Manifestations cliniques de l’infection à Coronavirus SARS-Cov-2 (COVID-19): Clinical characteristics of coronavirus infection disease (COVID-19)

The pandemic caused by the new coronavirus  (SARS-CoV-2) in Wuhan, China in December 2019 is a very contagious disease. The World Health Organization (WHO) has declared the ongoing epidemic to be a global public health emergency. Currently, research on this new coronavirus is in progress and several publications are available. The clinical manifestations linked to infection with the new Coronavirus-SARS-COV-2 virus seem to be polymorphic and multi-systemic, going beyond the typical respiratory nosological pattern described (fever, asthenia and respiratory symptoms cough and difficulty in breathing). These manifestations can be cardiovascular, dermatological, ORL, hepatic, renal, ophthalmological and neurological. This review describes the clinical manifestations as well as the pathogenesis known to date of the coronavirus disease 2019 (COVID-19); the diagnosis and treatment are not included in this mini review. La pandémie causée par le nouveau virus du coronavirus (SARS-CoV-2) à Wuhan, en Chine, en décembre 2019 est une maladie très contagieuse. L’Organisation mondiale de la Santé (OMS) a déclaré que l’épidémie en cours était une urgence mondiale de santé publique. Actuellement, les recherches sur ce nouveau coronavirus sont en cours et plusieurs publications sont disponibles. Les manifestations cliniques liées à l’infection au nouveau Corona-virus SARS-COV-2 semblent être très polymorphes et multi systémiques, dépassant largement le cadre nosologique typiquement respiratoire. Ces manifestations peuvent être cardio-vasculaires, dermatologiques, ORL, hépatiques, rénales, ophtalmologiques et même neurologiques. Cette revue décrit les manifestations cliniques ainsi que de la pathogénie connues à ce jour du coronavirus 2019 (COVID-19) ; le diagnostic et le traitement ne seront volontairement pas abordés

Assessment of treatment outcomes of multidrug-resistant tuberculosis patients in D R Congo: A study based on drug regimens used between 2007 to 2017: Évaluation des issues thérapeutiques des patients atteints de la tuberculose à bacilles multi résistants : étude basée sur les régimes de médicaments utilisés en République Démocratique du Congo de 2007 à 2017

Context. Little is known about therapeutic successes in MDR-TB patients under regimens containing second-line molecules. The present study aimed to assess therapeutic outcomes in patients under therapeutic regimens applied in DR Congo. Methods. This historical cohort study has included confirmed MDR-TB patients who received treatment between 2007 and 2017 in 218 TB centers in DR Congo. Treatment outcome and survival at 36 months were analyzed using Zscore and chi square test. Kaplan-Meier method was performed to describe survival and Log Rank test helped in comparing curve based on the therapeutical regimen. Factors associated with therapeutic success and mortality predictors were assessed using multivariate logistic regression and Cox regression analysis, respectively. Results. The therapeutic success in the study group (n=1,724) was 72% (range 68-74%) for all regimen combined. The average death rate was 12.8% although the group of patients receiving Cyclosérine and Ofloxacine was the most affected (16%). The death rate was significantly higher in patients living in urban areas (15.2% versus 14.9%, p = 0.013) and also among MDR-TB/HIV co-infected patients (28.4% vs 15.7%, p<0.001) patients. The median survival of the study group was 722.7 days compared to 601.1 days for MDR-TB/HIV co-infected patients, and 736.7 days for HIV negative patients (p<0.001). Conclusion. Therapeutic successes are significant for the short regimen. However, the death rate remains high when Cycloserine and Ofloxacin are included in the regimen. The predictors of mortality are HIV infection and living in urban areas. Contexte. L’issue thérapeutique de la tuberculose multi résistante (TB-MR) sous les molécules de deuxième intention n’est pas très bien connue. La présente étude a évalué les régimes thérapeutiques appliqués, en termes de succès thérapeutique et de survie. Méthodes. L’étude de cohorte historique a inclu les patients TB-MR confirmés et traités entre 2007 et 2017 dans 218 centres de tuberculose en RD Congo. L’issue thérapeutique et la survie à 36 mois ont été analysées. Le score Z ou le test de chi carré ont comparé des issues. La méthode de Kaplan-Meier a décrit les courbes de survie et le test de Log Rank a comparé la survie en fonction du regime therapeutique. Les facteurs associés au succès thérapeutique et les prédicteurs de mortalité ont été analysés respectivement, par l’analyse multivariée de régression logistique et de Cox. Résultats. Dans le groupe étudié (n=1724), le succès thérapeutique a été de 72% (68-74%) pour l’ensemble des régimes. Le taux était plus élevé pour le régime court (74%) et plus faible pour le régime contenant la Cyclosérine et l’Ofloxacine (68%). La moyenne de décès était de 12,8% ; mais plus élevée dans le groupe sous regime contenant la Cyclosérine et l’Ofloxacine (16%). Le taux de décès était significativement plus élevé en milieu urbain (15,2% versus 14,9 %, p = 0,013) et également chez les sujets co-infectés par la MDR-TB  et le VIH (28.4% vs 15.7%, p <0,001). La survie médiane dans le groupe était de 722,7 jours contre 601,1 jours chez les co-infectés MDR-TB/VIH, et de 736,7 jours) chez les patients VIH négatifs (p<0,001). Conclusion. Les succès thérapeutiques sont acceptables en particulier, pour le régime court ; toutefois, le taux de décès demeure encore très élevé dans le groupe sous Cyclosérine et Ofloxacine. Les prédicteurs de mortalité sont l’infection à VIH et la vie citadine. &nbsp

Épidémiologie clinique et grande diversité génétique parmi les isolats de Cryptococcus spp. infectant les personnes vivant avec le VIH à Kinshasa, République démocratique du Congo

Neuromeningeal cryptococcosis (NMC) is a life-threatening opportunistic infection in advanced HIV disease patients (AHDP). It is caused by Cryptococcus spp. complexes and mainly occurs in sub-Saharan Africa. In this study, we performed molecular characterization and antifungal susceptibility profiling of Cryptococcus isolates from AHDP in Kinshasa (DRC). Additionally, we investigated a possible association between NMC severity factors and the Cryptococcus neoformans (Cn) multilocus sequence typing (MLST) profiles. We characterized the isolates using PCR serotyping, MALDI-TOF MS, internal transcribed spacer (ITS) sequencing, and MLST. Susceptibility testing for the major antifungal drugs was performed according to the EUCAST guidelines. Parameters associated with NMC severity, such as hypoglycorrhachia ( 30 cm H2O), and poor therapeutic outcome were compared with the Cn MLST sequences type (ST). Twenty-three out of 29 Cryptococcus isolates were identified as serotype A using PCR serotyping (79.3%; 95% IC: 65.5-93.1), while six (20.7%; 95% IC: 6.9-34.5) were not serotypable. The 29 isolates were identified by ITS sequencing as follows: Cryptococcus neoformans (23/29, 79.3%), Cutaneotrichosporon curvatus (previously called Cryptococcus curvatus) (5/29, 17.2%), and Papiliotrema laurentii (Cryptococcus laurentii) (1/29, 3.5%). Using the ISHAM MLST scheme, all Cn isolates were identified as molecular type VNI. These comprised seven different STs: ST93 (n = 15), ST5 (n = 2), ST53 (n = 1), ST31 (n = 1), ST4 (n = 1), ST69 (n = 1), and one novel ST that has not yet been reported from other parts of the world and was subsequently assigned as ST659 (n = 2). Of the included strains, only Papiliotrema laurentii was resistant to amphoterin B (1/29, 3.5%), 6.8% (2/29) were resistant to 5-flucytosine (the single Papiliotrema laurentii strain and one Cryptococcus neoformans isolate), and 13.8% (4/29) to fluconazole, including two of five (40%) Cutaneotrichosporon curvatus and two of 23 (8.7%) C. neoformans strains. We found a significative association between poor therapeutic outcome and a non-ST93 sequence type of causative strains (these concerned the less common sequence types: ST53, ST31, ST5, ST4, ST659, and ST69) (87.5% versus 40%, p = 0.02). Molecular analysis of Cryptococcus spp. isolates showed a wide species diversity and genetic heterogenicity of Cn within the VNI molecular type. Furthermore, it is worrying that among included strains we found resistances to several of the commonly used antifungals.Cryptococcose chez les personnes vivant avec le VIH à Kinshasa : étude épidémiologique et moléculaire3. Good health and well-bein

Evaluation de la prise en charge intégrée de l’otite moyenne chronique dans le système des soins de santé primaires à Kinshasa, République Démocratique du Congo: Assessment of integrated management of chronic otitis media in the primary health care system in Kinshasa, Democratic Republic of the Congo

Context and objective. Chronic Otitis Media (COM) is common with significant health and economic consequences. Health care workers play a key role in the management of this condition. This study aimed to assess the availability and adequacy of human and material resources for the management of COM in the primary health care system (PHC) in Kinshasa. Methods. In a crosssectional analytical study, four categories of human resources (community health relay, nurse, general practitioner, and medical specialist) providing PHC in Kinshasa were interviewed between July 2 and 21, 2020. Results. 218 health care providers participated. At the primary level, the availability of providers was observed, but their performance on basic care activities was poor among the Reco and IT interviewed. In multivariate logistic regression analysis, female gender, lack of training in PHC of the ear and lack of management materials were the factors independently associated with poor response among Reco while A1 and A2 education (awareness), lack of training in PHC of the ear andlack of equipment were the factors independently associated among IT. At the Reference GeneralHospital (RGH) level, the General Practitioners (GPs) interviewed showed a lack of a coherentand reliable referral system between the Health Center (HC) and the RGH as well as between theRGH and the specialist Center. At the tertiary level, 75% of the facilities had only medical treatment as the only treatment option due to lack of expertise (75%) and surgical equipment (87.5%) in surgical management according to the specialist doctors interviewed. Conclusion. Management of COM is not efficient in PHC in Kinshasa. Capacity building of health care providers on the management of COM is an urgent need in Kinshasa. Contexte & objectif. L’otite moyenne chronique (OMC) est une maladie très fréquente aux conséquences sanitaires et économiques importantes. Le personnel soignant joue un rôle primordial dans la prise en charge de cette pathologie. L’objectif de l’étude était d’évaluer la disponibilité et l’adéquation entre les ressources humaines et matérielles et les activités de prise en charge de l’OMC. Méthodes. Dans une étude transversale analytique, 4 catégories de ressources humaines (relais communautaire, infirmier titulaire, médecin généraliste et médecin spécialiste) prestant dans le système des soins de santé primaire (SSSP) de Kinshasa, ont été interviewés, entre les 2 et 21 juillet 2020. Résultats. 218 prestataires de soins ont participé. Au niveau primaire, une disponibilité des prestataires a été objectivée, mais leur performance sur les activités de prise en charge de base a été faible chez les interviewés. En analyse de régression logistique multivariée, le sexe féminin, le manque de formation en SSP de l’oreille et l’absence d’équipement de PEC ont été les facteurs associés de manière indépendante à une mauvaise réponse chez les Reco tandis que chez les IT, il s’agissait des niveaux d’étude A1 et A2, le manque de formation en SSP de l’oreille et l’absence d’équipement. Au niveau de l’HGR, les médecins généralistes interviewés ont montré un manque de référence et de contre-référence entre le CS et l’HGR ainsi qu’entre l’HGR et le centre spécialisé. Au niveau tertiaire, 75% des structures ne donnent que le traitement médical faute d’expertise (75%) et de matériel de chirurgie (87,5%) dans la prise en charge chirurgicale selon les médecins spécialistes interviewés. Conclusion. La prise en charge intégrée de l’OMC n’est pas optimale dans le SSSP à Kinshasa. Un renforcement des capacités des prestataires des soins sur la prise en charge de l’OMC est impérieux à Kinshasa

Progressive phasing out of baseline CD4+ cell count testing for people living with HIV in Kinshasa, Democratic Republic of the Congo.

peer reviewe

Epidemiologic analysis of dental cellulitis in Kinshasa city (the Democratic Republic of the Congo)

Introduction: The study aimed to determine the prevalence, describe the sociodemographic profile of individuals with dental cellulitis, and identify its associated factors in a population of Kinshasa. Materials and methods: This was a cross-sectional analytical study conducted in October 2017 in five hospital departments in Kinshasa. The sample population consisted of patients with dental cellulitis. Sociodemographic data and factors associated with dental cellulitis were evaluated. Results: Dental cellulitis was found in 12.5% of the subjects, with a slight female predominance (58.2%). A significant difference between patients with cellulitis and those without cellulitis was observed for the following variables: education level, unemployment, and low socioeconomic status (p < 0.05). Dental carious lesions (93.7%) were the most common causative factor, and self-medication (100%) and poor oral hygiene (83.5%) were risk or contributing factors. Univariate analysis showed that for people of ages 16–59 and ≥60 years, education level, unemployment, sugar consumption, and low socioeconomic status were significantly associated with dental cellulitis. A multivariate logistic regression analysis showed that people of ages ≥60 years [odds ratio (OR) 3.12, 95% confidence interval (CI) 1.169–4.14, p = 0.014], non-university status (OR 2.79, 95% CI 1.68–4.64, p < 0.001), unemployment (OR 2.27, 95% CI 1.73–4.20, p = 0.005), sugar consumption (OR 3.17, 95% CI 1.71–4.94, p = 0.036), and low socioeconomic status (OR 2.60, 95% CI 1.85–3.01, p = 0.014) were independently associated with dental cellulitis in the study population. Conclusion: Dental cellulitis is a public health problem in the city of Kinshasa, the Democratic Republic of Congo

Progressive phasing out of baseline CD4+ cell count testing for people living with HIV in Kinshasa, Democratic Republic of the Congo

peer reviewe

Decrease in late presentation for HIV care in Kinshasa, DRC, 2006-2020.

peer reviewedINTRODUCTION: Late presentation for HIV care is a well-described issue for the success of ART outcomes and the cause of higher morbidity, mortality and further transmission. Monitoring the level of late presentation and understanding the factors associated with it would help to tailor screening and information strategies for better efficiency. We performed a retrospective cohort study in Kinshasa, the capital of the DRC. The studied population included HIV-positive adults newly enrolled in HIV care between January 2006 and June 2020 at 25 HIV urban care facilities. Patient information collected at presentation for HIV care included age, sex, WHO clinical stage and screening context. We used 2 definitions of late presentation: the WHO definition of advanced HIV disease (WHO stage 3/4 or CD4 cell count < 200 cells/mm(3)) and a more inclusive definition (WHO stage 3/4 or CD4 cell count < 350 cells/mm(3)). RESULTS: A total of 10,137 HIV-infected individuals were included in the analysis. The median age was 40 years; 68% were female. A total of 45.9% or 47.5% of the patients were late presenters, depending on the definition used. The percentage of patients with late presentation (defined as WHO stage 3/4 or CD4 cell count < 350 cells/mm(3)) decreased during recent years, from 70.7% in 2013 to 46.5% in 2017 and 23.4% in 2020. Age was associated with a significantly higher risk of LP (p < 0.0001). We did not observe any impact of sex. CONCLUSIONS: The frequency of late presentation for care is decreasing in Kinshasa, DRC. Efforts have to be continued. In particular, the issue of late diagnosis in older individuals should be addressed

Decrease in late presentation for HIV care in Kinshasa, DRC, 2006-2020.

peer reviewedINTRODUCTION: Late presentation for HIV care is a well-described issue for the success of ART outcomes and the cause of higher morbidity, mortality and further transmission. Monitoring the level of late presentation and understanding the factors associated with it would help to tailor screening and information strategies for better efficiency. We performed a retrospective cohort study in Kinshasa, the capital of the DRC. The studied population included HIV-positive adults newly enrolled in HIV care between January 2006 and June 2020 at 25 HIV urban care facilities. Patient information collected at presentation for HIV care included age, sex, WHO clinical stage and screening context. We used 2 definitions of late presentation: the WHO definition of advanced HIV disease (WHO stage 3/4 or CD4 cell count < 200 cells/mm(3)) and a more inclusive definition (WHO stage 3/4 or CD4 cell count < 350 cells/mm(3)). RESULTS: A total of 10,137 HIV-infected individuals were included in the analysis. The median age was 40 years; 68% were female. A total of 45.9% or 47.5% of the patients were late presenters, depending on the definition used. The percentage of patients with late presentation (defined as WHO stage 3/4 or CD4 cell count < 350 cells/mm(3)) decreased during recent years, from 70.7% in 2013 to 46.5% in 2017 and 23.4% in 2020. Age was associated with a significantly higher risk of LP (p < 0.0001). We did not observe any impact of sex. CONCLUSIONS: The frequency of late presentation for care is decreasing in Kinshasa, DRC. Efforts have to be continued. In particular, the issue of late diagnosis in older individuals should be addressed

Dépistage de la cryptococcose et caractérisation des isolats de Cryptococcus chez les personnes vivant avec le VIH asymptomatiques à Kinshasa, RDC

peer reviewedBackground: Cryptococcal meningitis (CM) is a life-threatening invasive mycosis affecting people living with HIV (PLHIV) and has a high prevalence and case fatality rate in sub-Saharan Africa. While most PLHIV presenting CM are symptomatic, the asymptomatic ones are diagnosed following routine screening tests indicated for all advanced PLHIV (CD4 &lt;200/μl). We, therefore, hypothesized that asymptomatic CM patients would be infected with different Cryptococcus spp. strains than those in symptomatic CM patients (referring to the parallel study conducted in the same clinics). This study describes the prevalence of serum and meningeal cryptococcosis in asymptomatic PLHIV presenting a CD4 count of &lt;200 cells/μl in the screening context. We then characterized and determined the antifungal susceptibility of Cryptococcus spp. strains isolated from these patients. Methods: We performed cross-sectional screening for serum cryptococcal antigen (CrAg) in ambulant PLHIV with &lt;200 CD4/μL in three clinics in Kinshasa (DRC). Lumbar puncture was indicated in positive patients to exclude a meningeal location for therapeutic purposes. The resulting cerebrospinal fluid (CSF) was then analyzed for CrAg and Cryptococcus spp. was isolated and characterized by MALDI TOF MS, serotyping PCR, ITS sequencing, and multilocus sequence typing (MLST). In addition, the EUCAST E.Def.7.3.2 microdilution procedure was followed to determine the susceptibility of strains to antifungal agents. Results: A total of 47 PLHIV out of 262 included were tested positive for serum CrAg (19%, 95% CI: 14.2–24.3) from which 46.8% (22/47) had a high antigenic titer (≥1/160). The prevalence of asymptomatic CM was then estimated at 50% in CrAg serum-positive patients who consented to lumbar puncture (19/38). Although the female proportion included in the study was higher than that of men, serum CrAg was more positive in men (21.4%, 18/84 men included) than in women (18.0%, 29/161 women included). While the mean CD4 count of CrAg serum-positive patients were significantly lower than that of negative patients (P &lt;.05), the median viral load between the two patient groups was approximately similar (P &gt;.05). Only four CSF samples were positive in culture for Cryptococcus spp. and were all characterized as Cryptococcus neoformans/serotype A. At this stage, two isolates have been analyzed using the ISHAM MLST scheme and two different sequence type (ST) profiles were identified, namely: ST93 and ST63. While ST93 is the main Cryptococcus neoformans profile described in Congolese (DRC) PLHIV with CM, ST63 has not yet been identified in the DRC before. Of note, epidemiological and clinical specificities of ST63 have so far been poorly characterized in the literature. Susceptibility testing against the major antifungals and the MLST typing of the two remaining strains are still ongoing. Conclusions: The prevalence of cryptococcosis should not be neglected among asymptomatic PLHIV in the DRC, to meaning that screening and preventive treatment measures should be integrated into the national policy for HIV management and related diseases. For the rest of the analyses still in progress, conclusions can only be drawn once they have been fully finalized.Cryptococcose chez les personnes vivant avec le VIH à Kinshasa : étude épidémiologique et génétique3. Good health and well-bein