Expérience précoce de la réponse à la pandémie à Syndrome Respiratoire Aigu Sévère à Corona Virus SARS-COV 2 appelé aussi Corona Virus Disease 19 (COVID-19) aux Cliniques Universitaires de Kinshasa: Early experience of response to Severe Acute Respiratory Syndrome-Coranovirus-2 (SARS-COV-2) pandemic at Kinshasa university hospital

The Democratic Republic of Congo (DRC) declared the first case of Coronavirus infection disease (COVID-19) on March 10, 2020. Ever since then, assessment in terms of management and care outcomes for COVID-19 patients has not yet been formally established. Since, the number of patients has been increasing; however, there has been no formal guideline for COVID-19 patient management. This paper provides an overview of the experience of the overall management of COVID-19 at the Kinshasa University Hospital (KUH), between March and the end of April 2020. Clinical data of 49 patients from surronding municipalities, including 61% of males, are presented in this report. Patients were young (median age 34 years). At admission, 20.4% of patients were at advanced stage and 6.1% at severe stage, and almost all of them have been using self-medication prior to admission at the hospital. The lethality rate was 10.2%. In almost all the cases (8 cases out of 10), death occurred within the first 24 hours following the admission. The response to COVID-19 was set up after a few twists and turns. With the support of a few partners and the government, we are seeing an improvement in the management of COVID-19 at the KUH. Delayed referral, self-medication and stigma are among the factors that influenced the disease severity and contributed to the high mortaly we have observed. La République démocratique du Congo (RDC) a déclaré le premier cas de la maladie à Coronavirus (COVID-19) le 10 mars 2020. Depuis lors, l’évaluation de la prise en charge et de l’issue vitale des patients suivis n’ont pas encore été formellement rapportées. Le présent article donne un aperçu de l’expérience de la prise en charge globale de la COVID-19 aux Cliniques Universitaires de Kinshasa, entre mars et fin avril 2020. Quarante-neuf (âge médian 34 ans, sexe masculin 61%, habitant les communes environnantes) ont été inclus. Près d’un tiers des patients étaient admis aux stades critiques (20,4%) ou sévère (6,1%) recourant souvent à l’automédication. Le taux de létalité a été 10,2% des cas. Le décès était survenu endéans les 24 premières heures dans la quasi-totalité des cas (8 cas/10 patients). Les patients sont très jeunes. La riposte à la pandémie a été d’installation lente, renforcée progressivement par l’appui des partenaires traditionnels et du gouvernement central. L’impact de ces interventions a contribué à une amélioration de la prise en charge de la COVID-19 aux CUK. La référence tardive, mais aussi l’autoprise en charge à domicile, corollaires à la stigmatisation communautaire seraient une explication plausible au nombre élévé de décès enregistrés dans cette institution

A possible case of spontaneous Loa loa encephalopathy associated with a glomerulopathy

It is well known that renal and neurological complications may occur after antifilarial treatment of patients infected with Loa loa. Conversely, spontaneous cases of visceral complications of loiasis have been rarely reported. A 31-year-old Congolese male patient who had not received any antifilarial drug developed oedema of the lower limbs, and then transient swellings of upper limbs. Two months after, he developed troubles of consciousness within several hours. At hospital, the patient was comatose with mild signs of localization. Laboratory tests and an abdominal echography revealed a chronic renal failure due to a glomerulopathy. Three weeks after admission, Loa microfilariae were found in the cerebrospinal fluid, and a calibrated blood smear revealed a Loa microfilaraemia of 74,200 microfilariae per ml. The level of consciousness of the patient improved spontaneously, without any specific treatment, but several days after becoming completely lucid, the patient died suddenly, from an undetermined cause. Unfortunately, no biopsy or autopsy could be performed. The role of Loa loa in the development of the renal and neurological troubles of this patient is questionable. But the fact that such troubles, which are known complications of Loa infection, were found concomitantly in a person harbouring a very high microfilarial load suggests that they might have been caused by the filarial parasite. In areas endemic for loiasis, examinations for a Loa infection should be systematically performed in patients presenting an encephalopathy or a glomerulopathy

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

Surveillance des décès aux Cliniques Universitaires de Kinshasa (RDC) : la COVID-19 a-t-elle entraîné une surmortalité ? Monitoring of deaths at the Kinshasa University Hospital: has COVID-19 resulted in increase of mortality?

Context and objectives. The extent of COVID-19 impact on overall in-hospital mortality is controversial. The objectives of the study were to compare the number of deaths in the first semesters of 2018, 2019 and 2020; determine the proportion of COVID-19 cases and identify the factors associated with COVID-19 among the deaths recorded at the morgue of the Kinshasa University Hospital (KUH). Methods. We collected death certificates registered at the KUH morgue. The diagnosis of COVID-19 was confirmed using RT-PCR in all suspected subjects (from March 2020), including those who have arrived dead. Pearson’s khi-square, Student’s t-test, and logistic regression were used as statistical tests. Results. The number of deaths recorded in the first semester of 2019 (868 cases) was higher than in 2020 (768 cases) and 2018 (744 cases). In 2020, 45 deaths related to COVID-19 (6.0%) were reported. The risk of COVID-19 depended on the period (month of June 2020, OR: 5.69; p = 0.002), sex (female, 0R: 0.42; p = 0.024) and age (one additional year of age, OR: 1.02; p = 0.009). Conclusion: COVID-19 did not lead to excess intra-hospital mortality in the first semester of 2020. The proportion of the disease among deceased patients was more marked in June 2020 and the risk increased with age, especially in men. Contexte et objectifs. L’ampleur de la COVID-19 sur la mortalité intra-hospitalière globale suscite des controverses. Les objectifs de l’étude étaient de comparer le nombre de décès lors des premiers semestres de 2018, 2019 et 2020 ; déterminer la proportion des cas de COVID-19 et identifier les facteurs associés à la COVID-19 parmi les décès enregistrés à la morgue des Cliniques Universitaires de Kinshasa (CUK). Méthodes. Nous avons colligé les certificats des décès enregistrés à la morgue des CUK. La COVID-19 a été recherchée par la RT-PCR chez tous les sujets suspects y compris les arrivés morts (à partir de mars 2020). Le Khi carré de Pearson, le test t de Student et la régression logistique ont été utilisés comme tests statistiques. Résultats. Le nombre de décès enregistrés au premier semestre 2019 (868 cas) était plus élevé qu’en 2020 (768 cas) et 2018 (744 cas). En 2020, on a rapporté 45 décès liés à la COVID-19 (6,0 %). Le risque d’avoir la COVID-19 dépendait de la période (mois de juin 2020, OR : 5,69 ; p = 0,002), du sexe (femme, 0R : 0,42 ; p = 0,024) et de l’âge (une année d’âge supplémentaire, OR : 1,02 ; p = 0,009). Conclusion. La COVID-19 n’a pas entraîné de surmortalité intra-hospitalière au premier semestre de l’année 2020. La proportion de la maladie parmi les patients décédés était plus marquée au mois de juin 2020 et le risque augmentait avec l’âge, particulièrement chez les hommes

Factors associated with acceptability of HIV self-testing (HIVST) among university students in a Peri-Urban area of the Democratic Republic of Congo (DRC)

Introduction: this paper examines the acceptability of HIV self-testing (HIVST) by students in a university in the DRC and identifies factors associated with uptake of HIVST. Methods: a cross-sectional study was conducted with a sample of 290 students from Kikwit University. Data were summarized using proportions and predictions of acceptability of HIVST by logistic regression. Results: the average age of students was 22.5 years, with the majority of the students being male (57%). Just over half the students sampled, reported being sexually active (51.8%). One hundred and sixty four (75%) reported that they had one sexual partner and fifty-six (25%) two or more sexual partners in the past year. Sixty-six percent had used condoms during their last sexual encounter. The acceptability of HIVST was high (81.4%) and 66.1% of students stated that they would confirm the self-test at a local health facility. The knowledge about the importance of the self-test (OR 5.02; 95% CI:1.33-18.88; p=0.017), the perception that counseling pre and post-test were important (OR 2.91; 95% CI:1.63-5.19; p < 0.0001) and the willingness to realize the test with a partner (OR 2.46; 95% CI:1.43-4.23; p=0.034) were factors associated with HIVST. Conclusion: the acceptability of HIVST was high and therefore its implementation is feasible in our country. However, prior to implementation, additional factors such as cost; access of HIVST; false reassurance of the test; missed early infections in the window period, limited counseling and linkage to care options, need to be considered

Interactions between malaria and HIV infections in pregnant women: a first report of the magnitude, clinical and laboratory features, and predictive factors in Kinshasa, the Democratic Republic of Congo

International audienceBackground: HIV and malaria are among the leading causes of morbidity and mortality during pregnancy in Africa. However, data from Congolese pregnant women are lacking. The aim of the study was to determine the magnitude, predictive factors, clinical, biologic and anthropometric consequences of malaria infection, HIV infection, and interactions between malaria and HIV infections in pregnant women. Methods: A cross-sectional study was conducted among pregnant women admitted and followed up at Camp Kokolo Military Hospital from 2009 to 2012 in Kinshasa, the Democratic Republic of Congo. Differences in means between malaria-positive and malaria-negative cases or between HIV-positive and HIV-negative cases were compared using the Student's t-test or a non-parametric test, if appropriate. Categorical variables were compared using the Chi-square or Fisher's exact test, if appropriate. Backward multivariable analysis was used to evaluate the potential risk factors of malaria and HIV infections. The odds ratios with their 95% confidence interval (95% CI) were estimated to measure the strengths of the associations. Analyses resulting in values of P < 0.05 were considered significant. Results: A malaria infection was detected in 246/332 (74.1%) pregnant women, and 31.9% were anaemic. Overall, 7.5% (25/332) of mothers were infected by HIV, with a median CD4 count of 375 (191; 669) cells/μL. The mean (±SD) birth weight was 2,613 ± 227 g, with 35.7% of newborns weighing less than 2,500 g (low birth weight). Low birth weight, parity and occupation were significantly different between malaria-infected and uninfected women in adjusted models. However, fever, anemia, placenta previa, marital status and district of residence were significantly associated to HIV infection. Conclusion: The prevalence of malaria infection was high in pregnant women attending the antenatal facilities or hospitalized and increased when associated with HIV infection

Enterocytozoon bieneusi Identification Using Real-Time Polymerase Chain Reaction and Restriction Fragment Length Polymorphism in HIV-Infected Humans from Kinshasa Province of the Democratic Republic of Congo

Objective. To determine the prevalence and the genotypes of Enterocytozoon bieneusi in stool specimens from HIV patients. Methods. This cross-sectional study was carried out in Kinshasa hospitals between 2009 and 2012. Detection of microsporidia including E. bieneusi and E. intestinalis was performed in 242 HIV-infected patients. Typing was based on DNA polymorphism of the ribosomal DNA ITS region of E. bieneusi. PCRRFLP generated with two restriction enzymes (Nla III and Fnu 4HI) in PCR-amplified ITS products for classifying strains into different lineages. The diagnosis performance of the indirect immune-fluorescence-monoclonal antibody (IFI-AcM) was defined in comparison with real-time PCR as the gold standard. Results. Out of 242 HIV-infected patients, using the real-time PCR, the prevalence of E. bieneusi was 7.9% (n=19) among the 19 E. bieneusi, one was coinfected with E. intestinalis. In 19 E. bieneusi persons using PCR-RFLP method, 5 type I strains of E. bieneusi (26.3%) and 5 type IV strains of E. bieneusi (26.3%) were identified. The sensitivity of IFI-AcM was poor as estimated 42.1%. Conclusion. Despite different PCR methods, there is possible association between HIVinfection, geographic location (France, Cameroun, Democratic Republic of Congo), and the concurrence of type I and type IV strains

Mortality associated with COVID‐19 and hypertension in sub‐Saharan Africa. A systematic review and meta‐analysis

Abstract Hypertension is a common comorbidity in COVID‐19 patients. However, little data is available on mortality in COVID‐19 patients with hypertension in sub‐Saharan Africa (SSA). Herein, the authors conducted a systematic review of research articles published from January 1, 2020 to July 1, 2021. Our aim was to evaluate the magnitude of COVID‐19 mortality in patients with hypertension in SSA. Following the PRISMA guidelines, two independent investigators conducted the literature review to collect relevant data. The authors used a random effect model to estimate the odds ratio, or hazard ratio, with a 95% confidence interval (CI). Furthermore, the authors used Egger's tests to check for publication bias. For mortality analysis, the authors included data on 29 945 COVID‐19 patients from seven publications. The authors assessed the heterogeneity across studies with the I2 test. Finally, the pooled analysis revealed that hypertension was associated with an increased odds of mortality among COVID‐19 inpatients (OR 1.32; 95% CI, 1.13–1.50). Our analysis revealed neither substantial heterogeneity across studies nor a publication bias. Therefore, our prespecified results provided new evidence that hypertension could increase the risk of mortality from COVID‐19 in SSA

Congrès AFMED 2017 : Co-infection VIH-Helminthiases intestinales à Kinshasa (RD Congo) : fréquence et facteurs associés: HIV-Helminthiasis co-infection in Kinshasa (DR Congo): frequency and associated factors

Objectifs. Montrer l‟ampleur des helminthiases intestinales chez les PVVs adultes en milieu de soins à Kinshasa et en identifier les facteurs associés.Méthodes. Étude transversale à visée analytique réalisée dans 8 structures de prise en charge des PVVs à Kinshasa choisies de manière aléatoire. Quatre cent vingt-deux PVVs adultes ont été incluses dans l‟étude selon une approche probabiliste. Un questionnaire pré-testé leur a été administré. Chaque patient avait remis un échantillon de selle conservé dans du formol à 10% pour examen par la méthode de RITCHIE. Les données ont été analysées l‟aide du logiciel SPSS version 21. La régression logistique a servi à identifier les facteurs associés à l‟infection helminthique chez les PVVs.Résultats. Sur 422 PVV, 324 étaient des femmes, soit un sex ratio de 1H/3,3F ; soit 10 H pour 33 F. L‟âge moyen était de 42 ans (ET =10 ans).La fréquence globale des helminthiases intestinales était de 22% (93/422). L‟helminthe le plus retrouvé était Ascaris lumbricoides 44/422 (10,4%) suivi de Trichuris trichiura (Trichocéphale) 33/422 (7,8%), et de Strongyloides stercoralis (Anguillule) 14/422 (3,3%). Ce dernier helminthe était associé à un taux de LT CD4 bas. Aucune infection helminthique mixte n‟a été détectée. Le taux de lymphocytes T CD4 médian était de 388 éléments/mm3 (EIQ : 342-412) pour toutes les PVVs de l‟étude, et 425 éléments/mm3 (EIQ : 373-456) pour les co-infectées, avec comme extrêmes : 13-1421 éléments/mm3. Plus de 70% de PVV étaient atteints d‟infections à faible intensité. Après ajustement, l‟utilisation d‟eau de robinet [OR ajusté 3,62 IC95% (1,04-12,58), p=0,018], la consommation des légumes crus ou fruits frais [OR ajusté 1,80 IC95% (1,11-2,92), p=0,018], la non consommation d‟eau traitée [OR ajusté 2,84 IC95% (1,81-4,72), p=0,018], le non lavage hygiénique des mains après usage de toilettes [OR ajusté 2,65 IC95% (1,14-8,21), p=0,010] et avant de manger [OR ajusté 2,01 IC95% (1,09-6,73), p=0,004] étaient les facteurs associés à l‟helminthiase intestinale.Conclusion. La co-infection VIH-helminthiasiase intestinale est fréquente à Kinshasa. Ascaris lumbrocoides est l‟helminthe le plus retrouvé. L‟immunodépression avancée favorise la strongyloïdose. Les campagnes de sensibilisation sur l‟éducation sanitaire et le déparasitage intermittent de masse chez les PVVs devraient être à envisagés

Human Immunodeficiency Virus Viral Load Monitoring and Rate of Virologic Suppression Among Patients Receiving Antiretroviral Therapy in Democratic Republic of the Congo, 2013-2020.

peer reviewedBACKGROUND: Antiretroviral therapy (ART) expansion and viral load as a treatment monitoring approach have increased the demand for viral load testing. Many hurdles affect the coverage, quality, and use of viral load results. Estimates of viral load monitoring and viral suppression rates are needed to assess the performance of ART programs and improve human immunodeficiency virus (HIV) management outcomes. METHODS: People with HIV (PWH) viral load monitoring data were routinely collected in 84 health facilities in Kinshasa, Democratic Republic of the Congo (DRC), between 2013 and 2020. The number of PWH under ART, the number of participants with at least 1 viral load test result, the rate of viral suppression (defined as ≤1000 HIV ribonucleic acid copies per mL), and the mean turnaround time from sample collection to release of viral load test results were collected together with clinical data. RESULTS: A total of 14 057 PWH were included in the analysis. People with HIV were mainly enrolled after the "test and treat" implementation. The patients were followed for a median period of 27 months. The proportion of PWH with at least 1 available viral load largely increased in recent years. The delay from sample collection to release of viral load test results decreased overtime, from 35 days in 2018 to 16 days in 2020. Pregnancy and advanced HIV disease were associated with a lower chance of viral suppression. CONCLUSIONS: There has been considerable success in increasing viral load access for all PWH under therapy in DRC. Nevertheless, viral load testing should be intensified with a particular effort to be made in groups at higher risk of viral failure