Érythraphérèses chez l’enfant drépanocytaire,expérience d’une unité d’aphérèse pédiatrique

Erythrocyte exchanges on cell separators can be used in children with sickle cell disease and are effective in lowering the level of haemoglobin S. Of the 938 aphereses performed in 2020 in our unit, we observed a low rate of failure of procedures and few complications. Ninety-six percent of erythraphereses were performed in the context of chronic exchange programs, in more than 80% of cases for cerebral vasculopathy or after the occurrence of ischemic strokes. Less than 4% of the procedures were performed for specific indications (preparation for cholecystectomy most often). The vascular access is rarely an obstacle to the realisation of the apheresis. In case of insufficient venous capital, installing an arteriovenous fistula may be considered. Depending on the child's weight, haemoglobin level, and the severity of the sickle cell anaemia, precautions may be necessary when priming the procedure. Nurses experienced in paediatric apheresis and a good medical knowledge of sickle cell disease allowed us to use this technique from the age of 3 years and the weight of 15 kg.     

Les défaillances de la délivrance : comment s’améliorer ?

If they are not stopped before transfusion, distribution of blood components (BC) errors can have serious consequences for patients. The study of reported incidents of transfusion chain shows that the risk of failure is important, especially on the steps of patient selection in software, packing and giving the BC to transporter. The analysis of these problems most often state “human” error by misapplication of procedures. These errors are favored by systemic causes: many interfaces with numerous actors in the transfusion process, breaking between different information systems, stress of the emergency and lot of visual self-checks. Improvement may be proposed by a better the organization of the different tasks, by the ergonomic of the work, by improving distribution software and training operators to the management of the emergency. But things must be thought again by all the actors involved in the transfusion management of patients in order to reduce the risks associated with multiple interfaces.     

Technique d’étude de quatre polymorphismes enzymatiques impliqués dans l’hyperhomocystéinémie

Hyperhomocysteinemia is an independant risk factor for cardiovascular diseases. The four most common functional polymorphism in genes involved in homocysteine metabolism are methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, methionine synthase (MS) A2796G, and cystathionine beta-synthase (CBS) 844ins68. An assay using conventional PCR-restriction fragment length polymorphism is developped. In a single lane on gel run, it allows the discrimination of the fourth polymorphism’s two alleles. This easy, unambiguous and unexpensive method will permit us to investigate these polymorphism’s implication in arterial rigidity development among an elderly population.     

Évolution temporelle des captures d’anophèles en région d’altitude de Lwiro-Katana (République démocratique du Congo)

This study has been done with the objective of knowing more about the Anopheles evolutions situation at Lwiro-Katana from 1967 up to 2014. On seven species identified in this region, only four were permanent in nine investigations done. The geometric average calculated shows the evolution of 3.152 for Anopheles funestus, 2.867 for An. gambiae, 2.663 for An. demeilloni and 2.441 for An. marshallii. These species share almost the same ecological conditions for their larval development found in different kinds of water. These conditions were created by the anthropisation of the region followed by some activities. The increasing process attests that An. funestus, An. gambiae and An. demeilloni have an increasing tendency while An. marshallii has a decreasing tendency and is likely to approach the 0 level. An. coustani and An. christyi miss the stability development due to the environmental pertubations since 1980 in this environment. An. kingi wasn’t identified after 1980. All of these species of anopheles share the same ecological niche and present a scientific interest. The knowledge of their evolution in this area is really very important because it helps to have better vector control. Also three of those mosquitos (An. gambiae, An. funestus and An. marshallii) are the greatest responsible of the killing paludism South of the Sahara.     

Prévention du paludisme post-transfusionnel en zone d’endémie

BackgroundMalaria is a real public health problem in Africa; more than 300 million new cases and approximately two million deaths arise every year. In spite of the blood transfusion is a potential way of Plasmodium transmission, there is no consensus for measures to prevent post-transfusion malaria in endemic area. This work aimed at comparing some tools and to discuss various strategies to be implemented.Material and methodsThe study concerned 3001 blood donors recruited in seven blood transfusion centers in Senegal during two periods: dry season (June–July, 2003) and rainy season (October–November, 2003). We evaluated the efficiency of the selection questionnaire for the blood donors to exclude those who are potentially asymptomatic carriers of the Plasmodium. Every donation was screened for pLDH antigen and antibodies against Plasmodium by Elisa technique (DiaMed, Cressier sur Morat, Suisse), morphological tests was also performed, as well as the screening of HIV, HBs Ag, HCV Ab and syphilis.ResultsMedian age of blood donors was of 27.7 years. Anti-Plasmodium antibodies prevalence was 65.3% and pLDH antigen was of 0.53%, all positivity was confirmed by microscopy. The prevalence of the other infectious markers was 11.7% for HBs Ag; 0.83% for syphilis; 0.49% for HCV Ab and 0.46% for HIV Ab. The risk factors associated with an asymptomatic carrier of Plasmodium were: the rainy season, irregular character of the blood donations, high frequency of malaria attacks in the past, and absence of treatment during the last episode.ConclusionPlasmodium represents the third risk of blood transmitted infectious agents after hepatitis B virus, syphilis, and before HCV and HIV in Senegal. The medical questionnaire is not useful enough for asymptomatic carriers deferral, and we propose to introduce Plasmodium screening. The screening for Plasmodium pLDH by Elisa technique seems to be the best tool in endemic area and the strategy of systematic screening is the most suited in terms of blood transfusion safety.     

Impact socio-économique du déversement de déchets toxiques à Abidjan en 2006 à l’échelle des ménages

In August 2006, toxic wastes were discharged in the district of Abidjan, causing important health consequences in many households in the area. In order to appreciate the socio-economic impact of the consequences of toxic waste discharge on the households and of the measures taken by the authorities to deal with this catastrophe, and to appreciate the spatial extent of the pollution, we undertook a multidisciplinary transversal investigation at the sites of discharge of oxic waste, from October the 19th to December the 8th, 2006, using a transect sampling methodology. This paper presents the results related to the socio-economic aspects of the survey while the environmental and epidemiological results are presented in two other published papers. The socioeconomics investigation, conducted using a questionnaire, concerned 809 households across the various sites of discharge of toxic waste. More than 62% of households had at least one person who had been affected by toxic waste (affected households). 62.47% of these households were in Cocody district (with 2 sites and 4 points of discharge), 30.14% in Abobo district (with 2 sites and 3 points) and 7.39% in Koumassi district (with 1 site and 1 point). To escape the bad smell and the nuisance, 22.75% of the 501 "affected" households had left their houses. To face the health consequences generated by the toxic waste, 30.54% of the "affected" households engaged expenses. Those were on average of 92 450 FCFA (?41), with a minimum of 1 000 FCFA (?.5) and a maximum of 1500000 FCFA (?.287), in spite of the advertisement of the exemption from payment treatment fees made by the government. The decision of destroying cultures and farms near the points of discharge of the toxic products in a radius of 200 meters, taken by the authorities, touched 2.22% of the households. For these households, it did nothing but worsen their state of poverty, since the zone of influence of the toxic waste went well beyond the 200 meters prescribed by the authorities as the limit of the operations of destruction.     

Hémolyse intravasculaire après prise d’artéméther-luméfantrine

A second haemolytic crisis of blackwater fever (BWF) following a combination of artemether-lumefantrine intake, in an 8-year-old Congolese boy is reported. The patient had a history of BWF after quinine intake. He was given artemether-lumefantrine treatment for malaria. He was free from G6PD deficiency and abnormal haemoglobin. Sepsis was eliminated. Haemolysis was noted with 5.6 g/dl of haemoglobin, negative direct antiglobulin test, and LDH at 893 IU/l. Low-level Plasmodium falciparum was found. The outcome was favourable with rehydration. BWF has been described with quinine, mefloquine and halofantrine. Several case reports have been published of haemolysis after lumefantrine, but it is quite rare. This case has a major therapeutic implication: aryl-amino-alcohol should be strictly contraindicated in patients with history of BWF with aryl-amino-alcohols intake.     

Un cas rare d’aspergillome volumineux développé au sein d’une lésion de fibrose pulmonaire secondaire à une sclérodermie systémique chez une malade immunocompétente à Madagascar

We report a rare case of a huge aspergilloma developed within a bronchiectasis due to pulling by a pulmonary fibrosis of systemic scleroderma. The patient is a 58-year-old woman presenting a deterioration of the general state associated with repeating hemoptysis, dyspnea, dysphagia, sclérodactylia, generalized cutaneous sclerosis and Raynaud's phenomenon. There was no antecedent pulmonary tuberculosis. The patient had a pulmonary arterial hypertension complicated by a chronic pulmonary heart at the stage of right cardiac decompensation. Aspergillosis serology was positive and the immunological assessment confirmed scleroderma. The computed tomography showed a huge oblong opacity in a small round bell shape ("signe du grelot", Monad's sign) in the left upper lobe developed within a bronchiectasis, and a bilateral pulmonary fibrosis. Although surgery remains the recommended treatment of an aspergilloma, the management of our patient was medical in front of contra-indication for surgery. The evolution was marked by repeating hemoptysis and stability of the pulmonary lesions 2 years later. The management of this entity remains difficult and complicated; the prognosis is in general unfavourable and depends at the same time on the evolution of scleroderma and the aspergilloma infection.     

(Re)vivre après Ebola : bilan à un an et perspectives d’une étude d’évaluation et accompagnement des patients déclarés guéris d’une infection par le virus Ebola en Guinée (cohorte PostEboGui)

Bulletin de la Société de pathologie exotique - L’épidémie de maladie à virus Ebola (MVE) qui a sévi en Afrique de l’Ouest de fin 2013 à début...     

Shoshin béribéri: réémergence d’une pathologie ancienne ? à propos d’une série de 11 cas à Mayotte

In the French island of Mayotte in the Indian Ocean, the health and food situation remains contrasted. For a very long time dry beriberi women in postpartum had been suspected and treated. But in 2004 the first infantile epidemic of beriberi was scientifically authenticated and a program of thiaminic supplementation for the pregnant women and infants was set up. In this context, we describe an epidemic of 11 cases of shoshin beriberi among adults between January 2008 and Februar 2009. Over 11 cases of shoshin beriberi, 5 cases were confirmed biologically and 6 were probable. The sex ratio M/W was 0.37. The median age was 34 years. The clinic picture was typical: severe acute dyspnea, an agitation/drowsiness, right cardiac failure: polynevritis of the lower limbs was noted in 9 cases over 11. Biologically it was characterized by a lactic acidosis (average pH: 7.08, lactates: 12.08 mmol/l). The evolution was favorable in the 8 cases which could benefit from early thiaminic refill. The outbreak of an epidemic of shoshin beriberi among adults mainly in groups not having benefited from supplementation shows the effectiveness of the program but also its limits. We compare our series with others: the period from April to June when the food is less diversified, is confirmed as a higher risk period. The programs of nutritional education must be increased and a B1 vitamin supplementation for broader people during the rain season might be discussed.