Spinal concentrations of amoxicillin in purulent meningitis in children

Hundred and fifteen children suffering of purulent meningitis (S.pneumoniae: 19; H.influenzae: 44; N.meningitidis; 23; others: 29) were treated by amoxicillin 200 mg/kg/day in four intramuscular injections. Spinal taps for assay of antibiotic levels in the CSF were taken 1 or 3 or 6 hours after the injection. The levels were respectively for this samples of 6.9 -1.7-1.4 micrograms/ml during the first 48 hours of treatment and 4.4-1.7-1.9 after one week. The concentrations CSF/serum were from 5 to 9.8 per cent at the beginning of treatment.     

Virus de l''immunodéficience humaine et virus des hépatites virales C et B chez les patients drépanocytaires au CHU Campus de Lomé (Togo)

CONTEXT: The clinical features of sickle cell disease (SCD) are vaso-occlusive and/or hemolytic crises which treatment may require blood transfusions. OBJECTIVE: This study aimed to determine the prevalence of HIV, Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) infections in a population of SCD patients. METHODS: All the samples were analyzed by Elisa technique. We studied 119 sera for HIV using Elisa and a confirmation test in case of positive Elisa. We screened 91 sera for HCV and 119 sera for HBV. RESULTS: The prevalence was 5.04% for HIV, 6.5% for HCV and 20.2% for HBs Ag. Homozygous (SS) patients were more infected than compound heterozygous patients SC, (p < 0.02). 24.6% of the children (0 to 15 years of age) were infected as well as adults (35.5%). The Relative Risk to be contaminated was 7.14 for HIV, 4.29 for HCV and 5.43 for HBV in transfused compared to non transfused SCD patients. CONCLUSIONS: This high infectious risk in SCD patients should lead us to elaborate a better strategy to increase the safety of blood transfusion in Togo.     

Pediatric salmonellosis at the Tokoin's teaching hospital, Lomé (Togo)

OBJECTIVE: The authors had for aim to describe the epidemiological, clinical, and bacteriological aspects and outcome of pediatric Salmonella enterica, Salmonella septicemia, over the last 10 years. PATIENTS AND METHODS: We analyzed the case history of 132 patients hospitalized for Salmonellasepticemia (positive blood culture) between 1995 and 2004. RESULTS: Salmonellosis accounted for 0.36% of all hospitalizations. The mean age of patients was 5.86 plus or minus 4.06 years, significantly higher in patients with S. ser. Typhi (7.14+/-4.04 years) than in patients with other serotypes (4.95+/-3.8 years). The clinical presentation was severe in many children (with dehydration (34.8%) and emaciation (55.3%)), so HIV was suspected and investigated in 51 patients (38.6%). Eight patients were HIV positive. Three serotypes of S. enterica were predominant: S. ser. Typhi, 55 cases (41.7%), S. ser. Enteritidis, 32 cases (24.2%), and S. ser. Typhimurium, 19 cases (14.4%). The bacterial susceptibility to antibiotics was good for ceftriaxone and ciprofloxacin (100%). But 78.8% of the serotypes were resistant to amoxicillin, 75.4% to chloramphenicol, and 69.4% to cotrimoxazole. The mean duration of hospitalization was 13.7 plus or minus 7.4 days (range 4-34 days). Complications occurred in 15.9% of cases, dominated by digestive bleeding (10.6%), and 6.1% of patients died.     

Virological outcome among HIV-1 infected patients on first-line antiretroviral treatment in semi-rural HIV clinics in Togo

The development of HIV related pulmonary arterial hypertension (PAH) reduces the probability of survival by half as compared with HIV-infected individuals without HIV related PAH. HIV infected patients have a greater incidence of PAH compared to general population and have a 2500-fold increased risk of developing PAH. It is therefore important to have a recent overview of the problem in Africa, the most HIV affected part of the world (70 % of all HIV infection in the world). First, we discussed the epidemiology of HIV-related PAH in Africa. Second, the current understanding of the HIV-related PAH pathogenesis has been covered. Third, role of highly active antiretroviral therapy on HIV-related PAH has been revisited. There are few data concerning epidemiology of HIV related pulmonary hypertension in Africa leading to necessity to conduct further prospective large studies. The prevalence of PAH among HIV infected people in Africa varies from 5 to 13 %. The prevalence of HIV-related PAH in Africa is notably high compared to those in developed countries and in general population. The pathogenesis of PAH is clearly complex, and probably results from the interaction of multiple modulating genes with environmental factors. The physiopathology includes cytokines secretion increase which induces dysregulation of endothelial and vascular smooth muscle cell growth and imbalance of endogenous vasodilators and constrictors; HIV viral proteins which induces vascular oxidative stress, smooth myocyte proliferation and migration, and endothelial injury and genetic predisposition due to some major histocompatibility complex alleles, particularly HDL-DR6 and HLA-DR5. Histologically, HIV related PAH has the same characteristics with other types PAH. Antiretroviral therapy have a beneficial effect on the outcome of HIV related pulmonary hypertension, but it lacks evidence from large prospective studies.     

Confirmatory tests for human T-cell leukemia virus type 1 (HTLV-1): Western blot compared with RIPA on African sera

Confirmation of human T-Cell leukemia virus type 1 (HTLV-1) seropositivity calls for reactivity against at least 2 proteins encoded by 2 different genes, revealed by Western blot (WB) and /or radioimmuno-precipitation assay (RIPA). To evaluate the use of WB as a basis for applying these criteria, we conducted a study of two types of WB and compared them with RIPA patterns. The first part of the work, performed with 40 African sera, used Dupont de Nemours commercialized WB and an ‘in-house’ WB. Both WB detected antibody to proteins encoded by 2 different genes: antibody to gag products were revealed equally by both WB, but commercialized WB detected antibody to tax protein whereas the ‘in-house’ WB detected antibody to env protein (gp46) more efficiently.

The second part of the work, conducted with 158 African sera, compared results of an ‘in-house’ virus lysate WB and RIPA. Our data show a perfect concordance between the two procedures when sera were clearly positive by WB (gag + env reaction). Sera reacting to p19 and p24 (both gag) by WB were confirmed positive by RIPA in 75% of the cases. The majority of the indeterminate WB profiles not confirmed by RIPA presented isolated gag reactivity (p15 or p19 or p24).     

Seroepidemiology of human herpesvirus-6 in pregnant women from different parts of the world.

The prevalence of HHV-6 IgG was studied in 11 different countries across several continents: Morocco, Burkina-Faso, Congo, Ivory Coast, Mali, Niger, Senegal, Togo, Ecuador, Martinique, and France. The study group consisted of 550 pregnant women, representative of the general adult population in each country. Antibodies were detected by immunofluorescence assay on HSB-2 cells infected with HHV-6. Each serum was tested at nine dilutions (1:20 to 1:5,120), sera greater than or equal to 20 being considered positive. For the negative antigen control, we used mock-infected HSB-2 cells. Great differences were seen between separate areas: Morocco showed both low prevalence (20%) and a low geometric mean titer (12), whereas sub-Saharan Africa displayed high prevalences (60% to 90%) and variable geometric mean titers (34 to 229). This study revealed a prevalence of 92% for Ecuador, significantly higher than the prevalence for Martinique (50%), yet both countries had very low antibody titers compared with those found in Africa. The prevalence in France (76%) was similar to previous results from other European countries.     

Antimicrobial activity of ciprofloxacin and netilmicin compared to various antibiotics in Lome, Togo

We report the antimicrobial activity of ciprofloxacin and netilmicin on 577 strains such as S. aureus, Pseudomonas, E. coli, Salmonella, Proteus, Klebsiella and Enterobacter. Isolation and identification were performed by standard methods. Disk diffusion tests were performed to evalute the susceptibility. The percentage resistance to ciprofloxacin for bacteria was: E. coli = 15%, Enterobacter = 13%, Proteus = 10%, Pseudomonas = 9%, S. aureus and Klebsiella = 4%. The percentage resistance to netilmicin for bacteria was: Pseudomonas = 29%, Proteus = 26%, S. aureus = 21%, Enterobacter = 16%, Klebsiella = 14% and E. coli = 5%. The antimicrobial activity of ciprofloxacin and netilmicin was higher than that of others antibiotics.     

Epidemiology and prognosis of Haemophilus influenzae meningitis in Africa (901 cases)

Haemophilus influenzae meningitis are frequent in Africa in infants between 6 months and two years of age. Type b is observed in 97% of cases. In Dakar, 2% of strains are resistant to ampicillin and 0% to chloramphenicol. Lethality is about 30% and sequellae are very frequent. Prognosis can be predicted by a cotation scale including consciousness, tonus, seizures, nutritional status, delay before treatment and initial bacterial antigen level in CSF.     

HIV seroprevalence among inmates in Togo

Background

There is no data on HIV seroprevalence among prisoners in Togo.

Methods

A cross-sectional study was conducted among prisoners in Togo from November 2011 to January 2012. The study population was included by selecting the most densely populated prison in each of the six Togo regions, and by including prisoners (at least18 years of age and having been in prison for more than 30 days) on a voluntary basis. HIV prevalence was estimated with a 95% confidence interval (CI).

Results

One thousand three hundred and fourty-two prisoners were included in the study. Their median age was 28 years, (IQR 25–33 years) and 39 (2.9%) were women. The median time spent in the prison was 10 months, interquartile range [4–24 months]. HIV testing was accepted by 96.0%. HIV seroprevalence in prisons was 4.3%, 95 CI% [3.2–5.5%]. Few prisoners (2.9%) reported having had sex in prisons. The only factor associated with HIV infection was gender with an HIV seroprevalence of 14.3% for women compared to 4.0% for men (P = 0.003).

Conclusion

The prevention and the management of HIV infection should be a priority in Togolese prisons. This requires implementing healthcare facilities in prisons.     

Comparison of immunofluorescence, particle agglutination, and enzyme immunoassays for detection of human T-cell leukemia virus type I antibody in African sera.

The effectiveness of four screening tests for detecting antibody to human T-cell leukemia virus type I (HTLV-I) was determined by using 2,700 African serum specimens. The tests studied were indirect immunofluorescence, particle agglutination from Fujirebio, and two enzyme immunoassays, one from Abbott Laboratories that used virus lysate from HUT 102 cells and the other from Cambridge BioScience Corp. that used an env recombinant protein. Positive and doubtful sera were confirmed by Western immunoblot and radioimmunoprecipitation assay with Food and Drug Administration seropositivity criteria. The best results were obtained with the two enzyme immunoassays, which were more sensitive (100 and 98.6% [Abbott and Cambridge, respectively]) and more specific (98.7 and 96.5%). Indirect immunofluorescence exhibited difficulties for reading and interpretation. With particle agglutination, prozone was observed for 9 of 78 HTLV-I-positive serum specimens. False-positives in any of the tests were not linked to cross-reactions with human immunodeficiency viruses. However, confirmation tests remain necessary for HTLV-I screening.