Evaluation of the Strategy and Efficacy of Treatment of Chronic Viral Hepatitis C with the Sofosbuvir/Daclatasvir Combination in a Resource-Limited Country

Introduction: The treatment of viral hepatitis C (HCV), a major public health problem, has evolved considerably since the introduction of direct-acting anti-virals (DAAs). The aim of this study was to evaluate the strategy for initiating treatment with Sofosbuvir/Daclatasvir, and also to assess its efficacy. Patients and Methods: Included were patients aged at least 15 years, with detectable hepatitis C viremia and treated with a pan-genotypic Sofosbuvir/Daclatasvir regimen at the Centre “Hospitalier Universitaire la Référence Nationale de N’Djamena” between October 2019 and October 2023. The APRI score was used to assess fibrosis. Cure was defined by an undetectable viral load 12 weeks after the end of treatment. Results: A total of 835 patients were included (sex ratio 1.55, mean age 50.5 ± 13.73, extremes 20 and 84 years). The 60 - 69 age group was the most represented. The mean APRI score was 0.42 ± 0.29, with extremes of 0.019 and 1.84. The mean viral load was 2,316,193.086 IU/mL. All subjects had good renal function. Cytolysis was absent in 70% of cases. Without genotyping, a pan-genotypic regimen was used in all patients: Sofosbuvir (400 mg)/Daclatasvir (60 mg). The cure rate was 99.4%, with good tolerability. However, four cases of failure were recorded out of the 668 patients who underwent follow-up HCV-PCR testing after 12 weeks of treatment. Conclusion: The Sofosbuvir/Daclatasvir regimen is highly effective, with an excellent safety profile. However, the still high cost of these molecules limits their accessibility to a large proportion of patients.

Toxoplasmic Chorioretinitis: About a Case in an Immunocompetent Adult at the Renaissance University Hospital Centre (UHC) in N’Djamena (Chad) and Review of the Literature

Toxoplasmic chorioretinitis also known as ocular toxoplasmosis is a parasitic infection caused by the obligately intracellular multiplying protozoan called Toxoplasma gondii. Active toxoplasmic chorioretinitis is a rare condition in immunocompetent people. We report a case of a 47-year-old patient who received reduced right visual acuity, left hemiparesis and eye pain. Examination of the right anterior segment of the eye is unremarkable. In the fundus of the right eye, there was a focus of active toxoplasmic chorioretinitis located in the macula at 1.5 mm papillary diameter next to old scar lesions. The ophthalmological examination of the left eye was unremarkable. The paraclinical assessment carried out on the patient shows a positive Remington test on two occasions three weeks apart. The clinical outcome after initiation of treatment was favorable with a healing of the active site within four weeks.

Visceral Leishmaniasis at the National Reference University Hospital Center of N’Djamena (Chad): Epidemiological, Clinical, Diagnostic, Therapeutic and Prognostic Aspects

Introduction: leishmaniasis is a group of parasitic diseases caused by a parasite of the genus Leishmania transmitted by the bite of an infected vector called a sandfly. There are four forms. Visceral leishmaniasis is the most severe form. The aim of our work is to study the epidemiological, clinical, diagnostic, therapeutic and prognostic aspects of the disease in the Infectious Diseases Department of the Centre Hospitalier Universitaire de Référence Nationale in N'Djaména. Methodology: Patients were recruited on the basis of clinical signs suggestive of visceral leishmaniasis, i.e. prolonged fever, splenomegaly and altered general condition. Biological confirmation was performed with a rapid diagnostic test using recombinant K39 parasite antigen, which is known to have good specificity and sensitivity. Epidata version 3.1 software was used to process patient data. Results: From 05/04/21 to 15/12/23, 153 positive cases were managed. The mean age of patients was 18 years, with a sex ratio of 9.2. Of these patients, 103 (67.3%) had recently stayed at gold mining sites. Patients testing positive were treated with sodium stibogluconate combined with paromomycin for 17 days. The mortality rate was 13.2%. Conclusion: Leishmaniasis is a serious and little-known disease in Chad. In order to respond to the disease, it is necessary to reinforce the capacities of health structures and to carry out appropriate actions in the outbreaks.

HIV and Seroconversion among Pregnant Women at the University Hospital of Mother and Child in Chad

Background: HIV in pregnant women presented a risk of transmission to newborns. This study was to determine HIV prevalence among pregnant women in the birthing rooms and give antiretrovirals to women infected and their newborns. Methods: A preliminary study was conducted from 2013 to 2015 at the Mother and Child Hospital. Pregnant women were counseled and tested for HIV-antibody according to the national algorithm using Determine HIV 1 & 2 and Immunocomb II Bispot HIV1 & 2. The women screened HIV-negative during the prenatal consultation and who accepted a second test were screened in the birth room. The data collected were processed using the Access Microsoft office 16 and SPSS software version 18. Results: A total of 6080 pregnant women were tested before and in the birth room. Of these, 5943 (97.4%) were detected as HIV-negative and 159 (2.6%) were HIV-positive. Of the 5943 with HIV-negative status, 1333 accepted the second test in the birth room, 10 of which have become HIV-positive. The rate of seroconversions was 0.75%. Conclusion: This study determined the prevalence of HIV in pregnant women. The result reveals the importance and necessity of repeating the screening test in the birth room because of the possibility of seroconversion or new infection during pregnancy.

Antimicrobial Resistance of Pseudomonas aeruginosa Isolated from Human Infections in N’Djamena, Chad

Background: Urinary Tract infections and pus are major public health problems. The evolution of bacterial resistance to antibiotics makes the treatment of these infections problematic. This is why this study is undertaken to identify and evaluate the resistance of Pseudomonas aeruginosa to antibiotics. Methods: This is a prospective study carried out from December 2020 to November 2021. The germs were isolated on the agar supplemented with cetrimide and identified by the API 20 NE gallery method according to the manufacturer’s protocol. The strains’ resistance profiles were determined by the diffusion method on Mueller-Hinton according to the criteria EUCAST- 2021. Results: A total of 46/1467 (3.13%) Pseudomonas aeruginosa were identified, of which 29/1008 (2.87%) were urinary tract infections and 17/459 (3.70%) were pus. The high resistances were: 97.8% to ceftazidim, 91.3% to aztreonam, 93.5% to cefepim, 82.6% to piperacillin, 58.7% to levofloxacin, 52.2% to amikacin, 47.8% to tazobactam-piperacillin, 47.8% to tobramycin and 43.5% to ciprofloxacin. Low resistance was only 2.2% to fosfomycin, 2.2% to colistin and 15.2% to imipenem. Conclusion: This study reveals the considerable resistance of Pseudomonas aeruginosa to commonly used antibiotics, and thus compromises the empirical treatment practiced in hospitals. This result motivates the need to carry out susceptibility testing of isolates before any prescription of antimicrobials.

Sydenham’s Chorea: Apropos of Three Observed Cases at the N’Djamena Mother and Child University Teaching Hospital (CHU-ME)-Chad

Introduction: Post-streptococcal chorea is the most common form of acquired chorea in children. Objective: The objective of this study was to contribute to better management of this condition by giving the characteristics of the epidemiological, clinical, biological, etiological, therapeutic and evolutionary aspects. Methodology: This was a retrospective and descriptive study from January 2021 to December 2021 which took place in the pediatrics department of the Mother and Child University Teaching Hospital of N’Djamena (CHU-ME). All the children in whom we observed abnormal involuntary movements whose age was less than or equal to 15 years were concerned. Result: there were three female children. The average age was 7.5, of which the two are 7 years old and the third is 8 years old. Two had a history of angina. A notion of polyarthralgia and dental caries was found in the third. The diagnosis of post-streptococcal chorea was retained on the basis of clinical arguments: observation of abnormal movements of the limbs and the face, which are involuntary, sudden with an insidious and progressive onset, muscular hypotonia, and psychic disorder. Medical imaging, in particular echocardiography, which objectified two cases of associated rheumatic valvular disease. Remission was observed in all three children after two weeks of treatment with haloperidol, penicillin. Those with associated rheumatic valve disease also received corticosteroid therapy. Complete remission of chorea was observed in all three girls. Prophylaxis in two patients based on Penicillin V was instituted. Conclusion: Although less frequent, post-streptococcal chorea is still seen in our country and is still an important health problem that needs more real medical efforts.

Management of Secondary Leyll Syndrome Due to Anti-Covid Vaccine in a Case, at the Renaissance University Teaching Hospital, Ndjamena (CHAD)

Introduction: Lyell’s syndrome (SL), called Toxic Epidermal Necrolysis is one of the most serious forms of medication accidents. It is an acute, rare pathology, its incidence is estimated at 1 to 2 cases out of one million inhabitants per year and its evolution can be fatal. Materials and Methods: We report the observation of a 60-year-old patient, with no significant pathological history, admitted to our intensive care unit at the Renaissance University Teaching Hospital in N’Djamena for the treatment of Toxic Epidermal Necrolysis. In whom the onset of symptoms dates back to few hours after vaccination against COVID-19 with Ag Johnson and Johnson. Results: An ophthalmology opinion was requested and the patient was put on Fucithalmic. In our case, in addition to the advanced age of the patient (60 years old), her SCORTEN was ≥5. Conclusion: The late management as well as the absence of a specific department for severe burns, which condition the presence of a technical plate was fatal to her despite multidisciplinary care: Resuscitators, Traumato-Orthopedist and ophthalmologist.

The Management Problem of Miliary Tuberculosis in the Service of Pneumo-Phtisiology at the National References University Teaching Hospital of N’Djamena (Chad): About 103 Cases

Introduction: Miliary tuberculosis (MT) is a rare form of tuberculosis (TB) and it is a major public health problem in our countries with limited resources. Materials and Methods: It is a retrospective and descriptive study that started from 1st January 2018 to 31 December 2020 at the pneumo-phtisiology service of the CHU-RN of N’Djamena., All records of patients aged at least 15 years treated for miliary tuberculosis confirmed by X-ray chest were included in our study. Results: The prevalence of TD was 1.5% (n = 103) of all TB diagnosed in the service. The sex ratio was 1.34. The average age was 37.7 years with extremes ranging from 19 to 80 years. A low social economic level was found in 75.7%. The principal comorbidity found in this study was HIV with the prevalence of (22.3%). The general signs were dominated by deterioration of general condition (96.1%) and fever (91.3%). The main symptoms were cough (85.4%) and dyspnea (52.4%). The radiology of chest found a homogeneous dissemination and symmetrical in both lung fields in 100% of cases. Our study reported that 14 (13.6%) of death cases were found among patients. Conclusion: TM is a severe form of TB;it affects a young population in our context. Mortality remains high with prevalence of 13.6% of cases. Early management would improve the prognosis.

Clinical Efficacy of Artemether-Lumefantrine Artesunate-Amodiaquine of Children from Three Chadian Provinces with Acute of Uncomplicated Falciparum malariae from 6 Months to 5 Years

Introduction: Artemisinin-based combination therapies are the first-line antimalarial drugs used to treat uncomplicated Plasmodium falciparum malaria in many endemic countries worldwide. In Chad, since the adoption of artemisinin-based combination therapy (ACTs) in its first-line treatment policy for uncomplicated malaria in 2005, Artemether-Lumefantrine and Artesunate-Amodiaquine have been used in many hospitals and health centers. The main objective of this study was to provide the baseline data of Artemether-Lumefantrine and Artesunate-Amodiaquine efficacy in three regions where many people suffered from malaria disease. Material and Methods: The baseline efficacy of two combination therapies was evaluated between January and April 2020 in Mosoro, Mondou and Dourbali Provinces in Chad. A two-arm single cohort study was conducted to assess the clinical efficacy of artesunate-amodiaquine and artemether-lumefantrine for the treatment of 1113 children aged from 6 to 59 months with uncomplicated Falciparum malariae diagnosed by thick blood smear examination, using the World Health Organization validated protocol. Results: On day 3, all patients in both groups had cleared parasitemia, after treatment, the patients presented a higher hemoglobin level in both groups artemether-lumefantrine (10.97 ± 1.39) and artesunate-amodiaquine (11.87 ± 1.81), respectively. On day 28, all patients had adequate clinical and parasitological responses with 99.82% of artesunate-amodiaquine and 99.10% of artemether-lumefantrine. Overall, both drugs were well tolerated at the clinical and biological level, no late parasitological failures have been recorded in artemether-lumefantrine and artesunate-amodiaquine groups, also both forms of Artemisinin-based combination therapy were still effective and safe in the treatment of uncomplicated P. falciparum malaria in Chad.

Unilateral Frontal Sinus Aspergillosis: A Case Report and Review Literature

Frontal sinus aspergillosis is a rare infection that can be usually associated with immunocompromised states and life-threatening with high mortality rate. The authors report in a developing country a case of immunocompetent patient with left unilateral frontal headache, associated with left eye ptosis. The Brain CT Scan revealed frontal sinus aspergillosis. She underwent surgery followed by itraconazole cure. The outcome is successful after a period of 14 months with resolution of symptomatology. Anatomopathological examination confirmed aspergillosis. They share their experience of management of this disease in a country where neurosurgery is very young specialty and where molecules against aspergillosis are not available.