Alterations of Thymus Cortical Epithelium and Interdigitating Dendritic Cells but No Increase of Thymocyte Cell Death in the Early Course of Simian Immunodeficiency Virus Infection

The role of the thymus in the pathogenesis of simian acquired immunodeficiency syndrome was investigated in 18 juvenile rhesus monkeys (Macaca mulatto). The thymus was infected from the first week post-SIVmac inoculation, but the amount of virus-positive cells was very low (< 1 in 10⁴ T cells) as demonstrated by polymerase chain reaction and in situ hybridization. First morphological alteration was a narrowing of the cortex at 12 and 24 wpi. Morphometry revealed no increase of pyknotic T cells but a decrease of the proliferation rate and flow cytometry showed a reduction of the immature CD4⁺/CD8⁺ double-positive T cells. Ultrastructural analysis revealed vacuolization, shrinkage, and finally cytolysis of the cortical epithelial cells and the interdigitating dendritic cells. Immunofluorescence staining exhibited a widespread loss of cortical epithelial cells. This damage to the thymic microenvironment could explain the breakdown of the intrathymic T cell proliferation. It preceded fully developed simian acquired immunodeficiency syndrome and is therefore considered to play a major role in its pathogenesis.     

Development of a clinical and biological scoring system for the prognosis of Rift Valley fever

With regard to an acute disease, Rift Valley fever, we tried to establish a prognostic score to help physicians to set prognosis and to choose a health management suitable in their context. Using clinical and biological data collected during the 1987 RVF epidemic in Southern Mauritania, we established a prognosis score card. Data analysis allows to prognosticate forms of possible severe evolution as an association of four syndromes: fever over 39 degrees, hemorrhagic syndrome, icterus and neurological signs. Using 12 clinical symptoms and 3 biological signs, it is possible to prognosticate cases with fatal evolution.     

Conservative valve surgery in endomyocardial fibrosis. Apropos of 8 cases among 46 surgically treated patients

The authors report their experience of conservative valvular surgery in endomyocardial fibrosis (EMF) (8 cases among 46 surgical cases). These patients were divided into 3 groups: Group I: bilateral EMF predominating on the left side with associated tricuspid involvement (n: 3). Group II: bilateral EMF predominating on the right side with moderate associated mitral involvement (n: 3). Group III: unilateral EMF with massive mitral insufficiency, (n: 2). At surgery, on the side of the conserved valve, the patients had a transvalvular endocardectomy (n: 3) and a valvuloplasty either tricuspid (n: 3) or mitral (n: 5). The results of the valvuloplasty were satisfactory. Two patients died in the post-operative period. Their death was unrelated with the conservative procedure. The authors study the literature concerning the cases of valvular conservative surgery in EMF (n: 4) and define the conditions under which this surgery can be done. They report 2 original cases of pure left sided limited EMF with massive mitral insufficiency successfully treated by a valvuloplasty.     

Morbidité et mortalité du tétanos dans le service de maladies infectieuses du CHU du Point G à Bamako, Mali (2004–2009)

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 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, entry way). 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 entry way for 64.7% of the patients. The entry way 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.     

Malaria in a holoendemic area of Burkina Faso: a cross-sectional study

A malaria survey of the entire population of a village in Western Burkina Faso (n=1,561) was conducted to assess malaria endemicity. The study population was examined for symptoms characteristic of malaria including fever, anaemia, splenomegaly and parasites present in thick blood films. In the overall study population, the prevalence of Plasmodium spp. infection by microscopic examination of thick blood films was 79.0% (1,233/1,561). In a subcohort with 201 individuals, PCR techniques found a prevalence rate for all Plasmodium spp. of 92.0% (185/201), while microscopy found one of 80.6% (162/201). A combination of both methods gives a rate of 95.5% (192/201). Though univariate logistic analyses of elevated body temperature, anaemia, splenomegaly and age showed them all to be predictors of or risk factors for an infection, only elevated body temperature and age were predictors in multivariate logistic analysis. However, the symptom of splenomegaly did show a highly significant association with infection by multiple species of Plasmodium.     

Contribution of ultrasound in the diagnosis of the complications of intramuscular injection in children

During a prospective study conducted at the rehabilitation Center of the physically handicapped persons and at the mother-child Hospital in Bamako, the authors report 50 cases of neuromuscular complications of the quinine intramuscular injection in the child. The scan revealed muscular calcifications in 37 cases (740%), abscesses, in 7 cases (14%) and muscular inflammations in 6 cases (12%). Xray of the affected limb was not systematic: it has been performed in four children in the case of a subjacent bone involment. It showed calcifications in two cases. If muscular abscess is easily diagnosed by clinical exam it is not the case for calcifications. The scan allows to set up a precise mapping of the muscular lesions, to determine their type and size. It also helps the clinicians in their therapeutic attitude. Medical treatment associated with rehabilitation has been carried out in 40 patients (80%) and surgery in 10 patients (20%).