La cryptococcose neuro-méningée au Mali

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 ± 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between 1 and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains

Prévalence des entérobactéries productrices de bêtalactamases à spectre étendu isolées des hémocultures sur le continent Africain et les gènes impliqués chez les souches BLSE : revue de la littérature

Introduction: Les entérobactéries productrices de bêta-lactamases à spectre étendu ont été trouvées partout dans le monde. Des études de surveillance sont présentes en Europe, en Amérique, et en Asie, mais en Afrique, il n'y a pas eu de recherche récapitulative montrant la prévalence et la répartition de BLSE sur ce continent.But: Cette revue de la littérature a pour but de décrire la prévalence des entérobactéries productrices de bêta-lactamases à spectre étendu (E-BLSE) isolées des hémocultures en Afrique et les gènes BLSE impliqués dans la résistance.Matériel et méthodes: Une recherche de la littérature a été effectuée sur PubMed. Les articles publiés sur le domaine entre 1996 et 2014 ont été examinés et lus en texte intégral dans le but d’observer l’intérêt et la pertinence de la publication. Dans notre contexte, les articles qui étaient pertinents ont été évalués et inclus dans l'étude.Résultats: La prévalence des E-BLSE chez les patients hospitalisés et dans les communautés, varie largement entre les pays et pouvant atteindre souvent jusqu’à 77,8%. Plusieurs types d’échantillons ont été étudiés pour estimer la prévalence des EBLSE, mais le cas particulier des hémocultures reste vraiment limité. Les BLSE (classe  A et D) et AmpC plasmidique (pAmpC) ont régulièrement été trouvées, le gène CTXM- 15 de la classe A est prédominant sur le continent africain.Conclusion: Les entérobactéries productrices de bêta-lactamases à spectre étendu en milieux hospitaliers et communautaires sont courantes en Afrique. La majorité des études se sont réalisées au Nord et à l’Est, laissant presqu’un vide sur les autres parties du continent.Mots-clés: Afrique ; Bêta-lactamases à spectre étendu ; Entérobactérie ; Hémoculture ; PrévalenceEnglish Title: Prevalence of extended spectrum beta lactamases producing enterobacteria isolated from blood cultures on African continent and the involved genes in ESBL strains: literature reviewEnglish AbstractIntroduction: Extended-spectrum beta-lactamases producing Enterobacteria have been found worldwide. Surveillance studies are present in Europe, America, and Asia, but in Africa, there has been no research summary showing prevalence and distribution of extended-spectrum beta-lactamases on this continent.Aim: This literature review aims to describe the prevalence of Extended-spectrum betalactamases producing Enterobacteria (ESBL-E) isolated from blood cultures in Africa and the involved ESBL genes in resistance.Method: A literature search was performed in PubMed. Published articles in the field between 1996 and 2014 were reviewed and read in full text in order to observe the interest and relevance of the publication. In our context, articles that were relevant were assessed and included in the study.Results: Prevalence of ESBL-E in hospitalized patients and in communities varies largely between countries and often can reach up to 77.8%. Several types of samples were studied to estimate prevalence of ESBL-E, but the particular case of blood cultures is really limited. ESBLs (class A and D) and plasmid-encoded AmpC (pAmpC) have regularly been found, CTX-M-15 gene of the class A is predominant in AfricaConclusion: Extended-spectrum beta-lactamases producing Enterobacteria in hospital and communities areas are common around in Africa. Majority of studies were conducted in the North and in the East, leaving almost empty on other parts of the continent.Keywords: Africa; Blood culture; Enterobacteria; Extended spectrum beta-lactamases; Prevalenc