ETIOLOGIES DES PLEURESIES DU SUJET AGE AU TOGO

Objective: The aim of this study was to review the current aetiologic profile of pleurisies in the elderly people. Materials and method: We carried out a retrospective study based on the data of 126 patients, old of at least 55 years, hospitalised from January 2007 to December 2011 for pleurisy in the pneumology department of Sylvanus Olympio teaching hospital of Lome. Results: Pleurisies represent 23,11 % of elderly people’s hospitalisation motives. The Sex-ratio was 1 and the average age of the patients 65 ± 09 years old. The clinical aspect was dominated by thoracic pain (88,88 %) and cough (69,84 %). The chest X-ray revealed pleural effusion at the left side in 48,41 %, at right side in 46,83% and of medium abundance in 57,93 %. The liquid was citrine in 53,97 %, haematic in 30,95% and purulent in 15,08% . Pleurisies were of cancerous origin in 32,54 %, tubercular in 17,46 % and bacterial not tubercular in 14,58%. No aetiology had been found in 33,33 %. The mortality was 27,78 % and due to cancers and idiopathic pleurisies in 86 % during three months’ follow up. Conclusion: Cancers are the first aetiology of pleurisies followed by tuberculosis in elderly people. The acquisition of the new means of pleural exploration is important to reduce the proportion of idiopathic pleurisies

ETIOLOGIES DES PLEURESIES DU SUJET AGE AU TOGO

Objective: The aim of this study was to review the current aetiologic profile of pleurisies in the elderly people. Materials and method: We carried out a retrospective study based on the data of 126 patients, old of at least 55 years, hospitalised from January 2007 to December 2011 for pleurisy in the pneumology department of Sylvanus Olympio teaching hospital of Lome. Results: Pleurisies represent 23,11 % of elderly people’s hospitalisation motives. The Sex-ratio was 1 and the average age of the patients 65 ± 09 years old. The clinical aspect was dominated by thoracic pain (88,88 %) and cough (69,84 %). The chest X-ray revealed pleural effusion at the left side in 48,41 %, at right side in 46,83% and of medium abundance in 57,93 %. The liquid was citrine in 53,97 %, haematic in 30,95% and purulent in 15,08% . Pleurisies were of cancerous origin in 32,54 %, tubercular in 17,46 % and bacterial not tubercular in 14,58%. No aetiology had been found in 33,33 %. The mortality was 27,78 % and due to cancers and idiopathic pleurisies in 86 % during three months’ follow up. Conclusion: Cancers are the first aetiology of pleurisies followed by tuberculosis in elderly people. The acquisition of the new means of pleural exploration is important to reduce the proportion of idiopathic pleurisies

Facteurs etiologiques des pneumopathies communautaires bacteriennes chez les sujets ages au Centre Hospitalier Universitaire Tokoin (Togo)

Objectif: Décrire les facteurs étiologiques des pneumopathies communautaires bactériennes non tuberculeuses chez les sujets âgés de 60 ans et plus au CHU-Tokoin au Togo.Patients et méthode: Il s’agissait d’une étude rétrospective réalisée dans le service de Maladies Infectieuses et de Pneumologie du CHU-Tokoin (Lomé) du 1er janvier 2003 au 31 décembre 2008. Les patients étaient retenus sur la base des arguments cliniques, radiographiques, bactériologiques et évolutifs. Ainsi tout dossier de patient âgé de 60 ans et plus pris en charge dans le service pour une infection pulmonaire à l’exception de la tuberculose a été considéré comme sujet d’étude. Les résultats bactériologiques étaient issus des examens cytobactériologiques (ECB) de la ponction pleurale, de l’expectoration et de l’hémoculture. Le test VIH pour la recherche de l’infection avait été réalisé chez les patients qui avaient donné leur accord.Résultats: Quatre vingt neuf (89) cas soit 11,1 % de pneumopathies bactériennes du sujet âgé ont été enregistrés. Quarante huit (54 %) avaient une mauvaise hygiène buccodentaire. Le sexe ratio homme/femme a été de 1,23. Vingt six soit 29,21 % ont été tabagiques .Vingt deux patients (25 %) ont bénéficié d’une antibiothérapie trois mois avant leur hospitalisation. Seize (35 %) des 46 patients qui ont accepté le test VIH avaient une infection par le VIH associée. Six patients étaient sous chimio prophylaxie au cotrimoxazole dans le cadre de la prise en charge de l’infection par le VIH. Le tableau clinique a été dominé par la toux (85,39 %), dyspnée 59,55 %, la douleur thoracique 57,30 %, fièvre 51,68 %, douleurs thoraciques 57,30 % et parfois l’altération de l’état général 28,09 %. Streptococcus pneumoniae, Klebsiella pneumoniae étaient les plus rencontrés. Toutes les souches de pneumocoque et Klebsiella étaient sensibles au ceftriaxone, amoxicilline-acide clavulanique, ciprofloxacine et à l’amoxicilline dans 50 % des cas pour le pneumocoque, Cinq souches de pneumocoque et trois de klebsiella étaient résistantes au cotrimoxazole. En première intention la bi antibiothérapie (Amoxicilline plus gentamicine) a été choisie dans 72 % des cas.Mots clés: Pneumopathies, sujet âgé, facteurs étiologiques, TogoEnglish AbstractObjective: Describe etiologic factors of bacterial community pneumonia among person old than 60 years and more in Infectious Diseases and Pneumology Service (CHU-Tokoin) of Togo.Material and methods: We retrospectively reviewed the records of hospitalized for community-acquired pneumonia among elderly persons in the service of Infectious Diseases and Pneumology (CHU-Tokoin, Togo). The patients were retained on the basis of clinical, radiographic, bacteriological and prognostic argument. Between January 1st 2002 and December 31st 2005 inpatient dossiers were identified. So all file of patient aged of 60 years and older admitted in the service for a pulmonary infection has been considered like topic of survey. The tuberculosis cases were excluded. The bacteriological results were descended of the exams cytobacteriological (ECB) of the pleural puncture, the expectoration and the haemoculture The HIV test had been achieved among the patients who had given their agreement.Results: Eighty nine (89) cases (11.1%) of elderly person with bacterial pneumopathies have been recorded in the service. Forty eight (54%) had bad mouth hygiene. The sex ratio (man / woman) was of 1.23. Twenty six, either 29.21% have smoked. Twenty two patients (25%) had used antibiotherapy three months before their hospitalization. Sixteen (35%) of 46 patients who accepted HIV test had an HIV infection. Six patients were under cotrimoxazole’s prophylaxis. The clinical picture has been dominated by the cough (85.39%), dyspnea 59.55%, the thoracic pain 57.30%, fever 51.68%, thoracic pains 57.30% and the general status alteration 28.09%. Streptococcus pneumoniae, Klebsiellas pneumoniae were the more accounted for pneumopathies. All pneumococcus and Klebsiella were sensitive to the ceftriaxone, amoxicillin-clavulanate, ciprofloxacine. Fifty percent (50%) of pneumococcus’s cases were also sensitive to amoxicillin.Five stumps of pneumococcus and three of klebsiella were resistant to the cotrimoxazole. In first intention the bi antibiothérapie (Amoxicilline plus gentamicine) has been chosen in 72% of the cases.Keywords: Pneumopathy, elderly persons, Tog

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA).We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region.Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3).This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population