Prognosis and Evolution of Lassa Virus Infected Persons during the 2017 Epidemic in Togo

Introduction: Lassa viral hemorrhagic fever is common in West Africa. Almost 300,000 persons are affected each year with 5000 deaths. The mice of the genus mastomys is the wild tank. Objective: The aim of our study is to describe clinic, therapeutic and evolution of the affected patients during February-March 2017 epidemic that occurred in the north of Togo. Methodology: Our study is a record review study from patients’ record, who were hospitalized from February, 1st to March, 31st 2017 at Mango hospital. Lassa diagnosis was performed by PCR. They patients have received Ribavirin and blood transfusion when necessary. Results: We have reported 5 clinical observations of Lassa viral hemorrhagic fever. Patients came from Benin (03 cases), from Burkina-Faso (1 case), from Togo (1 case) and were 25, 34, 60, 52 years old and a premature baby of 13 days. External hemorrhage and abdominal pains were the main symptoms. Fever was observed for all the cases. Complications were marked by hemorrhages and shocks. Only 3 patients had benefitted of Antiviral therapy with Ribavirin. The other 2 patients did not benefit from the treatment because the diagnosis of Lassa fever was done the day they dead before the treatment started. Lethality was 80% (4 cases) with a highly secured burial. Effective management of contacts was done. Conclusion: Diagnostic and therapeutic delays of patients are responsible of the bad prognosis of the disease.

The Lassa Virus Epidemic in Mango, Togo: Therapeutic Route of the First 4 Cases

Introduction: Lassa viral hemorrhagic fever is caused by the Lassa virus. The aim of our study is to describe the therapeutic itinerary of the 4 cases of Lassa virus hemorrhagic of February-March 2017 epidemic that occurred in Mango. Methodology: Our study is a transverse retro-prospective and descriptive study from February, 1st to March, 31st 2017 that dealt with 4 confirmed Lassa fever cases declared positive on the PCR basis;hospitalized or deceased at the hospital “Esperance” of Mango;support center of Lassa viral hemorrhagic fever. Results: we reported 4 clinical observations of Lassa viral hemorrhagic fever diagnosed on the PCR basis during the Lassa fever epidemic. Patients came from Benin (2 cases) or from Burkina-Faso (1 case) and were 25, 60, 52 years old and a premature baby of 13 days. The reasons for admission were external hemorrhage, a pultated tonsillitis and abdominal pains. Fever was observed for all the cases. Complications were marked by hemorrhages and shocks. Only two patients benefitted from Antiviral therapy with Ribavirin and were declared healed. The other two patients did not benefit from the treatment due to diagnostic and therapeutic delays. Lethality was 75% (3 cases) with a highly secured burial. Effective management of contacts was established. Conclusion: Diagnostic and therapeutic delays of patients are responsible of the Dark Prognosis of Lassa fever during the epidemic.

Cryptococcal Meningitis of the HIV-Infected Person in Lomé: About 102 Cases over 10 Years

Objective: To describe the clinical, epidemiological and evolutionary aspects of cryptococcal meningitis. Methods: This was a retrospective descriptive study on all HIV-infected patients who had been hospitalized for cryptococcal meningitis between 2006 and 2016 in the principal structures for the care of HIV infected person in Lomé. The diagnosis of meningitis was clinical and confirmed by the presence of cryptococci on Chinese ink or the detection of CSFsoluble antigens. All patients have made the CD4 rate assay and received an antifungal treatment based on fluconazole or Amphotericin B, followed later by antiretroviral triple therapy. Results: A total of 102 patients infected with cryptococcal meningitis (62 men for 40 women) were found. The sex ratio was 1.55. The median age was 34 years with extremes of 15 to 49 years. Clinically, headache was the symptomatic symptom in 100% of cases, prone to long runs and weight loss respectively in the proportions of 45% and 65%. The mean CD4 cell count was 65 ± 22 cells per mm3. The duration of hospital stay was short (less than 7 days) for the deceased. A total of 62 patients were able to receive treatment, 40 of them with fluconazole and 22 with Amphotericin B. The mortality was very high (65%), 25% were lost to follow-up, and 9.5% still in live 3 months after admission to the hospital. Conclusion: Cryptococcal meningitis has a very reserved prognosis. It is to be feared in cases of severe immunosuppression, hence the early detection of HIV for optimal management is important.

Diagnosis of HIV Delay: Lost Opportunities

The diagnosis delay in new cases of HIV infection is a frequent fact. Our objective was to detect and analyse the lost opportunities and describe the characteristics of these patients. Method: The search was done by a revision of personal histories of new diagnosis of HIV infection from 1st January to 31st December 2011 in the database of VACH. We selected those that had consulted a doctor in the previous year in the Emergency area, Primary Care and Specialised Consultations in the database of the histories of the Public Health Service. We called low attendance if they came 1 - 3 times and high if over 3. We grouped patients into those that fulfilled criteria of diagnosis delay by count of CD4s. We called no diagnosis delay to those that had count of CD4 over 350, diagnosis delay under 350 and advanced disease under 200. Results: There were 107 new cases. The global percentage of DD was 61.7% of cases. From these, 45.38% fulfilled criteria of AD. It was possible to find information about the existence of previous sanitary attendance in 59 patients. From these 58% were diagnosed with delay, fulfilling criteria of AD in 27%. The predominant means of infection was sexual. 35 patients attended a healthcare level, 19 two and 5 three. 47.5% consulted over 3 times. They requested a total of 274 consultations. Discussion: The diagnosis delay is a reality. It took our attention that from 59 patients having requested previous medical assistance 58% were diagnosed with delay and 27% fulfilled criteria of AD. We found that almost half of them had been attended in 4 and up to 14 times, in some occasions with suggestive symptoms of HIV infection. Facing this discovery we think that some interventions should be undertaken to get an early diagnosis and the control of the outbreak.

Risk Factors for Conjunctival Microorganism Colonization in Adults Undergoing Intraocular Surgery

Purpose: To assess prevalence of and risk factors for conjunctival colonization and types of organisms among adults undergoing elective intraocular surgery. Setting: Ha’Emek Medical Center, Afula, Israel. Methods: A prospective study conducted in the Ophthalmology Department at Ha’Emek Medical Center, Afula, Israel between May 1, 2006 and August 31, 2007. Included were adults undergoing elective intraocular surgeries. Conjunctival cultures were obtained from the lower fornix, prior to application of prophylactic decolonization treatment and were processed using routine microbiological techniques. Demographic, socioeconomic and medical data of our patient cohort were obtained from all participants. Results: Cultures were obtained from 501 patients. (Mean age 69.7 ± 12.0 years) of whom 52.1% were females. In 208 patients (40.5%) bacteria grew in conjunctival cultures, one type in 175 (34.9%) one, and two types in 28 (5.6%). In none fungi were isolated. Coagulase negative Staphylococcus was the most frequent bacteria isolated. By multivariate analysis, significant risk factors for conjunctival bacterial colonization were spring/summer seasons (OR 1.64, CI 1.15 - 2.36, P < 0.007), and showering on the day of the operation (OR 1.73, CI 1.11 - 2.69, P < 0.01). Conclusions: In addition to previously known risk factors for conjunctival microorganism colonization, the present study found showering on the morning of the operation, possibly related to bacteria on towels or in the eyelids and lashes, and time of year (spring/summer) perhaps resulting from higher temperature and humidity related to the presence of conjunctival bacteria to be significant in adults undergoing intraocular surgery.

Proteinuria in Children Living with HIV on Highly Active Antiretroviral Therapy (Haart)

Objective: To determine the prevalence of proteinuria in children living with HIV (CLHIV) and identify associated factors. Patients and methods: This was a cross-sectional, descriptive and analytical study carried out from April to August 2017 in the HIV care centres in Brazzaville and Pointe-Noire. The study included CLHIV with dipstick urinalysis test “Combur10 Test® M”. Results: Thirty seven CLHIV on HAART presented a proteinuria, 21.8%. Children were male gender in 21 cases (56.8%) and female gender in 16 cases (43.2%). Mean age was 10.9 ± 3.9 years. The children were infected with type 1 virus in 35 cases (94.6%), vertical transmission in all the cases (100%). Children were living with HIV for about 2 to 4 years of average n = 18 (48.6%) and they were WHO clinical stage 2 in 18 cases (48.6%). 13 children (35%) had CD4 level < 200 cells/mm3. All CLHIV (100%) were on HAART thus 20 (37.7%) on the combination of zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP). This combination AZT, 3TC, NVP was a protective factor regarding the occurrence of proteinuria (OR: 0.43;IC (95%). Conclusion: Proteinuria is less observed in CLHIV on HAART. Systematic screening and early management of proteinuria during follow-up of these children improve their survival.

Rape and Medical Consequences among Girls and Women Victims during the Post-Armed Conflict Context in Congo

Rape is a criminal, aggressive and violent act to have sexual intercourse with a person without her consent. Few studies have been conducted on rape and sexual assaults related to armed conflict in developing countries. The objective of this study was to assess the magnitude of rape and its medical consequences among victims during armed post-conflict period in Brazzaville from January to December 1999. Rape victim was defined as woman or girl having received medical care from January to December 1999 in care units following reporting having incident of rape. SPSS V 20 software was used for the analyses. A total of 1282 victims were assessed. We documented 106 post-rape pregnancies, of which 58 (54.7%) ended in abortion, 15 (14.2%) in miscarriage and 33 (31.1%) in childbirth. Sexually transmitted infections (STIs) were common, with 560 (44%) cases among the 1282 victims. Of these, 301 (23%) had trichomoniasis, 123 (10%) had salpingitis, 89 (7%) had vaginal candidiasis and 38 (3%) had gonorrhea. A large proportion of morbidity 362 (28%) was attributed to vulvovaginal injuries and traumatic pelvic pains. In conclusion, our study highlights that rape practice was common in context of armed conflict in Congo. Medical consequences were unwanted pregnancies leading to unsafe abortions, STIs and physical injuries. Results argue in favor of effective public health interventions for a better prevention and care of victims during and after armed conflict.

转变结核病住院与不住院治疗间的比例——减少经济负荷

背景:尽管治疗结核病不一定都需要住院,但在澳大利亚,90％结核病病人在医院启动治疗。 目标:计算和比较结核病住院与门诊治疗的费用,以衡量转变住院治疗为不住院治疗的影响。方法:在澳大利亚维多利亚州进行一项费用的研究,通过1994-1995会计年维多利亚州报告的疾病资料库与医院患者资料配对核实,计算所有登记报告的结核病病人中住院者的比例。以多种来源获得的数据计算住院与不住院的费用。采用Excel软件计算不同比例的住院与不住院治疗对卫生保健费用的影响。 结果:1994-1995年登记报告的结核病病人近90％(239/269)为住院治疗。住院治疗的费用(平均长达2周)每人约5447澳元,总费用为1301833澳元。住院费用占费用总数的60％。而门诊治疗费用则为每人2260澳元。如90％病人均门诊治疗,总费用则可降至693670澳元。作者估计至少55％结核病病人门诊治疗将是可行的,这样可减少近30％的费用。 结论:病情不复杂的结核病病人事实上可不必常规住院治疗,但工业化国家则常如此。如果更多结核病病人在门诊治疗,可在资源利用上更符合费用一效益原则。

Bronchiolitis in young infants: is it a risk factor for recurrent wheezing in childhood?

Background:Acute bronchiolitis in infancy is considered a risk factor for recurrent wheezing episodes in childhood.The present study assessed prevalence,clinical manifestaffons and risk factors for recurrent wheezing events during the first 3 years of life and persistent wheezing events beyond this age in children hospitalized as young infants with acute bronchioliffs.

Distinctive serotypes of SARS-related coronaviruses defined by convalescent sera from unvaccinated individuals

Multiple Omicron sub-lineages have emerged,with Omicron XBB and XBB.1.5 subvariants becoming the dominant variants globally at the time of this study.The key feature of new variants is their ability to escape humoral immunity despite the fact that there are limited genetic changes from their preceding variants.This raises the question of whether Omicron should be regarded as a separate serotype from viruses serologically clustered with the ancestral severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus.Here,we present cross-neutralization data based on a pseudovirus neutralization test using convalescent sera from naïve individuals who had recovered from primary infection by SARS-CoV-1 and SARS-CoV-2 strains/variants including the ancestral virus and variants Beta,Delta,Omicron BA.1,Omicron BA.2 and Omicron BA.5.The results revealed no significant cross-neutralization in any of the three-way testing for SARS-CoV-1,ancestral SARS-CoV-2 and SARS-CoV-2 Omicron subvariants.The data argue for the assignment of three distinct serotypes for the currently known human-infecting SARS-related coronaviruses.

艰难梭菌:诊断和治疗

艰难梭菌(Clostridioides difficile,原名Clostridium)感染是医源性腹泻的主要原因,目前社区中越来越多见。历史上,艰难梭菌感染被认为是容易诊断和治疗的。然而,在过去的二十年里,随着对艰难梭菌感染的生理病理的认识,诊断技术已有变化,新型治疗药物也已使用。诊断的演变表明,对艰难梭菌感染诊断存在严重不足和误诊,强调了欧洲和北美传染病协会推荐的流程对获得可靠诊断的重要性。以前甲硝唑被认为是治疗艰难梭菌感染的参照药物,但最近研究表明万古霉素和其他较新的药物具有更高的治愈率。感染复发是评价新药的一项关键指标,而针对适用的人群选用合适的治疗药物则是一个挑战。对于多次复发者,推荐粪菌移植。新的方法,包括抗体、疫苗和新分子药物已经可用或正在试验中,需要更多的数据支持指南纳入的新疗法。本综述拟基于最新数据,为临床医生面对艰难梭菌感染时,了解并能分级选择诊治方案,提供一些常识。

Impact of HIV on the health-related quality of life in youth with perinatally acquired HIV

Background Studies investigating health-related quality of life(HRQoL)in youth with perinatally acquired HIV(PHIV+)are scarce.This study aimed to compare HRQoL of PHIV+to sociodemographic-matched youth not living with HIV(HIV-),Spanish general youth population,and to explore associations between sociodemographic variables,drug consumption,and HRQoL.Methods PHIV+youth were randomly selected from CoRISpe database(Cohort of the Spanish Pediatric HIV Network).HRQoL was evaluated by SF-12v2.Results Thirty-nine PHIV+youth(mean age:23.36 years,SD=3.83)and thirty-nine HIV-youth(mean age:22.97 years,SD=3.80)participated in this study.PHIV+obtained lower scores in SF-12 physical health subscale(PCS)than HIV-(P=0.001)and Spanish general youth population(P=0.006).PHIV+had lower scores on the mental health subscale(MCS)than the Spanish general youth population(P<0.001).PHIV+who were at school obtained better scores than those were not at school.PHIV+youth who had used cocaine and cannabis had lower scores in MCS(P=0.002).Conclusions There is a need for HRQoL management in the associated medical follow-up.