Epid��miologie mol��culaire de la m��ningite �� m��ningocoque au Mali: isolement d'un nouveau variant (P1.y) de la prot��ine de classe 1.

The study deals with 570 strains of Neisseriaceae isolated between 1989 and 1994 in Mali: 396 of the strains were isolated from samples of cerebrospinal fluid and 174 from the throat. Serogroup C accounted for 55% of all strains. Antigenic structure was determined by ELISA, SDS-PAGE and transfer to nitrocellulose membrane for immunoblotting with monoclonal antibodies produced at the Max Planck Institute for Molecular Genetics. For serogroup A, the class 1 protein types found were P1.7 for strains isolated prior to 1994 and P1.9 for strains isolated in 1994. P1.7 is specific to clone IV-1 and P1.9 to clone III-1, which was responsible for the 1994 epidemic. All strains of serogroup C isolated from fluid CSF and most strains isolated from the throat exhibit a new type of class 1 protein which the authors have designated P1.y. P1.y is characteristic of Malian strains of serogroup C; it is rare or absent in strains from other countries (Burkina Faso, Ghana, Italy, USA). The nucleotide sequence of the gene expressing P1.y and the corresponding amino acid sequence were determined at the National Institute for Biological Standards and Control, England.     

Gastrointestinal manifestations of AIDS in adults in Mali

Our main objective consists in evaluating the frequency of digestive signs and digestive opportunistic infections in AIDS patients with diarrhea. The prospective study occurred from January 1997 to July 1998 in Bamako hospitals. The patients underwent a clinical examination, blood and stools tests, and sometimes upper digestive endoscopy. Among 434 cases of AIDS, 426 patients (98%) had at least one digestive sign. The main digestive signs were diarrhea (80.1%), abdominal pains (62.2%), vomiting (47.2%) and dysphagea (36.6%). Isospora belli and Cryptosporidium parvum have been pointed up in respectively 9% and 16.3% of examined specimen. Echerichia coli was found in 8.6% of stool cultures and in 2.9% in the case of Salmonella Arizonae. Twenty cases of Kaposi's sarcoma were diagnosed and mycosis was found in 71.9% of patients. In conclusion, digestive change is a constant phenomenon in AIDS patients. Patients survival could be improved by early management, improvement of diagnosis and provisioning of medicines.     

Contribution of radiography and repeat microscopy in the diagnosis of pulmonary tuberculosis in the hospital environment of Bamako]

WHO and IUAT-LD recommend repeated microscopy in order to improve the detection of contagious cases of pulmonary tuberculosis. Our aim was to determine the contributions of radiology and microscopy in the diagnosis of pulmonary tuberculosis. From January 1998 to April 1999 radiography and microscopy were performed for 275 patients who were admitted to the pneumology service. Pulmonary tuberculosis prevalence was higher among women aged 10 to 29 years than among men of the same age (p = 10(-6)). 188 (68.4%) women tested positive, 49 (17.8%) tested positive at the second microscopy and 1 (0.36%) at the the third. The main radiological lesions were nodules + infiltrats (46.2%), nodules + infiltrats + cavity (26.2%) and infiltrats + cavity (6.5%). Repeated microscopy significantly increased the proportion of pulmonary tuberculosis cases detected (from a prevalence 68.4% to 86.5%).     

Radiographic and bacteriologic data on pulmonary tuberculosis in Bamako as a function of HIV status

This prospective study included patients treated for tuberculosis between January 998 and April 1999 in the pneumology unit of the Point G Hospital in Bamako. The purpose was to analyze chest x-ray and bacteriological findings in HIV+ and HIV- patients. All patients had clinical and radiographic signs suggestive of tuberculosis with one or several sputum samples and HIV serology. Among the 127 patients, 36 were HIV positive (28.3%). There was no sex predominance in the HIV+ patients (p = 0.3). The most common radiographic aspect associated nodules and infiltration irrespective of the immune status (p = 0.014). Characteristic features of the chest x-rays in HIV-positive patients were: frequent military forms and rare cavernous forms (p = 0.007). Sputum tests were positive more often in HIV-negative than HIV-positive patients (p = 0.0003). The diagnosis of tuberculosis was retained in 11.7% of the patients with negative microbiology despite repeated samples. A normal chest x-ray was observed solely in one HIV-negative patient.     

Resistance of Vibrio cholerae 0:1 to the 0/129 compound and multiresistance to antibiotics]

The authors present a study of the in vitro susceptibility to O/129 compound and usual antibiotics of 29 strains of V. cholerae O:1 biotype El Tor isolated during epidemics in miscellaneous countries over the world from 1982 to 1991. Several identical isolates from the same epidemic are represented by one strain. Susceptibility testing by diffusion method and MICs by agar dilution method are used. The data show that the resistance to O/129 compound is often associated with the resistance to usual antibiotics such as trimethoprim, sulphonamides, chloramphenicol, ampicillin and tetracycline. This resistance to the vibrostatic compound leads to a double problem of diagnosis and therapy. The nitrofuranes derivatives and tiliquinol-tilbroquinol association, an intestinal antiseptic, are the most active antimicrobial agents as well on the strains O/129 sensitive as on the strains O/129 resistant.     

Epidemiologic aspects of whooping cough in a village of the central district of Kolokani in Mali]

Epidemiologic aspects of a whooping cough outbreak are studied in a village of a rural precinct of Kolokani in Mali. The survey shows that the village as been contaminated by two children coming from Bamako, an urban center. Spreading of the epidemic is due to the lack of suitable therapy and vaccination. Seventeen cases are noticed within 83 children aged 0 to 13 years (20.5%) from October 12th, 1988, to January 22nd, 1989. The attack rate is the same in males and females. Knowledge, attitudes and practices of the population to face whooping cough are noted. Measures are proposed for therapy and prevention.     

The feasibility of integrated STI prevalence and behaviour surveys in developing countries

BACKGROUND: In countries where STI/HIV prevalence data and behavioural data are scarce UNAIDS second generation HIV surveillance guidelines recommend measuring STI/HIV prevalence and risk behaviours in vulnerable populations but do not recommend conducting these surveys concurrently because of concerns about participation rates, cost, and provision of services. OBJECTIVES: To assess the feasibility of conducting a national combined STD prevalence and behaviour survey in Mali among vulnerable populations with the intention of institutionalisation. METHODS: From March to June 2000 an integrated STI prevalence and behaviour survey was conducted using cluster sampling among five risk groups in four sites in Mali, west Africa. 2229 individuals in non-traditional settings such as taxi/bus stations, market areas, households, and brothels participated in any one or all components of the study: (1) behavioural questionnaire, (2) urine sample for Neisseria gonorrhoeae (GC)/Chlamydia trachomatis (CT) testing, (3) a fingerstick drop of blood for syphilis, and/or (4) HIV testing. RESULTS: High participation rates of 84%-100% were achieved despite specimen collection and HIV testing. Rates fell only slightly when participants were asked to provide biological samples and participants were more likely to provide urine than blood. Rates among the different groups for HIV and syphilis testing are similar and suggest that refusal was most probably because of a reluctance to give blood rather than because of HIV testing. The cost of the biological component added approximately $30 per participant. Included in the $30 are the costs of training, participant services, laboratory personnel and supplies, STI drugs, and STI testing costs. The total cost of the survey was $154,905. Biomarkers aided in validation of answers to behavioural questions. Consenting individuals received HIV pretest and post-test counselling and referral to a trained health provider for treatment of STI and the provision of services provided the framework for interventions in the groups following the survey. CONCLUSION: This represents an effective methodology for collecting risk behaviour and STI/HIV prevalence information concurrently and should be considered by countries expanding STI/HIV surveillance as part of UNAIDS second generation HIV surveillance.     

Portage de l’AgHBs au Mali: bilan de dix ans de dépistage à l’Institut national de recherche en santé publique (INRSP)

Hepatitis B virus is a major public health issue worldwide and particularly in the African Sub-Saharan region. The aim of this study was to determine the frequency of HBsAg carriage in the reference laboratory located at the NIPHR over a ten-year period (1997–2006). Screening for HBsAg was carried out by VIDAS^® PC (BioMérieux^® France) using the ELFA method. The prevalence of HBsAg was estimated at 24.9% in a population of 4,466 patients, consisting of more men than women at a ration of 1.30. High frequency was observed in the 25–34 age-range, with a rate of 29.7%. Drivers and members of the armed forces had the highest prevalence, with 32.3 and 30.1% respectively. In 35.8% of cases, candidates taking the HBsAg test were in apparent good health. In 64.2% of cases, HBsAg screening had been requested because of hepatitis B related symptoms. To reduce hepatitis B related morbidity in Mali, the vaccination and public awareness campaigns must be intensified and focused on younger members of the population.