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International audience; The identification of human-associated bacteria is very important to control infectious diseases. In recent years, we diversified culture conditions in a strategy named culturomics, and isolated more than 100 new bacterial species and/or genera. Using this strategy, strain GM7, a strictly anaerobic gram-negative bacterium was recently isolated from a stool specimen of a healthy Gabonese patient. It is a motile coccobacillus without catalase and oxidase activities. The genome of Gabonibacter massiliensis is 3,397,022 bp long with 2880 ORFs and a G+C content of 42.09 %. Of the predicted genes, 2,819 are protein-coding genes, and 61 are RNAs. Strain GM7 differs from the closest genera within the family Porphyromonadaceae both genotypically and in shape and motility. Thus, we propose that strain GM7(T) (=CSUR P2336 = DSM 101039) is the type strain of the new genus Gabonibacter gen. nov. and the new species G. massiliensis gen. nov., sp. nov.

ERMA; International audience; BACKGROUND: Data supporting epidemiological transition from a predominant burden of infectious diseases to one of chronic diseases in Africa result mostly from hospital surveys. AIM: To estimate the cardiovascular disease (CVD) burden in Gabon. METHODS: The study was conducted in Ntoum (8765 inhabitants). All subjects aged greater or equal to 40 years were invited to participate. Participants were interviewed about CVD history and risk factors; they responded to questionnaires on claudication and angina and had a clinical examination, including lower limb pulse palpation and bilateral brachial pressure measurement. Subjects were considered to have CVD in case of history of CVD (coronary artery, cerebrovascular and peripheral arterial diseases), a positive questionnaire or an abnormal finding during clinical examination. RESULTS: The study included 736 subjects (313 men; 423 women). Systolic hypertension was highly prevalent (up to 47.7% and 53.7% in men and women aged 50 to 60 years, respectively). Of the 382 patients with hypertension, 74 (19.4%) were treated and only 22 (5.8%) were considered to have controlled hypertension. Overall, CVD was identified in 98 (13.3%) cases. Overall and newly diagnosed CVD prevalence rates were 14.7% and 11.5% for men and 14.9% and 8.9% for women, respectively. The presence of CVD was associated with hypertension (hazard ratio [HR] 3.69, 95% confidence interval [CI] 2.21-6.16; P

International audience; PURPOSE: Estimate the prevalence of epilepsy in the 15 years and older in Benin. METHODS: We used a random multistage sampling design to select a representative sample of the 15 years and older in Benin. From March to May 2010, people were screened door-to-door in the twelve regions of Benin. Screening and data collection were performed using a validated standardised questionnaire of epilepsy in tropical regions. A neurologist examined all people suspected of epilepsy. RESULTS: We identified 174 suspected epilepsy cases from 13,046 screened people; 105 were confirmed by the neurologist (54 men and 51 women). The mean age of PWE was 28.9±14.3 years. The estimate of crude prevalence of epilepsy in the 15 years and older in Benin was 8.05/1000 (95% CI: 6.52-9.58/1000). The crude prevalence of epilepsy among men was 9.77/1000 (95% CI 7.35-12.73/1000) and 6.79/1000 (95% CI 5.06-8.91/1000) for women. The age-adjusted prevalence of epilepsy on sub-Saharan Africa population was 8.25/1000 and 7.33/1000 on world population. Substantial heterogeneity was noted, with differences from one region to another. The most common seizure types were generalised tonic-clonic (80.0%), partial secondary generalised seizures (14.3%) and partial seizures (5.7%). SIGNIFICANCE: This nationwide study is the first in West Africa. It provides a low prevalence of epilepsy in Benin compared to previous studies performed in this country and in neighbouring countries. Restricted-area studies are often motivated by the presence of specific risk factors and could overestimate the prevalence, while large-scale studies could underestimate other subtle forms of epilepsy.

Background Malaria remains a major public health problem, due largely to emergence and widespread P. falciparum drug resistance. WHO recommends artemisinine combination based therapy (ACT) to overcome P. falciparum drug resistance, but reports of declining ACT efficacy have been published. A thorough understanding of the molecular bases of P. falciparum resistance to existing drugs is therefore needed. The aims of this study were to analyze the in vitro sensitivity of P. falciparum field isolates from Franceville, Gabon, to chloroquine (CQ), mefloquine (MF), dihydroartemisinine (DHA) and monodesethylamodiaquine (MDAQ), and to investigate polymorphisms associated with drug resistance. Methods We conducted a cross-sectional study of 53 field isolates. Field isolates sensitivity to CQ, MF, DHA and MDAQ was assessed using the colorimetric DELI test. The Pfmdr1 codons 86 and 1246, Pfcrt (haplotype codon 72 to 76) and the PfATPAse6 codons 110 and 2694 were analysed by PCR-RFLP. Associations between drug sensitivity and parasite gene polymorphisms were evaluated with the Chi square test, and routine hematological parameters were analyzed with Fisher’s exact test implemented with Epinfo software. In all statistical tests, significance was assumed at p Results A total of 46 P. falciparum isolates were successfully cultured in vitro and their sensitivity was tested. The proportions of isolates resistant to CQ, MF and MDAQ were 43.5%, 23.4% and 56.5%, respectively. Some isolates (23.9%) had DHA IC50 values higher than 10 nM. The median IC50 values were 71.67 (interquartile range (IQR, 1–438.2), 6.59 (IQR, 0.08-96), 64.79 (IQR, 0.09-448) and 6.45 nM (IQR, 0.09-23) for CQ, MF, MDAQ and DHA, respectively. The strongest correlation between diminished DHA sensitivity and MF resistance was observed (r2=0.73), followed by correlation between diminished DHA sensitivity and CQ resistance. Cross-resistance between CQ and MF was also observed. The prevalence of the 86Y and 1246Y mutations in Pfmdr1, 76T in Pfcrt, and 110A and 2694T in PfATPase6 was respectively 42% and 17.1%, 97.8%, and 0% and 22.2%. Conclusion These high levels of antimalarial drug resistance in Franceville, Gabon, call for reinforced surveillance of drug efficacy.

International audience; PURPOSE: The need for comparable epidemiologic data on epilepsy from various locations in tropical areas has led in 1994 to the creation of a questionnaire able to standardize information. The Limoges' questionnaire was created to collect information independently of the objectives of each survey performed, and since it has been employed in various continents under tropics latitude. In Africa between 1994 and 2004, 13 epidemiologic surveys in 12 countries were performed by this means. Authors of these works were solicited to communicate their raw data on people with epilepsy (PWE). METHODS: Information collected was aggregated in a database upon which operations of data management were processed. Undernutrition status was determined using an anthropologic method, according World Health Organization (WHO) recommendations. Factors associated with undernutrition and absence of treatment by phenobarbitone were searched for by using multivariate logistic regression. KEY FINDINGS: Information about 2,269 PWE was collected. Mean treatment gap and undernutrition were determined, respectively, to be 30.6% [95% confidence interval (95% CI) 28.7-32.6] and 25.4% (95% CI 22.7-28.2). Factors significantly associated with undernutrition and not being treated with phenobarbitone were determined. SIGNIFICANCE: Despite the different purposes of each study, we were able to pool information in order to characterize and study particular traits of PWE in Africa. Some items of particular importance should be collected systematically and will be highlighted in a newer version of this questionnaire. Because many surveys were undertaken using this tool in tropical areas, a backward compatibility should be ensured.

International audience; PURPOSE: The association between cysticercosis and epilepsy has been widely studied in Latin America and Asia and has proven to be one of the main causes of epilepsy. Despite high prevalences of both diseases in Africa, their association remains unclear. In this article we quantified the strength of the association between epilepsy and cysticercosis in Africa and we proposed some guidelines for future studies. METHODS: We performed a systematic review of literature on cysticercosis (considered as exposure) and epilepsy (considered as the disease) and collected data from both cross-sectional and case-control studies. A common odds ratio was estimated using a random-effects meta-analysis model of aggregate published data. RESULTS: Among 21 retrieved documents, 11 studies located in 8 African countries were included in the meta-analysis. Odds ratio of developing epilepsy when presenting cysticercosis (defined as Taenia solium seropositivity) ranged from 1.3-6.1. Overall, association between cysticercosis and epilepsy was found significant with a common odds ratio of 3.4 [95% confidence interval (CI) 2.7-4.3; p < 0.001]. DISCUSSION: The variability of the association found between the studies could be due to differences in study design or in pathogenesis of cysticercosis. Further studies should overcome identified problems by following some guidelines to improve epidemiologic and clinical assessment of the association. Better understanding of the relation between cysticercosis and epilepsy is a key issue in improving prevention of epilepsy in Africa.

International audience; Pediatric drug formulations of artemisinin combination therapies are urgently needed for improving the treatment of children suffering from uncomplicated malaria. The aim of this clinical trial was to evaluate the efficacy, safety and tolerability of a novel pediatric fixed-dose granule formulation of artesunate-mefloquine and a new co-blister tablet formulation. A total of 71 children aged 1-13 years suffering from uncomplicated falciparum malaria were stratified into two groups according to weight: 10-20 kg, pediatric group (n = 41); 20-40 kg, tablet group (n = 30). All the children were treated once daily for three days: the pediatric group received the novel granule formulation, the tablet group received the co-blister tablets. The PCR-corrected cure rate on day 28 was evaluated. There was no reappearance of parasitemia during the follow-up period and the day-28 cure rate was therefore 100% in per-protocol analysis. In intention-to-treat analysis the cure rates were 95% in the pediatric group and 97% in the tablet group. The most frequent adverse events were vomiting (17%), abdominal pain (11%) and headache (17%). This study confirms the excellent efficacy and favorable safety and tolerability profile of a novel pediatric artesunate-mefloquine formulation for treatment in African children.

International audience; A laboratory-confirmed diagnosis is the basis of malaria case management. Rapid diagnostic tests (RDTs) create new opportunities for improved care in endemic areas. Diagnostic performance of OptiMAL-IT and Acon was assessed in comparison with microscopy at 2 sites in Gabon. Between February 2008 and January 2009, 2125 febrile children under 11 years old were diagnosed using microscopy and RDTs. Plasmodial infection was detected more frequently using Acon (27%) and OptiMAL-IT (27%) compared to microscopy (20%) (P < 0.01). Among the samples diagnosed positive by OptiMAL-IT, 78% were infected by Plasmodium falciparum, whereas 99% of positive blood smears were P. falciparum infections, 0.5% Plasmodium malariae, and 0.5% Plasmodium ovale. Both RDTs had similar sensitivity (Se) (94.0%; 95% confidence interval [CI], 92-96), which varied depending on the site. When parasite density was >100 p/microL, the Se of the 2 tests was >98% (95% CI, 96-100). Likewise, the negative predictive values were high and comparable (>98%). Overtreatment with antimalarial drugs was 12%. These tests should be considered as a good alternative to microscopy, allowing not only an efficient and rapid diagnosis of malaria in primary health facilities but also to aid in promoting changes for antimalarial prescription behavior.

INTRODUCTION: Several neurological complications are associated with cerebral malaria (CM). However, few long-term data from childhood survivors have been published. METHODS: A cross-sectional study was carried out in Mali among children followed from 1999 to 2002 after serious and complicated malaria. Our aim was to evaluate the persistent neurological sequelae associated with CM. RESULTS: This study concerned 101 subjects who had had CM. Mean age was 5.6+/-3.6 years. Twenty-eight children presented persistent neurological sequelae (27.7p.cent). Among them eight (7.9p.cent) children had developed these sequelae just after CM and 20 (19.8p.cent) a few months later: headaches, mental retardation, speech delay, bucco-facial dyspraxia, diplegia and frontal syndrome (one case each), dystonia (two cases), epilepsy (five cases) and behavior and attention disorders (15 cases). CONCLUSIONS: In this study, we show that neurological signs due to CM can persist in the long run. Long-term follow-up and proper management after CM are essential.

International audience; PURPOSE: Cerebral malaria (CM) is suspected to be a potential cause of epilepsy in tropical areas. The purpose of this article was to evaluate the relationship between CM and epilepsy in Gabon. METHODS: A matched case-control study was carried out on a sample of subjects aged six months to 25 years and hospitalized between 1990 and 2004 in three hospitals in Libreville, Gabon. Cases were defined as patients suffering from epilepsy and confirmed by a neurologist. Controls were defined as patients without epilepsy. The exposure of interest was CM according to WHO criteria. RESULTS: In total, 296 cases and 296 controls were included. Of these, 36 (26 cases and 10 controls) had a CM history. The adjusted odds ratio (aOR) to develop epilepsy after CM was 3.9 [95% CI: 1.7-8.9], p

International audience; PURPOSE: Cerebral malaria (CM) is suspected to be a potential cause of epilepsy in tropical areas, but little information is available. The purpose of this study was to evaluate the role of CM in epilepsy among children in Mali. METHODS: An exposed-nonexposed study was performed to identify children who had epilepsy after malaria in the 0- to 15-year age group. The exposure factor was CM defined according to World Health Organization (WHO) criteria, and the nonexposure factor was symptomatic malaria without the characteristics of CM (NCM). All the children underwent a screening questionnaire and were examined by a medical physician. After the screening phase, a specialist in neuropediatrics examined the children suspected to have epilepsy. EEG and computed tomography (CT) scans were performed in some of these patients. RESULTS: In total, 101 subjects who had had CM and 222 who had had NCM were included. Fifty-four children (CM, 34; NCM, 20) were suspected to have epilepsy, and six were confirmed (CM, five; NCM, one). The incidence rate was 17.0 per 1000 person-years in the CM group and 1.8 per 1000 person-year in the NCM group; thus the relative risk (RR) was 9.4 [95% confidence interval (CI), 1.3-80.3; p = 0.02]. After adjustment on age and duration of follow-up, the RR was 14.3 (95% CI, 1.6-132.0; p = 0.01). CONCLUSIONS: The risk of sequelar epilepsy is significantly higher in the CM group compared with the NCM group. A reevaluation of this cohort should be carried out later to search for temporal epilepsy that appeared after age 10 years.