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In December 2023, we observed through hospital-based surveillance a severe outbreak of enterovirus D68 infection in pediatric inpatients in Dakar, Senegal. Molecular characterization revealed that subclade B3, the dominant lineage in outbreaks worldwide, was responsible for the outbreak. Enhanced surveillance in inpatient settings, including among patients with neurologic illnesses, is needed.

Abstract Sorindeia nitidula (Anacardiaceae) is used by traditional practitioners to treat influenza illnesses with cephalgia and febrile aches. However, the potential active ingredients for its remarkable antioxidant, anti-HIV and antitrypanosomal activities remain unexplored. The present study aims to evaluate the antioxidant, anti-HIV and antitrypanosomal activities of the ethyl acetate extract of S. nitidula (SN) in order to screen out the bioactive compounds and to analyze their possible mechanisms of action. Overall, 21 phenolic compounds were annotated, by using the MS and MS/MS information provided by the QTOF-MS. In vitro assays on the extract revealed potent antioxidant (IC50 = 0.0129 ± 0.0001 mg/mL), anti-HIV (IC50 = 1.736 ± 0.036 µM), antitrypanosomal (IC50 = 1.040 ± 0.010 µM) activities. Furthermore, SN did not present cytotoxic effect on HeLa cancer cell lines. The integrated strategy based on LC-ESI-QTOF-MS/MS provided a powerful tool and a multidimensional perspective for further exploration of active ingredients in S. nitidula responsible for the antioxidant, anti-HIV and antitrypanosomal activities.

Abstract While the SARS-CoV-2 dynamic has been described globally, there is a lack of data from Sub-Saharan Africa. We herein report the dynamics of SARS-CoV-2 lineages from March 2020 to March 2022 in Cameroon. Of the 760 whole-genome sequences successfully generated by the national genomic surveillance network, 74% were viral sub-lineages of origin and non-variants of concern, 15% Delta, 6% Omicron, 3% Alpha and 2% Beta variants. The pandemic was driven by SARS-CoV-2 lineages of origin in wave 1 (16 weeks, 2.3% CFR), the Alpha and Beta variants in wave 2 (21 weeks, 1.6% CFR), Delta variants in wave 3 (11 weeks, 2.0% CFR), and omicron variants in wave 4 (8 weeks, 0.73% CFR), with a declining trend over time (p = 0.01208). Even though SARS-CoV-2 heterogeneity did not seemingly contribute to the breadth of transmission, the viral lineages of origin and especially the Delta variants appeared as drivers of COVID-19 severity in Cameroon.

Abstract In 2022, many regions around the world experienced a severe respiratory syncytial virus (RSV) epidemic with an earlier-than-usual start and increased numbers of paediatric patients in emergency departments. Here we carried out this study to describe the epidemiology and genetic characteristics of RSV infection in patients hospitalized with severe acute respiratory infections in 2022. Samples were tested for RSV by multiplex real time reverse transcription polymerase chain reaction. Subsequently, a subset of RSV positive samples was selected for NGS sequencing. RSV was detected in 16.04%, among which RSV-A was confirmed in 7.5% and RSV-B in 76.7%. RSV infection were more identified in infants aged ≤ 11 months (83.3%) and a shift in the circulation pattern was observed, with highest incidences between September–November. Phylogenetic analyses revealed that all RSV-A strains belonged to GA2.3.5 genotype and all RSV-B strains to GB5.0.5a genotype. Three putative N-glycosylation sites at amino acid positions 103, 135, 237 were predicted among RSV-A strains, while four N-linked glycosylation sites at positions 81, 86, 231 and 294 were identified in RSV-B strains. Globally, our findings reveal an exclusive co-circulation of two genetic lineages of RSV within the pediatric population in Senegal, especially in infants aged ≤ 11 months.

Historically low levels of seasonal influenza circulation were reported during the first years of the COVID-19 pandemic and were mainly attributed to implementation of nonpharmaceutical interventions. In tropical regions, influenza’s seasonality differs largely, and data on this topic are scarce. We analyzed data from Senegal’s sentinel syndromic surveillance network before and after the start of the COVID-19 pandemic to assess changes in influenza circulation. We found that influenza shows year-round circulation in Senegal and has 2 distinct epidemic peaks: during January–March and during the rainy season in August–October. During 2021–2022, the expected January–March influenza peak completely disappeared, corresponding to periods of active SARS-CoV-2 circulation. We noted an unexpected influenza epidemic peak during May–July 2022. The observed reciprocal circulation of SARS-CoV-2 and influenza suggests that factors such as viral interference might be at play and should be further investigated in tropical settings.

Abstract During the COVID-19 pandemic in Senegal, contact tracing was done to identify transmission clusters, their analysis allowed to understand their dynamics and evolution. In this study, we used information from the surveillance data and phone interviews to construct, represent and analyze COVID-19 transmission clusters from March 2, 2020, to May 31, 2021. In total, 114,040 samples were tested and 2153 transmission clusters identified. A maximum of 7 generations of secondary infections were noted. Clusters had an average of 29.58 members and 7.63 infected among them; their average duration was 27.95 days. Most of the clusters (77.3%) are concentrated in Dakar, capital city of Senegal. The 29 cases identified as super-spreaders, i.e., the indexes that had the most positive contacts, showed few symptoms or were asymptomatic. Deepest transmission clusters are those with the highest percentage of asymptomatic members. The correlation between proportion of asymptomatic and degree of transmission clusters showed that asymptomatic strongly contributed to the continuity of transmission within clusters. During this pandemic, all the efforts towards epidemiological investigations, active case-contact detection, allowed to identify in a short delay growing clusters and help response teams to mitigate the spread of the disease.

Chronic hemodialysis (HD) patients are particularly vulnerable to coronavirus disease 2019 (COVID-19). We assessed the prevalence and psychosocial impact of COVID-19 in these patients in Senegal. This multicenter prospective, descriptive, and analytical study included 345 patients who had been on chronic HD for at least 1 month (average age = 49.67 ± 14.58 years; sex ratio: 1.14). Eighty-one patients (23.48%) believed that COVID-19 negatively impacted their dialysis treatment. In total, 257 patients (74.49%) perceived themselves to be at risk, and 128 patients (37.1%) were worried about attending the dialysis center. Only 109 patients (31.59%) were tested by polymerase chain reaction; 13 (11.92%) were positive. In total, 322 patients (93.6%) were informed through television or radio, 338 (97.97%) were aware of the barrier measures, and 83 (24.06%) had difficulty applying the barrier measures, mainly on transport. Masks were the best-known measure, as reported by 331 patients (95.94%). In a bivariate analysis, knowledge of the barrier measures was associated with education level (P

Abstract Profiling of the antibody responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) proteins in African populations is scarce. Here, we performed a detailed IgM and IgG epitope mapping study against 487 peptides covering SARS-CoV-2 wild-type structural proteins. A panel of 41 pre-pandemic and 82 COVID-19 RT-PCR confirmed sera from Madagascar and Senegal were used. We found that the main 36 immunodominant linear epitopes identified were (i) similar in both countries, (ii) distributed mainly in the Spike and the Nucleocapsid proteins, (iii) located outside the RBD and NTD regions where most of the reported SARS-CoV-2 variant mutations occur, and (iv) identical to those reported in European, North American, and Asian studies. Within the severe group, antibody levels were inversely correlated with the viral load. This first antibody epitope mapping study performed in patients from two African countries may be helpful to guide rational peptide-based diagnostic assays or vaccine development.

Abstract Akkermansia muciniphila is a human intestinal tract bacterium that plays an important role in the mucus layer renewal. Several studies have demonstrated that it is a modulator for gut homeostasis and a probiotic for human health. The Akkermansia genus contains two species with standing in nomenclature but their genomic diversity remains unclear. In this study, eight new Akkermansia sp. strains were isolated from the human gut. Using the digital DNA-DNA hybridization (dDDH), average nucleotide identity (ANI) and core genome-based phylogenetic analysis applied to 104 A. muciniphila whole genomes sequences, strains were reclassified into three clusters. Cluster I groups A. muciniphila strains (including strain ATCC BAA-835T as type strain), whereas clusters II and III represent two new species. A member of cluster II, strain Marseille-P6666 differed from A. muciniphila strain ATCC BAA-835T and from A. glycaniphila strain PytT in its ability to grow in microaerophilic atmosphere up to 42 °C, to assimilate various carbon sources and to produce acids from a several compounds. The major fatty acids of strain Marseille-P6666 were 12-methyl-tetradecanoic and pentadecanoic acids. The DNA G + C content of strain Marseille-P6666 was 57.8%. On the basis of these properties, we propose the name A. massiliensis sp. nov. for members of cluster II, with strain Marseille-P6666T (= CSUR P6666 = CECT 30548) as type strain. We also propose the name “Candidatus Akkermansia timonensis” sp. nov. for the members of cluster III, which contains only uncultivated strains, strain Akk0196 being the type strain.

Environmental surveillance for poliovirus is increasingly used in poliovirus eradication efforts as a supplement to acute flaccid paralysis (AFP) surveillance. Environmental surveillance was officially established in 2017 in Senegal, where no poliovirus had been detected since 2010. We tested sewage samples from 2 sites in Dakar monthly for polioviruses. We identified a vaccine-derived poliovirus serotype 2 on January 19, 2021, from a sample collected on December 24, 2020; by December 31, 2021, we had detected 70 vaccine-derived poliovirus serotype 2 isolates circulating in 7 of 14 regions in Senegal. Sources included 18 AFP cases, 20 direct contacts, 17 contacts in the community, and 15 sewage samples. Phylogenetic analysis revealed the circulation of 2 clusters and provided evidence on the virus introduction from Guinea. Because novel oral polio vaccine serotype 2 was used for response activities throughout Senegal, we recommend expanding environmental surveillance into other regions.

Abstract Early predictions forecasted large numbers of severe acute respiratory syndrome coronavirus (SARS-CoV-2) cases and associated deaths in Africa. To date, Africa has been relatively spared. Various hypotheses were postulated to explain the lower than anticipated impact on public health in Africa. However, the contribution of pre-existing immunity is yet to be investigated. In this study, the presence of antibodies against SARS-CoV-2 spike (S) and nucleocapsid (N) proteins in pre-pandemic samples from Africa, Europe, South and North America was examined by ELISA. The protective efficacy of N specific antibodies isolated from Central African donors was tested by in vitro neutralization and in a mouse model of SARS-CoV-2 infection. Antibodies against SARS-CoV-2 S and N proteins were rare in all populations except in Gabon and Senegal where N specific antibodies were prevalent. However, these antibodies failed to neutralize the virus either in vitro or in vivo. Overall, this study indicates that cross-reactive immunity against SARS-CoV-2 N protein was present in Africa prior to the pandemic. However, this pre-existing humoral immunity does not impact viral fitness in rodents suggesting that other human immune defense mechanisms could be involved. In Africa, seroprevalence studies using the N protein are over-estimating SARS-CoV-2 circulation.

We conducted 2 independent population-based SARS-CoV-2 serosurveys in Yaoundé, Cameroon, during January 27–February 6 and April 24–May 19, 2021. Overall age-standardized SARS-CoV-2 IgG seroprevalence increased from 18.6% in the first survey to 51.3% in the second (p

Abstract The proprotein convertase PACE4 has demonstrated value as a viable therapeutic target in prostate cancer (PCa). A novel isoform named PACE4-altCT, which arises in neoplastic lesions, plays an important role in tumor progression and has been validated as a pharmacological target. With the discovery of its overexpression in PCa and the alternative splicing of its pre-RNA to generate an oncogenic C-terminally modified isoform named PACE4-altCT, understanding and validating its value as a potential biomarker is of great interest either from prognostic or targeted therapy intervention. Expression of ERG in LNCaP cells was used to investigate the relationship between ERG expression occurring in PCa cells and PACE4-altCT expression by Western blot and qPCR. Using immunohistochemistry, the expression levels of PACE4 isoforms in patient tissues were investigated and correlated with ERG tumor status and Gleason score. An ELISA method was developed using affinity purified recombinant protein and used for quantitative analysis of plasma concentrations of PACE4-altCT and used for correlation. In contrast with the consensual isoform, PACE4-altCT was only strongly overexpressed in prostate cancer patients, correlated with ERG expression levels. Despite its intracellular retention PACE4-altCT could be detected in the plasma of most patients with prostate cancer, whereas it was only found at low levels in normal patients whereas total plasmatic PACE4 levels did not vary significantly between groups. Our study demonstrates that PACE4-altCT is strongly overexpressed in prostate cancer using both immunohistochemical and ELISA techniques and may have some interesting potential as a biomarker.

This overview of severe acute respiratory syndrome coronavirus 2 circulation over 1.5 years in Guinea demonstrates that virus clades and variants of interest and concern were progressively introduced, mostly by travellers through Conakry, before spreading through the country. Sequencing is key to following virus evolution and establishing efficient control strategies.

We tested for enterovirus D68 in fecal samples collected during June–September 2016 from 567 patients with acute flaccid paralysis in 7 West Africa nations. Children

BackgroundThe novel coronavirus disease 2019 (COVID-19) pandemic has spread from China to the rest of the world. Africa seems less impacted with lower number of cases and deaths than other continents. Senegal recorded its first case on March 2, 2020. We present here data collected from March 2 to October 31, 2020 in Senegal.MethodsSocio-demographic, epidemiological, clinical and virological information were collected on suspected cases. To determine factors associated with diagnosed infection, symptomatic disease and death, multivariable binary logistic regression and log binomial models were used. Epidemiological parameters such as the reproduction number and growth rate were estimated.Results67,608 suspected cases were tested by the IPD laboratories (13,031 positive and 54,577 negative). All age categories were associated with SARS-CoV-2 infection, but also patients having diabetes or hypertension or other cardiovascular diseases. With diagnosed infection, patients over 65 years and those with hypertension and cardiovascular disease and diabetes were highly associated with death. Patients with co-morbidities were associated with symptomatic disease, but only the under 15 years were not associated with. Among infected, 27.67% were asymptomatic (40.9% when contacts were systematically tested; 12.11% when only symptomatic or high-risk contacts were tested). Less than 15 years-old were mostly asymptomatic (63.2%). Dakar accounted for 81.4% of confirmed cases. The estimated mean serial interval was 5.57 (± 5.14) days. The average reproduction number was estimated at 1.161 (95%CI: 1.159-1.162), the growth rate was 0.031 (95%CI: 0.028-0.034) per day.ConclusionsOur findings indicated that factors associated with symptomatic COVID-19 and death are advanced age (over 65 years-old) and comorbidities such as diabetes and hypertension and cardiovascular disease.

The objective of this study was to determine the rates of virological failure (VF) and HIV drug resistance (HIVDR) amongst adolescents on antiretroviral Therapy (ART). A retrospectively designed study was conducted in 10 healthcare centers for adolescents living with HIV (ALHIV) in the two main cities of Cameroon (Yaoundé and Douala), from November 2018 to May 2019. Sociodemographic, clinical, therapeutic and laboratory parameters were collected from medical records. All enrolled ALHIV had viral load (VL) measurements following the national guidelines. All patients with a VL ≥ 1000 copies/ml were called to perform genotyping tests. The chi-square test was used to determine the factors associated with VF. Out of the 1316 medical records of ALHIV, we included 1083 ALHIV having a VL result. Among them, 276 (25.5%) were experiencing VF, and VF was significantly higher in ALHIV with suboptimal adherence (p

Sickle cell anemia (SCA) is caused by a single point variation in the β-globin gene (HBB): c.20A> T (p.Glu7Val), in homozygous state. SCA is characterized by sickling of red blood cells in small blood vessels which leads to a range of multiorgan complications, including kidney dysfunction. This case-control study aims at identifying sickle cell nephropathy biomarkers in a group of patients living with SCA from Senegal. A total of 163 patients living with SCA and 177 ethnic matched controls were investigated. Biological phenotyping included evaluation of glycemia, glucosuria, albuminuria, proteinuria, tubular proteinuria, serum creatinine, urine creatinine, urine specific gravity and glomerular filtration rate. Descriptive statistics of biomarkers were performed using the χ2 –test, with the significance level set at p

At the end of December 2019, they emerged a new coronavirus (SARS-CoV-2), triggering a pandemic of an acute respiratory syndrome (COVID-19) in humans. We report the relevant features of the first two confirmed cases of COVID-19 recorded from the 29th April 2020 in the Far North Region of Cameroon. We did a review of the files of these two patients who were admitted to the internal medicine ward of a medical Centre in Maroua Town, Far North Region. We present 2 cases of symptomatic COVID-19 patients, both males and health personnel, with an average age of 53 years, with no recent history of travel to a COVID-19 zone at risk and working in a then COVID-19 free region. They presented with extreme fatigue as their main symptom. Both were treated initially for severe malaria with quinine sulfate infusion with initial relief of symptoms. In the first confirmed case, at his re-hospitalization with an acute respiratory syndrome, a Polymerase chain reaction (PCR) test in search of SARS-COV-2 was requested with his results available 7 days into admission. For the second case, he had his results 48 hours on admission while he was prepared to be discharged. Both control PCR tests for COVID-19 came back negative 14 days after hospitalization. Health personnel remains a group at risk for the COVID-19 infection. The clinical manifestation at an early stage may be atypical mimicking endemic tropical infections. Also, the therapeutic potential of Quinine salts in the relief of symptoms of COVID-19 is questionable and remains a subject to explore in our context.

The spread of severe acute respiratory syndrome coronavirus 2 began later in Africa than in Asia and Europe. Senegal confirmed its first case of coronavirus disease on March 2, 2020. By March 4, a total of 4 cases had been confirmed, all in patients who traveled from Europe.

Abstract Ventricular noncompaction or hypertrabeculation is rare and unclassified cardiomyopathy that mostly affects the left ventricle. We report the case of biventricular hypertrabeculation in a 54‐year‐old woman who presented with congestive heart failure de novo associated with arrhythmia in a low‐income setting. We also discussed the therapeutic challenges.

Abstract Background The association of macrophage activation syndrome and primary Sjögren’s syndrome has been rarely reported in the literature. We report the first observation of this association in Africa, south of the Sahara, and we discuss the diagnosis and therapeutic challenge. Case presentation A 26-year-old Mauritanian and Berber woman was followed for primary Sjögren’s syndrome. After a voluntary cessation of her usual background treatment, she was admitted to our department for an outbreak of her illness. A clinical examination revealed anemic syndrome, peripheral polyarthritis, coughing rales at both pulmonary bases, and fever at 39.5 °C. On biologic examination, there was bicytopenia with anemia at 5.70 g/dl, lymphopenia at 796/mm3, a biological inflammatory syndrome with a sedimentation rate at 137 mm in the first hour, C-reactive protein at 97 mg/l, hyperferritinemia at 1778 mg/l (9 normal value), and hypergammaglobulinemia at 20.7 g/l of polyclonal appearance. The triglycerides were 1.95 g/l (1.4 normal value) and the lactate dehydrogenase level was 491 IU/l (1.5 normal value). Cytological examination of a medullary puncture revealed an image of hemophagocytosis. An infectious screening was negative. Thoracic computed tomography showed non-specific interstitial lung disease. A diagnosis of macrophage activation syndrome complicating primary Sjögren’s syndrome was selected with a probability of 97.2%, according to H-Score. The evolution was favorable under a treatment including etoposide (VP-16). Conclusion Macrophage activation syndrome is a rare entity, rarely reported during primary Sjögren’s syndrome. Its spontaneous evolution is invariably fatal. There is no consensus on therapeutic treatment. Etoposide is a therapeutic option especially in forms refractory to corticosteroid therapy.

To retrospectively investigate enterovirus D68 circulation in Senegal during the 2014 US outbreak, we retrieved specimens from 708 persons, mostly children, who had acute respiratory symptoms during September–December 2014. Enterovirus D68 was detected in 14 children (2.1%); most cases occurred in October. Phylogenetic analysis revealed that all strains clustered within subclade A1.

Introduction: la polyarthrite rhumatoïde est une maladie auto-immune systémique d’origine multifactorielle mettant en jeu des facteurs génétiques et environnementaux. L’existence de ces facteurs est à l’origine d’une prédisposition familiale de la maladie. Les études sur ces formes familiales de la PR n’ont jamais été réalisées en Afrique, ce qui justifie la présente étude.. Matériels et méthodes: étude transversale descriptive réalisée dans le service de Rhumatologie du CHU Aristide Le Dantec, Dakar, Sénégal du 1er Janvier 2013 au 31 Mars 2016. Nous avons colligé les observations de familles multiplex de PR répondant aux critères ACR/EULAR de 2010, avec confection de l’arbre généalogique et dépistage systématique chez les apparentés. Résultats: dix-sept familles ont été colligées à partir de 17 cas index dont 13 femmes et 4 hommes, d’âge moyen 31 ans au moment du diagnostic. Les familles totalisaient 716 membres. Le taux de consanguinité était de 42,3%. 49 membres présentaient une PR, soit une prévalence familiale de 6,8%. Les apparentés au 1er degré étaient les plus atteints avec 26 cas. Les autres MAI retrouvées chez les apparentés étaient le syndrome de Gougerot-Sjögren (10 cas), le vitiligo (1 cas), la maladie de Basedow (1 cas). L’évolution sous traitement symptomatique et de fond fut globalement favorable. Conclusion: le caractère familial de la PR chez nos malades plaide en faveur de l’implication de facteurs génétiques dans le déterminisme de la maladie. L’étude se poursuit afin de déterminer ces facteurs génétiques impliqués dans cette affection.

Abstract Introduction Several anthropometric measurements are variably recommended to assess adiposity in routine practice, with less agreement on their comparative performance. We assessed and compared the relationship of seven anthropometric measures of adiposity—waist circumference (WC), waist‐to‐height ratio (WHtR), Body Mass Index (BMI), Ponderal Index (PI), Conicity Index (C index), A Body Shape Index (ABSI), and Body Roundness Index (BRI)—with blood pressure (BP) levels and prevalent hypertension in adult Cameroonians. Methods Data were collected as Cameroon's contribution to the global May Measurement Month 2017(MMM17) survey. Participants were nonpregnant adults, who had no BP measurement in the past year and with no prior hypertension diagnosis. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic ≥90 mm Hg. Odds ratios (ORs) for the presence of hypertension per 1 SD increase in each adiposity metrics were estimated in separate logistic regression models. Assessment and comparison of discrimination used the area under the receiver operating characteristics curve (AUC) and nonparametric methods. Results We included 14 424 participants (8210 [58.25%] female; 39.84 ± 14.33 years). There was a graded association between measures of adiposity and prevalent screen‐detected (newly diagnosed) hypertension, with effect sizes being mostly within the same range across measures of adiposity. AUC for hypertension prediction ranged from 0.709 with PI to 0.721 with BRI for single measures, and from 0.736 to 0.739 with combinations of measures of adiposity. Conclusion WC, WHtR, and BRI were strongly associated with BP and better predicted prevalent hypertension, with effects enhanced with the inclusion of BMI.

Decompressive craniectomy is a surgical technique considered to be the last step in the management of intracranial hypertension. The objective of our study was to evaluate our results in the management of intracranial hypertension by decompressive craniectomy. This was a retrospective study of 24 cases of decompressive craniectomy performed over a 9-year period (from January 2010 to December 2019) at the Fann Neurosurgery Clinic. The mean age of the patients was 33.82 years, there was a male predominance with a sex ratio of 2.42. The most frequent indication was severe cranioencephalic trauma with 50%. The cerebral CT scan was the key examination and was performed in all our patients. Complications were entirely infectious and were the cause of 73.33% of deaths. Thirty-five percent of the patients had received prior treatment before the decompressive craniectomy. The functional prognosis was good in 44.44% of cases, moderate in 33.33% of cases, 1 (11.11%) patient had a severe disability and 1 (11.11%) patient was in a vegetative state. Mortality was 62.5% of patients in our study series. Despite the lack of sophisticated techniques for diagnosis and monitoring of intracranial hypertension, our results remain acceptable with 37.5% survival. The early completion of this surgery allows us to be more efficient with a significant reduction in morbidity and mortality.

INTRODUCTION: In Cameroon, data on viral hepatitis B infection in prison environments is limited. We determined the prevalence of hepatitis B infection (HBV) and correlates among prisoners incarcerated at the Douala New Bell Central Prison in Cameroon. METHODS: this was a cross-sectional study carried out in July 2018 and included 940 randomly selected prisoners. Data were collected using pre-tested questionnaire while blood screening for HBV surface antigen (HBs Ag) used rapid test, with confirmation via Elisa test. Sociodemographic characteristics and risk factors were compared among the three age groups with respect to the prison´s partitioning. Factors associated with positive HBs Ag were identified using logistic regression adjusted to age and gender. Confounders were then excluded by logistic multivariate analysis. All p values less than 0.05 were considered statistically significant.

ObjectiveIn the present study, we aimed to evaluate the virological failure (VF) and drug resistance among treated HIV-infected children after five years follow-up in the ANRS-Pediacam cohort in Cameroon.MethodsFrom November 2007 to October 2011, HIV-infected children born to HIV-infected mothers were included in the ANRS-PEDIACAM study and followed-up for more than 5 years. Plasma viral load (VL) was measured at each visit (every three months until month 24 and every 6 months thereafter). VF was the main outcome and HIV drug resistance test was performed using the ANRS procedures and algorithm.ResultsData from 155 children were analyzed. The median age at combination antiretroviral therapy (cART) initiation was 4.2 months (interquartile range (IQR): 3.2-5.8), with 103 (66.5%) children taking LPV/r-containing regimen and 51 (32.9%) children taking NVP. After five years follow-up, 63 (40.6%; CI: 32.9-48.8) children experienced VF. The median duration between cART initiation and VF was 22.1 months (IQR: 11.9-37.1) with a median VL of 4.8 log10 (IQR: 4.0-5.5). Among the 57 children with HIV drug resistance results, 40 (70.2%) had at least one drug resistance mutation. The highest resistance rates (30.4-66.1%) were obtained with Lamivudine; Efavirenz; Nevirapine and Rilpivirine.ConclusionsThese results show high resistance to NNRTI and emphasize the need of VL and resistance tests for optimal follow-up of HIV-infected people especially children.

Le diverticule de Zenker est une pathologie rare et généralement bénigne. Sa présence chez le malade en hémodialyse a des implications thérapeutiques et pronostiques et constitue un facteur de risque de morbi-mortalité du fait de ses complications comme la dénutrition protéino-énergétique et la pneumopathie. Nous rapportons le cas d'un diverticule de Zenker diagnostiqué chez une patiente hémodialysée chronique. Il s'agissait d'une patiente âgée de 61 ans, qui était reçue pour une hémorragie digestive haute accompagnée d'une dysphagie. L'examen physique trouvait une altération de l'état général avec une perte de poids estimée à 5 kg en 3 mois. Le transit œsogastroduodénal objectivait un refoulement de la portion cervicale de l'œsophage par une volumineuse image d'addition hétérogène dont le pôle supérieur se situe au niveau de la jonction pharyngo-œsophagienne. Le diagnostic d'un diverticule de Zenker avait été retenu. Une diverticulectomie par voie cervicale externe avait été réalisé. La patiente est décédée dans les suites postopératoires précoces d'une pneumopathie d'inhalation. Le diverticule de Zenker est une pathologie rare qui est généralement bénigne mais sa présence chez le malade hémodialysé chronique augmente sa morbi-mortalité.

Enterovirus A71 (EV-A71) is a non-polio enterovirus that currently represents a major public health concern worldwide. In Africa, only sporadic cases have been reported. Acute flaccid paralysis and environmental surveillance programs have been widely used as strategies for documenting the circulation of polio and non-polio enteroviruses. To date, little is known about the molecular epidemiology of enterovirus A71 in Africa where resources and diagnostic capacities are limited. To fill this gap in Senegal, a total of 521 non-polio enterovirus isolates collected from both acute flaccid paralysis (AFP) and environmental surveillance (ES) programs between 2013 and 2020 were screened for enterovirus A71 using real-time RT-PCR. Positive isolates were sequenced, and genomic data were analyzed using phylogeny. An overall rate of 1.72% (9/521) of the analyzed isolates tested positive for enterovirus A71. All positive isolates originated from the acute flaccid paralysis cases, and 44.4% (4/9) of them were isolated in 2016. The nine newly characterized sequences obtained in our study included eight complete polyprotein sequences and one partial sequence of the VP1 gene, all belonging to the C genogroup. Seven out of the eight complete polyprotein sequences belonged to the C2 subgenotype, while one of them grouped with previous sequences from the C1 subgenotype. The partial VP1 sequence belonged to the C1 subgenotype. Our data provide not only new insights into the recent molecular epidemiology of enterovirus A71 in Senegal but also point to the crucial need to set up specific surveillance programs targeting non-polio enteroviruses at country or regional levels in Africa for rapid identification emerging or re-emerging enteroviruses and better characterization of public health concerns causing acute flaccid paralysis in children such as enterovirus A71. To estimate the real distribution of EV-A71 in Africa, more sero-epidemiological studies should be promoted, particularly in countries where the virus has already been reported.

Abstract Objective This study aimed to describe the clinical characteristics of patients with infantile hypertrophic stenosis, management and its outcome in two tertiary care centres in Cameroon. Results A total of 21 patients were included from the two centres. The mean age at presentation was 5.2 ± 1.2 weeks, predominantly male with a male-to-female ratio of 4.25:1. The triad of vomiting, visible peristalsis and palpable mass was present in only 7 (33.3%) of the participants. The diagnosis was confirmed with ultrasounds in all participants. Ramstedt pyloromyotomy was done in all participants and in 9.5% of the participants it was complicated by intra-operative duodenal perforation whereas in the postoperative period the most common complications were vomiting (6, 28.6%), sepsis (2, 9.5%), and paralytic ileus (2, 9.5%). The mortality rate from the series is 9.5%. According to univariate logistic regression: severe dehydration [OR = 5.41, 95% CI = (3.11–6.97), p = 0.002], hypokalaemia [OR = 2.63, 95% CI = (1.02–5.91), p = 0.042] and surgical site infection [OR = 3.12, 95% CI (1.22–5.64), p = 0.023] were the main predictors of mortality whereas postoperative hospital length of stay > 5 days was significantly associated with surgical site infection [OR = 2.44, 95% CI = (1.12–6.44), p = 0.002] and postoperative nausea and vomiting [OR = 3.64, 95% CI = (1.18–6.64), p = 0.022].

L´objectif de ce travail était de faire un état des lieux de l´hémodialyse chronique pédiatrique au Sénégal. Il s´agissait d´une enquête transversale descriptive et analytique concernant tous les centres publics ayant admis des enfants en hémodialyse chronique du 1er janvier 2016 au 31 décembre 2017; sur les 08 centres fonctionnels à cette période, 06 ont été retenus. Au total, nous avions recensés 311 patients hémodialysés dont 08% (n=25) étaient des enfants. L´âge moyen des enfants dialysés était de 13,92 ans ± 3,67 ans. Le sex-ratio était de 0,66. Les glomérulonéphrites chroniques identifiées représentaient 24% (n=6) dont 50% (n=3) de HSF primitive. La fistule artério-veineuse (FAV) était utilisée dans 36% (n=9) des cas. Le consommable de dialyse utilisé était gratuit pour tous les enfants et leur famille (100%). La presque totalité des enfants dialysés 96% (n=24) étaient régulièrement hémodialysés à raison de trois séances par semaine. Le décès était observé chez 44% (n=11) au cours des 16 premiers mois après l´initiation à la dialyse. Parmi les patients vivants, 86% (n=12) étaient toujours en hémodialyse. Un patient avait été transféré en dialyse péritonéale continue ambulatoire (DPCA) et un autre transplanté en France grâce à un don intrafamilial; les débuts de l´hémodialyse pédiatrique au Sénégal étaient confrontés à de nombreuses difficultés liées au faible accès des enfants malgré la gratuité de la dialyse et le vote de la loi autorisant la transplantation rénale depuis décembre 2015. Nous recommandons l´élaboration d´un projet thérapeutique pour la prévention et la prise en charge des enfants atteints de maladie rénale chronique.

INTRODUCTION: Hypertensive diseases in pregnancy are the leading medical problem during pregnancy. Some of the women affected remain hypertensive after pregnancy and the post-partum period. This study aimed to assess the factors associated to the persistence of hypertension after preeclampsia.

The authors report the first case of successful peritoneal dialysis (PD) in a developing country performed about a 13-year-old adolescent followed-up for stage V chronic kidney disease (CKD) with anuria. After 3 months of hemodialysis, the parents opted for continuous ambulatory peritoneal dialysis (CAPD) as they wished to return home located 121km from Dakar. After PD catheter insertion, the plan proposed to the patient consisted 3-4 hours stasis of isotonic dialysate during the day and a night stasis of 8 hours of icodextrin for an injection volume of 1L per session. The patient and his mother were trained and assessed on the PD technique. After dialysis adequacy was tested while hospitalised, they were able to return home and continued the sessions following the same plan prescribed and while keeping in touch, by telephone, with the medical team. The technique assessment at the day hospital every 2 weeks revealed dialysis adequacy and satisfactory tolerance of PD at home after 04 months of observation. It was the first case of successful CAPD in the pediatrics unit in this context. Scaling this technique is a challenge for the pediatric nephrologist in developing countries like Senegal.

BackgroundLong-term growth in HIV-infected infants treated early in resource-limited settings is poorly documented. Incidence of growth retardation, instantaneous risk of death related to malnutrition and growth parameters evolution during the first five years of life of uninfected and early treated HIV-infected children were compared and associated factors with growth retardation were identified.MethodsWeight-for-age (WAZ), weight-for-length (WLZ), and length-for-age (LAZ) Z-scores were calculated. The ANRS-PEDIACAM cohort includes four groups of infants with three enrolled during the first week of life: HIV-infected (HI, n = 69), HIV-exposed uninfected (HEU, n = 205) and HIV-unexposed uninfected (HUU, n = 196). The last group included HIV-infected infants diagnosed before 7 months of age (HIL, n = 141). The multi-state Markov model was used to describe the incidence of growth retardation and identified associated factors.ResultsDuring the first 5 years, 27.5% of children experienced underweight (WAZConclusionsHIV-infected children remained at high risk of wasting and stunting within the first 5 years period of follow-up. There is a need of identifying suitable nutritional support and best ways to integrate it with cART in pediatric HIV infection global care.

La communication interauriculaire (CIA) constitue la seconde cardiopathie congénitale la plus importante chez l'enfant, elle représente 6 à 8% des malformations congénitales cardiaques de l'enfant. Toutefois, de nombreuses questions demeurent ouvertes concernant cette pathologie. Ainsi notre objectif était de rapporter la prévalence hospitalière des CIA mais surtout d'en décrire les aspects cliniques, paracliniques et thérapeutiques. Pour y parvenir nous avons réalisé une étude rétrospective descriptive. Les données ont été recueillies grâce à un questionnaire puis saisies et analysées sur Sphinx (V5). La prévalence hospitalière était de 2 pour 1000. L'âge moyen était de 37mois et le sex-ratio de 0,75. Il n'y a eu aucun cas diagnostiqué en anténatal. Une consanguinité parentale était retrouvée dans 30% des cas. Les infections respiratoires étaient présentes dans 24% des cas. Une cardiomégalie était retrouvée dans 35 cas avec une hyper vascularisation pour 63%. L'échographie notait une prédominance du type ostium secundum; la CIA était large dans 63% des cas. La sténose pulmonaire représentait l'atteinte cardiaque associée la plus importante. L'HTAP était présente dans 63% des cas. Les diurétiques étaient très utilisés et seuls 7 enfants avaient bénéficié d'une cure chirurgicale. L'évolution était favorable chez 39 patients soit 79%. Le diagnostic précoce des CIA doit être amélioré ainsi que la prise en charge chirurgicale des formes avec retentissement du nourrisson.

Le syndrome de résistance à l'Adrénocorticotrophine Hormone (ACTH) est l'une des rares causes d'insuffisance surrénalienne chez l'enfant. Toutes les formes d'insensibilité héréditaire à l'ACTH décrites à ce jour sont d'origine autosomique récessive. Dans nos pays à ressources limitées, bon nombre de ces pathologies rares sont méconnues ou non diagnostiquées, en raison des plateaux techniques insuffisants. Nous rapportons l'observation d'un nourrisson de 4 mois hospitalisé pour des hypoglycémies réfractaires et chez qui; malgré la présence d'une mélanodermie généralisée et importante, des troubles digestifs, et des troubles ioniques, le diagnostic d'insuffisance cortisolique n'a été évoqué que rétrospectivement au décours d'un arrêt respiratoire avec une évolution favorable et dépendante de l'hydrocortisone. L'objectif de ce travail est donc, de mettre en exergue les particularités, cliniques, biologiques et thérapeutiques des déficits périphériques en cortisol, en dehors des blocs enzymatiques, notamment ce syndrome de résistance à l'ACTH.

L'holoprosencéphalie (HPE) est une malformation cérébrale grave due à un défaut de clivage médian du prosencéphale. C'est une anomalie le plus souvent associée à des malformations cranio-faciales, d'un retard du développement psychomoteur, d'un diabète insipide et de troubles endocriniens variables. Les étiologies sont diverses regroupant les anomalies chromosomiques (trisomie 13, 18), les syndromes polymalformatifs (syndrome de CHARGE). Le diagnostic repose sur l'imagerie cérébrale. Quelques rares cas ont été décrits dans la littérature. Nous rapportons le cas d'une HPE alobaire chez un nourrisson de 10 mois. Le diagnostic a été posé au scanner cérébral devant la constatation d'un retard du développement psychomoteur en l'absence de malformations visibles. Le bilan endocrinien a permis de déceler un diabète insipide central et une hypothyroïdie centrale probablement d'origine hypothalamique.

La TVC est rare en général et particulièrement chez l'enfant. La survenue d'une HSA dans ce contexte est une situation très peu fréquente et seuls quelques cas sont rapportés dans la littérature. Sa symptomatologie est variable et souvent trompeuse. Non traitée ou en cas de traitement tardif l'issue peut être fatale ou conduire à des séquelles potentiellement graves. Nous rapportons l'observation d'un nourrisson de 22 mois reçu pour des convulsions avec coma stade II, syndrome d'hypertension intracrânienne et syndrome infectieux. Une septicémie à Pseudomonas spp a était retrouvée à la biologie et le scanner cérébral a permis de poser le diagnostic. Le traitement a été basé sur l'antibiothérapie mais surtout l'anticoagulation. Une nette amélioration clinique a été ainsi notée et le scanner cérébral de contrôle montrait une disparition de la thrombose avec images hémorragiques séquellaires droites. La TVC est une pathologie grave d'origine généralement infectieuse. Le traitement anticoagulant est aujourd'hui sujet à controverse notamment en cas d'hémorragie associée, mais l'expérience clinique serait en faveur de l'efficacité et de l'innocuité de ce traitement.

La drépanocytose pose un problème de santé publique au Sénégal. Elle concerne principalement les enfants et les adolescents. L'objectif de notre travail était de déterminer les profils épidémiologiques, cliniques et hématologiques de la drépanocytose homozygote SS dans une cohorte d'enfants suivis à l'hôpital de la paix de Ziguinchor. Il s'agit d'une étude rétrospective portant sur des dossiers d'enfants drépanocytaires. Etaient inclus, les drépanocytaires SS âgés entre 2mois et 21ans, reçus en phase inter critique durant la période d'étude allant du 1er Janvier 2015 au 31 Août 2017. N'étaient pas inclus dans l'étude les hétérozygotes composites (SC, S béta thalassémie). Nous avons colligé 46 dossiers de drépanocytaires SS (20 filles et 26 garçons). L'âge moyen des enfants était de 8,0ans [11mois-21ans]. Environ 1/3 des enfants (39,1%) avaient un âge inférieur ou égal à 5 ans. Il y avait une diversité ethnique avec une prédominance de diola (30,2%) suivi de mandingue (27,9%) et de poular (25,6%). L'âge moyen des enfants à la 1ére crise était de 35,5mois [7-192 mois]. Plus de 1/3 des enfants (41,3%) avaient fait une 1ére crise avant le deuxième anniversaire. Le type de la 1ére crise, qu'avait présenté l'enfant, était dominé par la crise vaso-occlusive (32,6%) suivi du syndrome pied-main (30,4%). Les signes cliniques en phase inter critique étaient la pâleur 95,6%); l'ictère (36,9%) et la splénomégalie (21,7%). A l'hémogramme, le nombre de globules blancs moyen était de 12465 leucocytes/mm3 [5340-26900]. L'hyperleucocytose, supérieure à 10 000 leucocytes/mm3 était retrouvée chez 34 malades (73,9%). La totalité des malades présentait une anémie avec une moyenne 08,6 g/dl [05,7-11,8]. Le taux d'hémoglobine S variait entre 54,6 et 98,4%. Le diagnostic et la prise en charge médicale de la drépanocytose SS sont tardifs à Ziguinchor. Le dépistage néonatal pourrait favoriser une prise en charge précoce dans la région.

INTRODUCTION: l'hyperthyroïdie de l'enfant semble rare et constitue un problème de par son retentissement psychosomatique. L'objectif était de faire le point sur ces aspects chez l'enfant à Dakar. METHODES: il s'agissait d'une étude multicentrique, descriptive sur 15 ans. Etaient analysés les aspects épidémiologiques, cliniques et étiologiques. RESULTATS: 239 patients sélectionnés avec une prévalence de 2.4%, un sex ratio (H/F) de 0.36, un âge moyen de 10.8 ans. À l'inclusion, il s'agissait d'un ainé de famille (26.3%), d'une croissance avancée (36.9%), retardée (12.5%), d'une corpulence insuffisante (40.1%). L'étiologie était la maladie de Basedow dans 90.3% avec un facteur psychoaffectif dans 22.1%. Sur le plan clinique, prédominaient la tachycardie (92.4%), le goitre (91.1%), l'exophtalmie (81.8%), l'amaigrissement (69.8%) avec cependant une énurésie (30.2%) et des manifestations psychiques (3.1%). Les manifestations cardiovasculaires et cutanées étaient positivement associées avec l'âge (p =0.05). Le goitre était associé au sexe féminin (p = 0.005), aux signes cardiovasculaires (p = 0.02), neuropsychiques (p = 0.03), cutanées (p = 0.03) et à la diarrhée (p = 0.03). La T4 libre était corrélée à l'âge (p = 0.007), la diarrhée (p = 0.021), l'anxiété (p = 0.024), la fréquence cardiaque (p = 0.00) et la maladie de Basedow (p = 0.04). Plus le goitre était volumineux, plus était augmentée la T4 libre (p = 0.007). CONCLUSION: l'hyperthyroïdie de l'enfant se différencie de celle de l'adulte par les facteurs d'induction, les perturbations sur la croissance et l'énurésie. L'âge et le sexe semble favoriser le tableau clinique de thyrotoxicose et les signes associés.

INTRODUCTION: Vascular hyperreactivity is a risk factor and a factor predicting hypertension (high blood pressure). Unlike other continents where several studies were carried out, it has rarely been studied in black Africa in general and in Cameroon in particular. METHODS: vascular reactivity was measured by the cold test. Vascular hyperreactivity was defined as an increase in blood pressure 20 mmHg for systolic and/or 15 mmHg for diastolic. Khi2, Man-Withney, Wilcoxon's signed ranks and logistic regression tests were used for statistical analysis. RESULTS: a total of 31 hypertensive and 31 normotensive patients matched by age and sex participated in this study. Vascular hyperreactivity was present in 77.4% hypertensive patients and 51.6% normotensive patients. There was a significant association between vascular hyperreactivity and hypertension [OR = 3.2 (1.07 - 9.63), p = 0.034]. The median arterial pressure was higher in responders compared to non-responders in the normotensive group. Age 45 years, female sex, obesity and family history of hypertension appeared to be associated with vascular hyperreactivity, but only in normotensive patients. CONCLUSION: vascular hyperreactivity appears to be a risk factor for high blood pressure in black Cameroonians. It appeared to be associated with low blood pressure, age, sex, obesity and family history of hypertension but this was only in the normotensive.

INTRODUCTION: l'objectif de ce travail était d'analyser les caractéristiques diagnostiques, thérapeutiques et évolutives de l'enfant atteint de néphrose dans un service de pédiatrie de Dakar. METHODES: l'étude était réalisée au service de pédiatrie de l'hôpital Aristide Le Dantec. Il s'agissait d'une étude rétrospective sur une période de 03 ans allant du 1 janvier 2012 au 31 décembre 2014. Ont été inclus tous les patients âgés de 02 ans à 12 ans présentant un tableau de Syndrome néphrotique idiopathique. RESULTATS: quarante cas de néphrose étaient colligés soit une prévalence de 23% parmi les néphropathies prises en charge dans le service. L'âge moyen était de 7,11' 3,14 ans. Le syndrome néphrotique était pur chez 72,5% (n=29) des patients. Les èdèmes des membres inférieurs étaient présents chez 100% des patients, l'oligurie dans 55% (n=22) et l'HTA dans 5% (n=2) des cas. La protéinurie moyenne était de 145,05 ' 85,54 mg/kg/24heures. La protidémie moyenne était de 46,42 '7,88 g/L et l'albuminémie moyenne de 17,90 , 7,15 g/L. Trente-neuf patients avaient reçu une corticothérapie à base de prednisone. La corticosensibilité était retenue chez 77% (n=30) des patients et la corticorésistance chez 13% (n=5) des cas. Le facteur de mauvaise réponse à la corticothérapie était un niveau de protéinurie initiale supérieure à 150 mg/kg/jour (p = 0,024). La biopsie rénale était réalisée chez 18% (n=7) des patients et retrouvait dans 57,2% (n=4) des cas une hyalinose segmentaire et focale. Le cyclophosphamide et l'azathioprine étaient associés aux corticoïdes dans 10% (n=4) des cas chacun. Le taux de rémission globale était de 89,8%. L'évolution vers l'insuffisance rénale chronique était notée chez trois (03) des patients. CONCLUSION: la néphrose représentait près du quart des néphropathies prises en charge dans notre service. Le taux de rémission globale était élevé. Le seul facteur de mauvaise réponse à la corticothérapie était le niveau de protéinurie initiale élevée. En cas d'indication de la biopsie rénale chez nos patients, la HSF était la lésion la plus fréquemment retrouvée.