Psychosocial issues in HIV positive women during the perinatal period]

OBJECTIVE: To study the feelings of HIV infected mothers during the perinatal period regarding circumstances of HIV diagnosis, disclosure to partner and fear of contamination. POPULATION AND METHODS: A study based upon personal interviews was carried out from November 2003 to January 2004 upon routine pediatric outpatient visits for infants born to HIV positive mothers. RESULTS: This study included 54 women of which 70% were from Sub-Saharan Africa. Fifty-nine per cent discovered their HIV status during a pregnancy. Seventy-seven per cent of partners were informed of maternal status. Among the women reluctant to inform their partner, the main reasons given were fear of violence and separation. Seventy-two per cent of interviewed women refused their spouses to be informed by the medical staff. Medical care during pregnancy (moral support, delivery) was judged as good by a majority of women (90%) who found the behavior of the staff mostly satisfactory. Final child serology remains the most definitive test for mothers, 47% of whom fear the risk of a potential postnatal contamination of their children. CONCLUSION: In these isolated women, many of whom have recently discovered their HIV status, a multidisciplinary approach including psychosocial support is essential.     

The filaria Litomosoides galizai in mites; microfilarial distribution in the host and regulation of the transmission

The mites, Bdellonyssus bacoti, are engorged on rodents having 800 to 60,000 microfilarie/10 mm3 blood. Quantitation of L. galizai larval development shows that an additional blood meal improves development and that high microfilaremiae do not result in a proportional increase in the number of infective larvae. The first important stage of transmission regulation occurs during ingestion of microfilariae: the numbers of ingested microfilariae are lower than expected in cases of high microfilaremia. This phenomenon cannot be ascribed to the mite vector that engorges a constant blood meal whatever the level of microfilaremia. Contrarily, one finds that microfilarial density in the small peripheral blood vessels (blood drawn from incision of the dorsal skin) increases less than in large blood vessels (retro-orbital sinus). A similar observation was reported by Dickerson et al. (1989) working with Wuchereria bancrofti. We assume that in both cases, the high microfilaremiae cause the small blood vessles accessible to the vector to become saturated with parasites. Although regulation during engorging is not the sole factor to monitor the infection in B. bacoti (another one operates during larval development of L. galizai), demonstrating its existence seems to us fundamental: it points out the concept that sub-ingestion, as well as over-ingestion, shows the inequalities of microfilarial densities in the host which seem to be dependent on mechanical factors such as the diameter of blood vessles and the size of microfilariae.     

Increased susceptibility to malaria during the early postpartum period

BACKGROUND: Pregnancy is associated with increased susceptibility to malaria. It is generally agreed that this increased risk ends with delivery, but the possible persistence of increased susceptibility during the puerperium had not been investigated. METHODS: From June 1, 1990, to December 31, 1998, we monitored exposure to malaria, parasitemia, and morbidity among the residents of a village in Senegal in which the rate of transmission of malaria was high. In this population we analyzed 71 pregnancies in 38 women from the year before conception and through one year after delivery. RESULTS: Among the 38 women, there were 58 episodes of clinical Plasmodium falciparum malaria during 61,081 person-days of observation. The incidence of malaria was 20.2 episodes per 1000 person-months during the year preceding conception and 12.0 episodes per 1000 person-months during the period from 91 to 365 days after delivery. The incidence of episodes of malaria increased significantly during the second and third trimesters of pregnancy and reached a maximum of 75.1 episodes per 1000 person-months during the first 60 days after delivery. The adjusted relative risk of an episode of malaria was 4.1 (95 percent confidence interval, 1.8 to 9.5) during the first 60 days post partum, as compared with the year preceding pregnancy. The duration of fever during the episodes of malaria was longer and the prevalence and density of asymptomatic malarial parasitemia were significantly higher during pregnancy and the early postpartum period than during the other periods. CONCLUSIONS: Among women who live in areas with high rates of transmission of malaria, the susceptibility to malaria is highest during the second and third trimesters of pregnancy and the early postpartum period.     

Patterns of a Sylvatic Yellow Fever Virus Amplification in Southeastern Senegal, 2010

During the wet season of 2010, yellow fever virus (YFV) was detected in field-collected mosquitoes in the Kédougou region in southeastern Senegal. During this outbreak, we studied the association of the abundance of YFV-infected mosquitoes and land cover features to try and understand the dynamics of YFV transmission within the region. In total, 41,234 mosquito females were collected and tested for virus infection in 5,152 pools. YFV was detected in 67 pools; species including Aedes furcifer (52.2% of the infected pools), Ae. luteocephalus (31.3% of the infected pools), Ae. taylori (6.0% of the infected pools) and six other species (10.4% of the infected pools) captured in September (13.4%), October (70.1%), and November (16.4%). Spatially, YFV was detected from mosquitoes collected in all land cover classes but mainly, forest canopies (49.2%). Human infection is likely mediated by Ae. furcifer, the only species found infected with YFV within villages. Villages containing YFV-infected mosquitoes were significantly closer to large forests (> 2 ha) than villages in which no infected mosquitoes were detected.