Surveillance épidémiologique de la rage humaine dans un contexte d’endémie de rage canine en Cote d’Ivoire

Aim

The objective of this study was to analyze the epidemiologic monitoring of human rabies in the rabies medical center of Abidjan.

Patient

A cross-sectional study was undertaken based on files of patients having consulted in the rabies center after exposure and suspicion of human rabies between January 2001 and June 2009.

Results

Twenty-six cases of human rabies were reported in 10,706,136 inhabitants (annual incidence of 0.028 cases per 100,000). The number of detected cases increased considerably after reinforcing the monitoring of the disease. Most cases occurred in an urban environment and concerned both sexes. The most concerned age range was under 31 years. The patients’ were mostly school children and housewives. In all cases, the rabid animal was a dog and the type of exposure was a bite. Fifty-six percent of the victims had not received any local treatment and almost all no post-exposure prophylaxis. The mean delay before the first symptoms was 49.5 days after exposure and for death, 4 days after the onset of symptoms. Virological diagnosis was made in four cases.

Conclusion

In spite of the increase of cases observed since 2006, certainly due to reinforcement of the monitoring network, improvement is needed to assess the real incidence of rabies in the Ivory Coast.     

Bartonella henselae, un agent d’infections ubiquitaires

Bartonella henselae is the causative agent of cat scratch disease, a human infection usually characterized by persistent regional lymphadenopathy. It is transmitted to humans by cat scratches or bites. Cats are the major reservoir for this bacterium thus B. henselae has a worldwide distribution. The bacterial pathogenicity may bay emphasized by the immune status of the infected host. Angiomatosis or hepatic peliosis are the most frequent clinical manifestations in immunocompromised patients. B. henselae is also responsible for endocarditis in patients with valvular diseases, and may induce various clinical presentations such as: bacteriemia, retinitis, musculoskeletal disorders, hepatic or splenic diseases, encephalitis, or myocarditis. Several diagnostic tools are available; they may be combined and adapted to every clinical setting. B. henselae is a fastidious bacterium; its diagnosis is mainly made by PCR and blood tests. No treatment is required for the benign form of cat scratch disease. For more severe clinical presentations, the treatment must be adapted to every clinical presentation.     

Tuberculose compliquée d’un syndrome hémophagocytaire ou syndrome d’activation macrophagique

Introduction

The hemophagocytic syndrome is rare and sometimes associated with tuberculosis.

Observation

We report the case of a 30-year-old migrant from Congo presenting with a recurrent right pleuropneumonia, cachexia and night sweat. Blood tests revealed bicytopenia with a normal myelogram. Thorax CT-scan showed large mediastinal lymph nodes and pleuritis. Mediastinal lymph node biopsy concluded to granulomatosis lymphadenopathy with necrosis and bone marrow biopsy suggested hemophagocytic syndrome. The outcome was favorable with antibiotics and corticosteroids.     

Mise au point d’un questionnaire d’analyse des pensées et sentiments autour de l’alimentation

Purpose

It was to construct a questionnaire in French on the thoughts and the feelings in the respect of the food in the general population. We also wished to detect some eating disorders.

Methods

Eight experts selected nine major subjects concerning the thoughts and the feelings around the food and elaborated a questionnaire including 8 to 10 questions by subject. Having twice been revised by the experts, the questionnaire was criticized by a sample group of 20 persons of different circles, then by 42 medical students in Nutrition. The questionnaire was then handed in 88 medical students (4^th year). These various stages allowed to suppress, to modify and to add different questions. The questionnaire was then sent to 114 medical students and 112 subjects from the general population.

Results

The percentage of returned and totally informed questionnaires (from a sending of 202 questionnaires) was very satisfying (>85%). The concordance of the answers to the redundant questions was very high (>90%). In this population (74% of women), we noted that fear towards the food and eating disorder were frequent: binge eating: 11%, bulimia nervosa: 4,2%, anorexia nervosa: 5%, “the glance of the other one when I eat frightens me”: yes, absolutely: 15%.

Conclusion

This questionnaire concerning thoughts and feelings around the food was validated by the interest which was carried to it, its reproducibility, its understanding by the interrogated persons and the behavioral aspects which it brings. It will be send to 3 000 unselected people of Dijon to judge its interest in the general population. It will be accompanied with a validated inventory to detect eating disorders in order to test its sensitivity and its reproducibility.