19 research outputs found

    Serotype Profile of Nasopharyngeal Isolates of Streptococcus pneumoniae Obtained from Children in Burkina Faso before and after Mass Administration of Azithromycin.

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    Mass drug administration (MDA) with azithromycin (AZ) has been used successfully to control trachoma. However, several studies have shown that MDA with AZ has led to the emergence of resistance to AZ in Streptococcus pneumoniae. The emergence of resistance to AZ has also been observed when this antibiotic was combined with the antimalarials used for seasonal malaria chemoprevention (SMC). The development of antibiotic resistance, including resistance to AZ, is sometimes associated with the emergence of a bacterial clone that belongs to a specific serotype. We hypothesize that the increase in resistance of S. pneumoniae observed after 3 years of SMC with AZ might be associated with a change in the distribution of pneumococcal serotypes. Therefore, 698 randomly selected isolates from among the 1,468 isolates of S. pneumoniae obtained during carriage studies undertaken during an SMC plus AZ trial were serotyped. A polymerase chain reaction (PCR) multiplex assay using an algorithm adapted to the detection of the pneumococcal serotypes most prevalent in African countries was used for initial serotyping, and the Quellung technique was used to complement the PCR technique when necessary. Fifty-six serotypes were detected among the 698 isolates of S. pneumoniae. A swift appearance and disappearance of many serotypes was observed, but some serotypes including 6A, 19F, 19A, 23F, and 35B were persistent. The distribution of serotypes between isolates obtained from children who had received AZ or placebo was similar. An increase in AZ resistance was seen in several serotypes following exposure to AZ. Mass drug administration with AZ led to the emergence of resistance in pneumococci of several different serotypes and did not appear to be linked to the emergence of a single serotype

    Impact of mass administration of azithromycin as a preventive treatment on the prevalence and resistance of nasopharyngeal carriage of Staphylococcus aureus

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    Staphylococcus aureus is a major cause of serious illness and death in children, indicating the need to monitor prevalent strains, particularly in the vulnerable pediatric population. Nasal carriage of S. aureus is important as carriers have an increased risk of serious illness due to systemic invasion by this pathogen and can transmit the infection. Recent studies have demonstrated the effectiveness of azithromycin in reducing the prevalence of nasopharyngeal carrying of pneumococci, which are often implicated in respiratory infections in children. However, very few studies of the impact of azithromycin on staphylococci have been undertaken. During a clinical trial under taken in 2016, nasal swabs were collected from 778 children aged 3 to 59 months including 385 children who were swabbed before administration of azithromycin or placebo and 393 after administration of azithromycin or placebo. Azithromycin was given in a dose of 100 mg for three days, together with the antimalarials sulfadoxine-pyrimethamine and amodiaquine, on four occasions at monthly intervals during the malaria transmission season. These samples were cultured for S. aureus as well as for the pneumococcus. The S. aureus isolates were tested for their susceptibility to azithromycin (15 g), penicillin (10 IU), and cefoxitine (30 g) (Oxoid Ltd). S. aureus was isolated from 13.77% (53/385) swabs before administration of azithromycin and from 20.10% (79/393) six months after administration (PR = 1.46 [1.06; 2.01], p = 0.020). Azithromycin resistance found in isolates of S. aureus did not differ significantly before and after intervention (26.42% [14/53] vs 16.46% [13/79], (PR = 0.62 [0.32; 1.23], p = 0.172). Penicillin resistance was very pronounced, 88.68% and 96.20% in pre-intervention and in post-intervention isolates respectively, but very little Methicillin Resistance (MRSA) was detected (2 cases before and 2 cases after intervention). Monitoring antibiotic resistance in S. aureus and other bacteria is especially important in Burkina Faso due to unregulated consumption of antibiotics putting children and others at risk

    The African Network for Improved Diagnostics, Epidemiology and Management of common infectious Agents

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    In sub-Saharan Africa, acute respiratory infections (ARI), acute gastrointestinal infections (GI) and acute febrile disease of unknown cause (AFDUC) have a large disease burden, especially among children, while respective aetiologies often remain unresolved. The need for robust infectious disease surveillance to detect emerging pathogens along with common human pathogens has been highlighted by the ongoing novel coronavirus disease2019 (COVID-19) pandemic. The African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA) is a sentinel surveillance study on the aetiology and clinical characteristics of ARI, GI and AFDUC in sub-Saharan Africa.Peer Reviewe

    Analyse épidémio-génétique de la fonction rénale chez les personnes d’Afrique sub-Saharienne vivant avec le VIH

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    Nearly 500 million people worldwide suffer from chronic kidney disease (CKD) and about 80% of them live in low- and middle-income countries. Paeople living with HIV (PLHIV) are at increased risk of renal disease, particularly in sub-Saharan Africa. This situation is probably related to genetic susceptibility conferred by variants of the apolipoprotein L1 gene (APOL1). These variant highly prevalent in Africa, and particularly in West Africa, have been identified as being strongly implicated in the occurrence of serious renal diseases experienced by PLHIV.The aim of this thesis was to provide data about the long-term evolution of renal function in sub-Saharan African PLHIV treated for HIV infection and assess the risk of kidney complications associated with APOL1. We analyzed the medical and genetic data of several cohorts of PLHIV followed in different health care facilities in West and Central Africa.The prevalence and incidence of CKD in the different cohorts and estimated according to the recommendations of the Kidney Disease Outcomes Quality Initiative are low to moderate and contrast with the observations made in some countries of the region with prevalence reaching 30%.The frequencies of the 2 risk variants of the APOL1 gene are also lower than expected, with only 3 to 5% of carriers of the high-risk genotype. The observation of higher frequencies in West Africa than in Central Africa is, however, confirmed.Due to the low number of carriers of the high-risk genotype and the low prevalence of CKD, we were unable to demonstrate a significant effect of APOL1 variants on the risk of kidney complications.However, our work confirms the role of other risk factors such as age, immunosuppression, hypertension and Tenofovir Disoproxil Fumarate exposure. These observations led us to evaluate the performance of a prediction score of CKD initially developed for Western PLHIV. We show that this score can be used in sub-Saharan Africa to identify people at risk of developing a CKD and provide them with targeted monitoring and prevention intervention.These findings provide reassuring information about the evolution of renal function in West African PLHIV followed and treated for their HIV infection. However, given that management of severe kidney disease is a major challenge is these settings, the implementation of screening and prevention strategies must be a public health priority.Près de 500 millions de personnes dans le monde souffrent de maladies rénales chroniques (MRC) et environ 80% d’entre eux résident dans des pays à revenu faible ou intermédiaire. Les personnes vivant avec le VIH (PVVIH) sont exposées à un risque rénal accru en particulier en Afrique sub-Saharienne. Cette situation est probablement liée à une susceptibilité génétique conférée par des variants du gène de l’apolipoprotéine L1 (APOL1). Ces variants, dont la fréquence est élevée en Afrique et en particulier en Afrique de l’Ouest, ont été identifiés comme fortement impliqués dans la survenue de pathologies rénales graves rencontrées chez les PVVIH.Ce travail de thèse avait pour objectif d’améliorer les connaissances sur l’évolution à long terme de la fonction rénale chez des PVVIH d’Afrique subsaharienne traités contre l’infection à VIH et sur le risque de complications rénales associé aux variants génétiques de APOL1. Nous avons analysé les données médicales et génétiques de plusieurs cohortes de PVVIH suivies dans différentes structures sanitaires d’Afrique de l’Ouest et du Centre.Les prévalences et incidences de la MRC observées dans les différentes cohortes et estimées selon les recommandations du Kidney Disease Outcomes Quality Initiative sont faibles à modérées et contrastent avec les observations faites dans certains pays de la région avec des prévalences atteignant 30%.Les fréquences des 2 variants à risque du gène APOL1 sont également plus faibles qu’attendues, avec seulement 3 à 5% de porteurs du génotype à haut risque. L’observation de fréquences plus élevées en Afrique de l’Ouest qu’en Afrique Centrale est cependant confirmée.En raison du faible nombre de porteurs du génotype à haut risque et des faibles prévalences de MRC, nous n’avons pas pu mettre en évidence un effet significatif des variants de APOL1 sur le risque de complications rénales.En revanche, nos travaux confirment le rôle des facteurs de risque connus tels que l’âge, l’immunodépression, l’hypertension artérielle et l’exposition au Ténofovir Disoproxil Fumarate. Et ces observations nous ont conduits à évaluer les performances d’un score prédictif de la MRC initialement développé pour les PVVIH occidentaux. Nous montrons qu’il peut être utilisé en Afrique sub-saharienne pour identifier les personnes à risque de développer une MRC et leur proposer un suivi et une prise en charge adaptés.Ces travaux apportent des éléments rassurants quant à la santé rénale des PVVIH d’Afrique de l’Ouest suivis et traités pour leur infection VIH. Cependant, au regard des difficultés de prise en charge des maladies rénales sévères, la mise en place de stratégies de dépistage et de prévention doit constituer une priorité de santé publique

    Genetic and epidemiological analysis of kidney function in people of sub-Saharan Africa living with HIV

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    Près de 500 millions de personnes dans le monde souffrent de maladies rénales chroniques (MRC) et environ 80% d’entre eux résident dans des pays à revenu faible ou intermédiaire. Les personnes vivant avec le VIH (PVVIH) sont exposées à un risque rénal accru en particulier en Afrique sub-Saharienne. Cette situation est probablement liée à une susceptibilité génétique conférée par des variants du gène de l’apolipoprotéine L1 (APOL1). Ces variants, dont la fréquence est élevée en Afrique et en particulier en Afrique de l’Ouest, ont été identifiés comme fortement impliqués dans la survenue de pathologies rénales graves rencontrées chez les PVVIH.Ce travail de thèse avait pour objectif d’améliorer les connaissances sur l’évolution à long terme de la fonction rénale chez des PVVIH d’Afrique subsaharienne traités contre l’infection à VIH et sur le risque de complications rénales associé aux variants génétiques de APOL1. Nous avons analysé les données médicales et génétiques de plusieurs cohortes de PVVIH suivies dans différentes structures sanitaires d’Afrique de l’Ouest et du Centre.Les prévalences et incidences de la MRC observées dans les différentes cohortes et estimées selon les recommandations du Kidney Disease Outcomes Quality Initiative sont faibles à modérées et contrastent avec les observations faites dans certains pays de la région avec des prévalences atteignant 30%.Les fréquences des 2 variants à risque du gène APOL1 sont également plus faibles qu’attendues, avec seulement 3 à 5% de porteurs du génotype à haut risque. L’observation de fréquences plus élevées en Afrique de l’Ouest qu’en Afrique Centrale est cependant confirmée.En raison du faible nombre de porteurs du génotype à haut risque et des faibles prévalences de MRC, nous n’avons pas pu mettre en évidence un effet significatif des variants de APOL1 sur le risque de complications rénales.En revanche, nos travaux confirment le rôle des facteurs de risque connus tels que l’âge, l’immunodépression, l’hypertension artérielle et l’exposition au Ténofovir Disoproxil Fumarate. Et ces observations nous ont conduits à évaluer les performances d’un score prédictif de la MRC initialement développé pour les PVVIH occidentaux. Nous montrons qu’il peut être utilisé en Afrique sub-saharienne pour identifier les personnes à risque de développer une MRC et leur proposer un suivi et une prise en charge adaptés.Ces travaux apportent des éléments rassurants quant à la santé rénale des PVVIH d’Afrique de l’Ouest suivis et traités pour leur infection VIH. Cependant, au regard des difficultés de prise en charge des maladies rénales sévères, la mise en place de stratégies de dépistage et de prévention doit constituer une priorité de santé publique.Nearly 500 million people worldwide suffer from chronic kidney disease (CKD) and about 80% of them live in low- and middle-income countries. Paeople living with HIV (PLHIV) are at increased risk of renal disease, particularly in sub-Saharan Africa. This situation is probably related to genetic susceptibility conferred by variants of the apolipoprotein L1 gene (APOL1). These variant highly prevalent in Africa, and particularly in West Africa, have been identified as being strongly implicated in the occurrence of serious renal diseases experienced by PLHIV.The aim of this thesis was to provide data about the long-term evolution of renal function in sub-Saharan African PLHIV treated for HIV infection and assess the risk of kidney complications associated with APOL1. We analyzed the medical and genetic data of several cohorts of PLHIV followed in different health care facilities in West and Central Africa.The prevalence and incidence of CKD in the different cohorts and estimated according to the recommendations of the Kidney Disease Outcomes Quality Initiative are low to moderate and contrast with the observations made in some countries of the region with prevalence reaching 30%.The frequencies of the 2 risk variants of the APOL1 gene are also lower than expected, with only 3 to 5% of carriers of the high-risk genotype. The observation of higher frequencies in West Africa than in Central Africa is, however, confirmed.Due to the low number of carriers of the high-risk genotype and the low prevalence of CKD, we were unable to demonstrate a significant effect of APOL1 variants on the risk of kidney complications.However, our work confirms the role of other risk factors such as age, immunosuppression, hypertension and Tenofovir Disoproxil Fumarate exposure. These observations led us to evaluate the performance of a prediction score of CKD initially developed for Western PLHIV. We show that this score can be used in sub-Saharan Africa to identify people at risk of developing a CKD and provide them with targeted monitoring and prevention intervention.These findings provide reassuring information about the evolution of renal function in West African PLHIV followed and treated for their HIV infection. However, given that management of severe kidney disease is a major challenge is these settings, the implementation of screening and prevention strategies must be a public health priority

    The Day-Hospital of the University Hospital, Bobo Dioulasso: An Example of Optimized HIV Management in Southern Burkina Faso

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    International audienceObjectivesTo evaluate the epidemiological evolution of patients with HIV (PtHIV), between 2002 and 2012, in a day-hospital that became an HIV reference centre for south-west Burkina Faso.Materials and MethodsThis was a retrospective study of PtHIV followed in the Bobo Dioulasso university hospital since 2002. The study was based on clinical data recorded using ESOPE software and analysed using Excel and SAS.ResultsA total of 7320 patients have been treated at the centre since 2002; the active file of patients increased from 147 in 2002 to 3684 patients in 2012. Mean age was stable at 38.4 years and the majority were female (71%). The delay to initiation of antiretroviral (ARV) treatment after HIV diagnosis decreased from 12.9 months in 2002 to 7.2 months in 2012. The percentage of PtHIV lost to follow-up, untreated for HIV and deaths all decreased after 2005. Voluntary anonymous screening and/or an evocative clinical picture were the main reasons for HIV diagnosis, usually at a late stage (41.1% at WHO stage 3). Virological success increased due to a decrease in time to initiation of ARV treatment and an increase in percentage of patients treated (90.5% in 2012, mainly with 1st line drugs). However, there was also a slight increase in the rate of therapeutic failures and the percentage of patients who progressed to 2nd or 3rd line-ARVs.ConclusionOur day-hospital is a good example of the implementation of a specialist centre for the management of PtHIV in a resource-limited country (Burkina Faso)

    Prévalence de la Maladie Rénale Chronique chez les personnes retraitées dans la ville de Bobo-Dioulasso (Burkina Faso)

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    La maladie rĂ©nale chronique (MRC) est une pathologie silencieuse, frĂ©quente au sein de la population des personnes âgĂ©es. Les donnĂ©es Ă©manant de l’Afrique sub-saharienne sont rares. Notre objectif Ă©tait de dĂ©terminer la prĂ©valence de la maladie rĂ©nale chronique chez les sujets retraitĂ©s Ă   Bobo-Dioulasso. Nous avons conduit une Ă©tude prospective durant la pĂ©riode allant de juin Ă  septembre 2014 chez dessujetsretraitĂ©s dans la ville de Bobo-Dioulasso. Des constantes physiques ainsi que des donnĂ©es sociodĂ©mographiques et cliniques ont Ă©tĂ© collectĂ©es chez tous les participants. Les variables biologiques dosĂ©es sur des prĂ©lèvements sanguins et urinaires Ă©taient : l’albuminurie, la leucocyturies, le nitrite, l’hĂ©maturie, la  crĂ©atininurie, la crĂ©atinĂ©mie et la cystatine C plasmatique. Les dĂ©bits de filtrations glomĂ©rulaires (DFG) ont Ă©tĂ© estimĂ©s selon les Ă©quations MDRD et CKD-EPI Cystatine C. La prĂ©valence de l’insuffisance rĂ©nale chez lessujetsretraitĂ©s Ă©tait de 15,3 % (25/163) (IC95 % = 9,8-20,9 %) de la population en considĂ©rant le dĂ©bit de filtration glomĂ©rulaire utilisant la formule MDRD et 39,9 % (65/163) (IC95 % = 32,4-47,4 %) avec la cystatine C (p 0,01). Le rapport albuminurie/crĂ©atininurie supĂ©rieur Ă  3 mg/mmol a notĂ© une albuminurie chez 14,7 % (24/163) (IC95 % = 9,3-20,3 %) des sujets retraitĂ©s avec une moyenne de 26,8 ± 44,7 mg/mmol. L’hĂ©maturie a Ă©tĂ© retrouvĂ©e chez 6,1 % des sujets. Cette Ă©tude a fourni une prĂ©valence de la maladie rĂ©nale chronique relativement forte chez les sujets retraitĂ©s dans la ville de Bobo-Dioulasso. La cystatine C serait un bon marqueur avec unebonne sensibilitĂ© dans le dĂ©pistage de la MRC. Mots-clĂ©s : Maladie rĂ©nale chronique, âgĂ©, retraitĂ©s, Afrique sub-saharienne.   Chronic kidney disease (CKD) is a silent disease, common in the elderly population. It is rarely reported in sub-saharan Africa. Our aim wasto  determine the prevalence of chronic kidney disease among retired seniors. We conducted a prospective study during June to September 2014 among elderly retired people in BoboDioulasso’s city of Burkina Faso. Physical constants as well as socio-demographic and clinical data werecollected from all participants. The biological variables measured on blood and urine samples were: albuminuria, leucocyturia, nitrite, hematuria, creatinuria, serum creatinemia and plasma cystatin C. Glomerular filtration rate (GFR) were estimated using MDRD and CKD-EPI Cystatin C  equations. The prevalence kidney failure among retired peoples was 15.3 % (25/163) (CI95 % = 9.8-20.9 %) of our population for glomerular filtrationrate using MDRD equation versus 39.9 % (65/163) (CI95 % = 32.4-47.4 %) with CK-EPI cystatin C equation (p Ë‚ 0.01). Albuminuria defined by albuminuria/creatininuria ratio greater than 3 mg/mmol was found in 14.7 % (24/163) (CI95% = 9.3-20.3 %) of the retired people with an average of 26.8 ± 44.7 mg/mmol. Hematuria was found in 6.1 % of the subjects. This study thus provided a relatively high prevalence of chronic kidney disease among retired people in Bobo-Dioulasso’s city. Cystatin C would be a better marker with better sensitivity in screening the CKD among elderly people. Keywords: Chronic kidney disease, elderly, retired people, sub-saharan Africa

    Distribution of ARV treatment lines given to patients (up to 31/12/2012).

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    <p>AZT: zidovudine; 3TC: lamivudine; EFV: efavirenz;</p><p>NEV: nevirapine; FTC: emtricitabine;</p><p>TDF: tenofovir disoproxil fumarate; LPV: lopinavir;</p><p>RTV: ritonavir; D4T: stavudine.</p><p>Distribution of ARV treatment lines given to patients (up to 31/12/2012).</p
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