Première observation malienne d’histoplasmose africaine disséminée à prédominance osseuse chez un enfant VIH négatif. Revue de la littérature

Endemic deep fungal infections are still under recognised diseases in daily medical practice because of their rarity in sub-Saharan area. The African histoplasmosis Histoplasma capsulatum var. duboisii (H. capsulatum duboisii) is the most frequent variety described in Mali through limited studies in adult patients, since the first case described by Catanei and Kervran (1945). Our case report is a disseminated histoplasmosis in a young 6-year-old african child. He was male and rural. The infectious localisations were mucosae, skin, lymphnodes, urinary tract and bones. Evolution has been marred by an episode of worsening of symptoms despite initial clinical improvement with ketoconazole. After healing of mucocutaneous lesions, we noticed a limitation of ampliation of both wrists. The radiographic bone lesions were lysis of the right lower end of the right radius and cubitus and fragmentation of cubital epiphysis of the same arm. Lacunes were present on the fifth right finger in metatarsus and phalanx; lacune and blowing aspect of the second phalanx of the left third finger was noted. The disseminated form of African histoplasmosis may occur in HIV-negative subject. The prognosis depends on early diagnosis and administration of appropriate and well-conducted therapy

La cryptococcose neuro-méningée au Mali

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 ± 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between 1 and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains

Recent progress on univariate and multivariate polynomial and spline quasi-interpolants

Polynomial and spline quasi-interpolants (QIs) are practical and effective approximation operators. Among their remarkable properties, let us cite for example: good shape properties, easy computation and evaluation (no linear system to solve), uniform boundedness independently of the degree (polynomials) or of the partition (splines), good approximation order. We shall emphasize new results on various types of univariate and multivariate polynomial or spline QIs, depending on the nature of coefficient functionals, which can be differential, discrete or integral. We shall also present some applications of QIs to numerical methods

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1�4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980�2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age�sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, 5·8 million (95 uncertainty interval UI 5·7�6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7�53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3�43·6) to 2·6 million (2·6�2·7) neonatal deaths and 47·0% (35·1�57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6�3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

Blastic plasmacytoid dendritic cell leukemia in a black Malian

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, clinically aggressive hematologic malignancy, that most commonly manifests as cutaneous lesions. A 19-year-old Malian female was admitted to the Unit of Medicine of Hopital du Mali with anemia, fever, weakness, and weight loss. On physical examination she was wasted, pale, febrile (37.4°C), and had inguinal and axillary lymphadenopathies. The complete blood count found pancytopenia with Hemoglobin level of 4.8 g/dL, Leucocytes count of 1900/μL (neutrophil: 300/μL), and platelets count of 56 000/μL. The ultrasonographic examination found hepatomegaly and splenomegaly. The bone marrow biopsy and flow cytometer analysis were in keeping with a diagnosis of BPDCN. The patient, unfortunately, was lost four months later after her hospital admission due to late diagnosis by septicemia. The early diagnosis and availability of specific drugs for acute leukemia could improve the clinical outcome of patients with BPDCN in Mali.Keywords: Acute Leukemia, black african, dendritic cell, Mal

Apport de l’imagerie en coupes dans le diagnostic du diverticule urétral de la femme : à propos d’un cas révélé par une rétention aiguë d’urine

Encore appelé poche sous urétrale, le diverticule de l'urètre est une pathologie de la femme jeune. Ilse définit comme une hernie de la muqueuse urétrale à travers les fibres musculaires, créant une cavité néoformée à partir de la paroi urétrale et qui communique avec la lumière urétrale par un orifice de diamètre variable. Il peut être acquis ou congénital. Lessymptômessontsouvent non spécifiques, dominés par lessignes d’infection urinaire ou encore d’une instabilité vésicale idiopathique. C'est une pathologie rare avec une prévalence de  0,5 à 6% selon les séries Cependant, cette prévalence ne reflète pas la fréquence réelle de cette pathologie. Sa méconnaissance dansla plupart du temps expose à des  difficultésthérapeutiques, voire à des complications (cancérisation). La mise au point de techniques d’imagerie performantes telles que la TDM et l’IRM aident à confirmer le diagnostic et à localiser la lésion en vue d’une prise en charge précoce et adéquate. Nousrapportons un cas de diverticule urétralsurvenu chez une jeune femme de 40 ansrévélé par une rétention aiguë d’urine dans le but de décrire le rôle clé de l’imagerie en coupes dans le diagnostic précoce de cette affection. Mots-clés : Diverticule urétral, IRM pelvis, rétention d’urine

Effets indesirables medicamenteux lies a la vaccination de Riposte contre Neisseria meningitidis au Togo

Une campagne de vaccination de riposte, s’est déroulée, en mars 2017, au Togo, par un vaccin contre les sérogroupes A, C, Y et W135 de Neisseria meningitidis. La population-cible était de 2 à 29 ans. L’objectif de cette étude était d’analyser les Manifestations Post-Vaccinales Indésirables (MAPI) liées à ce vaccin. Il s’est agi d’une étude descriptive, menée du 20 au 27 juillet 2017 au Centre National de Pharmacovigilance (CNPV). Les fiches de notification ayant rapportées une MAPI ont constitué notre population d’étude. Les MAPI ont été classées et l’imputabilité réalisée, selon les critères de l’OMS. Au total, 50 559 personnes ont été vaccinées. Deux (2) MAPI ont été transmises au CNPV (3,96 notifications pour 100 000 personnes vaccinées). Les fiches ont été transmises 3 semaines après la fin de la campagne (délai légal respecté). Le premier cas était celui d’une fillette de 2 ans, décédée 3 jours après la vaccination. Un paludisme grave, forme anémique, avec perte de connaissance et crises convulsives a été retrouvé, à l’investigation. Cette MAPI est classée comme grave. Le score d’imputabilité était improbable. Le deuxième cas était celui d’une fille de 15 ans, décédée 4 jours après la vaccination. Le Neisseria meningitis a été retrouvé, à l’analyse de son liquide céphalo-rachidien. Cette MAPI est grave. Le score d’imputabilité était improbable. Les professionnels de santé au Togo, doivent être sensibilisés sur la nécessité de notifier davantage de cas y compris les effets indésirables connus et non graves.Mots-clés : vaccin contre les sérogroupes A, C, Y et W135 de Neisseria meningitidis,pharmacovigilance, manifestations post vaccinales indésirables, Togo