Resurgence of Ebola Virus Disease in Guinea Linked to a Survivor With Virus Persistence in Seminal Fluid for More Than 500 Days.

We report on an Ebola virus disease (EVD) survivor who showed Ebola virus in seminal fluid 531 days after onset of disease. The persisting virus was sexually transmitted in February 2016, about 470 days after onset of symptoms, and caused a new cluster of EVD in Guinea and Liberia

Stigmatisation de la maladie mentale par les étudiants en médecine en Guinée, Conakry

Introduction: Stigmatisation of mental illness constitutes a major problem in the development of mental healthcare programs, especially when it originates from health professionals themselves. The aim of this research is to investigate possible attitudes of stigmatisation among first and final year medical students registered at the University of Conakry faculty of medicine in Guinea-Conakry (West Africa). Methods: Focus group discussions identified students' attitudes and perceptions in relation to mental illness, their explanatory models, their opinions concerning traditional and modern therapeutic practices with regard to mental illness, and their interest to possibly incorporate psychiatry in their future medical practice. Results: Many students explicitly regret the stigmatisation of mental health patients, but nevertheless share the general population's prevailing attitudes of discrimination. The dominant stereotype of mental illness is that of madness, although final year medical students describe a more diverse spectrum of mental health problems. There is strong adherence to secular occult explanations of mental illness and advocacy for traditional medicine in addressing these illnesses, including among final year medical students. Discussion: No student would opt for psychiatry as a specialisation, although some expressed interest in integrating psychiatry into their future medical practice. However, this research indicates that stigmatising attitudes are not cut in stone. Under the impetus of specific teaching programmes, attitudes can evolve to create room for tolerance and compassion.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Séroprévalence de la co-infection VIH /virus de l’hépatite B à l’Hôpital de l’Amitié sino-guinéenne (HASIGUI) Kipé/Conakry (Guinée)

Objectif: L’objectif de cette étude était de déterminer la séroprévalence de la co-infection Virus de l’immunodéficience humaine et Virus de l’hépatite B (VIH/VHB) et les facteurs associés chez les patients reçus au laboratoire biomédical de l’Hôpital de l’Amitié Sino-guinéenne (HASIGUI).Méthodologie et Résultats: Il s’agit d’une étude prospective qui a été menée du 18 juillet 2016 au 18 Avril 2017 sur 525 patients reçus au laboratoire biomédical de HASIGUI pour des examens biologiques. La détection du VIH et le typage ont été faits par immuno-chromatographie à l’aide des Kits spécifiques. La recherche de l’hépatite B a été réalisée par la détection de l’AgHBs par immuno-chromatographie à l’aide de kits spécifiques et par méthode ELISA. Les résultats obtenus ont montré que la prévalence de la coinfection VIH/VHB était de 2,3%. L’âge moyen des patients était de 37 ans avec des extrêmes de 1 et 83 ans. Le sexe masculin était le plus représenté (71,2%) avec une sex-ratio (H/F) égal 2,47. La tranche d’âge la plus représentée était celle des 25 à 34 ans (37,7%). Les prévalences du VIH et de l’hépatite B étaient respectivement de 10,5 et 17,9%. La prévalence du VIH était plus élevée chez le sexe féminins (P=0,05). Tous les cas de VIH détectés étaient du type 1 (VIH1).Conclusion et application: Il ressort de cette étude que la séroprévalence du VIH et du virus de l’hépatite B sont élevées à Conakry. En revanche, celle de la co-infection VIH/VHB est relativement faible par rapport à la plupart des données rapportées dans d’autres pays d’Afrique Sub-saharienne. Cependant, la coinfection VIH/VHB pourrait être considérée comme un problème de santé publique non négligeable en Guinée, nécessitant ainsi son diagnostic précoce en organisant des campagnes de sensibilisation et de  dépistage dans la population, permettant ainsi une meilleure prise en charge des patients co-infectés (VIH/VHB) par un double traitement antirétrovirales et anti-hépatites B.Mots clés: Co-infection, VIH, AgHBs (VHB), HASIGUI, Kipé/ConakryEnglish Title:  Seroprevalence of Hepatitis B Virus and Human Immunodeficiency Virus Coinfection at the Chinese and Guinean Friendships Hospital (HASIGUI) of Kipé Conakry/ GuineaEnglish AbstractObjective: The aim of this study was to determine the seroprevalence of Hepatitis B virus (HBV) and Human Immunodeficiency virus (HIV) coinfection at the Chinese and Guinean friendships hospital of Kipé/Conakry.Methodology and Results: This prospective study was carried out on 525 patients attending to the biomedical laboratory of Kipé/Conakry (HASIGUI) from July 18th, 2016 to April 18th, 2017. HIV and HBV detection assays were done in the sera of all patients by immunochromatographic methods and ELISA. HIV detection and serotyping were processed in sera by immunochromatographic methods. Hepatitis B virus surface Antigen (HBsAg) was detected by immune-chromatographic methods and confirmed by ELISA. The seroprevalence of HIV/HBV coinfection was 2.3%. The mean age was 37 years, ranging from 1 to 83 years. Males were more represented than females and the sex-ratio (M/F) was 2.47%. HIV seroprevalence was 10,5%, while HBV seroprevalence was 17,9%. The HIV prevalence was high in females than males (P=0.05). HIV1 was the only type screened.Conclusion and application of results: This study findings showed that the seroprevalence of HIV/HBV coinfection rate was lower than that reported in other sub-Saharan Africa countries. HBV and HIV infections were similar to some reported prevalence in other sub-Saharan African countries. Then HIV/HBV coinfection must be considered as an important health problems in Guinea. Then, early diagnosis of HIV/HBV co-infected patients must be done to reduce its evolution and to improve its management practices by organizing awarenes and screening campaigns and treatment for both infections, using molecules against HBV and HIV infections.Keywords: HIV, HBV/HBsAg, Co-infection; HASIGUI; Kipé/Conakr

Caractéristiques cliniques, biologiques, thérapeutiques et évolutives des leucémies aigues en République Centrafricaine

Introduction: leucémies aigues restent encore non documentées aux milieux hospitaliers République Centrafricaine. Objectif: Décrire les caractéristiques, cliniques, biologiques, thérapeutiques et évolutives des patients Centrafricains porteurs d’une leucémie aigüe. Matériels et méthodes: il s’agissait d’une étude descriptive menée sur une période de 5 ans dans les centres hospitaliers de Bangui. Le diagnostic des leucémies était retenu par le myélogramme en exigeant un nombre de blastose ≥ 20%. Notre échantillon était constitué de 27 patients. Les paramètres épidémiologiques, cliniques, biologiques, thérapeutiques étaient étudiés. Résultats: L’âge moyen des patients était de 29,1 ans avec les extrêmes de 3 et 75 ans. La prédominance de sexe était masculine, un sexe ratio de 1.7. 62,9% des patients résidaient en zone rurale et étaient agriculteurs (29,6%), commerçants (22,2%). Les facteurs de risques étaient l’exposition aux pesticides (22.2%) et benzènes (25.9%). Le tableau clinique était dominé par une altération de l’état général (85,2%), les signes d’insuffisance médullaire (100%), le syndrome tumoral (51.2%). Au plan biologique, l’anémie et la thrombopénie étaient constantes. Les types cytologiques selon FAB étaient les LAL1 (29,6%), LAL2 (14,8%), LAL3 (7,4%), LAM1 (18,5%), LAM2 (3,7%), LAM3 (7%). Les protocoles thérapeutiques associant Oncovin-Prednisone et Oncovin Prednisone-Cytarabine selon le type de leucémie étaient utilisés avec 18.5% de réponse partielle, aucune rémission complète, 59.2% de décès, 37% de perdu de vue. La probabilité de survie à 1 mois est de 59%, 43% à 2 mois et elle est nulle à 3 mois. Conclusion: Les leucémies aigues restent une affection grave et potentiellement mortelle en République Centrafricaine. La prise en charge reste un challenge et nécessite l’amélioration de nos plateaux technique. Mots clés: Leucémie aigüe, République Centrafricaine English Title: Clinical, biological, therapeutic and evolutionary characteristics of acute leukemia in the Central African Republic. English Abstract Introduction: acute leukaemias still remain undocumented in Central African Republic. Objective: To describe the clinical, biological, therapeutic and evolutionary characteristics of Central African patients with acute leukemia. Materials and methods: It was a descriptive study with duration of 5 years, conducted in Bangui. The diagnosis of leukemia was required a number of blastosis ≥ 20%. Our sample consisted of 27 patients. The epidemiological, clinical, biological and therapeutic parameters were studied. Results: The mean age of the patients was 29.1 years with the extremes of 3 and 75 years. The sex predominance was male, a sex ratio of 1.7. 62.9% of patients lived in rural areas and were farmers (29.6%), traders (22.2%). The risk factors were exposure to pesticides (22.2%) and benzenes (25.9%). The clinical picture was dominated by deterioration in general condition (85.2%), signs of bone marrow failure (100%), tumor syndrome (51.2%). Biologically, anemia and thrombocytopenia were constant. The cytologic types according to FAB were LAL1 (29.6%), LAL2 (14.8%), LAL3 (7.4%), LAM1 (18.5%), LAM2 (3.7%), LAM3 (7 %). The treatment protocols combining Oncovin-Prednisone and Oncovin Prednisone-Cytarabine according to the type of leukemia were used with 18.5% partial response, no complete remission, 59.2% death, 37% loss to follow-up. The probability of survival at 1 month is 59%, 43% at 2 months and it is zero at 3 months. Conclusion: Acute leukemia remains a serious and potentially fatal condition in the Central African Republic. Support remains a challenge and requires the improvement of our technical platforms. Key words: Acute leukemia, Central African Republi

Hypercalcémie importante révélant un myélome multiple chez une adolescente de 19 ans

Le myélome multiple est caractérisé par une prolifération des plasmocytes malins sécrétant une immunoglobuline monoclonale complète ou incomplète. C’est une affection de l’adulte mûr. L’âge moyen de survenue est au-delà de 50 ans, rare avant 40 ans et exceptionnel chez les enfants ce qui fait qu’il n’est pas toujours évoqué en première intention chez les sujets jeunes en Afrique Noire. Nous rapportons dans cette étude, l’observation d’une adolescente de 19 ans, sans antécédents pathologiques particuliers, adressée dans notre service pour l’investigation d’une anémie sévère. La symptomatologie était dominée par une hypercalcémie importante inexpliquée associée à une insuffisance rénale. Le myélogramme fait dans le compte d’une anémie normochrome normocytaire arégénérative notait une infiltration médullaire d’environ 12 % par les plasmocytes dysmorphiques. La présence d’une immunoglobuline monoclonale IgG exprimant la chaine légère de type kappa à l’immunofixation des protéines urinaires et les lésions osseuses multiples ont permis de porter le diagnostic de myélome multiple. La chimiothérapie par le protocole VRD a permis une rémission partielle avec correction de la calcémie. L’intérêt de cette étude réside dans le caractère exceptionnel de cette affection à cette tranche d’âge suscitant un intérêt étiopathogénique. Ceci devait motiver les praticiens à y penser devant les signes révélateurs chez les sujets jeunes.Mots-clés: Myélome multiple, adolescent, AbidjanEnglish Title: Significant hypercalcaemia revealing multiple myeloma in young girls of 19-year-oldEnglish AbstractMultiple myeloma is characterized by proliferation of malignant plasma cells secreting complete or incomplete monoclonal immunoglobulin. It is an affection of the elderly. The average age of onset is beyond 50 years old, rare before 40 years old and exceptional in children so that it is not always evoked in first intention in young people in Black Africa. We report, the case of the girl who was 19 years old, with no particular medical history, adressed for the investigation of severe anemia. The symptomatology was dominated by unexplained significant blood calcemia associated with renal failure. The bone marrow exam, done because of an aregenerative normocytic normochromic anemia noted an infiltration about 12% of dysmorphic plasma cells in the bone marrow. The monoclonal IgG immunoglobulin expressing the kappa light  chain found during the urinary proteins immunofixation and multiple bone lesions confronted to the diagnosis of multiple myeloma. The chemotherapy with the VRD protocol allowed a partiel remission with correction of the calcemia. The interest of this study resides in the exceptional character of the affection with this age group and which arouses an etiopathogenic interest. This should motivate practitioners to think about it during signs in young people.Keywords: Multiple myeloma, young people, Abidja

Correction: Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea.

[This corrects the article DOI: 10.1371/journal.pmed.1001967.]

Experimental treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial) : a historically controlled, single-arm proof-of-concept trial in Guinea

BACKGROUND:Ebola virus disease (EVD) is a highly lethal condition for which no specific treatment has proven efficacy. In September 2014, while the Ebola outbreak was at its peak, the World Health Organization released a short list of drugs suitable for EVD research. Favipiravir, an antiviral developed for the treatment of severe influenza, was one of these. In late 2014, the conditions for starting a randomized Ebola trial were not fulfilled for two reasons. One was the perception that, given the high number of patients presenting simultaneously and the very high mortality rate of the disease, it was ethically unacceptable to allocate patients from within the same family or village to receive or not receive an experimental drug, using a randomization process impossible to understand by very sick patients. The other was that, in the context of rumors and distrust of Ebola treatment centers, using a randomized design at the outset might lead even more patients to refuse to seek care. Therefore, we chose to conduct a multicenter non-randomized trial, in which all patients would receive favipiravir along with standardized care. The objectives of the trial were to test the feasibility and acceptability of an emergency trial in the context of a large Ebola outbreak, and to collect data on the safety and effectiveness of favipiravir in reducing mortality and viral load in patients with EVD. The trial was not aimed at directly informing future guidelines on Ebola treatment but at quickly gathering standardized preliminary data to optimize the design of future studies.METHODS AND FINDINGS:Inclusion criteria were positive Ebola virus reverse transcription PCR (RT-PCR) test, age ≥ 1 y, weight ≥ 10 kg, ability to take oral drugs, and informed consent. All participants received oral favipiravir (day 0: 6,000 mg; day 1 to day 9: 2,400 mg/d). Semi-quantitative Ebola virus RT-PCR (results expressed in "cycle threshold" [Ct]) and biochemistry tests were performed at day 0, day 2, day 4, end of symptoms, day 14, and day 30. Frozen samples were shipped to a reference biosafety level 4 laboratory for RNA viral load measurement using a quantitative reference technique (genome copies/milliliter). Outcomes were mortality, viral load evolution, and adverse events. The analysis was stratified by age and Ct value. A "target value" of mortality was defined a priori for each stratum, to guide the interpretation of interim and final analysis. Between 17 December 2014 and 8 April 2015, 126 patients were included, of whom 111 were analyzed (adults and adolescents, ≥13 y, n = 99; young children, ≤6 y, n = 12). Here we present the results obtained in the 99 adults and adolescents. Of these, 55 had a baseline Ct value ≥ 20 (Group A Ct ≥ 20), and 44 had a baseline Ct value < 20 (Group A Ct < 20). Ct values and RNA viral loads were well correlated, with Ct = 20 corresponding to RNA viral load = 7.7 log10 genome copies/ml. Mortality was 20% (95% CI 11.6%-32.4%) in Group A Ct ≥ 20 and 91% (95% CI 78.8%-91.1%) in Group A Ct < 20. Both mortality 95% CIs included the predefined target value (30% and 85%, respectively). Baseline serum creatinine was ≥110 μmol/l in 48% of patients in Group A Ct ≥ 20 (≥300 μmol/l in 14%) and in 90% of patients in Group A Ct < 20 (≥300 μmol/l in 44%). In Group A Ct ≥ 20, 17% of patients with baseline creatinine ≥110 μmol/l died, versus 97% in Group A Ct < 20. In patients who survived, the mean decrease in viral load was 0.33 log10 copies/ml per day of follow-up. RNA viral load values and mortality were not significantly different between adults starting favipiravir within <72 h of symptoms compared to others. Favipiravir was well tolerated.CONCLUSIONS:In the context of an outbreak at its peak, with crowded care centers, randomizing patients to receive either standard care or standard care plus an experimental drug was not felt to be appropriate. We did a non-randomized trial. This trial reaches nuanced conclusions. On the one hand, we do not conclude on the efficacy of the drug, and our conclusions on tolerance, although encouraging, are not as firm as they could have been if we had used randomization. On the other hand, we learned about how to quickly set up and run an Ebola trial, in close relationship with the community and non-governmental organizations; we integrated research into care so that it improved care; and we generated knowledge on EVD that is useful to further research. Our data illustrate the frequency of renal dysfunction and the powerful prognostic value of low Ct values. They suggest that drug trials in EVD should systematically stratify analyses by baseline Ct value, as a surrogate of viral load. They also suggest that favipiravir monotherapy merits further study in patients with medium to high viremia, but not in those with very high viremia.TRIAL REGISTRATION:ClinicalTrials.gov NCT02329054.Evaluation of the efficacy and of the antiviral activity of T-705 (favipiravir) duringEbola virus infection in non-human primates humansEbola Virus Disease - correlates of protection, determinants of outcome, and clinical managemen