Tétanos du post-partum sur déchirure vaginale à propos d’un cas à l’Hôpital National de Zinder, Niger

We report an exceptional case of postpartum tetanus occurring in an unvaccinated primipara having given birth in a health center. Six days after childbirth, she had a trismus associated with generalized muscle contractions suggestive of tetanus. Obstructed labor was complicated by a vulvar tear repaired with wires under septic conditions. Functional sequelae, such as dysarthria, quadriesteria, and a decrease in visual acuity, marked the evolution. The newborn was free from neonatal tetanus. Our patient poses the problem of access to preventive care and the quality of care in health facilities in developing countries

Disseminated Herpes Zoster in the Immunocompetent, A Case at Zinder National Hospital

Introduction: Herpes zoster, shingles, is a secondary pathology due to a reactivation of the varicella-zoster virus (VZV) and common in the general population. It is responsible for a painful skin rash localized in the area of the body innervated by a nerve root. The rash can be widespread affecting several dermatomes especially in the immunocompromised subject. Observation: We report an observation of disseminated shingles in an immunocompetent adult hospitalized in the Internal Medicine Department of Zinder National Hospital. AT 55 years old, was admitted for management of a very painful skin rash. Pruriginous vesicles extended diffusely out of the metameric topography to all the enveloping membranes of the body including vulvo-vaginal and oral enanthem. Biologically, blood count (CBC), blood glucose, and renal function were normal. Human immunodeficiency virus (HIV) status was negative. The clinical course was uneventful characterized by apyrexia at 48 hours and drying of the lesions. Medical care was based on symptomatic treatment. Conclusion: Shingles is a common viral disease, but potentially serious in some situations. The disseminated form is exceptional in the immunocompetent subject. Its detection and early treatment ensure a reduction in the severity of the complications. &nbsp

Profils Épidémiologiques, Cliniques et Thérapeutiques de la Sténose Urétrale de L’homme à l’Hôpital National de Zinder (HNZ), Niger

Objectif : Décrire les aspects épidémiologiques, cliniques et thérapeutiques de la sténose urétrale à L’hôpital national de Zinder (HNZ) NIGER. Patients et méthodes : Il s’agissait d’une étude rétrospective descriptive réalisée dans le service d’Urologie de l’HNZ durant la période de janvier 2016 à Décembre 2019. Nous avons colligé 116 dossiers médicaux des patients, chez qui le diagnostic de rétrécissement urétral était posé et documenté par une urétro-cystographie rétrograde et mictionnelle (UCRM) et pris en charge. Résultats : Au cours de cette étude, 116 dossiers étaient retenus sur 964 interventions durant la période soit 8, 31%.L’âge moyen des patients était de 39,53 ans avec des extrêmes de 18 ans et 74 ans. Les principaux motifs de consultations étaient la dysurie (25 ,86%), la pollakiurie (15,52%), et la rétention aiguë dans (17,24%). L’urétro-cystographie rétrograde et mictionnelle (UCRM) était le principal examen complémentaire du diagnostic. Cet examen avait permis de découvrir, 69,3% de sténose urétrale au niveau bulbaire, 17,5% au niveau pénien antérieur, 9,4% multiples, 3,8% au niveau du méat urétral. Le traitement avait consisté en une résection anastomose termino-terminale (RATT) au niveau bulbaire dans 57,21%(n=67), de dilatations urétrales (DU) aux béniqués dans 19, 01% (n=22) des cas, urétroplastie en deux temps selon Johanson dans 11, 52%(n=13), de plasties par greffe de peau glabre de la crête iliaque dans 8,42% (n=10), et une méatotomie 3,45%(n=4). Après un recul de 21 mois, les anastomoses (RATT) étaient jugées bonnes pour 61,19% (41/67). Les échecs étaient enregistrés dans 16,42% (n=11) et 22,39% (n=15) étaient perdus de vue. Pour les dilatations aux béniqués à 9 mois de recul, 59% (n= 13) étaient évaluées bonnes, et mauvaises dans 41% (n=9) des cas. Les plasties avec greffe étaient réussies dans 30% (n=3) des cas, et 70% (n=7) étaient des échecs. Les urétroplasties selon Johanson étaient jugées satisfaisantes à six mois de récul dans 23,07% (3/13) des cas, et non satisfaisantes dans 76,93% (10/13) des cas.Toutes les méatotomies étaient réussies (n=4). Un RPM ≤ 30 ml était enregistré dans 55,17% des cas et ≥ 100ml dans 31,90% des cas. Quinze patients soit 12,93 étaient perdus de vue après leur première évaluation. Conclusion : La sténose de l’urètre est une affection fréquente dans les consultations en urologie à l’HNZ. Les patients consultent souvent au stade de complications. L’UCRM est la clé du diagnostic topographique de la lésion. La résection anastomose terminoterminale donne de bons résultats. La maitrise des plasties avec greffe de muqueuse, ou cutanée reste encore un défi dans notre contexte. Objective: To describe the epidemiological, clinical and therapeutic aspects of urethral stenosis at Zinder National Hospital (ZNH) NIGER. Patients and methods: This was a descriptive retrospective study carried out in the Department of Urology of the ZNH during the period from January 2016 to December 2019. We collected 116 medical records of patients, in whom the diagnosis of narrowed Urethral donation was performed and documented by retrograde and voiding urethro-cystography and managed. Results: During this study, 116 files were retained on 964 interventions during the period, ie 8.31%. The average age of the patients was 39.53 years with extremes of 18 and 74 years. The main reasons for consultations were dysuria (25.86%), pollakiuria (15.52%), and acute retention in (17.24%). Retrograde and voiding urethro-cystography (UC) was the main complementary diagnostic examination. This examination had revealed 69.3% urethral stenosis at the bulbar level, 17.5% at the anterior penis level, 9.4% multiple, 3.8% at the urethral meatus. The treatment consisted of resection of the end-to-end anastomosis at the bulbar level in 57.21% (n = 67), from urethral dilation to the benign in 19.01% (n = 22) of the cases, urethroplasty in two stages according to Johanson in 11.52% (n = 13), of plasties by glabrous skin graft of the iliac crest in 8.42% (n = 10), and a meatotomy 3.45% (n = 4). After a 21-month follow-up, anastomoses were considered good for 61.19% (41/67). Failures were recorded in 16.42% (n = 11) and 22.39% (n = 15) were lost to follow-up. For dilations to the benign patients at 9 months of follow-up, 59% (n = 13) were rated good, and poor in 41% (n = 9) of the cases. Plasty with grafting was successful in 30% (n = 3) of the cases, and 70% (n = 7) were failed. Johanson's urethroplasty was considered satisfactory after six months of recession in 23.07% (3/13) of the cases, and unsatisfactory in 76.93% (10/13) of the cases. All meatotomies were successful (n = 4). An RPM ≤ 30 ml was recorded in 55.17% of the cases and ≥ 100ml in 31.90% of the cases. Fifteen patients (12.93) were lost to follow-up after their first evaluation. Conclusion: Stenosis of the urethra is a common condition in consultations at the NHZ. Patients often consult for complications. The UC is the key to the topographic diagnosis of the lesion. Resection with end to end anastomosis gives good results. Plasties with mucosal or skin grafting still remain a challenge in our context

Péritonites Aiguës d’Origine Gynécologique à l’Hôpital National de Zinder, Niger

Introduction : les péritonites aiguës gynécologiques (PAGy) sont rares dans notre pratique chirurgicale. Un retard diagnostique et thérapeutique conduit à une laparotomie dans notre contexte. L’objectif de cette étude était de décrire les caractéristiques épidémiologiques et thérapeutiques des PAGy à l’Hôpital National de Zinder, Niger. Patientes et méthodes : il s’agissait d’une étude rétrospective allant de janvier 2013 à décembre 2016 (4 ans). Étaient incluses les patientes opérées pour péritonite dont le diagnostic de péritonite aiguë gynécologique(PAGy) était confirmé en peropératoire. Étaient exclues les péritonites d’autres causes non gynécologiques. Les patientes présentant une infection génitale non opérées n’étaient pas incluses. Résultats : Durant la période d’étude, 660 cas de péritonites étaient enregistrés, dont 190 femmes. Les péritonites aiguës gynécologiques (PAGy) représentant 2,87% (n=19) toutes les péritonites opérées. L’âge moyen de nos patientes était de 27,9±7,7 ans. Une notion d’algie pelvienne chronique était retrouvée dans 42,1% (n=8), de fièvre au long cours dans 36,8% (n=7). Les patientes étaient mariées dans 79% (n=15) et multipares dans 57,9% (n=9). Le délai médian de consultation était de 8 jours (extrêmes : 6-25 jours). La péritonite était généralisée dans 84,2% (n=16) et localisée dans 15,8% (n=3). L’origine était tubo-ovarienne dans 94,5% (n=18). Le traitement conservateur préservant les annexes était fait dans 78,9% (n=15). Les infections du site opératoire étaient enregistrées dans 21,1% (n=4). La mortalité était de 21,1% (n=4). Les facteurs associés au risque de décès étaient : le délai d’admission > 9 jours (p=0,032), la fièvre > 38,5°C et l’infection à VIH (p=0,035). Conclusion : Les péritonites aiguës gynécologiques affectent les femmes jeunes avec un statut socio-économique bas. Elles sont souvent diagnostiquées au stade de péritonites généralisées. Dans notre contexte l’origine est tuboovarienne est prédominante. La mortalité élevée pourrait être prévenue par un diagnostic et un traitement précoce des infections génitales. Introduction: Acute gynecological peritonitis is rare in our surgical practice. The diagnostic and therapeutic delay leads to a laparotomy in our context. The objective of this study was to describe the epidemiological and therapeutic characteristics of acute gynecological peritonitis at the Zinder National Hospital, Niger. Patients and methods: this was a retrospective study from January 2013 to December 2016 (4 years). Patients operated for peritonitis whose diagnosis of acute gynecological peritonitis was confirmed intraoperatively were included. Patients with peritonitis from other non gynecological causes were excluded. Patients with unoperated genital infection were not included. Results: During the study period, 660 cases of peritonitis were recorded, including 190 women. Acute gynecological peritonitis (PAGy) representing 2.87% (n = 19) all operated peritonitis. The average age of our patients was 27.9 ± 7.7 years. A notion of chronic pelvic pain was found in 42.1% (n = 8), of long-term fever in 36.8% (n = 7). Patients were married in 79% (n = 15) and multiparous in 57.9% (n = 9). The median consultation time was 8 days (range: 6-25 days). Peritonitis was generalized in 84.2% (n = 16) and located in 15.8% (n = 3). The origin was adnexal in 94.5% (n = 18). Conservative treatment preserving the appendices was done in 78.9% (n = 15). Operative site infections recorded in 21.1% (n = 4). Mortality was 21.1% (n = 4). Factors associated with the risk of death were: time to admission> 9 days (p = 0.032), fever> 38.5 ° C, and HIV infection (p = 0.035). Conclusion: Acute gynecological peritonitis affects young women with low socio-economic status. They are often diagnosed at the stage of generalized peritonitis. In our context adnexal origin is predominant. High mortality could be prevented by early diagnosis and treatment of genital infections. &nbsp

Epidémies de Choléra en Afrique Sub-Saharienne: Revue documentaire de 2010 à 2016

Introduction: Cholera remains a major public health problem in many parts of the world and particularly in sub-Saharan African countries. The objective of this study is to review data on cholera epidemiology, risk, microbiological and disease control factors in sub-Saharan Africa from 2010 to 2016. Material and method: A literature review on cholera epidemics in sub-Saharan Africa from 2010 to 2016 was conducted using electronic databases from countries that have experienced epidemics. Annual cholera data for countries with outbreaks from 2010 to 2016 have been reported. Results: From 2010 through 2016, 35 of the 54 African countries have experienced cholera epidemics. An overall of 1268 outbreaks have been reported, of which 13.04% were recorded in Nigeria and 4.35% in Burundi. The number of cases reported was 801022 and 13232 deaths (overall CFR =1.65%). Vibrio cholerae O1 and O139 are the main etiological agents. The main risk factors are heavy rains, floods, contamination of water sources and lack ofsanitation. Conclusion: In addition to the suffering of patients, cholera outbreaks cause panic, disrupt economic and social structures and hinder the development of affected communities. Mobilization of the water, sanitation and hygiene sectors is essential to ensure the benefits of patient care and cholera vaccination.Introduction : Le choléra demeure un problème majeur de Santé Publique dans de nombreuses parties du monde et en particulier dans les pays d’Afrique subsaharienne. L’objectif de cette étude de faire une revue des donnéessur les épidémies de choléra, les facteurs de risques, microbiologiques et de lutte contre la maladie en Afrique sub-saharienne de 2010 à 2016. Materiels et méthode: Une revue de la littérature sur les épidémies de choléra en Afrique sub-saharienne de 2010 à 2016 a été conduite dans des banques de données ou bases de données et bibiothèques électroniques des pays ayant connu des épidémies. Les données annuelles de choléra dans les pays ayant connu des épidémies de 2010 à 2016 ont été rapportées. Résultats : Entre 2010 et 2016, 35 des 54 pays d'Afrique ont connu des épidémies de choléra. 1268 épisodes épidémiques ont été rapportés dont 13,04% au Nigeria et 4,35% au Burundi. Le nombre de cas notifiés était de 801022 dont 13232 décès (létalité globale =1,65%). Le Vibrio cholerae O1 et O139 sont les principaux agents étiologiques épidémiogènes. Les principaux facteurs de risques sont les pluies abondantes, les inondations, la contamination des sources d’eau et le manque d’assainissement. Conclusion : En dehors des souffrances éprouvées par les malades, les flambées de choléra provoquent la panique, désorganisent les structures économiques et sociales et freinent le développement des communautés touchées. Cependant, la mobilisation des secteurs de l’eau, de l’assainissement et de l’hygiène ainsi que le rensforcement des systemes de surveillance et riposte surtout au niveau transfrontalier sont des etapes essentielles pour la lutte contre les epidemies de cholera en Afrique subsaharienne

Infections Du Site Opératoire À l’Hôpital National De Zinder, Niger: Aspects Épidémiologiques Et Bactériologiques

Objectif : Rapporter les caractéristiques épidémiologiques et bactériologiques des infections du site opératoire (ISO) dans les services de chirurgie de l'hôpital national de Zinder, Niger. Patients et méthodes : Il s’agissait d’une étude transversale qui s’est déroulée sur une période de 5 mois (Mai à Aout 2016) aux services de chirurgie et de laboratoire de l’Hôpital National de Zinder (HNZ) au Niger incluant tous les patients opérés et ayant développé une ISO. Résultats : Durant l’étude, 485 patients avaient été opérés et 38 cas d’ISO étaient enregistrés soit une incidence de 7,83 %. L’âge médian était de 31,5 ans (8-78 ans). Le sexe masculin était majoritaire avec un sexratio de 6,6 (33/5). Les urgences chirurgicales représentaient 57,9% des cas (n=22). Selon la classification d’Alte Meier, 13 cas (34,2%) étaient considérés comme une chirurgie contaminée et 21 cas (55,3%) une chirurgie sale. Les ISO étaient superficielles dans 36,8% (n=14), profondes dans 42,1% (n=16). Sur les 38 prélèvements analysés, 33 cultures étaient positives soit 86,8%. Les entérobactéries représentaient 69,7% (n=23), les Cocci à Gram positif 24,2% (n=8). Escherichia coli était l’espèce prédominante avec 45,5% (n=15), suivie de Staphylococcus aureus avec 18,2% (n=6). La majeure partie des cultures positives provenait du service de chirurgie viscérale 15 cas (45,5%) puis de l’urologie et de traumatologie-orthopédie avec respectivement 10 cas (30,3%) et 8 cas (24,2%). La quasi-totalité des entérobactéries était résistante aux antibiotiques usuels (amoxicilline, amoxicilline-acide clavulanique) et plus de 84% étaient résistantes à la ceftriaxone. En général les bacilles Gram négatifs étaient sensibles à l’imipenème (100%), la colistine (93,8%), l’aztréonam (68,7%) et le chloramphénicol (47,8%). Les cocci-Gram positifs étaient sensibles à la vancomycine, au chloramphénicol et à l’érythromycine dans respectivement 100% ; 62,5% et 57,1%. Conclusion : Les infections du site opératoires représentent un problème majeur. La fréquence des ISO rend indispensable la mise en place d'une équipe multidisciplinaire pour la surveillance de celles-ci. Le fort taux de résistance aux antibiotiques usuels doit susciter des actions préventives et systématiser l’examen bactériologique en cas de suppurations postopératoires. Objective: To report the epidemiological and bacteriological characteristics of surgical site infections (SSI) in the surgical departments of Zinder National Hospital. Patients and methods: This was a cross-sectional study that took place over a period of 5 months (May to August 2016) at the Zinder National Hospital (HNZ) Surgical and Laboratory Services in Niger including all patients operated on and having developed an SSI. Results: During the study, 485 patients had been operated on and 38 cases of ISO were recorded with an incidence of 7.83%. The median age was 31.5 years (8-78 years). The male sex was in the majoritywith a sex ratio of 6.6 (33/5). Surgical emergencies accounted for 57.9% of cases (n = 22). According to Altemeier's classification, 13 cases (34.2%) were considered as contaminated surgery and 21 cases (55.3%) were dirty surgery. Surgical site infections were superficial in 36.8% (n = 14), deep in 42.1% (n = 16). Of the 38 samplings analyzed, 33 cultures were positive, i.e. 86.8%. The enterobacteria accounted for 69.7% (n = 23), Gram-positive Cocci 24.2% (n = 8). Escherichia coli was the predominant species with 45.5% (n = 15), followed by Staphylococcus aureus with 18.2% (n = 6). The majority of positive cultures came from the visceral surgery department 15 cases (45.5%) followed by urology and orthopedic trauma with respectively 10 cases (30.3%) and 8 cases (24.2%). Virtually all enterobacteria were resistant to the usual antibiotics (amoxicillin, amoxicillinclavulanic acid) and more than 84% were resistant to ceftriaxone. In general Gram-negative bacilli were sensitive to imipenem (100%), colistin (93.8%), aztreonam (68.7%) and chloramphenicol (47.8%). Gram-positive cocci were sensitive to vancomycin, chloramphenicol and erythromycin in 100%, respectively; 62.5% and 57.1%. Conclusion: Surgical site infections represent a major problem. The frequency of SSI makes it essential to set up a multidisciplinary team to monitor them. The high rate of resistance to the usual antibiotics must provoke preventive actions and systematize the bacteriological examination in case of postoperative suppuration

Prise En Charge Des Dermo-Hypodermites Nécrosantes Au Centre Hospitalier Régional De Diffa, Niger

Introduction : la dermo-hypodermite nécrosante (DHN) est une affection redoutable, responsable d’une morbi-mortalité importante constituant un véritable problème de santé publique dans la région de Diffa. L’objectif de cette étude est décrire la prise en charge des DHN dans le service de chirurgie du Centre Hospitalier Régional (CHR) de Diffa. Patients et méthodes : Il s’est agi d’une étude rétrospective descriptive, menée dans le service de chirurgie du CHR de Diffa, et incluant les dossiers des cas de DHN, pris en charge de Janvier 2017 à Décembre 2018. Résultats : 132 cas ont été enregistrés. L’âge médian était de 25 ans (extrêmes : 10 jours et 87 ans). Tous les patients ont bénéficié d’une antibiothérapie et dans 91,8% un traitement chirurgical était nécessaire. Le nombre de passage au bloc opératoire était compris entre 2 et 36. Une greffe de peau a été réalisée dans 25,7% des cas. Le taux d’amputation de membre était de 9,1%. La durée moyenne de séjour hospitalier était de 32,3 jours (extrêmes : 17 jours et 189 jours). La mortalité intra hospitalière était de 3,8% (n=5). Conclusion: la dermo-hypodermite nécrosante est une affection grave, fréquente dans la région de Diffa dont la prise en charge médico-chirurgicale est lourde, grevée d’un mauvais pronostic. Un accent devrait être mis sur la recherche étiologique et le contrôle des facteurs prédisposant et aggravant de la maladie. Introduction: Necrotizing dermo-hypodermatitis (NHD) is a dreaded condition, responsible for a significant morbi-mortality constituting a real public health problem in the region of Diffa. The objective of this study is to describe the management of NHD in the surgical department of the Regional Hospital Center (CHR) of Diffa. Patients and methods: This was a descriptive retrospective study, conducted in the surgery department of the CHR of Diffa, and including the records of NHD cases, taken in charge from January 2017 to December 2018. Results: 132 cases were recorded. The median age was 25 years (extremes: 10 days and 87 years). All patients received antibiotic therapy and in 91.8% of cases surgical treatment was required. The number of visits to the operating theatre ranged from 2 to 36. A skin graft was performed in 25.7% of cases. The limb amputation rate was 9.1%. The average length of hospital stay was 32.3 days (extremes: 17 days and 189 days). Intra-hospital mortality was 3.8% (n=5). Conclusion: Necrotizing dermo-hypodermatitis is a serious condition, frequent in the region of Diffa, with a poor prognosis and heavy medical and surgical management. Emphasis should be placed on etiological research and control of predisposing and aggravating factors of the disease

Facteurs prédictifs de décès au cours de la TB pulmonaire chez les PvVIH au CNHU Fann de Dakar

Objectives: In sub-Saharan Africa, tuberculosis is the first pulmonary-located opportunistic infection and the leading cause of death among people living with HIV (PLWHA). This paper focuses on studying the predictive factors of death in people co-infected with pulmonary tuberculosis and HIV at the Ibrahima DIOP MAR clinic for infectious and tropical diseases at the CHNU Fann in Dakar. Materials and Methods: This was a retrospective, descriptive, and analytical study conducted from 1st January 1998 to 31st December 2009. It has been of interest to all patients with a successful pulmonary tuberculosis diagnosis and positive HIV status. Epidemiological, clinical, para-clinical, and progressive parameters were studied. Results: A total of 665 cases of tuberculosis/HIV co-infection were observed during the study period, of which 207 deaths or lethality (31.37%) was recorded. The average age of patients was 39±9 years with extremes of 5 and 74 years. The average length of hospitalization was 31.67 ± 20.67 with extremes of 4 and 312 days for surviving patients compared to 19.00 ± 16.42 with extremes of 1 to 90 days for deceased patients. Immunosuppression was significantly associated with death (p=0.001) with a median CD4 of 32.50 elts/mm3. Lethality was significantly elevated in the presence of dyspnea (p= 0, 00014), consciousness disorder (p=10-6 ), motor deficit (p= 0.008), and hemoptysis (p= 0.03). Conclusion: Tuberculosis/HIV co-infection is a common association in Africa. Here, we are talking about a deadly duo. Taking it requires a good knowledge of the factors of poor prognosis and a good integration of the two programs

Lassa fever outcomes and prognostic factors in Nigeria (LASCOPE): a prospective cohort study

BACKGROUND: Lassa fever is a viral haemorrhagic fever endemic in parts of west Africa. New treatments are needed to decrease mortality, but pretrial reference data on the disease characteristics are scarce. We aimed to document baseline characteristics and outcomes for patients hospitalised with Lassa fever in Nigeria. METHODS: We did a prospective cohort study (LASCOPE) at the Federal Medical Centre in Owo, Nigeria. All patients admitted with confirmed Lassa fever were invited to participate and asked to give informed consent. Patients of all ages, including newborn infants, were eligible for inclusion, as were pregnant women. All participants received standard supportive care and intravenous ribavirin according to Nigeria Centre for Disease Control guidelines and underwent systematic biological monitoring for 30 days. Patients' characteristics, care received, mortality, and associated factors were recorded using standard WHO forms. We used univariable and multivariable logistic regression models to investigate an association between baseline characteristics and mortality at day 30. FINDINGS: Between April 5, 2018, and March 15, 2020, 534 patients with confirmed Lassa fever were admitted to hospital, of whom 510 (96%) gave consent and were included in the analysis. The cohort included 258 (51%) male patients, 252 (49%) female patients, 426 (84%) adults, and 84 (16%) children (younger than 18 years). The median time between first symptoms and hospital admission was 8 days (IQR 7-13). At baseline, 176 (38%) of 466 patients had a Lassa fever RT-PCR cycle threshold (Ct) lower than 30. From admission to end of follow-up, 120 (25%) of 484 reached a National Early Warning Score (second version; NEWS2) of 7 or higher, 67 (14%) of 495 reached a Kidney Disease-Improving Global Outcome (KDIGO) stage of 2 or higher, and 41 (8%) of 510 underwent dialysis. All patients received ribavirin for a median of 10 days (IQR 9-13). 62 (12%) patients died (57 [13%] adults and five [6%] children). The median time to death was 3 days (1-6). The baseline factors independently associated with mortality were the following: age 45 years or older (adjusted odds ratio 16·30, 95% CI 5·31-50·30), NEWS2 of 7 or higher (4·79, 1·75-13·10), KDIGO grade 2 or higher (7·52, 2·66-21·20), plasma alanine aminotransferase 3 or more times the upper limit of normal (4·96, 1·69-14·60), and Lassa fever RT-PCR Ct value lower than 30 (4·65, 1·50-14·50). INTERPRETATION: Our findings comprehensively document clinical and biological characteristics of patients with Lassa fever and their relationship with mortality, providing prospective estimates that could be useful for designing future therapeutic trials. Such trials comparing new Lassa fever treatments to a standard of care should take no more than 15% as the reference mortality rate and consider adopting a combination of mortality and need for dialysis as the primary endpoint. FUNDING: Institut National de la Santé et de la Recherche Médicale, University of Oxford, EU, UK Department for International Development, Wellcome Trust, French Ministry of Foreign Affairs, Agence Nationale de Recherches sur le SIDA et les hépatites virales, French National Research Institute for Sustainable Development

Changing trends in the epidemiology of vertebral osteomyelitis in Marseille, France

The incidence and significant morbidity of vertebral osteomyelitis are increasing despite the progress of diagnosis competences. Among the 50 cases of vertebral osteomyelitis managed in our centers over the past 5 years, 84% of the cases were in men. The mean age was 55 years. Sixty-two percent of patients had comorbidities and risk factors: diabetes mellitus (24%), malignancy (16%), intravenous drug use (10%) and alcoholism (4%). A source of infection was identified in 66% of cases, including postvertebral surgery infection (18%) and hematogenous infection (48%). The mean time to diagnosis was 36 days. Back pain were occurred in 90% of cases, fever (70%), neurologic deficits (40%), epidural abscesses (32%), completed vertebral bone destruction (26%) and psoas abscess (12%). A single organism was isolated in 92% of cases. Gram-positive bacteria were identified in 76% of cases, while Gram-negative bacilli (GNB) were found in 18% of cases. The presence of GNB was significantly associated with malignancy (p 0.041). The mean duration of antibiotic therapy was 123 days. Surgical treatment was performed in 41 cases: spinal stabilization (26%), drainage of abscesses (32%) and relief of compression (40%). Residual pain was found in 24% of cases, and neurologic sequelae in 22%. Cervical or thoracic localization was a risk factor for neurologic compromise (p 0.042). The epidemiology of vertebral osteomyelitis has changed; an increase in malignancy that was significantly associated with vertebral osteomyelitis due to GNB has been observed. Our study shows that the rate of neurologic complications remains high despite improved diagnostic capabilities and optimal treatment