Acute Malnutrition and Infection with the Human Immuno-Deficiency Virus (HIV) in Children Followed up at the Pediatrics University Hospital Charles de Gaulle: Evolution of Anthropometric Parameters on Antiretroviral Treatment

Burkina Faso, a country with very scarce resources, undertook to fight against HIV infection. In 2013, according to UNAIDS, 110,000 persons were living in this country with HIV infection. 18,000 children among these persons were under 15. We conducted a retrospective study from January 2003 to December 2012 at the Pediatrics University Hospital Charles De Gaulle, Ouagadougou (CHUP CDG), Burkina Faso. The study aimed at assessing the children’s ponderal growth when under antiretroviral treatment. The children who were under 15 and who had been on antiretroviral treatment for at least 5 years were included in the study. Acute malnutrition concerned children whose height/weight ratio (H/W) was lower at -2 width type (or Z score) of the median of reference regarding age according to WHO. Two categories of malnutrition were outstanding in our study: moderate acute malnutrition, (-3 Z-score ≤ H/W -2 Z-score) and severe acute malnutrition (W/H -3 Z-score). The clinical and paraclinical data recorded during previous consultations were extracted from the ESOPE (Monitoring and follow-up of patients) data basis and exported to the ENA software and SPSS for their analysis. In total, 210 out of 529 children’s cases were considered. These children’s average age was 6.9 years. There were 55.7% of male and 44.3% of female children. HIV1 was found in 97.6% of the children against 2.4% for HIV2. In a 5 year follow-up, 46 among the children, namely 20.4% were on a second line protocol of antiretroviral treatment and 164 among them were still on a first line protocol of antiretroviral treatment. When they were admitted at hospital, 38% of the children showed characteristics of acute malnutrition. 17.8% of these children presented characteristics of severe form of acute malnutrition. During this 5-year follow-up, the average of the W/H index of the children gradually rised from -1.62 Z-score when being admitted to -0.18 Z-score at after a 60-month antiretroviral treatment. Our study showed an effective ponderal catch-up with an average of the W/H index at -1.02 Z-score after a 12-month antiretroviral treatment. This study completed by the search for nutritious factors is likely to influence the infected children’s ponderal growth.

Seroepidemiological Study of Dengue Virus Infection Suspected Cases in Burkina Faso

Dengue fever is a mosquito-borne disease caused by four related but antigenically distinct dengue viruses. In the last half-century, the prevalence of dengue fever has increased dramatically (up to 30%) worldwide, especially in Sub-Saharan Africa. In Burkina Faso, the last dengue epidemic occurred in 2016, and the epidemiological situation is still poorly documented at the national level. Therefore, the present study aimed to conduct a sentinel seroepidemiology of suspected dengue virus infections from 2017 to 2020 at Charles de Gaulle University Pediatric Hospital Center of Ouagadougou. This investigation was designed to be a descriptive and analytical study. Patients with suspected cases of dengue fever were recruited from January 2017 to December 2020 during general medicine consultation and referred to Charles de Gaulle University Pediatric Hospital Center of Ouagadougou for the serological diagnosis of dengue. Venous blood was collected in dry or EDTA tubes and tested for DENV NS1 antigen, anti-dengue IgM, and anti-dengue IgG using SD Bioline Dengue Duo Rapid Detection Kit (Standard Diagnostic Inc., Korea). A total of 3400 blood samples from clinically suspected dengue cases were analyzed, of which 1784 (52.5%) were males, and 1616 (47.5%) were females. Among the 3400 patients included in the study, 661 (19.4%) were tested at least positive for NS1 antigen, anti-dengue IgM or anti-IgG. Among them, individuals positive for IgG suggesting past dengue virus infection were found in more than a third of 262 (7.7%) of the cases. Approximately, 80.0% (2705/3400) dengue suspected cases and 85.5% (341/399) early or primary dengue infections were recorded in the last four months of the study (September to December 2020), with a peak in mid-October and mid-November. There was no statistically significant difference in seroprevalence between males and females (p = 0.7), but an increasing seropositivity trend with age, from 11.6% for the patient under 5 years group to 39.7% for 30 years and over age group were noted. This study puts in evidence a considerable level of transmission of dengue viruses in Burkina Faso and provides baseline seroprevalence data. The recurrent outbreaks of dengue infection in multiple geographical areas need comprehensive surveillance and a diagnostic system to identify the actual burden and pinpoint the risk factors. A larger study is, therefore, needed to determine the actual prevalence of dengue in Burkina Faso and map the serotypes.

ST of Streptococcus pneumonia Circulating in Burkina Faso before the Introduction of PCV-13, 2013

Introduction: Burkina Faso experiences regular cases of Streptococcus pneumoniae meningitis. As part of the strategy to reduce cases of meningitis, the 13-valent pneumococcal conjugate vaccine (PCV-13) has been introduced in the Expanded Programme on Immunisation (EPI). Despite these efforts, there are some cases of pneumococcal meningitis including both vaccine and non-vaccine serotypes. The objective of this study was to describe the pneumococcal sequence types (ST) circulating in Burkina Faso before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV-13). Methods: It was a descriptive cross-sectional study that took place from 27th October 2013 to 7th January 2014. S. pneumoniae strains were collected in Burkina Faso and Multi Locus Sequence Typing (MLST) was performed at the Pneumococcal Laboratory at the Centers for Disease Control and Prevention (CDC) in the USA (United States of America). MLST consists of 4 steps: amplification, purification, sequencing and interpretative reading of the results. The amplification used 7 primers consisting of sequences of aroe, gdh, gki, recP, spi, xpt, ddl genes. Results: Of 37 strains tested, 10 serotypes were identified. Serotype 1 was prevalent in 48.7% (18/37) followed by serotype 25F in 10.8% (4/37). Serotypes 5 and 12F/12A/12B/44/46 were 8.1% (3/37) each. Serotype 1 contained 5 STs including ST303 24.3% (9/37), ST217 8.1% (3/37) and ST618 8.1% (3/37);followed by serotype 25F with ST105 10.8% (4/37), serotype 5 with ST289 8.1% (3/37) and serogroup 12F/12A/12B/44/46 with ST 989 8.1% (3/37). Conclusion: Pneumococci are characterised by their great variability both in number of serotypes and in ST within the same serotype. Thus, 10 serotypes have been identified. Also, within serotype 1, 5 different STs have been described. These data indicate the complexity of the pneumococcus which is strongly involved in purulent bacterial meningitis at national level. This requires continuous surveillance of pneumococcal meningitis through laboratory capacity building.

Congenital Toxoplasmosis or the Tip of an Iceberg. Report of Two Cases

Among the many parasitic diseases observed in the tropics, Toxoplasmosis is a fairly common occurrence. An infected pregnant woman can transmit it, transplacentally, to her foetus. Two cases of congenital toxoplasmosis are discussed in this study. One patient is at 7 days of life, while the other is at 9 days of life. The newborns displayed the typical symptoms of jaundice, hepatosplenomegaly, chorioretinitis, and cranioencephalic abnormalities. However, the uniqueness of these observations is the presence of umbilical haemorrhage, a symptom not described in the literature researched. The evolution of this finding, during treatment is distinguished by the symptoms persisting until six months of age, in addition to growth retardation of saturation-weight, with no retardation of psychomotor development in one patient, and with hydrocephalus accompanied by psychomotor retardation in the other one. Hence, it is recommended that pregnant women are systematically screened for toxoplasmosis, and seronegative women are monitored;in fact, the early and suitable management of congenital toxoplasmosis will significantly control this parasitosis.

Ulcerative Colitis in Infant: A Case Report at the University Hospital Yalgado Ouedraogo, Ouagadougou in Burkina Faso

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD), characterized by acute exacerbations and remissions. We report the clinical case of an infant, an 8 months female baby. The time between disease onset and diagnosis of the disease was 6 months. It was from an unknown etiology. The main clinical picture was weight stagnation, mucoid bloody diarrhea, and rectal bleeding. The macroscopic aspect in anorectoscopy was an erythematous mucosa with healthy beaches intervals. The mucosa was bleeding easily on contact. Pathological examination realized within the various lesions of the association was highly suggestive. The suggested treatment was made of symptomatic, corticosteroids and immunosuppressant’s therapy. Conclusion: Ulcerative colitis is rare in infants and difficult to manage in our tropical context.

Ocular Manifestations among HIV Infected Children in Ouagadougou, Burkina Faso

Ocular manifestations among HIV infected children are diverse and global incidence varies from 7% to 75%. At this age, eye lesions are often unnoticed because of the incapacity to express eye discomfort. The purpose of this study is to describe ocular manifestations among HIV-infected children and hence associated factors in the Department of Paediatrics at the Yalgado Ouédraogo Teaching Hospital. This was a cross-sectional descriptive and analytical study conducted between July 2014 and December 2014. A complete ophthalmic examination was systematically done to all HIV-positive children attending the clinic, as part of their routine medical visit. The most recent socio-demographic, clinical, biological and treatment data were registered. Seventy-nine children had an ocular examination and among them 92.4% were on ARV treatment. The incidence of ocular manifestations was 46.7%. Median age was 8 years old (interquartile 6 - 12 years old). Sex ratio was 1.3. The risk of ocular manifestations involvement among boys was twice than that of girls. More than half (59.5%) of children who had ocular problems had not expressed ocular discomfort. Ocular adnexal lesions were more common (35.4%) compared to eye segments (8.9%) lesions. Anterior segment and posterior segment lesions were statistically associated with immune system depression (p = 0.003 and 0.001). However, this relationship was not statistically significant (p = 0.15). Five out of seven children who had eye fundus lesions had CD4 count 3. Ocular manifestations were very common among HIV infected children in our context. Ophthalmic examination should be systematic at admission and regularly repeated during follow-up.