The Case for Fungal Keratitis to Be Accepted as a Neglected Tropical Disease

Amongst the treatable cause of blindness among young people, fungal keratitis ranks high. There are an estimated 1,051,787 to 1,480,916 eyes affected annually, with 8-11% of patients having to have the eye removed. Diagnosis requires a corneal scraping, direct microscopy and fungal culture with a large number of airborne fungi implicated. Treatment involves the intensive application of antifungal eye drops, preferably natamycin, often combined with surgery. In low-resource settings, inappropriate corticosteroid eye drops, ineffective antibacterial therapy, diagnostic delay or no diagnosis all contribute to poor ocular outcomes with blindness (unilateral or bilateral) common. Modern detailed guidelines on fungal keratitis diagnosis and management are lacking. Here, we argue that fungal keratitis should be included as a neglected tropical disease, which would facilitate greater awareness of the condition, improved diagnostic capability, and access to affordable antifungal eye medicine

Tests diagnostiques de l’infection à Coronavirus (COVID-19) : des atouts et des limites: Diagnosis testing for Coronavirus infection disease (COVID 19): Assets and limits

The world is going through a serious health crisis due to the COVID 19 pandemic. Although little is known about COVID-19, we have observed an increased interhuman transmission of etiological agent SARS-Cov-2 and we assume that each new cases of COVID-19 get at least two or three news persons infected. Therefore, the test for detection of the infection should be much implemented as an efficient strategy to fight against the COVID 19 pandemic. The COVID-19 diagnostic tests are an essential tool for assessing the pandemic. This review paper will discuss the advantages and limitations of the diagnosis tests for COVID 19. There are 2 categories of tests: those that directly detect the virus or its component, and those that search for the antibodies generated by the virus infection. The real time Reverse transcriptase Polymerase chain reaction (test rt-RT-PCR) remains the gold standard for the diagnosis of COVID-19. Its sensitivity on the nasopharynx swab seems high, though false negative cases can occur, with an average of 30% of cases. Serological test detect specific antibodies against SARS-COV-2. They help identify individuals that have been infected by the virus, those healed and that have acquired immunity against the virus. They are diagnosis orientation tests of COVID-19. Until now, none of these tests are 100% reliable, but they are used by a qualified collaborating medical staff. They can help identify the majority of the infected and immunized individuals. Le monde entier fait face à une crise sanitaire sans précédent due à la pandémie de maladie à virus SARS-COV-2 alias COVID-19. Malgré les connaissances très incomplètes sur la COVID-19, on a constaté une contagiosité interhumaine élevée au début de la pandémie actuelle, et on estime que chaque nouveau cas de COVID-19 infecte en moyenne deux à trois personnes. En conséquence, la stratégie de lutte contre la pandémie à COVID-19 qui ébranle nos sociétés passe nécessairement par une intensification des tests de détection de l’infection. Ces tests diagnostiques de la COVID-19 sont un outil essentiel pour suivre la propagation de la pandémie. Ainsi, l’objectif de la présente revue de la littérature est d’aborder le diagnostic de l’infection à Coronavirus (COVID-19) en s’attardant sur les tests de diagnostic, leurs atouts et leurs limites. Il y a deux catégories de test : ceux qui recherchent la présence directe du virus ou de ses fragments, et ceux qui recherchent les anticorps résultant de l’infection par le virus du COVID-19. Le test real time –Reverse Transcriptase –Polymerase chain reaction (rt-RT-PCR) reste le gold standard pour le diagnostic de la COVID-19. Sa sensibilité sur les écouvillons nasopharyngés semble élevée, mais des faux négatifs peuvent se produire, avec une fréquence incertaine (environ 30% des cas). Les tests sérologiques détectent les anticorps spécifiques du SARS-CoV-2. Ils permettent l’identification des individus qui ont été infectés par le virus, se sont rétablis, et ont développé, en théorie, une réponse immunitaire efficace contre le virus. Ils constituent des tests d’orientation diagnostique de la COVID-19. A ce jour, aucun de ces tests n’est fiable à 100 %, mais, utilisés par un personnel médical qualifié et en combinaison, ils permettent l’identification de la majorité des individus infectés et immunisés

Seventh Pandemic Vibrio cholerae O1 Sublineages, Central African Republic

International audienceFour cholera outbreaks were reported in the Central African Republic during 1997–2016. We show that the outbreak isolates were Vibrio cholerae O1 serotype Inaba from 3 seventh pandemic El Tor sublineages originating from West Africa (sublineages T7 and T9) or the African Great Lakes Region (T10)

Genomic Microevolution of Vibrio cholerae O1, Lake Tanganyika Basin, Africa

Africa’s Lake Tanganyika basin is a cholera hotspot. During 2001–2020, Vibrio cholerae O1 isolates obtained from the Democratic Republic of the Congo side of the lake belonged to 2 of the 5 clades of the AFR10 sublineage. One clade became predominant after acquiring a parC mutation that decreased susceptibility to ciprofloxacin

Diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa: a continent-wide survey

BACKGROUND: Fungal infections are common causes of death and morbidity in those with advanced HIV infection. Data on access to diagnostic tests in Africa are scarce. We aimed to evaluate the diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa. METHODS: We did a continent-wide survey by collecting data from 48 of 49 target countries across Africa with a population of more than 1 million; for Lesotho, only information on the provision of cryptococcal antigen testing was obtained. This survey covered 99·65% of the African population. We did the survey in six stages: first, questionnaire development, adaptation, and improvement; second, questionnaire completion by in-country respondents; third, questionnaire review and data analysis followed by video conference calls with respondents; fourth, external validation from public or private sources; fifth, country validation by video conference with senior figures in the Ministry of Health; and sixth, through five regional webinars led by the Africa Centres for Disease Control and Prevention with individual country profiles exchanged by email. Data was compiled and visualised using the Quantum Geographic Information System software and Natural Earth vectors to design maps showing access. FINDINGS: Data were collected between Oct 1, 2020, and Oct 31, 2022 in the 48 target countries. We found that cryptococcal antigen testing is frequently accessible to 358·39 million (25·5%) people in 14 African countries. Over 1031·49 million (73·3%) of 1·4 billion African people have access to a lumbar puncture. India ink microscopy is frequently accessible to 471·03 million (33·5%) people in 23 African countries. About 1041·62 million (74·0%) and 1105·11 million (78·5%) people in Africa do not have access to histoplasmosis and Pneumocystis pneumonia diagnostics in either private or public facilities, respectively. Fungal culture is available in 41 countries covering a population of 1·289 billion (94%) people in Africa. MRI is routinely accessible to 453·59 million (32·2%) people in Africa and occasionally to 390·58 million (27·8%) people. There was a moderate correlation between antiretroviral therapy usage and external expenditure on HIV care (R2=0·42) but almost none between external expenditure and AIDS death rate (R2=0·18), when analysed for 40 African countries. INTERPRETATION: This survey highlights the enormous challenges in the diagnosis of HIV-associated Pneumocystis pneumonia, cryptococcal disease, histoplasmosis, and other fungal infections in Africa. Urgent political and global health leadership could improve the diagnosis of fungal infections in Africa, reducing avoidable deaths. FUNDING: Global Action For Fungal Infections

Epidemiological, clinical Characteristics and mortality of patients Infected with SARS-CoV-2 Admitted to Kinshasa University Hospital (KUH), the Democratic Republic of the Congo from March 24th, 2020, to January 30th, 2021: Two waves, two faces?

Context and objective: Like all epidemics, the COVID-19 pandemic occurs in several highly diverse waves. The objective of the present study was to  compare the demographic and clinical characteristics and mortality of patients between the first and second waves of COVID-19. Methods: This was a historical follow-up study conducted at the Kinshasa University Hospital (KUH) between March 2020 and January 2021. We used  the χ² test to compare proportions. Survival was described by the Kaplan Meier method. Cox regression was used to identify independent  predictors of mortality. Results: A total of 411 COVID-19 patients were enrolled. Compared to wave 1 patients, wave 2 patients were significantly  older (52.4 ±17.5 vs. 58.1 ±15.7; p=0.026). The death rate of patients in the first wave was higher than in the second wave (p=0.009). Survival was  more reduced in the first wave compared with the second wave. Predictors of mortality present in both the first and second waves were respiratory  distress and severe COVID-19 stage. Conclusion: The first wave was more lethal than the second wave with respiratory distress and severe COVID-19  stage as independent predictors in both waves. Strengthening the health system and raising awareness of preventive measures including  vaccination should continue to sustain gains.    French title: Caractéristiques épidémiologiques, cliniques et mortalité des patients infectés par le SRAS-CoV-2 admis aux Cliniques Universitaires  de Kinshasa, République démocratique du Congo du 24 mars 2020 au 30 janvier 2021 : Deux vagues, deux visages ? Contexte et objectif: Comme toutes les épidemies, la pandémie à COVID-19 sévit en plusieurs vagues très diversifiées. L’étude a comparé les  caractéristiques démographiques et cliniques ainsi que la mortalité des patients entre la 1ère et la 2ème vague de COVID-19. Méthodes: Il s’agissait  d’une étude de suivi historique réalisée aux Cliniques Universitaires de Kinshasa entre mars 2020 et janvier 2021. Le test de χ² a permis la  comparaison des proportions, et la la survie a été étudiée par la méthode de Kaplan Meier. L’identification dess prédicteurs indépendants de la  mortalité a été déterminée par la régression de Cox. Résultats: Des 411 patients enrôlés, ceux de la 2ème vague étaient beaucoup plus âgés ((58,1 ±15,7 vs 52,4 ±17,5 ; p=0,026). La 1ère vague a été  plus meurtrière que la seconde (p=0,009). La survie était plus réduite dans la première vague par rapport à la seconde. Les facteurs prédictifs de  mortalité présents à la fois dans la première et la deuxième vague étaient la détresse respiratoire et le stade COVID-19 sévère. Conclusion: La 1ère  vague était plus meutrière que la 2ème avec comme prédicteurs indépendants la détresse respiratoire et le stade COVID-19 sévère dans les deux  vagues. Le renforcement du système de santé et la sensibilisation sur les mésures préventives dont la vaccination devraient continuer à maintenir  les gains