[Show abstract][Hide abstract] ABSTRACT: Background:
Acute bacterial cellulitis of the leg (erysipelas) is a common problem involving considerable morbidity in dermatology practice in Africa. Previous studies conducted in Europe and North Africa have highlighted lymphoedema and toe-web intertrigo as independent factors associated with leg erysipelas. The aim of this case-control study was to identify risk factors associated with leg erysipelas in sub-Saharan Africa, within a different socio-economic and culture context.
Patients and methods:
We conducted a prospective case-control study in hospital dermatology departments in 8 sub-Saharan African countries over a 12-month period (October 2013 to September 2014). Each case of acute leg cellulitis was matched with 2 controls for age (±5 years) and sex. We analysed the general and local factors.
During the study period, 364 cases (223 female, 141 male) were matched with 728 controls. The mean age was 42.15±15.15 years for patients and 42.11±36 years for controls. Multivariate analysis showed the following to be independent risk factors associated with leg erysipelas in our study: obesity (odds ratio [OR]=2.82 ; 95% confidence interval: 2.11-3.76), lymphoedema (OR=3.87, 95%CI: 2.17-6.89), voluntary cosmetic depigmentation (OR=4.29, 95%CI: 2.35-7.83), neglected traumatic wound (OR=37.2, 95%CI: 24.9-57.72) and toe-web intertrigo (OR=37.86, 95%CI: 22.27-64.5).
The results of this study confirms the major role of local risk factors (toe-web intertrigo, lymphoedema) previously identified in other geographical settings. However, the originality of our study consists of the identification of voluntary cosmetic depigmentation as a risk factor for leg erysipelas in sub-Saharan Africa.
No preview · Article · Sep 2015 · Annales de Dermatologie et de Vénéréologie
[Show abstract][Hide abstract] ABSTRACT: La mangue, principal fruit du Sénégal, est transformée en tranches et vendue en sachets dans les rues de Dakar. Ce produit est sensible aux altérations microbiennes faute de technologies de conservation adaptéesau contexte local. Ce travail propose une évaluation de la qualité microbiologique du produit et de son impact sur la santé des consommateurs. Pour cette étude, 3 répétitions d’échantillons par vendeur ont été prélevées chez quatorze vendeurs de cinq quartiers (Médina, Fann, Habitats Loyers Modernes ou HLM, Grand Yoff et Guédiawaye). Ensuite, des analyses ont été menées pour la recherche de la flore mésophile aérobie totale, de coliformes, d’entérobactéries et d’Escherichia coli présomptifs. Les résultats montrent une forte pollution des échantillons en flore totale sauf pour l’échantillon V3 (vendeur 3) des HLM et une charge élevée en coliformes et en Escherichia coli (> 103 UFC/g). D’autres entérobactéries comme Enterobacter agglomerans, Enterobacter amnigenus, Serrati rubidaea et Klebsiella pneumoniae sont retrouvées respectivement dans les échantillons V2 de Médina, V1 de Fann, V1 et V2 Guédiawaye. Ces bactéries ne présentent pas de risques sur la santé publique mais rendent le produit impropre à la consommation. Cette étude nécessite une expansion aux autres quartiers pour mieux veiller sur la santé des consommateurs.Mots clés: Evaluation, qualité, microbiologie, mangues, santé des consommateurs, Dakar.
[Show abstract][Hide abstract] ABSTRACT: Objectives:
The authors studied the epidemiological, clinical, and outcome features of the Ebola virus disease in patients hospitalized at the Ebola treatment center (ETC) in Conakry to identify clinical factors associated with death.
Materials and methods:
A prospective study was conducted from March 25 to August 20, 2014. The diagnosis of Ebola virus infection was made on real-time PCR.
Ninety patients, with a positive test result, were hospitalized. Their mean age was 34.12±14.29 years and 63% were male patients. Most worked in the informal sector (38%) and in the medical and paramedical staff (physicians 12%, nurses 6%, and laboratory technicians 1%). Most patients lived in the Conakry suburbs (74%) and in Boffa (11%). The main clinical signs were physical asthenia (80%) and fever (72%). Hemorrhagic signs were observed in 26% of patients. The comparison of clinical manifestations showed that hiccups (P=0.04), respiratory distress (P=0.04), and hemorrhagic symptoms (P=0.01) were more frequent among patients who died. Malaria (72%) and diabetes (2%) were the most frequent co-morbidities. The crude case fatality rate was 44% [95% confidence interval (33-54%)]. The average hospital stay was 7.96±5.81 days.
The first Ebola outbreak in Conakry was characterized by the young age of patients, discrete hemorrhagic signs related to lethality. Its control relies on a strict use of preventive measures.
[Show abstract][Hide abstract] ABSTRACT: Objectives:
In resource-limited settings, few data are available on virological failure after long-term first-line antiretroviral therapy. This study characterized the genotypic resistance patterns at the time of failure after at least 36 months of a first-line regimen in Mali, West Africa.
Plasma samples from 84 patients who were receiving first-line antiretroviral treatment and with an HIV-1 RNA viral load (VL) >1000 copies/mL were analysed. Genotypic resistance testing was performed and HIV-1 drug resistance was interpreted according to the latest version of the National Agency for HIV and Hepatitis Research algorithm.
At the time of resistance testing, patients had been treated for a median of 60 months (IQR 36-132 months) and had a median CD4 cell count of 292 cells/mm(3) (IQR 6-1319 cells/mm(3)), a median HIV-1 RNA level of 28266 copies/mL (IQR 1000-2 93 495 copies/mL) and a median genotypic susceptibility score of 1 (IQR 1-4). The prevalence of nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations was 78% and 82%, respectively. Viruses were resistant to at least one drug in 92% of cases. Although etravirine and rilpivirine were not used in the first-line regimens, viruses were resistant to etravirine in 34% of cases and to rilpivirine in 49% of cases. The treatment duration, median number of NRTI and NNRTI mutations and some reverse transcriptase mutations (T215Y/F/N, L210W, L74I, M41L and H221Y) were associated with the VL at virological failure.
This study demonstrated a high level of resistance to NRTIs and NNRTIs, compromising second-generation NNRTIs, for patients who stayed on long-term first-line regimens. It is crucial to expand the accessibility of virological testing in resource-limited settings to limit the expansion of resistance and preserve second-line treatment efficacy.
Preview · Article · May 2014 · Journal of Antimicrobial Chemotherapy