Three new cases of visceral leishmaniasis in Côte d'Ivoire

The objective of this work is to report three cases of visceral leishmaniasis in non-HIV infected native patients in C?te 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 C?te d'Ivoire therefore an epidemiological survey is requested in order to identify Leishmania species, reservoirs and vectors.     

Accidents of circumcision in children in Abidjan, Côte d'Ivoire

Circumcision is the most common surgical procedure carried out in boys in our countries. It is performed by medical members but also by traditional practitioners. Circumcision is considered as a benign operation but its complications are common, sometimes severe and the treatment delicate. Authors reported 35 cases of circumcision's complications in boys, aged of 2 days to 14 years old who were circumcised by traditional practitioners and by medical members. The most frequent complications were urinary meatus stenosis (17 cases), haemorrhage (5), total glans section (3), urethral fistula (3), and incomplete circumcision (3). These complications were caused by traditional practitioners in 19 cases, paramedical members in 11 cases, and 5 cases by physicians. Among these complications, fistula and amputation had required delicate surgical procedure. All the stenosis were treated by meatal plasty and fistula were sutured with one recurrence. Partial glans section underwent Mathieu's procedure and the total sections were referred to the plastic surgeon. Authors recommend surgical procedure for circumcision which must be performed in medical center or by well trained practitioners.     

Detection by RT-PCR of the 1st cases of Astrovirus in human stools in Abidjan, Côte d'Ivoire

Viral gastroenteritis are a problem of public health because of the high rate of morbidity and mortality, particularly in children. Among the etiologic agents, human Astroviruses are the third agents most often incriminated after Rotaviruses and Caliciviruses. Symptoms of gastroenteritis caused by Astroviruses are generally moderated compared with those observed with Rotaviruses and rarely involve hospitalization. In sub-Saharan Africa, particularly in C?te d'Ivoire, the majority of viral gastroenteritis is attributed to Rotavirus with rates varying from 20 to 26%. No study on the circulation of human Astroviruses has been carried out in C?te d'Ivoire. Our objective was to detect human Astroviruses in the diarrhoeal stools in Abidjan. Seventy-two samples of human diarrhoeal stools were collected in ambulatory patients. This population was made up of 44 patients from 0 to 15 and 28 patients over 15 years old. The concentration of the viral particles of the samples was followed by the extraction of the RNA by the modified method of Boom. The extracted RNA were amplified by RT-PCR by using specific primers targeting a portion of the 3' end of the open reading frame ORF la of the genome of human Astroviruses. The amplified fragment was 192 pb. The genome of human Astroviruses was detected in 3 stools out of the 72 samples. That is a frequency of 4%. Among these 3 stools, 2 came from 4 month and 3 year-old children and the 3rd stool came from a 33 year-old patient. For the first time this survey has pointed out the circulation of human Astroviruses in the C?te d'Ivoire population. This survey also showed that human Astroviruses could be found in children as well as in adults.     

Intestinal helminthiasis in school background in six towns of southwestern Côte d'Ivoire

A coproparasitological investigation was conducted in six towns located in the humid dense forest area of South West C?te d'Ivoire in order to determine the prevalence of intestinal helminthosis. During this study faeces of 2220 school children aged from 4 to 15 years old were analysed by four coprological techniques: direct analysis, Kato, Baermann and Graham methods. The overall prevalence rate of intestinal helminthosis in school children in the area is 37.9%. Male subjects are more infested than females. The more frequent parasite species were: hookworm (17%), Ascaris lumbricoides (10.8%), Trichuris trichiura (8.9%) and Enterobius vermicularis (7.2%).     

Efficacy of chloroquine in treatment of non-complicated malaria with Plasmodium falciparum in children at the San Pedro dispensary in Côte d'Ivoire

A survey has been carried out in south-west of C?te d'Ivoire in order to study chloroquine resistance in treatment of malaria according to 14 days protocol of WHO (World Health Organisation) (1996) for evaluation of antimalarial drugs activity; 63 children, aged from 6 months to 15 years and suffering from noncomplicated malaria due to Plasmodium falciparum, received by oral way 25 mg/kg of chloroquine over three days (10-10-5). During the survey, they were subjected to a clinic and parasitologic (thick and thin blood film) follow up. We obtained, for 51 children (81%), a satisfactory clinical answer, for 8 children (13%) an early therapeutic failure and for the other 4 (6%) a late therapeutic failure. Moreover, we obtained 40% of failure in children of less than 24 months old, 25% between 24 months and 59 months and 7% beyond 6 years old.     

Severe malaria in native adults in 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.     

Impact of Buruli ulcer secondary prevention program in an endemic area in Côte d'Ivoire

Mycobacterium ulcerans infection or Buruli ulcer begins by a papule, nodule, blotch or oedema and develops into ulceration with complications which can lead to disabilities. Its prevalence is high in West Africa and in C?te d'Ivoire particularly. Until recently, only ulcerated forms were mostly observed, whereas nodular ones were unnoticed or did not draw patients' attention. From 1999 to 2002 we conducted a before-after survey in the endemic area of Zoukougbeu located in Daloa region, the central west part of C?te d'Ivoire in order to assess the potential impact of a screening and treatment strategy for nodular forms of Buruli ulcer on ulceration rate decrease. The survey used clinical criteria necessary to identify Buruli ulcer nodule which were defined according to a former study carried out in the same area in 1998. As result of our survey 781 Buruli ulcer cases were reported of which 34.7% were ulcerative forms, 61.1% were nodules and 4.2% were other forms (blotch and oedema). By comparing the data of 1999, when the prevention program started, to those of 2002, we observed a drop of 47.6% in the ulcerative lesions and an increase of 57.4% in nodule ones. These changes were statistically significant (p < 10-5). Annual trend, from 1999 to 2002, showed a decrease in the detection rate of the respective forms under study. It ranged from 25.8/10000 to 7.3/10000 for ulcerative lesions and from 23/10000 to 19.7/10000 for nodules. In spite of possible defects in the methodology of a before/after survey the incidence decrease of both ulcerative and nodular forms that coincided with the prevention program probably reflects the efficacy of the secondary prevention program that promotes early diagnosis and treatment of nodular forms of Mycobacterium ulcerans infection.     

Value and limits of microscopy of exudates in Mycobacterium ulcerans cutaneous infection in Côte d'Ivoire

The objective of this study was to estimate the interest and the limits of skin exudate microscopy for patients with chronic ulceration with clinically suspected Buruli's ulcer and living in an endemic area in C?te d'Ivoire. Two stained smears, one with Ziehl-Neelsen and the other Dugomier staining, were produced from 140 samples obtained after a swab of skin lesions. The positive smear rate for the acid fast bacilli (AFB) was respectively 16.4% and 12.9% for Dugomier and Ziehl-Neelsen staining. The ulceration with less than one year of evolution have high AFB rates of 15.8% for Ziehl-Neelsen staining and 21.1% for Dugomier's. Microscopic examination of skin exudate in face of ulceration, clinically suspected to be a Buruli's ulcer is not the best tool for biological diagnosis, due to poor technical sensibility. Nevertheless, it remains a good first means of investigation in an endemoepidemic area.     

Land-use and urinary schistosomiasis in Daloa (Côte d'Ivoire)

The relation between agricultural land development of inland-valleys and health population has been studied in a town of the Ivorian forest area using urinary schistosomiasis as an indicator. Snails were collected during 4 months in rice fields and water holes used for market gardening of two urban inland-valleys (Batagnihi and Gakognihi). Prevalence of schistosomiasis was evaluated in two districts, Kennedy II and Fadiga, located close to the investigated inland-valleys. Schistosomiasis risk was higher in the Batagnihi where rice cultivation was more developed and prevalence of urinary schistosomiasis was higher in the Kennedy II district which is close to this inland-valley particularly among the Northern migrant people. The Kennedy II population has much more contacts with the inland-valley because of rice cultivation and social status. The higher socio-economic level of the Fadiga population limiting its contacts with the inland-valley can explain this result.     

Epidemiologicl aspects of Buruli ulcer in Côte d'Ivoire: results of a national survey

Ulcer caused by Mycobacterium ulcerans and called Buruli ulcer is characterised by large cutaneous ulceration which often leads to debilitating sequelae. The disease occurs in swampy and stagnant water areas in intertropical regions of Asia, the Indian Ocean, Latin America and Africa. West Africa has been affected for two decades with a significant increase in the last ten years. In C?te d'Ivoire, from 1991 to 1994, 2,246 cases have been detected. In 1995, the cumulative number was 5000 cases distributed throughout the forested and marshy areas of the southern part of the country. In order to assess the magnitude and severity of the disease in C?te d'Ivoire and to collect data necessary for developing a control plan, the National Programme of Buruli Ulcer Control (PNUM) conducted an extensive cross-sectional nation-wide survey. The results provide a total cumulative number of 10,382 cases distributed throughout almost all regions. The number of active cases was 4,642 which was equivalent to a prevalence of 0.32 per 1000. Buruli ulcer is the second most prevalent mycobacteriose in C?te d'Ivoire after tuberculosis and before leprosy. From 1996, the average annual incidence exceeded 2,000 cases. Moreover, the main identified risk factor was the presence of a watering point used by people nearby. Children were affected at a rate of 57%, with male predominance, while in adult cases, the female rate was higher. Children and women enjoyed higher recovery rates. Ulcerated cases represented 89.5% of active ones against 6.5% for oedematous forms and 4% in nodule cases. Definitive sequelae were more frequently observed in children with no difference of sex. We conclude that Buruli ulcer has been endemic in C?te d'Ivoire and is characterised by the severity of the lesions.     

Adult non-viral lymphocytic meningitis in Abidjan (Côte d'Ivoire)

Our prospective and longitudinal study aimed to analyse the aetiologies, clinical features and prognostic of non viral lymphocytes meningitis (NVLM). We recruited 131 patients, 77 males (59%) and 54 females (41%) sex-ratio 1.4. The mean age was 35 years [15-67]. 117 patients were HIV positive (89%) and 14 (11%) were HIV negative. Feverish meningoencephalitis was present in 85% of cases, with 7 days for mean delay of admission into hospital. 80 germs were found in the C.S.F. 70 Cryptococcus neoformans, 4 Mycobacterium tuberculosis, 3 Streptococcus pneumoniae, 1 Candida albicans, 1 Neisseria meningitis and 1 Trypanosoma gambiense. 63 aetiologies were linked to lymphocytes meningitis by indirect deduction: 41 cases of tuberculous meningitis with lung X-ray anomalies and M. tuberculosis in sputum (11 times), 11 cases of cerebral malaria with Plasmodium falciparum in blood, 11 cases of cerebral toxoplasmosis by significant features with cerebral tomodensitometry. Letality was 53%, 35% of patients improved and 12% were lost to follow-up. Our study shows the difficulties in the management of the NVLM, due to the delay of diagnosis, particularly for tuberculous meningitis.     

Distribution of HIV-1 subtypes among HIV-seropositive patients in the interior of Côte d'Ivoire

Limited data exist on the distribution of HIV-1 subtypes in C?te d'Ivoire. The aim of this study is to describe the distribution of genetic subtypes of HIV-1 strains in six regions of C?te d'Ivoire. In 1997, we consecutively collected blood from 172 HIV-1-infected patients from six regional tuberculosis treatment centers. Peripheral blood mononuclear cells (PBMCs) from these people were analyzed by a restriction fragment-length polymorphism (RFLP) assay that involves a sequential endonuclease digestion of a 297-base pair polymerase chain reaction (PCR) fragment; plasma samples were tested by a V3-loop peptide enzyme immunoassay (PEIA). DNA sequencing of the protease or env genes was performed on all samples discordant in the two assays as well as a random sample of the concordant subtyped samples. Of 172 specimens, 3 were PCR-negative, and 169 were putatively classified as subtype A by RFLP. The 3 PCR-negative samples were unequivocally subtyped A by PEIA. Of the 169 RFLP subtype A samples, 159 (94%) were subtyped A by PEIA. Of the 10 discordant samples, PEIA testing classified 3 as subtype C, 2 as D, and 5 as F. Sequencing of the env gene classified these samples as 1 subtype A, 4 Ds, and 5 Gs. Thus, 163 (95%) of the specimens were subtype A, 3 subtype D, 4 subtype G, 1 A/D, and 1 A/G (IbNG) circulating recombinant forms (CRF). In conclusion, most HIV-1-infected tuberculosis patients throughout the interior of C?te d'Ivoire are infected with HIV-1 subtype A, which are very likely the A/G (IbNG) CRF. The uniform distribution of this subtype makes C?te d'Ivoire a potential site for vaccine trials.     

Prevalence of Herpes simplex virus infection in pregnant women in Yopougon (Côte d'Ivoire)

A transversal survey on 150 pregnant women was carried out at the P.M.I. center in Yopougon, in order to determine the prevalence of genital herpes and to estimate the frequency of asymptomatic excreting of Herpes simplex virus (HSV) in pregnant women. The viral isolation and the direct immuno-fluorescence (IF) assay of the genital secretions were found to have a prevalence of 12.7% Among the women who tested positive (the majority of whom were from modest socio-economic origin and young), 10% had antecedents of genital herpes, 2.7% showed an asymptomatic excretion and 36.8% had an acute episode during their pregnancy including a primary infection in the 20th week. In these women an unexpected recurrence will constitute the major risk for maternal transmission and an emergence of neonatal herpes.     

Zidovudine-associated mitochondriopathy: three possible observations in Abidjan, Côte d'Ivoire

In Africa, prevention of mother-to-child transmission of HIV (PMTCT) with antiretrovirals is becoming a key component of the response to the pandemic. Toxicity issues remain however a concern and require careful monitoring. We report here three observations of mild neurological deterioration among children for whom a diagnosis of mitochondrial dysfunction was considered possible. These children were identified within a PMTCT research program (ANRS 049) conducted in Abidjan, C?te d'Ivoire, and evaluating a short regimen of maternal zidovudine monotherapy for PMTCT of HIV type 1. Maternal HIV-1 infection was diagnosed during pregnancy before enrolment in the randomised trial (two cases) or in the subsequent open cohort (one case). These three women had been allocated to the ZDV group and had no particular medical history. Pregnancy check-up was negative except the diagnosis of HIV-1 infection. The three children were diagnosed as uninfected by HIV-1. Symptoms developed by the age of six months (two cases) and 13 months (one case): growth failure, anthropometric abnormalities, impaired psycho-motor development, generalised and repeated seizures. The evolution of these three HIV-uninfected children was favourable after 12 to 18 months. The transient nature of these abnormalities is compatible with mild complications of mitochondrial dysfunction. We conclude however that the anticipated benefits of PMTCT with antiretrovirals in Africa greatly outweigh the potential risks and should not lead to reconsider their public health interest     

Contribution of gene amplification in Mycobacterium ulcerans detection in exudates and cutaneous biopsies in Côte d'Ivoire

Mycobacterium ulcerans skin ulceration is a major issue of public health in C?te d'Ivoire. The diagnosis of M. ulcerans infection is hampered by the slow growth of the bacterium in culture, implying a delay of several weeks before a specific diagnosis can be obtained. In C?te d'Ivoire the diagnosis of Buruli ulcer is almost based on clinical features. During the last decade, many studies have demonstrated the extremely high capacity of PCR for rapidly and specifically detecting bacteria and genes of interest. That ability has revealed PCR as a powerful tool in clinical microbiology studies. In this study we evaluated the M. ulcerans detection in specimens of exudates and biopsies collected from patients clinically suspected of Buruli ulcer and treated in "Raoul Follereau" centre of Manikro in the North-central region of C?te d'Ivoire. The microscopic research of BAAR in 185 swabs loaded with skin lesions collected from these patients showed a positive rate of 14.6%. The PCR detection in 48 h or 72 h of the M. ulcerans IS2404 and IS2606 in the swabs and in the 26 biopsies, from these patients, showed positive rates of 15.7% and 84.6% respectively and in the same samples. These results obtained with PCR detection of M. ulcerans insertions sequences suggest that this technique performed with exudates and biopsy can be used to confirm a routine specific diagnosis of M. ulcerans and early screening of Buruli ulcer in C?te d'Ivoire.     

Therapeutic efficiency of chloroquine in the savannah region in the north of Côte d'Ivoire (1997)

We evaluated from August to December 1997 the therapeutic effect of chloroquine (CQ) in treatment of mild malaria. Five villages of the savannah area of C?te d'Ivoire were selected for this study In this area and season, the transmission of malaria is of hyper-endemic type. The 14-day protocol of WHO was used and all the patients were treated with CQ 25 mg/kg over three days. 360 febrile children between 6 and 83 months old out of 545 were selected, and 286 were fully followed. At the beginning of the study axillary temperatures and parasitemia showed no difference in the 5 villages. The average therapy failure rate was 11.5% (IC to 95%; 7.8-15.2) with a maximum of 18.5%. The failure rates estimated in the various villages showed a hardly significant difference (p = 0.05). In the North of C?te d'Ivoire, the good efficiency of CQ can be explained by the low drugs pressure related to the behaviour of populations who use traditional phytotherapy in first resort to treat the fevers.     

Agricultural activities and malaria transmission in two eco-epidemiological settings in central Côte d'Ivoire

We comparatively studied the dynamics of malaria transmission in the villages of Zatta (located in close proximity to an irrigated rice perimeter) and Tiémélékro (rural area with traditional agriculture), central C?te d'Ivoire. In the former village, the irrigated rice farming had been interrupted in 2003/2004 due to a farmers' conflict over land. In each village, mosquitoes were collected by human landing catches at night in sentinel houses. Anopheles gambiae was the predominant malaria vector, followed by An. funestus. In Zatta, the return to an irrigated rice farming in January 2005 was paralleled by a significant increase of the entomological inoculation rate (EIR) ranging from 38 infective bites per person per year (ib/ply) in 2003 to 295 ib/ply in 2005. In Tiémélékro high EIRs were found in 2003 (342 ib/ply) and 2005 (572 ib/ply). 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.