Routine use of antimicrobial drugs during the 2004 cholera epidemic in Douala, Cameroon

Objectives: To evaluate routine use of antimicrobial drugs for treatment and prevention of cholera with special regards to the evolution of the antimicrobial drug resistance patterns of V. cholerae strains. Design: Retrospective population-based descriptive study. Subjects: Four thousand nine hundred and forty one notified cholera cases, their 15,381 patients' guards and their 159,263 household members and close neighbours. Results: A total of 4,941 patients received antibiotic therapy according to the treatment protocols. Prophylactic treatment was administered to 15,381 patients' guards in hospitals and to 159,263 household members and close neighbours during home visits. Over the entire outbreak, the antimicrobial susceptibility patterns of V. cholerae strains isolated remained stable. Conclusions: The routine use of antimicrobial therapy for cholera cases associated with simultaneous and large scale chemoprophylaxis of close contacts does not seem in our experience to compromise the stability of V. cholerae susceptibility profiles to drugs when applied within a comprehensive package of rigorously monitored community interventions. The role of therapy and chemoprophylaxis in limiting the extent of a cholera epidemic is however difficult to ascertain from our experience. Field trials need to be designed to elucidate this aspect. The East African Medical Journal Vol. 83 (11) 2006: pp. 596-60

Infestation humaine par

Les auteurs décrivent un cas d’infestation par Trichostrongylus vitrinus chez une marocaine âgée de 53 ans

Etat vegetatif post-traumatique: quand arrêter la réanimation en zone déshéritée? - Fait clinique

L'état végétatif est l'une des complications les plus redoutables du traumatisme crânien. Les auteurs présentent un cas clinique à propos d'un état végétatif chez une femme de 32 ans suite à un traumatisme crânien après accident de la circulation. La patiente est entrée avec un Glasgow à 6/15. L'évolution a été marquée par la survenue d'une anémie, des convulsions et d'une fièvre à J7 d'hospitalisation. Un état végétatif à été note J38. La prise en charge a consisté en : un remplissage, une antibiothérapie, l'administration du phénobarbital, levo-dopa et du valproate de sodium. La patiente est décédée à J90 de suite d'une surinfection des escarres. Les patients en état végétatif posent beaucoup de problèmes de prise en charge dans les pays en voie de développement, pour des raisons économiques (car n'étant pas assurés) et logistiques (très peu de formations sanitaires sont adaptées à la prise en charge de ces patients en phases primaire et secondaire). Mots cles: etat végétatif, arrêt thérapeutique, prise en charge, pays en voie de développement Clinics in Mother and Child Health Vol. 2(1) 2005: 291-29

La trypanosomose humaine africaine en faciès épidémiologique de mangrove. Présentation, déterminants et prise en charge dans le contexte de la Guinée (2005 à 2007) = Human African Trypanosomiasis in mangrove epidemiologic area. Presentation, diagnosis and treatment in Guinea, 2005-2007

Gambiense human African trypanosomiasis is still assumed to be endemic in many part of West Africa, particularly in Guinea coastal area with mangrove swamp. Diagnosis is usually made during active medical screening or by passive initiative. Objectives. - To describe clinical and epidemiological characteristics of Gambiense human African trypanosomiasis in the coastal area of Guinea. Methods. - Exhaustive and retrospective analysis of all patients attending the trypanosomiasis center in the coastal area of Guinea between January 2005 and December 2007 with a diagnosis of human African trypanosomiasis. Results. - A total of 196 patients were recruited for the study. out of them, 55 % of the 73 patients diagnosed during active screening were classified stage I (haemolymphatic stage) or early stage 2 (meningoencephalitic stage). Contrarily, 115 of the 120 diagnosed by passive procedure were classified late stage 2, which features more specific signs and neurological symptoms, and leads to coma and death. More than 90 % of all cases presented cervical lymph nodes with identification of trypanosome on direct examination of fluid puncture. Less than one third of the patients were reexamined three months later. Discussion. - In the coastal area of Guinea with mangrove swamp, direct examination of lymph node fluid puncture seems to be the most contributive test for the diagnosis of human African trypanosomiasis. Hence, associating clinical examination of cervical lymph nodes area and direct examination of fluid puncture may allow an early diagnosis of Gambiense human African trypanosomiasis and favor the implementation of efficient therapeutic strategies

Safety and pharmacokinetics of the CIME combination of drugs and their metabolites after a single oral dosing in healthy volunteers

International audienceThis phase I, pilot clinical study was designed to evaluate the safety and the pharmacokinetic (PK) profiles of the CIME (Metabolic Identity Card) combination of ten drugs, with a view to its use as a phenotyping cocktail. Ten healthy Caucasian subjects were orally dosed with the CIME combination (caffeine-CYP1A2, repaglinide-CYP2C8, tolbutamide-CYP2C9, omeprazole-CYP2C19, dextromethorphan-CYP2D6, midazolam-CYP3A, acetaminophen-UGT1A1, 6&9 and 2B15, digoxin-P-gp, rosuvastatin-OATP1B1&3 and memantine-active renal transport). Blood was collected over 3 days and on day 7. CIME probes and relevant metabolites were assayed by LC-MS/MS and PK parameters were calculated. Main results were: (1) good safety with reversible mild or moderate adverse effects, (2) an analytical method able to quantify simultaneously the 10 probes and the major metabolites, (3) calculation of PK parameters for all probes in general agreed with published values, and (4) identification of the low CYP2D6 metabolizer. This pilot study showed that the CIME combination was well tolerated and that its pharmacokinetics could be accurately measured in healthy volunteers. This combination can now confidently be checked for sensitivity and specificity and for lack of interaction to be validated as a phenotyping cocktail