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Background: The prevalence of the Histoplasma capsulatum var. capsulatum ( Hcc) histoplasmosis may be underestimated West Africa, both because the diagnosis is not mentioned in the early stages of the disease and due to limited biological resources available. Case Report: We report a case of disseminated histoplasmosis due to Hcc in a Senegalese HIV patient. The diagnosis was suspected following the demonstration of small encapsulated yeasts within neutrophils on a thin blood smear. It was further confirmed using a specific real-time PCR applied on a DNA specimen extracted from the thin blood smear. Conclusion: To the best of our knowledge, this is the first case of Hcc infection diagnosed in Senegal. Blood smear may be a valuable screening tool in the case of bloodstream dissemination and can be used for further molecular approaches to confirm the diagnosis. [ABSTRACT FROM AUTHOR]

Résumé Justificatif Les données relatives à la pneumonie à Pneumocystis en Afrique sub-saharienne ne sont pas bien connues. La faiblesse du plateau technique et l’utilisation d’outils de diagnostic biologique peu sensibles sont parmi les raisons évoquées. L’objectif de cette étude est de réactualiser les données de l’affection au centre hospitalier universitaire de Fann à Dakar et d’évaluer les méthodes de diagnostic biologique utilisées. Matériel et méthodes Une étude prospective descriptive est réalisée du 5 janvier 2009 au 31 octobre 2011 au service de parasitologie-mycologie du centre hospitalier universitaire de Fann à Dakar. Les prélèvements du liquide de lavage broncho-alvéolaire reçus au laboratoire sont examinés au microscope par immunofluorescence indirecte ou après coloration au Giemsa ou au bleu de toluidine O pour la mise en évidence de Pneumocystis jirovecii. Résultats Cent quatre-vingt-trois prélèvements de liquide de lavage broncho-alvéolaire provenant de 183 patients sont reçus au laboratoire. Seize sont positifs pour la recherche de P. jirovecii , soit une fréquence de 9 %. Quatre parmi eux sont infectés par le VIH. L’immunofluorescence indirecte a permis de retrouver P. jirovecii chez les 16 patients alors que la coloration au Giemsa n’a détecté P. jirovecii que chez un seul patient. Aucun cas n’est diagnostiqué par le bleu de toluidine O. Conclusion La pneumonie à Pneumocystis au laboratoire de parasitologie-mycologie du centre hospitalier universitaire de Fann à Dakar est majoritairement diagnostiquée chez des patients infectés par le VIH. Summary Background Data relative to Pneumocystis pneumonia in sub-Saharan Africa are not well known. Weakness of the technical material and use of little sensitive biological tools of diagnosis are among the evoked reasons. The objective of this study is to update the data of the disease at the Fann Teaching Hospital in Dakar and to estimate biological methods used in diagnosis. Materials and methods A descriptive longitudinal study was carried out from January 5th, 2009 to October 31st, 2011 in the parasitology and mycology laboratory of the Fann Teaching Hospital in Dakar. The bronchoalveolar lavages received in the laboratory were examined microscopically for Pneumocystis jirovecii by indirect fluorescent assay or after Giemsa or toluidine blue O staining. Results One hundred and eighty-three bronchoalveolar lavages withdrawn from 183 patients were received in the laboratory. Sixteen were positive for P. jirovecii at 9% frequency. Four among these patients were HIV positive. Indirect fluorescent assay allowed finding of P. jirovecii among 16 patients while Giemsa staining discovered P. jirovecii only in a single patient. No case was diagnosed by toluidine blue O staining. Conclusion Pneumocystis pneumonia in Parasitology and Mycology Laboratory of Fann Teaching Hospital at Dakar was mainly diagnosed among HIV patients. [ABSTRACT FROM AUTHOR]

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Abstract Background In view of the high level of chloroquine resistance in many countries, WHO has recommended the use of combination therapy with artemisinin derivatives in the treatment of uncomplicated malaria due to Plasmodium falciparum. Four antimalarial drug combinations, artesunate plus amodiaquine (Arsucam®), artesunate plus mefloquine (Artequin®), artemether plus lumefantrine (Coartem®; four doses and six doses), and amodiaquine plus sulphadoxine-pyrimethamine, were studied in five health districts in Senegal. Methods This is a descriptive, analytical, open, randomized study to evaluate the efficacy and tolerability of these four antimalarial combinations in the treatment of uncomplicated falciparum malaria using the 2002 WHO protocol. Results All drug combinations demonstrated good efficacy. On day 28, all combinations resulted in an excellent clinical and parasitological response rate of 100% after correction for PCR results, except for the four-dose artemether-lumefantrine regimen (96.4%). Follow-up of approximately 10% of each treatment group on day 42 demonstrated an efficacy of 100%. The combinations were well tolerated clinically and biologically. No unexpected side-effect was observed and all side-effects disappeared at the end of treatment. No serious side-effect requiring premature termination of treatment was observed. Conclusion The four combinations are effective and well-tolerated.