A STUDY ON RECTAL CARRIAGE OF MULTIRESISTANT GRAM-NEGATIVE BACILLI IN CHILDREN ATTENDING PEDIATRIC HOSPITAL AMBOHIMIANDRA, MADAGASCAR

Introduction: Gram-negative bacilli are often responsible for rectal colonization in children. These bacilli normally sensitive to third generation cephalosporins (3GC) have acquired disturbing antibiotic resistance in recent years, hence the interest of our study. The aims are to monitor the epidemiological evolution resistance of Enterobacteriaceae with antibiotics in particular β-lactams, estimate the prevalence of enterobacteria responsible for rectal colonization and their resistance to 3GC. Material and methods: This is a descriptive prospective study of Enterobacteriaceae in children attending Ambohimiandra Hospital for a period of 3 months (from 01 August to 31 October 2015). We have done a rectal swab of all the children whom we have parental consent. The samples were processed at the Laboratory of Medical Biology Faravohitra. The parameters studied are the antecedent of therapy antibiotic, notion of recent hospitalization and the results of microbiological examinations. Results: Of the 55 bacteriological samples obtained, 39 strains of Enterobacteriaceae were isolated, Escherichia coli (n = 12), Enterobacter cloacae (n = 13), Citrobacter spp (n = 1), Salmonella spp. (N = 5) and Shigella spp (n = 2), Proteus mirabilis (n = 1). Six isolated strains (50%) of Escherichia coli showed resistance to ceftriaxone, of which 4 (33.33%) produced ESBL. Conclusion: Gram-negative bacilli responsible for colonization of the digestive tract have several resistances to β-lactams, in particular 3GC, by the production of enzymes (Expanded spectrum beta-lactamase or ESBL and cephalosporinase or CASE) which hydrolyze these antibiotics. Measures to combat the spread of these phenomena resistance must be implemented in the Malagasy community to limit them. KEYWORDS: Rectal porous; Gram negative bacillus; ESBL; Multiresistence

Phase Pre-Analytique Des Prelevements Sanguins: Connaissances, Attitudes Et Pratiques Du Personnel Paramedical Du Chu-Jra En 2022

Résumé La maîtrise de la qualité des analyses biologiques implique la maîtrise de la phase préanalytique. La phase pré-analytique se déroule à l’extérieur comme à l’intérieur du laboratoire. Les objectifs de cette étude sont de décrire les caractéristiques socioprofessionnelles des participants, d’identifier les besoins en formation, d’évaluer les connaissances des paramédicaux et d’identifier les attitudes pratiques et relever les écarts par rapport à la norme. Il s’agit d’une étude prospective descriptive sur un mois allant de 20 Mars au 20 Avril. Nous avons tiré au sort de façon aléatoire les services participants. Tous les paramédicaux tirés au hasard ont été inclus dans cette étude. La méthode choisie pour la collecte des données était des questionnaires. Sur l’ensemble des 76 questionnaires distribués, le taux de réponse était de 84,2%.   L’âge médian des participants était                 de 28 ans, avec des extrêmes allant de 21 ans à 48 ans, un sex-ratio de 0.79. Le personnel provenant des services de réanimation chirurgicale occupait la première place (19%). Le besoin de recevoir une formation dans la phase pré-analytique a été exprimé par 97% des participants. Comme matériels de prélèvements, 96,9% ont répondu n’avoir utilisé que des seringues. Le motif évoqué était l’absence d’aiguille vacutainer® dans 81,2% des cas. L’ablation du garrot après le remplissage en moins d’une minute était seulement envisagée par 9 participants. Relativement à l’ordre du remplissage des tubes, 71,9% ont eu de réponses fausses. La majorité des participants a indiqué des tubes inappropriés pour le dosage de l’HbA1c.     Mots clés: Attitudes, CHU-JRA, connaissances, paramédicaux, pré-analytique AbstractControlling the quality of biological analyzes involves controlling the preanalytical phase. The pre-analytical phase takes place both outside and inside the laboratory. The objectives of this study are to describe the socio-professional characteristics of the participants, to identify the training needs, to evaluate the knowledge of the paramedics and to identify the practical attitudes and to note the deviations from the norm. This is a descriptive prospective study over a month from March 20 to April 20. We randomly selected the participating services. All paramedics drawn at random were included in this study. The method chosen for data collection was questionnaires. Of all the 76 questionnaires distributed, the response rate was 84.2%. The median age of the participants was 28 years old, with extremes ranging from 21 to 48 years old, a sex ratio of 0.79. Staff from surgical resuscitation services occupied the first place (19%). The need to receive training in the pre-analytical phase was expressed by 97% of the participants. As sampling materials, 96.9% replied that they had only used syringes. The reason given was the absence of a vacutainer® needle in 81.2% of cases. Removal of the tourniquet after filling in less than one minute was only considered by 9 participants. Regarding the order of filling the tubes, 71.9% had wrong answers. The majority of participants indicated inappropriate tubes for the HbA1c assay.Keywords: Attitudes, CHU-JRA, knowledge, paramedics, pre-analytica

Characteristics tests of cerebrospinal fluid cytology, chemistry and bacteriology in invasive paediatric bacterial meningitis in Madagascar

Background: Paediatric bacterial meningitis is a major public health problem. CSF laboratory analysis is the key element to confirm the disease but remains difficult to access by clinicians or patients in low-resource settings. We described CSF biological tests results in invasive paediatric bacterial meningitis at the University Hospital Mother and Child of Tsaralalàna (CHUMET) in Madagascar.Methods: In this retrospective and descriptive study from January 2013 to December 2018, all CSF samples that were confirmed for bacterial meningitis by triplex PCR Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis were enrolled. CSF collected from eligible children were tested by microscopy, culture, soluble antigen at CHUMET laboratory. Residual CSF was referred to the regional reference laboratory (RRL) for real-time polymerase chain reaction (RT-PCR) confirmatory testing and serotyping.Results: Over the 6-year study period, 2286 CSF were tested by PCR, 141 (6.1%) were positive. The age group of (1-12 months) was the most affected (68.0%). The majority of CSF were cloudy with pleiocytosis >100/mm3. Hyperproteinorrhea >1 g/l was noted in 48.2% of cases. The sensitivity of gram stain was respectively 56.6% and 75% for Pneumococcus and Meningococcus detection while for culture it was 28.3% and 66.6%, respectively. The average white cell count was notably higher in meningococcal meningitis and changed significantly according to the pathogens identified (p=0.007).Conclusions: Paediatric bacterial meningitis diagnosis are based on CSF laboratory testing. Accessibility to multiplex PCR point-of-care tests targeting meningitis pathogens should be made easier for laboratories in low-income countries to improve patient care, monitor pathogen trends and vaccine impact program.

SEROPREVALENCE OF HIV, HBV, HCV, SYPHILIS AMONG DONORS OF BLOOD AT THE NATIONAL CENTER OF BLOOD TRANSFUSION ANTANANARIVO IN 2014

Introduction: Currently, routine screening for HIV, hepatitis B and C and syphilis is done in most blood banks in the world. Methods: We conducted a prospective descriptive study at the National Blood Transfusion Center (CNTS) Antananarivo for a period of 7 months from January to July 2014, which aims to assess the socio-clinical factors accompanying ineligibility of blood products and to determine the seroprevalence of HIV, hepatitis B, C and syphilis of the blood donors who have spent at CNTS HU JRA Antananarivo during this period. All donors who have abnormal results of microbiological examinations were included. The parameters used and studied were age, sex, marital status, blood and results microbiological examinations for HIV, hepatitis B, C, and syphilis. The prevalence of blood donors who presented a serological abnormality is 3.95% with a predominance of donors with hepatitis B (72.93%) followed by syphilis (18.29%) of the hepatitis C (6.95%) and HIV (1.80%) and a predominance of young people. Conclusion: At the CNTS Antananarivo, the HBV is the main definitive reason for exclusion of these donors. This high prevalence is a real public health problem for the country\u27s health authorities. The search for maximum safety in blood transfusion through firstly a better selection of blood donors by implementing a policy of strong loyalty and other early diagnosis of major diseases transmissible by blood and likely to infect the recipient. KEYWORDS: Antananarivo; Blood donor; Microbiology; Seroprevalence

SEROPREVALENCE OF HIV, HBV, HCV, SYPHILIS AMONG DONORS OF BLOOD AT THE NATIONAL CENTER OF BLOOD TRANSFUSION ANTANANARIVO IN 2014

Introduction: Currently, routine screening for HIV, hepatitis B and C and syphilis is done in most blood banks in the world. Methods: We conducted a prospective descriptive study at the National Blood Transfusion Center (CNTS) Antananarivo for a period of 7 months from January to July 2014, which aims to assess the socio-clinical factors accompanying ineligibility of blood products and to determine the seroprevalence of HIV, hepatitis B, C and syphilis of the blood donors who have spent at CNTS HU JRA Antananarivo during this period. All donors who have abnormal results of microbiological examinations were included. The parameters used and studied were age, sex, marital status, blood and results microbiological examinations for HIV, hepatitis B, C, and syphilis. The prevalence of blood donors who presented a serological abnormality is 3.95% with a predominance of donors with hepatitis B (72.93%) followed by syphilis (18.29%) of the hepatitis C (6.95%) and HIV (1.80%) and a predominance of young people. Conclusion: At the CNTS Antananarivo, the HBV is the main definitive reason for exclusion of these donors. This high prevalence is a real public health problem for the country's health authorities. The search for maximum safety in blood transfusion through firstly a better selection of blood donors by implementing a policy of strong loyalty and other early diagnosis of major diseases transmissible by blood and likely to infect the recipient. KEYWORDS: Antananarivo; Blood donor; Microbiology; Seroprevalence

Profil anthropométrique des enfants scolarisés tananariviens

Abstract Les enfants tananariviens sont en état de malnutrition chronique. Notre objectif est d'évaluer l'indice de masse corporelle (IMC) pour estimer les enfants apparemment "sains". Une enquête et une mesure de la taille et du poids des enfants scolarisés tananariviens de 6 à 11 ans ont été réalisées. Après leur accord, la taille et l'indice de masse corporelle des 442 enfants tirés au hasard ont été ainsi obtenus. L'analyse de la moyenne de la taille a révélé une différence significative à 8 ans, une différence non évidente sur l'indice de masse corporelle. La comparaison avec les valeurs de référence (OMS 2006) a montré un retard statural de 34% avec une tendance globale à la hausse et un déficit pondéral égal à 5,5% selon le z score. Ainsi, au sein d'une population malnutrie, l'indice de masse corporelle pourrait être utilisé comme un des paramètres à considérer dans l'évaluation de l'état de santé pour classer ces enfants en bonne santé apparente

Séroprévalence de la cysticercose et facteurs de risque associés chez un groupe de patients vus au Centre Hospitalier Régional de Référence d’Antsirabe, Madagascar

Introduction: A Madagascar, la cysticercose, maladie causée par la forme larvaire de Taenia solium, demeure un problème de santé publique. En 2003, la séroprévalence de la cysticercose variait entre 7% et 21% avec un taux plus élevé dans les régions centrales de l’île. Toutefois, depuis une dizaine d’année, les données épidémiologiques concernant la cysticercose humaine restent limitées. Notre étude a pour objectif de déterminer, chez les patients issus de la région de Vakinankaratra et qui sont suspects cliniquement, la séroprévalence de la cysticercose par Western blot ainsi que les facteurs de risque associés. Méthodes: Il s’agit d’une étude descriptive transversale menée sur une période de 6 mois au sein du Centre Hospitalier Régional de Référence d’Antsirabe. Tous les patients inclus dans l’étude ont répondu à un questionnaire clinique recueillant leurs caractéristiques sociodémographiques et culturelles ainsi que leurs habitudes alimentaires et leurs symptômes cliniques. Résultats: La séroprévalence de la cysticercose retrouvée dans la population d’étude était de 14,8% (35/237). Ce taux ne diffère pas significativement selon le sexe, l’âge, la consommation de viande de porc ou le mode de préparation de la viande (p > 0,05). Par contre, une différence significative (p < 0,05) a été observée chez les sujets présentant des nodules sous-cutanés ou un résultat de cysticercose antérieur positif. Conclusion: L’index élevé d’exposition à Taenia solium retrouvé dans notre étude justifie le renforcement des mesures de contrôle et de prévention déjà implantés dans le pays

Acid fast bacillus pulmonary and extra pulmonary in a laboratory of university hospital center in Antananarivo, Madagascar since 2003-2014

Background: Tuberculosis has even been a grave public health problem in Madagascar, one of the main causes responsible for death at the hospital for active and productive people.Methods: It was a descriptive and analytical retrospective study of patient records admitted for the research of acid-fast bacillus (AFB) pulmonary and extra pulmonary from January 2003 to December 2014 at the microbiology laboratory of the University Hospital Joseph Ravoahangy Andrianavalona (HU-JRA) Antananarivo, Madagascar. We did this study in order to describe the epidemiology of pulmonary and extra pulmonary tuberculosis at the laboratory. All of the requests about researching AFB for bacterial analysis have been received. Incomplete folders have been rejected. Age, sex, clinic information and the results of AFB research have been analyzed.Results: During 12 years, 1060 requests have been received to research AFB with 89 cases (8.39%) of positivity. Patients were between 9 months and 93 years old. The middle patient age was 41.7 years. Sex-ratio of infected patients was 1.36. There was a significant difference between gender and positive cases (p=0,001). 82 positive cases (93.77%) were pulmonary localization and 7 cases of extra pulmonary (6.23%).Conclusions: Despite the lack of screening, the high rate of bacillary pulmonary tuberculosis found was one of the great epidemiological importances because of their contagiousness. It is obvious that only health actions cannot solve the problem of tuberculosis.

Anemia in Malagasy hospitalized patients

Background: Anemia is a public health problem with major health consequences. According to the WHO, anemia worldwide is 1.62 billion people (95% confidence interval (CI): 1.50-1.74 billion), which corresponds to 24.8% Of the population (95% CI: 22.9-26.7%).Methods: We studied the clinical and biological data of hospitalized patients who applied for a complete blood count in hematology laboratory of Joseph Ravoahangy Andrianavalona Antananarivo hospital between January and April 2017.Results: Sixty-four percent of hospitalized patients had anemia. Anemia was more common in women. Anemia was encountered mainly in intensive care unit (33.9%) and occurred in perioperative cases in the majority of cases (33.4%).Conclusions: Anemia is a common symptom in hospitals, particularly in intensive care unit. In the Malagasy hospital environment, etiologies are numerous, in particular hemorrhage, sickle cell disease or cancer

MICROBIOLOGICAL SCREENING OF OTORRHOEA FROM PEOPLE COMING TO HOSPITAL IN MAHAJANGA

In whole, 56 patients were included. Amidst identified microorganisms were fungus (4,7%) and bacteria (95,3%) to which Gram negative bacilli represented 72,1% (n=44), Gram positive cocci 6,4% (n=10), Gram positive bacilli 8,2% (n=5) and Gram negative cocci 3,3% (n=2). Among these bacterias, Pseudomonas aeruginosa and Proteus sp were predominant, with respectively 41% (n=25), 23% (n=14). However, three cases of S. aureus reported, six with negative coagulase Staphylococcus, one with Escherichia coli, one with Klebsiella sp, one with Haemophilus sp, two cases with Neisseria sp and four cases with Corynebacterium sp. Two types of cultures were noticed, one of them monomorphic (91,1%, n=51) and the other polymorphic (8,9%, n=5) to which 3 associations of P. aeruginosa-Proteus sp, 1 association of P. aeruginosa- coagulase negative Staphylococcus and 1 association of P. aeruginosa- E. coli. No resistance to ciprofloxacin was observed with Pseudomonas, Neisseria sp, Haemophilus, and enterobacteria except for E. coli. No resistance to rifampicin was observed with S. aureus. However, the sensitivity of S. aureus to ciprofloxacin decreased (one bacterium out of three). The use of rifampicin or fluoroquinolones should be based on the type of ear infections