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Introduction : Les detresses respiratoires sont une cause majeure de morbidite et de mortalite en pediatrie ; l’objectif de notre etude etait d’etudier les aspects epidemiocliniques des detresses respiratoires chez les enfants âges de 1 a 59 mois dans le service de pediatrie de CHU. Gabriel Toure. Methodologie : Il s’agit d’une etude transversale descriptive sur douze mois du 1 er au 31 decembre 2012 au service de pediatrie du CHU Gabriel Toure Bamako Mali. Tous les enfants de 1 a 59 mois presentant une detresse respiratoire ont ete inclus. Resultats : Ainsi 678 dossiers d’enfants en detresse respiratoire sur un total de 2241 hospitalises en pediatrie ont ete analyses soit un taux d’admission de 30,25%. 64,75% des enfants avaient un âge compris entre 1 et 11 mois. Le sex-ratio etait de 1,38 en faveur des garcons; les signes de lutte respiratoire (battement des ailes du nez, tirage intercostal et le geignement) etaient presents dans 96,22%. La pathologie pulmonaire la plus frequente etait la pneumonie (68,36%) celle extra-pulmonaire etait le paludisme grave (11,80%). Le taux de mortalite etait de 20,65%. Conclusion : les detresses respiratoires restent une importante cause de mortalite du nourrisson dans notre contexte avec des problemes majeurs de prise en charge Mots cles : Detresse respiratoire, Sante publique, Pediatrie

Resume Objectif Etudier entre 1996 et 2006, l’evolution des schemas therapeutiques et du profil clinique et immunologique des patients infectes par le VIH au debut du traitement antiretroviral (TARV) en Afrique de l’Ouest. Cadre et methode Les donnees issues de 12 centres cliniques adultes (IeDEA West Africa reseau collaboratif de prise en charge de l’infection a VIH) de cinq pays (Benin, Cote d’Ivoire, Senegal, Gambie, Mali) ont ete mises en commun et analysees. Les patients âges de 16 ans et plus dont le sexe, la date de naissance et la date d’initiation du TARV etaient connus ont ete inclus dans cette etude. Resultats Quatorze mille quatre-cent-quatre-vingt-seize patients avaient debute un TARV entre 1996–2006 avec 55 % des patients l’ayant debute entre 2005–2006. La proportion de femmes etait de 46 % en 1996–2000 et de 63 % en 2005–2006. L’âge median a la mise sous traitement etait constant : 35 ans chez les femmes et 40 ans chez les hommes. La proportion de patients qui ont debute le TARV avec un taux de CD4 inferieur a 200 cellules/μl etait de 54 % en 1996–2000 et de 64 % en 2005–2006. Les combinaisons therapeutiques les plus prescrites etaient : AZT/3TC (ou d4T/DDI)/IDV (27 %) en 1996–2000 ; d4T (ou AZT)/3TC/EFV (59 %) en 2003–2004 ; et d4T/3TC/NVP (49 %) en 2005–2006. Les traitements de premiere ligne recommandes par l’OMS etaient debutes dans 83 % de cas en 2005–2006. Conclusion De nouvelles approches pour debuter un TARV plus precocement doivent etre developpees pour ameliorer la survie des patients sous TARV.

SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs.RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages.CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

Schistosoma haematobium-related morbidity was studied in the perennial irrigation area of Office du Niger and the small reservoirs area of Plateau Dogon in Mali. Questionnaire, clinical, parasitologic, and ultrasound examination data were collected from 1,041 individuals at the baseline survey in 1991; 705 were re-examined one year after treatment. At baseline, the overall prevalence of S. haematobium infection was 55.2%; half of those infected had no clinical symptoms and 30% had pathologic lesions. Both infection and morbidity were more frequent in children than in adults, with a peak prevalence at 7-14 years of age. The rates of lesions were more than twice as high in those heavily infected as in lightly infected individuals. Reagent strip testing for microhematuria was more sensitive in detecting individuals with pathologic lesions than in detecting individuals with infection. One year after treatment with praziquantel, more than 80% of the urinary tract lesions had cleared. It is concluded that S. haematobium-related morbidity is frequent in Mali, but passive case detection for treatment would not cover a great deal of early stages of the disease; active intervention using reagent strip testing for microhematuria at the most peripheral levels would be an efficient system for morbidity control and monitoring of control operations.

Background As access to antiretroviral drugs increases in developing countries, it will become increasingly important to monitor the emergence of resistance and to define the molecular pathways involved to identify optimal therapeutic regimens. Methods We performed genotypic resistance testing on plasma obtained from 101 HIV-infected treatment-naive individuals from Mali. Genotyping was carried out using the Virco protocols and HXB2 was used as the reference strain. Results CRF02_AG was the most common subtype, present in 71.3% of our patient population. Other subtypes included B, C, G, CRF06_CPX, CRF09_CPX, CRF01_AE, A2/CRF16_A2D, A1 and CRF13_CPX. A total of 9.9% [95% confidence interval (CI) 6.9–12.9%] of patients had at least one resistance mutation. The prevalences of mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 5% (95% CI 0.7–9.2%), 6% (95% CI 1.3–10.6%) and 0%, respectively. The most frequent mutations were T215A/Y for NRTIs and K103N/T for NNRTIs. One patient harboured three NRTI resistance mutations and one NNRTI mutation. This is the first reported case of multi-drug-resistant viral transmission in Mali. Polymorphisms at protease codons 10I/V and 33F potentially associated with resistance were observed in 18.8% and 1% of patients, respectively. Several polymorphisms in the C-terminal domain of reverse transcriptase were observed: A371V (in 63.4% of patients), G335D (76.2%), E399D (10.9%) and G333E (1%). Conclusion Primary resistance was seen in 9.9% of subjects, which is higher than previously reported in Mali. Taking into consideration other polymorphisms in protease such as L10I/V and 33F, primary resistance could reach 28.7% (95% CI 19.9–37.5%). Our study reflects the need to monitor the evolution of resistance on a regular basis and trends of transmitted resistance.

Eighteen patients hospitalized with intestinal parasitic infections associated with diarrhea and dehydration completed a study of nitazoxanide in the treatment of Cryptosporidium parvum and other intestinal parasitic infections. Seventeen of the 18 patients were positive for human immunodeficiency virus. Twelve patients were diagnosed with clinical Stage 4 acquired immunodeficiency syndrome (AIDS) according to the 1990 World Health Organization proposed clinical classification system and cryptosporidiosis. Nitazoxanide (500 mg tablets) were administered orally, one tablet twice a day for seven consecutive days. Cryptosporidium parvum oocysts were eradicated or reduced by more than 95% in seven of the 12 Stage 4 AIDS patients who completed the study based upon two post-treatment fecal examinations conducted on days 7 and 14 following the initiation of treatment. The elimination or reduction of C. parvum oocysts was associated with a complete resolution of diarrhea in four of the seven patients. The test drug was also effective against cases of Isospora belli, Entamoeba histolytica, Giardia lamblia, Ascaris lumbricoides, Enterobius vermicularis, Hymenolepis nana, and Dicrocoelium dentriticum. Treatment with nitazoxanide was well tolerated by the patients. There were no abnormalities in blood chemistry or hematology data that were considered to be attributable to nitazoxanide therapy. Transient episodes of vomiting were observed in four patients, all with Stage 4 AIDS and cryptosporidiosis, which resolved spontaneously without discontinuation of treatment and were not considered to be related to administration of nitazoxanide.The effectiveness of nitazoxanide in the treatment of Cryptosporidium parvum and other intestinal parasitic diseases was assessed in 18 patients hospitalized at Point G. National Hospital in Bamako, Mali, with parasite-related diarrhea, dehydration, and weight loss. 17 of the 18 patients were infected with HIV, and 12 of these had progressed to clinical stage 4 AIDS. 500 mg tablets of nitazoxanide were administered twice a day for 7 days. After completion of treatment, Cryptosporidium parvum oocysts were eradicated or reduced by more than 95% in 7 of the stage 4 AIDS patients; diarrhea was completely resolved in 4 of these patients. Nitazoxanide was also effective against other parasites common in AIDS patients, including Entamoeba histolytica, Giardia lamblia, and Isospora belli. The test drug was well tolerated by all recipients, with no blood chemistry abnormalities.