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Background: Risk assessment is the means of identifying and evaluating potential errors or problems that may occur in testing process. The aim of this study was to perform risk assessment of antimicrobial susceptibility testing (AST) process in clinical microbiology laboratories of Niamey, Niger Republic.Methodology: We conducted a descriptive cross-sectional study from October 1 to December 31, 2019, to evaluate AST performance in seven clinical microbiology laboratories at Niamey, the capital city of Niger republic. The evaluation focused on the determination of the criticality index (CI) of each critical point (frequency of occurrence of anomalies, severity of the process anomaly, and detectability of the anomaly during the process) in the AST process and the performance of the AST through an observation sheet using two reference strains; Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 29213.Results: The criticality index (CI) was greater than 6 for most of the critical points related to material, medium, equipment, method and labour for the AST process in all the laboratories. A range of 18-100% errors on the inhibition zone diameters of the reference strains were observed. Major and/or minor categorization (Sensitive S, Intermediate I and Resistance R) discrepancies were found at all the laboratories for either one or both reference strains. The antibiotics most affected by the S/I/R discrepancies were trimethoprim (100%), vancomycin (100%), amoxicillin (80%) and amoxicillin + clavulanic acid (70%).Conclusion: This study showed a deficiency in the control of critical control points that impacts the performance of the AST reported by the laboratories in Niger. Corrective actions are needed to improve the performance of AST in clinical microbiology laboratories in Niger. French title: Evaluation du processus de réalisation de l’antibiogramme dans les laboratoires d’analyses de biologie médicale de la ville de Niamey, Niger Contexte: L'évaluation des risques est le moyen d'identifier et d'évaluer les erreurs ou les problèmes potentiels qui peuvent survenir dans le processus de test. L'objectif de cette étude était de réaliser une évaluation des risques du processus d'antibiogramme (ABG) dans les laboratoires de microbiologie clinique de Niamey, en République du Niger.Méthodologie: Nous avons mené une étude transversale descriptive du 1er octobre au 31 décembre 2019 pour évaluer la performance des ABG dans sept laboratoires de microbiologie clinique à Niamey, capitale de la république du Niger. L'évaluation a porté sur la détermination de l'indice de criticité (IC) de chaque point critique (fréquence d'apparition des anomalies, gravité de l'anomalie du processus et détectabilité de l'anomalie au cours du processus) dans le processus et la performance des AGB à travers une fiche d'observation en utilisant deux souches de référence; Escherichia coli ATCC 25922 et Staphylococcus aureus ATCC 29213.Résultats: L'indice de criticité était supérieur à 6 pour la plupart des points critiques liés au matériel, au milieu, à l'équipement, à la méthode et à la main-d'oeuvre pour le processus AST dans tous les laboratoires. Une fourchette d'erreurs de 18 à 100% sur les diamètres des zones d'inhibition des souches de référence a été observée. Des écarts de catégorisation majeurs et/ou mineurs (Sensible: S, Intermédiaire: I et Résistance: R) ont été constatés dans tous les laboratoires pour l'une ou les deux souches de référence. Les antibiotiques les plus touchés par les écarts S/I/R étaient la triméthoprime (100%), la vancomycine (100%), l'amoxicilline (80%) et l'amoxicilline + acide clavulanique (70%).Conclusion: Cette étude a montré une déficience dans le contrôle des points de contrôle critiques qui a un impact sur la performance de l'antibiogramme rapportée par les laboratoires au Niger. Des actions correctives sont nécessaires pour améliorer la performance des ABG dans les laboratoires de microbiologie clinique au Niger.

laboratory request forms (LRF) is a means of communication between the biologist and the clinician. In Niger, to our knowledge, no study focused on the editorial quality of LRF. The purpose of this study was to evaluate the editorial quality and cost of non-compliant LRF in four main hospitals in Niamey and the representation of the CERBA laboratory in Niger.we conducted a multicenter, cross-sectional, descriptive study over a period of eight months. All LRFs sent to selected laboratories over the study period were included in this study.a total of 5.651 LRFs from 30 different clinical departments were included in this study. The most reported information in the LRFs was: the patient's last name (99.79%), first name (99.65%) and date of prescription (97.45%). On the other hand, the sample date, time, and nature were reported in 0.02%, 0.21%, and 1.68% of the LRFs respectively. Overall, 9.45% of the LRFs complied with the principles of good prescribing. While the bivariate analysis showed that doctors had a tendency to prescribe better than other health workers, multivariate analysis showed that the risk of non-compliance of LRFs was not associated with the prescriber's qualification, the requesting service, and the testing cost.

The present study aimed to determine the seroprevalence of HBs Ag in HIV-infected patients followed at the Maradi CHR.This is a retrospective study based on the records of the infectious diseases department of the CHR of Maradi. Included were all HIV-positive adults seen in consultation who received HBs Ag research between 2006 and 2018. The data was collected from patients' medical records.In total, 2770 patients included in our study. The average age of the cohort was 38 years old. Of these patients, 159 had HBs Ag or a prevalence of 5.74% (95% CI: 4.93 - 6.67). HIV-HBV coinfections were higher in men (52.20%). HIV1 subtype was involved in 96.86% of cases. Two patients co-infected with HIV-HBV had HIV1 and HIV2 dual profile. Which represents 1.26% (95% CI: 0.15 - 4.47).This study confirms the high prevalence rate of HBV coinfection in HIV-infected patients. It is therefore necessary to screen all HIV-infected patients for better management.La présente étude visait à déterminer la séroprévalence de l'Ag HBs chez les patients infectés par le VIH suivi au CHR de Maradi.Il s'agit d'une étude rétrospective réalisée à partir des registres du service des maladies infectieuses du CHR de Maradi. Ont été inclus tous les adultes séropositifs au VIH vus en consultation et ayant bénéficié d'une recherche de l'Ag HBs entre 2006 et 2018. Les données ont été collectées à partir des dossiers médicaux des patients.Au total, 2770 patients inclus dans notre étude. L'âge moyen était de 38 ans. Parmi ces patients, 159 étaient porteuses de l'Ag HBs soit une prévalence de 5,74% (IC 95% : 4,93 - 6,67). Le taux des coinfectés VIH-VHB étaient plus élevé chez les hommes (52,20%). Le sous type VIH1 était impliqué dans 96,86% des cas. Deux patients co-infectés VIH-VHB avait présenté le double profile VIH1 et VIH2 soit 1,26% (IC 95% : 0,15 - 4,47).Cette étude confirme le taux de prévalence élevé de la coinfection par le VHB chez les patients infectés par le VIH. Il est donc nécessaire de dépister tous les patients infectés par le VIH en vue d'une meilleure prise en charge.

Background: Influenza infection is a serious public health problem that causes an estimated 3 to 5 million cases and 250,000 deaths worldwide every year. The epidemiology of influenza is well-documented in high- and middle-income countries, however minimal effort had been made to understand the epidemiology, burden and seasonality of influenza in Africa. This study aims to assess the state of knowledge of seasonal influenza epidemiology in Africa and identify potential data gaps for policy formulation following the 2009 pandemic. Method: We reviewed articles from Africa published into four databases namely: MEDLINE (PubMed), Google Scholar, Cochrane Library and Scientific Research Publishing from 2010 to 2019. Results: We screened titles and abstracts of 2070 studies of which 311 were selected for full content evaluation and 199 studies were considered. Selected articles varied substantially on the basis of the topics they addressed covering the field of influenza surveillance (n=80); influenza risk factors and co-morbidities (n=15); influenza burden (n=37); influenza vaccina- tion (n=40); influenza and other respiratory pathogens (n=22) and influenza diagnosis (n=5). Conclusion: Significant progress has been made since the last pandemic in understanding the influenza epidemiology in Africa. However, efforts still remain for most countries to have sufficient data to allow countries to prioritize strategies for influenza prevention and control. Keywords: Influenza; epidemiology; review; Africa; post pandemic.

Among other West African countries experiencing the high endemicity of deadly tuberculosis, the situation in Niger is poorly evidenced by microbiological investigations.The study of 42 isolates of Mycobacterium tuberculosis from Niger by whole genome sequencing using Illumina iSeq technology yielded four M. tuberculosis lineages: Indo-Oceanic L1 (n = 1) (2.3%), East-Asian (n = 1) (2.3%), East-African Indian L3 (n = 2) (4.7%) and Euro-American L4 (n = 38) (90.4%). The sub-lineage L4.1.3 comprising 18 isolates (47.3%) was predominant, followed by the L4.6.2.2 sub-lineage (Cameroon genotype, n = 13 isolates) (34.2%). Investigating drug resistance profile for 12 antibiotics found 8/42 (19%) pan-susceptible isolates and 34/42 (81%) resistant isolates; with 40/42 (95.2%) isolates being susceptible to clofazimine-bedaquiline.These unprecedented data from Niger highlight the dynamics of tuberculosis transmission and drug resistance in Niger and may assist tuberculosis control in this country which continues to support a high burden of tuberculosis.

The short treatment regimen (STR) achieves a >80% cure in rifampicin-resistant tuberculosis (RR-TB) patients. However, ototoxicity induced by the injectable is a concern. This is the first study to evaluate the replacement of injectables by linezolid in patients with audiometry abnormalities at baseline or during the treatment.We conducted a retrospective cohort study of all RR-TB patients started on the STR between 2016 and June, 2019, in Niger. Patients underwent audiometry every 2 months in 2016 and every month since 2017.Of 195 patients, 16.9% (33 out of 195) received linezolid from the start (n=17), or switched from injectables to linezolid during treatment (n=16), based on audiometry abnormalities. In 2016, two patients developed severe ototoxicity despite switching to linezolid. Since 2017, no patient developed severe hearing loss or complete deafness. Severe haematological toxicity was observed in 18.1% (six out of 33) of patients on linezolid, none of which was life threatening. The use of linezolid was associated with severe but manageable adverse events (hazard ratio 8.9, 95% CI 2.5–31.5; p=0.001). A total of 90.9% (30 out of 33) of patients on a linezolid-containing STR were cured, and none experienced treatment failure. Three died, but not due to adverse events.Baseline and monthly audiometry monitoring and using linezolid after detection of hearing abnormalities appears effective to prevent severe ototoxicity, while keeping high treatment success and manageable adverse events.

Background: As the coronavirus disease 2019 (COVID-19) pandemic unfolds, laboratory services have been identified as key to its containment This article outlines the laboratory organisation and management and control interventions in Niger Intervention: The capitol city of Niger, Niamey, adopted a ‘National COVID-19 Emergency Preparedness and Response Plan’ to strengthen the preparedness of the country for the detection of severe acute respiratory syndrome coronavirus-2 Laboratory training and diagnostic capacity building were supported by existing active clinical and research laboratories for more rapid and practicable responses The National Reference Laboratory for Respiratory Viruses located at the Centre de Recherche Medicale et Sanitaire was designated as the reference centre for COVID-19 testing The national plan for COVID-19 testing is being gradually adopted in other regions of the country in response to the rapidly evolving COVID-19 emergency and to ensure a more rapid turn-around time Lessons learnt: After the decentralisation of COVID-19 testing to other regions of the country, turn-around times were reduced from 48–72 h to 12–24 h Reducing turn-around times allowed Niger to reduce the length of patients’ stays in hospitals and isolation facilities Shortages in testing capacity must be anticipated and addressed In an effort to reduce risk of shortages and increase availability of reagents and consumables, Niamey diversified real-time reverse transcriptase–polymerase chain reaction kits for severe acute respiratory syndrome coronavirus-2 detection Recommendations: Continued investment in training programmes and laboratory strategy is needed in order to strengthen Niger’s laboratory capacity against the outbreak © 2020 AOSIS OpenJournals Publishing AOSIS (Pty) Ltd All rights reserved

International audience; Background and Aims: In Niger, acute respiratory infections (ARIs) are the second most common cause of death in children aged younger than 5 years. However, the etiology of ARI is poorly understood in the country. This study aims to describe viral and bacterial infections among children aged younger than 5 years hospitalized with febrile ARI at two hospitals in Niamey, Niger's capital city, and the reported clinical procedures.Methods: We conducted a prospective study among children aged younger than 5 years hospitalized with febrile ARI at two national hospitals in Niamey between January and December 2015. Clinical presentation and procedures during admission were documented using a standardized case investigation form. Nasopharyngeal specimens collected from each patient were tested for a panel of respiratory viruses and bacteria using the Fast Track Diagnostic 21 Plus kit.Results: We enrolled and tested 638 children aged younger than 5 years, of whom 411 (64.4%) were aged younger than 1 year, and 15 (2.4%) died during the study period. Overall, 496/638 (77.7%) specimens tested positive for at least one respiratory virus or bacterium; of these, 195 (39.3%) tested positive for respiratory viruses, 126 (25.4%) tested positive for respiratory bacteria, and 175 (35.3%) tested positive for both respiratory viruses and bacteria. The predominant viruses detected were respiratory syncytial virus (RSV) (149/638; 23.3%), human parainfluenza virus (HPIV) types 1 to 4 (78/638; 12.2%), human rhinovirus (HRV) (62/638; 9.4%), human adenovirus (HAV) (60/638; 9.4%), and influenza virus (INF) (52/638; 8.1%). Streptococcus pneumoniae (249/638; 39.0%) was the most frequently detected bacterium, followed by Staphylococcus aureus (112/638; 12.2%) and Haemophilus influenzae type B (16/638; 2.5%). Chest X-rays were performed at the discretion of the attending physician on 301 (47.2%) case patients. Of these patients, 231 (76.7%) had abnormal radiological findings. A total of 135/638 (21.2%) and 572/638 (89.7%) children received antibiotic treatment prior to admission and during admission, respectively.Conclusion: A high proportion of respiratory viruses was detected among children aged younger than 5 years with febrile ARI, raising concerns about excessive use of antibiotics in Niger.

Background In Niger, the Shorter Treatment Regimen (STR) has been implemented nationwide for rifampicin resistant tuberculosis (RR-TB), since 2008. No previous publication has shown the results from countrywide programmatic implementation using few exclusion criteria, nor exhaustively assessed the effect of initial resistance to companion drugs on outcomes. Methods The National Tuberculosis Programme and the Damien Foundation conducted a retrospective observational study to evaluate the management of RR-TB from 2008 to 2016. Baseline resistance to drugs was assessed phenotypically, complemented by screening the inhA, katG and pncA genes. Cured patients were followed-up for a period of one year after cure. Findings Among 1044 patients tested for rifampicin resistance, mainly previously treated patients, 332 were diagnosed with pulmonary RR/TB, 288 were enrolled on treatment and 255 started on STR. Six patients received a modified STR. Among 249 patients on standardised STR, 207 (83·1%) were cured relapse-free, eight (3·2%) had failure, 23 (9·2%) died, seven (2·8%) were lost to follow-up and four (1·6%) relapsed. The risk of unfavourable outcome was higher in patients with initial resistance to fluoroquinolones (aOR 20·4, 95%CI:5·6–74·6) and very severely underweight (aOR 3·9, 95%CI:1·5–10·1). Successful outcome was not affected by initial resistance to companion drugs. Serious ototoxicity was reported in eight patients (3·2%). Interpretation A comprehensive nationwide approach to multidrug-resistant tuberculosis management using the STR was feasible and successful. Outcomes were not affected by initial resistance to companion drugs. Our study confirms the effectiveness and safety of the STR. Funding Damien Foundation and Institute of Tropical Medicine-Antwerp.

BACKGROUND Niger has experienced multiple cholera outbreaks since the occurrence of cholera in West Africa in 1970-1971. Understanding the origins of these geographic variations at different scales in the region and in health districts is an essential step in the rational and operational fight against this disease. METHODS We conducted a retrospective review of all suspected cholera cases in Niger from 2003 to 2015. Data from 2010 to 2015 were reviewed to determine the number and percentage of stool specimens tested, with distribution by serotype. We also determined the time between sampling and sending to a laboratory. RESULTS From 2003 through 2015 a total of 16 328 cases of cholera, including 578 deaths, were reported to the National Surveillance Database (overall case fatality rate 3.5%). The number of cases was greater among males (63.29%). Patients >15 y of age accounted for 69.80% of cases. All regions recorded cholera cases throughout the period 2003 to 2015, except in 2009, when no outbreak was reported. All epidemics recorded were due to the subtype serogroup O1 serotype Ogawa and all strains confirmed the presence of the ctxB, rstR, tcpA, zot, ace and ctxA genes encoding the toxin of this serotype. CONCLUSIONS The global burden of cholera remains high in Niger. To successfully prevent and control outbreaks, adapted guidelines and strategies should be reviewed to provide more focused information and assign clear roles and responsibilities.

Ce travail à consister à étudier les aspects épidémiologiques et bactériologiques des souches bactériennes isolées au cours des infections du site opératoire (ISO) à l'Hôpital National de Niamey. Nous avions mené une étude rétrospective, et descriptive sur une période de 24 mois. Toutes les souches isolées à partir de prélèvements bactériologiques effectués chez les patients présentant une infection du site opératoire ont été identifiées et testés aux antibiotiques selon les méthodes classiques conventionnelles. Les analyses bactériologiques ont permis d'isoler 126 souches bactériennes avec une prédominance de S.aureus (n=39, 31%) suivi d'Escherichia coli (n = 29, 23%) et de Pseudomonas aeruginosa (n=12, 9,5%). Les souches d'Escherichia coli étaient sensibles à 100% à l'imipenème. Elles ont montré des résistances marquées à l'ampicilline, l'amoxicilline, l'acide-clavulanique et la ticarcilline. Elles présentaient des résistances variables aux aminosides (62% à la gentamycine, et 78% à l'amikacine), et aux fluoroquinolones (acide nalidixique 74%, pefloxacine 33%, l'ofloxacine 69%, ciprofloxacine 61%). L'ensemble des isolats d'entérobactéries étaient sensibles à l'imipénème. Les souches de S.aureus avaient montré des résistances à la Pénicilline G (88,6%) et à l'oxacilline (83%). Elles avaient montré aussi des résistances de 37% et 57% respectivement à la vancomycine et teicoplanine. Par contre, elles étaient sensibles à la lincomycine et aux aminosides testés. Compte tenu de ces résultats, nous pensons qu'il faudra améliorer les protocoles d'antibioprophylaxie et d'antibiothérapie probabiliste dans les services chirurgicaux. Aussi, mener des études périodiques de surveillances des ISO.

Introduction : En Guinee, les etudes publiees sur le tabagisme en milieu scolaire sont rares. Cette enquete avait pour objectif de determiner la prevalence du tabagisme et de ses facteurs associes en milieu scolaire urbain guineen. Methodes : Il s’agit d’une etude transversale realisee d’avril a juin 2012 sur un echantillon d’eleves des quatre colleges publics de la commune de Dixinn. Les donnees sur la consommation du tabac et le contexte de cette pratique ont ete recueillies a l’aide de questionnaires auto-administres de facon anonyme et analyses avec le logiciel Spss 20. Resultats : La prevalence de fumeurs etait de 13,4 % (IC95 % : 10,6-16,1) parmi les collegiens. Les produits fumes etaient toujours des cigarettes. L’initiation du tabagisme etait precoce (13,9 ans) et les perspectives d’un sevrage etaient frequentes parmi les collegiens fumeurs. L’influence de la mode et de la publicite (45,6 %) et l’imitation de l’entourage (32,9 %) etaient les facteurs favorisants du tabagisme les plus frequemment cites. Apres ajustement, le sexe masculin [odd ratio = 7,9 (Intervalle de Confiance a 95 % : 3,8-16,9)], avoir un ami proche fumeur [1,7 (1,1-2,8)] et voir tres souvent les eleves fumer [3,8 (2,3-6,2)] etaient associes au tabagisme. Conclusion : Le tabagisme est frequent chez les collegiens a Dixinn en Guinee. Les pouvoirs publics, dont ceux de l’enseignement, devraient s’impliquer davantage dans la lutte contre ce fleau qui est en expansion dans les pays en developpement.

Introduction: Cutaneous tuberculosis is a skin infection due to the Mycobacterium tuberculosis and rarely due to Mycobacterium bovis or Mycobacterium africanum. The disease is difficult to diagnose, given the fact that the skin is seldom a location for tuberculosis. The aim of this study is to determine the epidemiological, clinical and therapeutic profile of the disease in Niger. Materials and Methods: This is a retrospective study over a period of 9 years in the Department of Dermatology and Venereology at the National Hospital of Niamey. The study included all cases of cutaneous tuberculosis that were clinically diagnosed and confirmed or not by some conventional complementary examinations. Results: Over a period of nine years, 49 cases of cutaneous tuberculosis were diagnosed, which represents 0.34% of the total 14376 dermatological consultations in the dermatological unit. Patients of both sexes were affected, but the majority were male with 69% or a sex ratio M/F of 2.26. The patients ranged in age from 6 to over 60 years. The mean age was 34.67 years. Patients between 31 and 40 years were the most affected at 34.69%. A personal or family history of tuberculosis was noted in 8.16% of the cases. Scrofuloderma is the most frequent form of the disease (93.87% of the cases). The average course of the disease before consultation was 30.28 months. The tuberculin skin test was positive in 83.67% of the cases. The TB smear test was positive in only 6% of the cases. The hyperleukocytosis, which was mostly lymphocytic, was noted in 21.62% of the cases. Radiological evaluation was normal in 91.83% of the cases. All patients responded well in 100% of the cases with a treatment period ranging from 6 to 9 months. No clinical and/or biological treatment-related side effects were observed. Conclusion: Cutaneous tuberculosis is still a common infection in third world countries where it affects both sexes. The scrofuloderma is the most observed form in our study. A TB test-based treatment is often a good solution in the face of an array of clinical and epidemiological evidence. Systematic vaccination after birth would drastically reduce all forms of tuberculosis.

Very few published studies are available on smoking in schools In Guinea. This investigation was designed to determine the extent of smoking in Guinean urban schools.This cross-sectional study was conducted from April to june 2012. Students from four public schools in the municipality of Dixinn were anonymously interviewed by self-administered questionnaire concerning their smoking habits. The questionnaires were then analysed by SPSS 20 softwareThe prevalence of smoking, always in the form of cigarettes, was 13.4% (C/95%: 10.6-16.1) among college students. Early initiation of smoking was observed (13.9 years) and smokers frequently expressed the prospect of withdrawal. The most common predisposing factor was the imitation of the environment (32.9%). The influence of fashion and advertising (45.6%) and imitation of the per group (32.9%) were the factors most frequently cited to promote smoking. Male gender [odd ratio= 7.9 (95% confidence interval3.8 to 16.9)], having a close friend who smoked [1.7 (1.1-2.8)], and frequently seeing other students smoking {3 8 (2.3 to 6.2)] were associated with smoking.Smoking is common among college students in Conakry, Guinea. The authorities, including educational authorities, should be more actively involved in the fight against this growing scourge in developing countries.

Saïdou Mamadou1,2, Moussa Ide3, Amadou Roufaï Ali Maazou2, Balki Aoula2, Seyni Labo4, Mamane Bozari41Laboratory of Bacteriology-Virology, Faculty of Health Sciences, University Abdou Moumouni, Niamey, Niger; 2National Reference Laboratory for STI/HIV/TB, Niamey, Niger; 3Coordination Board, Inter-Sectorial Program on STI/HIV/AIDS, Niamey, Niger; 4National Center for Social Sciences Expertise, Niamey, NigerAbstract: This transversal study was suggested in order to estimate the nationwide seroprevalences of HIV infection and hepatitis B among 495 pregnant women in Niger in 2008. The study detected anti-HIV antibodies with Genscreen® Plus HIV Ag/Ab Ultra Kit (Bio-Rad; Hercules, CA), Vironostika® HIV Uni-Form II Ag/Ab (bioMérieux; Marcy-l’Etoile, France), and ImmunoComb® II HIV 1 and 2 BiSpot (Orgenics; Yavne, Israel). HBsAg was detected by Monolisa® HBsAg Ultra (Bio-Rad) and ImmunoComb® II HBsAg (Orgenics). The rates obtained were 2.02% (95% confidence intervals (CI): 1.03%–3.81%) and 16.16% (95% CI: 13.09%–19.77%), respectively. There were no significant variations according to environment, region, age, marital status, educational level, antecedent of surgery and transfusion. But these data need a large sample, and periodic updates for a better planning of activities in the framework of a national reproductive health program, including prevention of mother-to-child HIV transmission.Keywords: HIV, HBV, seroprevalence, pregnant women, Niger

Background The aim of the study was to assess the prevalence of antiretroviral drug resistance mutations in HIV-1 from recently diagnosed and untreated patients living in Conakry, Guinea-Conakry and in Niamey, Niger. Methods The study was performed in two countries of Western Africa – Guinea-Conakry and Niger – using the same survey method in both sites. All newly HIV-1 diagnosed patients, naive of antiretroviral drugs, were consecutively included during September 2009 in each of the two sites. Protease and reverse transcriptase sequencing was performed using the ANRS procedures. Drug resistance mutations were identified according to the 2009 update surveillance drug resistance mutations. Results In Conakry, 99 patients were included, most of whom (89%) were infected with CRF02_AG recombinant virus. Resistance analysis among the 93 samples showed that ≥1 drug resistance mutation was observed in 8 samples, leading to a prevalence of primary resistance of 8.6% (95% CI 2.91–14.29%). In Niamey, 96 patients were included; a high diversity in HIV-1 subtypes was observed with 47 (51%) patients infected with CRF02_AG. Resistance analysis performed among the 92 samples with successful genotypic resistance test showed that ≥1 drug resistance mutation was observed in 6 samples, leading to a prevalence of primary resistance of 6.5% (95% CI 1.50–11.50%). Conclusions We reported the first antiretroviral drug resistance survey studies in antiretroviral-naive patients living in Guinea-Conakry and in Niger. The prevalence of resistance was between 6% and 9% in both sites, which is higher than most of the other countries from Western Africa region.

In the framework of HIV serosurveillance serosurveys in pregnant women are a good alternative to population-based surveys which are more difficult to implement. In 2002 and 2006 surveys were conducted in Niger to assess the HIV seroprevalence in pregnant women and to evaluate the trend of the HIV epidemic. The overall seroprevalence was 0.96% (95% CI 0.5-1.7%) and 1.3% (95% CI 0.9-1.8%) in 2002 and 2006 respectively showing no significant change. In the 2006 overall sample women living in urban areas were significantly more infected than those in rural environments with prevalences of 1.9% and 0.7% respectively (P = 0.006). Women with higher school attainment were more often HIV-positive than other women (4.6% vs. 1.7%; P < 0.001). The 2006 prevalence which is among the lowest of the sub-Saharan region was not significantly different from the national seroprevalence measured in adults in 2002 (0.87% 95% CI 0.5-1.3%). Close monitoring of the epidemic must be continued. (authors)

On the basis of partial env and gag subtyping, we documented that the majority of HIV-1 strains circulating in Niger were CRF02-AG (54.3%) or CRF06-cpx (18.1%) and that 9% of the samples were possible recombinants between CRF02 and CRF06. To determine in more detail the precise structure of these viruses we sequenced the full-length genomes for three such strains (97NE-003, 00NE-036, and 00NE-095). From the bootscan and phylogenetic tree analysis it is evident that the new viruses are the result of recombination events between CRF02-AG and CRF06-cpx strains. Importantly, each virus had a different complex recombinant structure with multiple breakpoints, leading to viruses with complex mosaic patterns.

A total of 110 HIV-1-positive samples obtained in 1997 (n = 44) and 2000 (n = 66) were genetically characterized in the V3-V5 envelope region and the p24 gag region. The majority of the strains were CRF02-AG (54.3%) or CRF06-cpx (18.1%) in env and gag. More than 9% of the samples were recombinants between CRF02 and CRF06; 9 were CRF06 in env but CRF02 in gag, and for one sample the opposite was seen. Overall for 23 (20.9%) samples, the subtype designation was different between env and gag, and in 20 of these 23 samples a CRF was involved in the recombination event. No significant differences were seen between subtype distributions in 1997 and 2000, except that the proportion of recombinants increased from 13.6% in 1997 to 27.2% in 2000.

Introduction Le mycetome est un processus pathologique au cours duquel des agents fongiques ou actinomycosiques d’origine exogene produisent des grains parasitaires. Les localisations extrapodales restent rares. Nous rapportons une observation d’un mycetome geant cervico-facial chez une fille de 14 ans. Observations Il s’agissait d’une fille âgee de 14 ans nee dans une region rurale du Niger et dont les parents etaient pauvres et analphabetes. Elle presentait depuis quatre ans une tumefaction geante a localisation cervico-faciale deformant l’hemi-face droite avec des lesions ulcero-crouteuses des paupieres. La tumefaction atteignait la region cervicale posterieure et faisait un bloc avec l’atteinte occipitale. On notait des fistules plus ou moins humides a partir desquelles echappaient des grains jaunâtres. L’oreille droite etait le siege d’un ecoulement purulent jaunâtre. Le reste de l’examen clinique etait sans particularite. A la radiographie, il s’agissait de lesions diffuses d’osteocondensation et d’osteoporose interessant le squelette de la boite crânienne et maxillaire droit. La coloration a l’hematoxyline eosine, d’une piece de biopsie mettait en evidence dans un infiltrat de PNN, plusieurs grains d’aspect grisâtre arrondis de type d’actinomycetes genre Streptomyces somaliensis . Apres un bilan pretherapeutique normal, mise en route de traitement a base de ketoconazole en raison de 200 mg par jour depuis mai 2011. Trois mois plus tard nous avons revu la patiente avec une amelioration malgre un tableau de malnutrition. On notait un assechement et la cicatrisation de la plupart des lesions. Apres un notre bilan tout a fait normal, nous avons reconduit le meme traitement. Notre patiente est malheureusement decedee en juin 2012, 6 mois apres l’arret de traitement par manque de medicament. Discussion Les mycetomes a localisation cervico-faciale sont rarement rapportes. La conception mythique que fait la population de cette forme ayant resiste a toute therapeutique traditionnelle, explique le desinteret a la consultation medicale precoce. Un cas similaire du aussi au S. somaliensis venant de la meme region a ete pris en charge avec guerison totale. La pauvrete et l’analphabetisme ont ete determinants pour ce cas, d’une l’evolution vers la mort. Conclusion Malgre le caractere tumoral volumineux, le traitement antifongique par le ketoconazole devrait etre favorable apres au moins un an. La sensibilisation de la population serait ainsi tres necessaire pour la prise en charge d’autres cas, vue le caractere endemique de cette mycose.

The objective of the study was to estimate the prevalence of transmitted resistance to antiretroviral of HIV-1 circulating in Niger. We collected plasmas from 96 drug-naive patients followed up in the main HIV/AIDS Care Center of Niamey, the capital city of Niger. After RNA extraction and retrotranscription to proviral DNA, nested PCR was performed to amplify PR (codons 1–99) and RT (codons 1–240) fragments for sequencing. Sequences were analysed for phylogeny, then for resistance-associated mutations according to IAS-USA and Stanford's lists of mutations. We characterized six HIV-1 genetic variants: CRF02-AG (56.3%), CRF30_0206 (15.6%), subtype G (15.6%), CRF06_cpx (9.4%), CRF11_cpx (2.1%), and CRF01_AE (1%). About 8.3% of HIV strains had at least 1 resistance mutation: 4 strains with at least 1 mutation to NRTI, 5 for NNRTI, and 1 for PI, respectiveley 4.2%, 5.2%, and 1.0%. These preliminary results gave enough information for the need of instauring HIV drug resistance national surveillance.

Young Kwang Chae and Jeong Hyun Yun query whether data from our randomised controlled trial of early high-dose vitamin A supplementation (50 000 I given with the three diphtheria-tetanus-pertussis [DPT] vaccinations at 6 10 and 14 weeks) in Gambian infants can contribute to the ongoing controversy about whether there might be harmful interactions between vitamin A supplementation and killed vaccines particularly in girls. Several notes of caution are necessary. The observations by Benn and colleagues that have raised the concerns relate to excess mortality. Our trial is greatly underpowered for this endpoint. There were two postneonatal deaths in the high-dose group (n=99) and none in the standard WHO dose group (n=98). One male infant died of pneumonia and septicaemia at 7 months and one female of unknown causes at 3 months. This overall post-neonatal infant mortality rate equates to 10 in 1000 which is exceptionally low for this region and reflects the high level of monitoring and clinical care offered to the study participants. This point reduces the usefulness of our data in contributing to the debate. In response to Chae and Yuns query as to whether the vitamin A might have exacerbated DTP-related side-effects we have reanalysed our data in an attempt to identify potentially life-threatening illnesses. In our original paper we restricted the analyses to clinic visits that elicited a treatment. Numerous non-critical conditions such as colds and skin rashes remained. We have now excluded these and repeated the analysis of potentially life-threatening events for the time window between the first DPT vaccination and vitamin A dose at 6 weeks and the first live vaccine (measles at 9 months). We analysed four diseases (malaria diarrhoea pneumonia and septicaemia) separately and combined. There were 73 events in the high-dose group and 79 events in the WHO group. Owing to small numbers of events there were wide confidence intervals and no differences were significant. The closest to significance (pneumonia) was if anything lower in the high-dose group. In summary our trial is under powered to contribute to this important debate but we will be happy to contribute the data to future meta-analyses. (full text)

We performed a systematic screening of HIV infection and five other sexually transmitted infections on a consecutive sample of 529 female sex workers from Niamey. HIV seroprevalence rate was 30.1% with HIV-1 profile in 93.1% of the cases. For curable STI 4.7% of women had treponematosis 7% gonorrhoea 16.8% Gardnerella vaginalis 36.9% Mycoplasma hominis and 68.2% Chlamydia trachomatis infection. The percentage of women with at least one STI was significantly higher in HIV positives: 95.6% against 87.9%. Only 7.9% of women were free of any infection.