worse if one of the parents has an irregular residential status and all the more so if both the parents have an irregular status. Affiliation to the social security system, however, improves the situation. The results show a delay in accessing healthcare, a poor vaccination programme and disturbing data on severe acute malnutrition. The specific healthcare measures in Mayotte do not respect the International Convention on the Rights of the Child. Direct affiliation to the social security system for children would entail a reduction in health insecurity for the children of parents with irregular residential status. It would also be necessary to reduce the factors that provoke fear of displacement, which would facilitate physical access to consultations.

• [Clinical study of tolerance and effectiveness of a F(ab')(2) polyvalent antienom for African snake bites in Kindia, Guinea.]

  Authors: M C Baldé, J -P Chippaux, M Y Boiro, R Stock, A Massougbodji

  Bulletin de la Societe de pathologie exotique (1990).

  An open, pragmatic, phase IV clinical trial was undertaken to measure tolerance and assess the effectiveness of Antivipmyn® Africa, antivenom composed of lyophilized F(ab')(2) fragments ofAn open, pragmatic, phase IV clinical trial was undertaken to measure tolerance and assess the effectiveness of Antivipmyn® Africa, antivenom composed of lyophilized F(ab')(2) fragments of immunoglobulin G in field conditions. The study was conducted at the Institut Pasteur of Guinea (IPG) from August 2009 to February 2010. Two hundred twenty-eight victims of snakebites presented at the processing center of the IPG during this period, including one hundred fifty (65.8%) envenomations, mostly young men. One hundred twenty-four of them (82.7%) suffered from viper envenomations and 26 (17.3%) from elapid ones. All patients were treated by intravenous Antivipmyn® Africa, averaging 1.4 (± 1.0) vials, more in patients with neurotoxic envenomation than others (P < 10(-5)). Four patients (2.7%), showing cobralike envenomation, died shortly after their arrival at the IPG despite the administration of the antivenom. Ten patients showed mild side effects (rash or pruritus), out of which 5 (3.3%) were probably due to treatment. This study confirms the efficacy and safety of Antivipmyn® Africa.

• [Evolution of the access to the kidney transplantation in France of foreign patients and French patients living in overseas territories.]

  Authors: C Cantrelle, F Pessione, M -A Macher, M Thuong

  Bulletin de la Societe de pathologie exotique (1990).

  In France, foreign patients, whether resident or not in France, can register on the national waiting list under administrative and financial conditions. We performed a retrospective analysis toIn France, foreign patients, whether resident or not in France, can register on the national waiting list under administrative and financial conditions. We performed a retrospective analysis to evaluate the access to kidney transplantation on a cohort 2004-2008, using the national registry. Among the 14,732 patients registered during this period, 15.3% are of non-French nationality (3.4% other European, 5.9% North African, 3.9% sub-Saharan African, 2.9% other). Among the 84.6% of French nationality, 3.3% are living in French overseas territories. Compared to the 17.6-month median waiting time of the cohort, median waiting time differs significantly between groups, from 15.7 months for mainland French patients to 36 months for sub-Saharan African patients. Despite the regular development of the allocation rules, these disparities in access to transplantation are mainly, but not completely, explained by blood group or HLA matching difficulties. After adjustment for the other factors known to be significantly linked to a difficult access to transplantation, North and sub-Saharan African patients have the worst difficulties. Future research should consider nonmedical factors, such as socio-economic or socio-cultural factors, potentially relevant to avoid disparities in access to transplantation and should aim at developing specific interventions.

• [Primary and isolated phrenic hydatid cyst in Tunisia.]

  Authors: A Makni, F Fetirich, M Jouini, M Kacem, Z Ben Safta

  Bulletin de la Societe de pathologie exotique (1990).

  The hydatid cyst of the diaphragm is defined as the development of a hydatid cyst in the diaphragm muscle. The purpose of this study is to identify the specific pathogenic, clinical and therapeuticThe hydatid cyst of the diaphragm is defined as the development of a hydatid cyst in the diaphragm muscle. The purpose of this study is to identify the specific pathogenic, clinical and therapeutic aspects of this hydatid cyst. It is important to confirm the diagnosis of the location before surgery. We report the case of a patient aged 40 years, in whom the diagnosis of hydatid cyst of the diaphragm was made incidentally in the course of a gastric stromal tumour. The patient was operated by a midline laparotomy. Resection of the protruding dome of hydatid cyst of the diaphragm was carried out along with total gastrectomy. The postoperative course was uneventful. After 12 months, the results were negative. The diagnosis of hydatid cyst of the diaphragm is based on the thoraco-abdominal CT scan. The treatment is surgical based on the topographic features of the cyst.

• [International adoption: children's health risk evolution.]

  Authors: C Dartiguenave

  Bulletin de la Societe de pathologie exotique (1990).

  The socioeconomic and sanitary conditions in many countries make it necessary to weigh as precisely as possible the uncertainties which might affect the health of internationally adopted children,The socioeconomic and sanitary conditions in many countries make it necessary to weigh as precisely as possible the uncertainties which might affect the health of internationally adopted children, which is one of the key drivers to adoption decision. Indeed, health troubles are more and more frequent among children proposed by countries, at a time when there are fewer children to be adopted. Hence the institutions and the actors in the field of international adoption are compelled to frequently update their professional practices, so as to cope both with the declining offer for adoptable children and with the increasing pressure from the birth countries of children to make host countries adopt children with high age or with special needs. It also requires from the administrations the will to provide better initial information and to implement the demand for an agreement. Meanwhile, in spite of those growing constraints, adopting families have been more and more risk adverse during the latest decades, this being a common trend in our developed countries.

• [The psychological disorders of children whose parents are without residence permits.]

  Authors: P Le Loher, C Puybaret-Bataille

  Bulletin de la Societe de pathologie exotique (1990).

  The authors and child psychiatrists are concerned about the psychological effects on children who are victim of the current policy on families without regular residence permits (regularization isThe authors and child psychiatrists are concerned about the psychological effects on children who are victim of the current policy on families without regular residence permits (regularization is increasingly restricted). These children often live for many years in hotels; they lead a life of insecurity and promiscuity, which is prejudicial to their development. The risk of expulsion makes their future uncertain. The authors denounce a form of abuse that has traumatic social and political effects on the parents and children; the symptoms are not specific, but are of concern due to their frequency and intensity. The treatment of these families requires social networking, which can be mentally exhausting due to a lack of financial and human resources. However, it is a public health issue and an ethical obligation concerning children's rights.

• [A randomized clinical trial comparing the effectiveness and tolerability of artemisinine-naphthoquine (Arco®) and artemether-lumefantrine (Coartem®) in the treatment of uncomplicated malaria in Benin.]

  Authors: D Kinde-Gazard, A Ogouyèmi-Hounto, L Capo-Chichi, J Gbaguidi, A Massougbodji

  Bulletin de la Societe de pathologie exotique (1990).

  The Ministry of Health recommended in Benin, since 2004, artemisinin-based combination, artemether-lumtefantrine (Coartem®), therapy for the treatment of uncomplicated malaria. To resolve theThe Ministry of Health recommended in Benin, since 2004, artemisinin-based combination, artemether-lumtefantrine (Coartem®), therapy for the treatment of uncomplicated malaria. To resolve the difficulties related to observance, we are interested in a new combination, artemisinin-naphthoquine (Arco®). A study was conducted to assess and compare the efficacy and tolerability of the fixed combination artemisinin (125 mg)-naphthoquine (50 mg), a single-dose drug, administered one day versus artemether (20 mg)-lumefantrine (120 mg).The clinical assessment was a single-blinded, two-arm, randomized trial comparing Arco® combination as a single-dose regimen and three-day regimen of Coartem® for the treatment of uncomplicated falciparum malaria, from july to october 2008 and may to september 2009, with 28 days of follow-up in children. PCR genotyping was used to classify re-infection or recrudescence. The primary outcome measures for efficacy were cure rates on days 3, 7, 14, 21 and 28. Secondary outcomes included parasite clearance time and fever clearance time. The main outcome measures for safety were incidences of post-treatment clinical and laboratory adverse events. A total of 174 patients (84 in Arco® group and 90 in Coartem® group) were evaluated for clinical and parasitological outcomes. The cure rate was 98.8% for Arco® and 100% for Coartem® on day 28, with no statistically significant difference. Fever clearance was obtained within 24 hours in both groups. The parasite clearance is obtained at 48 hours in Arco® group and at 60 hours in Coartem® group. Both treatments were well tolerated without major side effects. This study therefore concluded that the combination of artemisinin-naphthoquine is as effective and well tolerated as the combination artemether-lumefantrine in the treatment of uncomplicated malaria in Benin children. This medication administered in single dose is therapy of choice to reduce compliance problems during malaria treatment and also to facilitate community-based care of malaria.

• [Malaria among immigrants, experience of a Parisian hospital (2006-2010).]

  Authors: M Develoux, G Le Loup, S Dautheville, G Belkadi, D Magne, L Lassel, P Bonnard, G Pialoux

  Bulletin de la Societe de pathologie exotique (1990).

  In recent days immigrants represent the main risk group for imported malaria in northern countries. Most of them are migrants returning to their country of origin to visit friends and relativesIn recent days immigrants represent the main risk group for imported malaria in northern countries. Most of them are migrants returning to their country of origin to visit friends and relatives (VFR). We retrospectively examined the main clinical, biological, and therapeutic data of all malaria cases in immigrants from 2006 to 2010 in Tenon hospital, Paris. The hospital is situated in a Paris district with an important African community. During the study period 239 imported malaria cases were observed in adults of which 199 were immigrants, 186 VFR, and 13 recently arrived. Most cases were from sub-Saharan Africa and Comoro islands. Chimioprophylaxis was not taken in 81.2% of VFR. It was inadequate in 43.7% and not taken correctly in 84.4%. Plasmodium falciparum was the most frequent species identified: 190/199 (95.5%). Severe P. falciparum malaria was observed in 25 cases (13.2%); two of them were recently arrived. One patient, African VFR, died. In this series two high-risk groups were represented: HIV-infected patients and pregnant women. Six of the HIV patients had severe malaria and all pregnant women had anemia. Our results are similar to those observed recently in other European countries. Mean age of VFR is increasing and the risk for severe P. falciparum malaria became identical to the one observed in non-immune travelers. Protection measures remain still insufficient in this population of travelers.

• [Efficacy of artemether-lumefantrine in the treatment of uncomplicated malaria in children living in a rural area of Burkina Faso in 2009.]

  Authors: M Siribié, A Diarra, A B Tiono, I Soulama, S B Sirima

  Bulletin de la Societe de pathologie exotique (1990).

  In order to implement community case management of malaria strategy in a rural area of intense transmission, of children using artemether-lumefantrine combination, we assessed the therapeuticIn order to implement community case management of malaria strategy in a rural area of intense transmission, of children using artemether-lumefantrine combination, we assessed the therapeutic efficacy of the medicine. We conducted an open label and uncontrolled clinical trial in an unique centre from September 2009 to December 2009 in children 6-59 months old who consulted at health facilities for uncomplicated malaria. The primary endpoint was clinical and parasitological cure rate at day 28 corrected by PCR. In total 106 children were enrolled. Parasite clearance at day 2 was 99.04% and the adequate clinical and parasitological response corrected by PCR at day 28 was 90.5%. Our results confirm that artemether-lumefantrine combination is still effective.

• [Description of poisoning reported in Marrakech-Tensift-Al Haouz region in Morocco between 1981 and 2008.]

  Authors: N Echahbi, A Soulaymani, H Hami, B Benazzouz, L Ouammi, A Mokhtari, S Achour, I Semlali, R Soulaymani-Bencheikh

  Bulletin de la Societe de pathologie exotique (1990).

  In Morocco, the Marrakech-Tensift-Al Haouz region is one of the 16 regions most affected by poisoning. The aim of this study was to determine the epidemiological profile of poisoning recorded in theIn Morocco, the Marrakech-Tensift-Al Haouz region is one of the 16 regions most affected by poisoning. The aim of this study was to determine the epidemiological profile of poisoning recorded in the study region. A retrospective study of poisoning cases, declared between 1981 and 2008 in the Morocco Poison Control and Pharmacovigilance Center, was conducted. During the study period, 8517 poisoning cases were collected. The average age of patients was 22 ± 15 years. The male/female sex ratio was 0.85. Food poisoning was the most reported in the region, with 26.6% of cases. Among the 2,779 patients for whom the outcome was known, 65 died, with lethality rate of 23.4‰. The maximum lethality rate was recorded among those poisoned by paraphenylenediamine (170.7‰).

• [Hospitalization rates for immigrant-related illness among individuals with low income and full health insurance coverage in France, 2009.]

  Authors: P Tuppin, P -O Blotière

  Bulletin de la Societe de pathologie exotique (1990).

  Complementary Universal Health Insurance (CMUC) which provides free access to health care has been available in France since 2000 for people with an annual income less than 60% of the povertyComplementary Universal Health Insurance (CMUC) which provides free access to health care has been available in France since 2000 for people with an annual income less than 60% of the poverty threshold. Hospitalization rates in 2009 for common diseases among immigrants were compared between beneficiaries of the general scheme under the age of 60 years with (4.5 millions) or without CMUC (34.1 millions) in 2008 and still alive at the end of the year. Data were derived from the French national health insurance reimbursements and short-stay hospital discharge database. Age- and sex-adjusted hospitalization rates and relative risks (RR) were calculated. CMUC beneficiaries had significantly greater overall hospitalization rates (17.5% vs 13.2%) (males RR = 2.0, females RR = 2.3) and each 20-years age class. This was also the case for infectious and parasitic diseases (RR = 2.1), which include viral diseases and fevers of unknown origin (1.1/1000, RR = 1.6), septicaemia (0.4/1000, RR = 2.2), HIV infection (0.7/1000, RR = 3.5), other infectious and parasitic diseases (0.7/1000, RR = 2.5) and, more precisely, measles (2.7/1000, RR = 5.0). Hospitalizations for sickle cell disease (3%, RR = 4.5) were also more frequent as also for lead poisoning (0.12/1000, RR = 5.2). In this low-income population with free access to health care, hospitalizations were higher for many diseases that are targets for prevention and screening actions. This is the case for immigrants with CMUC coverage arriving in France and when they travel to their country of origin.

• [Complete immunization coverage and reasons for non-vaccination in a periurban area of Abidjan.]

  Authors: K J Sackou, A S S Oga, A A Desquith, Y Houénou, K L Kouadio

  Bulletin de la Societe de pathologie exotique (1990).

  An immunization coverage survey was conducted among children aged 12-59 months in a suburban neighbourhood in Abidjan. The objective was to determine the complete immunization coverage, the reasonsAn immunization coverage survey was conducted among children aged 12-59 months in a suburban neighbourhood in Abidjan. The objective was to determine the complete immunization coverage, the reasons for non-vaccination and factors influencing the immunization status of children. The method of exhaustive sampling enabled us to interview the mothers of 669 children using a questionnaire. Overall vaccination coverage was 68.6%, with 1.2% of children never having received vaccine. The logistic regression analysis showed that the level of education, knowledge of the immunization schedule and the marital status of mothers, as well as the type of habitat, were associated with full immunization of children. These determinants must be taken into account to improve vaccination coverage.

• [Haitian women living with HIV/AIDS in Guadeloupe: pregnancy between medical stakes, social benefits and administrative vulnerability. A qualitative study.]

  Authors: D Pourette

  Bulletin de la Societe de pathologie exotique (1990).

  Guadeloupe (FrenchWest Indies) is a part of French departments which has the largest number of persons living with HIV/AIDS. A large part of them consists of foreign women, mainly native of Haiti.Guadeloupe (FrenchWest Indies) is a part of French departments which has the largest number of persons living with HIV/AIDS. A large part of them consists of foreign women, mainly native of Haiti. This article is based on an anthropological study conducted in 2009 among 32 professionals of health, social and associative sectors taking care of persons living with HIV in Guadeloupe, and among 10 infected women, 6 of whom are native of Haiti. Semi-directive and individual qualitative interviews were conducted with each of these persons. During their course of illness and migration, many women experienced one or several pregnancies. The analysis of their discourses and trajectories underlines the articulation of the multiple stakes - medical, social, political, emotional stakes - with which they are confronted.

• [International clinical practice guidelines and management of rheumatology in Madagascar].

  Authors: S Ralandison, E Rafalimanana, H Rakotonirainy, R Rabenja

  Bulletin de la Société de pathologie exotique (1990). 105(1):64-7.

  Developed countries issue recommendations regarding healthcare that aren't constantly appropriate for emergent countries. We suggest some remarks concerning rheumatology in Madagascar, taking accountDeveloped countries issue recommendations regarding healthcare that aren't constantly appropriate for emergent countries. We suggest some remarks concerning rheumatology in Madagascar, taking account of scientific data, medical ethics, equality and equity. We have studied the minimal cost of care of medical conditions found in our hospital department if we were to follow international recommendations for their management. Then, we have estimated treatment expenses as a percentage of the SMIC (Malagasy minimum monthly salary). Out of 517 patients examined yearly, we have found 62.8% osteoarthritis cases, 6.3% rheumatoid arthritis (RA), and 4,2% septic arthritis. Therefore, the first month of treatment for an arthritis of the knee would absorb 147.3% of the SMIC; diagnosis and treatment of a case of septic arthritis would take up 1762.8% of the minimum wage, and a case of RA without biotherapy would require 175%. According to the American College of Rheumatology criteria which are used as a reference, the treatment of an arthritis of the knee would take only 23% of the SMIC. Caring for septic arthritis would demand 57.5% of the SMIC and while it would yield more arguments for diagnosis such as clinical examination, CRP, and Gram coloration on joint liquid aspiration. We can proceed to RA diagnosis with an acceptable security through precise clinical examination, blood cell count, ESR, CRP, rheumatoid factor and radiography. This means 56% of the SMIC. From this 517 patients, our suggestions would reduce the expense by 35,850% of the SMIC per year. The allocation of such funds onto the treatment of complicated forms of rheumatism would be fair. By refining and evaluating these suggestions, we would come up with appropriate recommendations for emergent countries.

• [Mortality and morbidity of tetanus in the infectious diseases department, Point G teaching hospital, in Bamako, Mali (2004-2009)].

  Authors: D K Minta, A M Traoré, A K Soucko, M Dembélé, Y Coulibaly, M S Dicko, I Coulibaly, N Diany, N G E Maboune, B Ba-Sall, A K Traoré, N Koné, H A Traoré

  Bulletin de la Société de pathologie exotique (1990). 105(1):58-63.

  Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical recordsOur study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entryway). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entryway for 64.7% of the patients. The entryway was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

• [Agricultural activities and epidemiology of malaria in Soudano-Sahelian zone in Cameroon].

  Authors: J Atangana, A Fomena, J Lebel Tamesse, E Fondjo

  Bulletin de la Société de pathologie exotique (1990). 105(1):23-9.

  We have comparatively studied the dynamics of malaria transmission in the villages of Mokolo-Douvar located in the rural area with traditional agriculture and Gounougou irrigated rice area, in 2004We have comparatively studied the dynamics of malaria transmission in the villages of Mokolo-Douvar located in the rural area with traditional agriculture and Gounougou irrigated rice area, in 2004 August and November and 2006 May and October, to assess vectors biting habits, and malaria inoculation rate and malaria parasite prevalence in cohort of children from 0 to 15 years. Mosquitoes were collected by landing catches on volunteers and by pyrethrum spray collections. A total of 5961 Anopheles were collected. Seven Anopheles species were identified: Anopheles gambiae s.s., Anopheles arabiensis, Anopheles funestus, Anopheles pharoensis, Anopheles rufipes, Anopheles ziemanni and Anopheles squamosus. A. arabiensis was the major species (56.2%) and the main malaria vector in both study sites, followed by A. funestus (32.6%). Malaria transmission was high in the irrigated area of Gounougou (1.42 infection bites per man per night) whereas in the non-irrigated zone of Mokolo-Douvar, it was below detection level during the rainy season (0,245 ib/h/n). In Gounougou, a total of 655 children were examined. The mean plasmodic index was 21.1%. Our findings confirm that changes in irrigated rice agriculture influence malaria transmission dynamics, and call for control measures that are readily adapted to local eco-epidemiological settings.

• Epidemiology of cutaneous leishmaniasis in five villages of Dogon country, Mali.

  Authors: A K Kone, P Delaunay, A A Djimdé, M A Thera, P D Giudice, D Coulibaly, K Traoré, S M Goita, A Abathina, A Izri, P Marty, O K Doumbo

  Bulletin de la Societe de pathologie exotique (1990). 105(1):8-15.

  The epidemiology of the cutaneous leishmaniasis (CL) with Leishmania major is poorly documented in Mali. Following reports of CL in the tourist areas of the Dogon country (Bandiagara Escarpment), aThe epidemiology of the cutaneous leishmaniasis (CL) with Leishmania major is poorly documented in Mali. Following reports of CL in the tourist areas of the Dogon country (Bandiagara Escarpment), a joint French and Malian bio-clinical team conducted a field study from 16 to 27 January, 2010. The population of 5 villages has been examined by a dermato-infectiologist and cases were selected by visual inspection of skin lesions. Smears and biopsies (from the lesions) and venous blood were obtained from suspected cases of CL. Diagnosis was performed by light microscopy, in vitro cultures, serology and molecular biology. Fifty patients with skin lesions have been examined. Twenty-one have been suspected as CL. At least one sample was obtained from 18 patients. The lesions were predominantly old, more or less scarring and secondary infected. A skin smear was performed for 15 patients, a skin biopsy for 14 patients: smears and cultures were all negative. The PCR (Leishmania spp.) made on 14 biopsies was positive for 12 patients (86%). The low amount of amplified DNA obtained did not allow the sequencing and identification of the species of Leishmania. Western blot (WB) serology was positive in 11 cases out of 12 (92%). This investigation showed the presence of cutaneous leishmaniasis in Bandiagara. A further investigation is required during transmission period (September-October) to confirm the presence of Leishmania major epidemic in Dogon country.

• [Preliminary study of snake fauna in the Lama forest, South Benin.]

  Authors: A Piquet, C Toudonou, L Konetché, B Sinsin, J -P Chippaux

  Bulletin de la Societe de pathologie exotique (1990).

  The following study aims at assessing the ophidian diversity of the Lama Forest, a classified area, situated in the South of Benin. One can distinguish three types of habitat according to the degreeThe following study aims at assessing the ophidian diversity of the Lama Forest, a classified area, situated in the South of Benin. One can distinguish three types of habitat according to the degree of human activity: the remaining dense forest at the centre, the intermediate plantation area, and finally the area around the edge which has been entirely subjected to human habitation. Each day for two weeks we have been working on various plots of study (by day), patrolled along transect routes (by night), and installed a trap in the central area. As a result, we were able to observe 32 snake specimens, 24 of which we captured. Nearly all were able to be identified, and have been classified into 13 genera and 17 species.

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