CHOIX ET PLACE DE L’ANTIBIOTHERAPIE SUR LES INFECTIONS ORL AUX CLINIQUES UNIVERSITAIRES DE KINSHASA, RD CONGO

Les infections des voies aériennes supérieures et de la sphère oto rhino laryngologie constituent une des premières causes de consultation en médecine générale. Malgré leur faible taux de complications, elles sont source d’une forte demande thérapeutique de la part des patients. Cette demande peut être considérée comme étant l’une des causes de l’importante consommation d’antibiotiques. Cette étude a pour objectif de Contribuer à l’utilisation judicieuse d’antibiotique chez les patients souffrants d’infections oto rhino laryngologie. Une étude descriptive. Sur les 251 cas d’infections oto rhino laryngologie répertoriées, 137 ou 55% ont bénéficié d’une antibiothérapie. L’âge médian était de 25 ans avec des extrêmes allant de 1 à 60 ans, Les motifs de consultation otologique, rhinologique et pharyngo-laryngologique les plus observés étaient : otorrhée, rhinorrhée et toux.   Quant aux infections oto rhino laryngologie, la Rhinite et la Rhino sinusite revenaient en tête avec 21 et 17% des cas respectivement, suivi du Syndrome obstructive des VRS (Végétations adénoïdes) avec 10%. L’antibiothérapie faite de l’association Amoxicilline Acide clavulanique était la plus utilisée, suivie d’Amoxicilline seul puis les Céphalosporines de 3ième génération.Les infections des voies aériennes supérieures et de la sphère oto rhino laryngologie constituent une des premières causes de consultation en médecine générale. Malgré leur faible taux de complications, elles sont source d’une forte demande thérapeutique de la part des patients. Cette demande peut être considérée comme étant l’une des causes de l’importante consommation d’antibiotiques. Cette étude a pour objectif de Contribuer à l’utilisation judicieuse d’antibiotique chez les patients souffrants d’infections oto rhino laryngologie. Une étude descriptive. Sur les 251 cas d’infections oto rhino laryngologie répertoriées, 137 ou 55% ont bénéficié d’une antibiothérapie. L’âge médian était de 25 ans avec des extrêmes allant de 1 à 60 ans, Les motifs de consultation otologique, rhinologique et pharyngo-laryngologique les plus observés étaient : otorrhée, rhinorrhée et toux.   Quant aux infections oto rhino laryngologie, la Rhinite et la Rhino sinusite revenaient en tête avec 21 et 17% des cas respectivement, suivi du Syndrome obstructive des VRS (Végétations adénoïdes) avec 10%. L’antibiothérapie faite de l’association Amoxicilline Acide clavulanique était la plus utilisée, suivie d’Amoxicilline seul puis les Céphalosporines de 3ième génération

GERMES INCRIMINES DANS LES OTITES MOYENNES SUPPUREES AUX CLINIQUES UNIVERSITAIRES DE KINSHASA, RD CONGO

L'otite moyenne suppurée est une infection de l'oreille moyenne caractérisée par un écoulement purulent à travers une perforation de la membrane tympanique. C'est une cause importante de perte de l'audition évitable. La prédominance des germes pathogènes de l'otite moyenne suppurée étant variable d'un pays a un autre, voir même d'une région a une autre d'où la connaissance des germes pathogènes de cette maladie dans un milieu donné se révèle très importante pour mener un traitement adéquat. Nous identifions  par cette étude le profil bactériologique de l'otite moyenne suppurée des patients qui ont consulté le service d'ORL des Cliniques Universitaires de Kinshasa et la sensibilité de ces germes au regard des antibiotiques utilisés. L'étude de la sensibilité a été faite par la méthode de diffusion en milieu gélose.  Il s'agissait de 7 femmes et 5 hommes avec 4 de plus de 44 ans soit 34%, 3 de 0 à 10 ans soit 25%, 3 de 33 à 43 ans soit 25%, 1 de 11 à 21 ans soit 8% et enfin 1 de 22 à 32 ans soit 8%. Le profil bactériologique était dominé par les entérobactéries (Klebsiella pneumonie, Citrobacter freundii et Shewanella putrefaciens), le Pseudomonas aeruginosa et le Staphylocoques aureus. Ces germes se sont montres tous sensibles aux fluoroquinolones (ciprofloxacine) et aux aminosides (amikacine).L'otite moyenne suppurée est une infection de l'oreille moyenne caractérisée par un écoulement purulent à travers une perforation de la membrane tympanique. C'est une cause importante de perte de l'audition évitable. La prédominance des germes pathogènes de l'otite moyenne suppurée étant variable d'un pays a un autre, voir même d'une région a une autre d'où la connaissance des germes pathogènes de cette maladie dans un milieu donné se révèle très importante pour mener un traitement adéquat. Nous identifions  par cette étude le profil bactériologique de l'otite moyenne suppurée des patients qui ont consulté le service d'ORL des Cliniques Universitaires de Kinshasa et la sensibilité de ces germes au regard des antibiotiques utilisés. L'étude de la sensibilité a été faite par la méthode de diffusion en milieu gélose.  Il s'agissait de 7 femmes et 5 hommes avec 4 de plus de 44 ans soit 34%, 3 de 0 à 10 ans soit 25%, 3 de 33 à 43 ans soit 25%, 1 de 11 à 21 ans soit 8% et enfin 1 de 22 à 32 ans soit 8%. Le profil bactériologique était dominé par les entérobactéries (Klebsiella pneumonie, Citrobacter freundii et Shewanella putrefaciens), le Pseudomonas aeruginosa et le Staphylocoques aureus. Ces germes se sont montres tous sensibles aux fluoroquinolones (ciprofloxacine) et aux aminosides (amikacine)

ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed

Clinical and Epidemiological Aspects of Allergic Rhinitis in Kinshasa Democratic Republic of Congo)

Background Allergic rhinitis (AR) is a common disorder, which causes a considerable burden both on individual patients and society, particularly in large cities where air pollution is the substantial problem causing respiratory diseases. AR constitutes a worldwide public health problem. However, little is known about allergic diseases in Africa because of a lack of data and resources and by the difficulty, or even absence of diagnostic tools in sub-Saharan Africa. Objective The present PhD project aimed to study epidemiology and clinical characteristics of AR and associated diseases in both urban and rural areas of Kinshasa, and to assess the risk factors and allergen sources in order to improve the disease management. Methods The present work was done by combining studies in the general population, among patients presenting with nasal symptoms and among individuals exposed to flour dust in comparison to the controls. The first cross-sectional clustered survey was done from February to May 2010 on inhabitants of 8 health zones randomly selected in Kinshasa. A total of 1412 individuals (aged from 5-83 year-old) were interviewed and 1005 of them skin tested. The second cross-sectional study enrolled 423 consecutive outpatients presenting (January- May 2009) with nasal symptoms related to rhinitis/rhinosinusitis at the ENT services of Kinshasa. Patients were face-to-face interviewed and skin tested. The last study was conducted from April to August 2012 among 809 consecutive individuals: 263 workers directly exposed to flour dust, 278 indirectly exposed to wheat flour and 268 controls. Individuals were questioned and skin prick tests (SPT), nasal and pulmonary parameters were assessed. Results In the general population, 62% of respondents reported at least one disease in the 12 previous months. The 12-monthprevalence of rhinitis, rhinoconjunctivitis, wheezing and skin itch-rash symptoms was of 30.8%, 24.4%, 15.4% and 6.2% respectively. Rhinoconjunctivitis and wheezing were significantly more prevalent in urban individuals, while skin itch-rash was significantly more prevalent in rural individuals. Although not statistically significant, rhinitis seemed more prevalent in urban than in rural areas. Twenty three percent of individuals showed positive SPT results with dermatophagoides pteronyssinus (DPT) and cockroach being the most prevalent allergens. AR and non-allergic rhinitis prevalence was of 13.9% and 27.9% respectively. 59.7% and 48.0% of AR individuals expressed moderate to severe and persistent symptoms respectively. In multivariate analysis having any diseases were associated with active smoking, presence of cockroach in the home, history of atopy among siblings, personal history of atopy, using a straw or herbs mattress and positive SPT responses. The study of rhinologic patients highlighted that about one third of patients had positive SPT results, with 40.9% of these showing polysensitization. DPT and cockroach were the most common allergens among sensitized patients. Persistent and moderate/severe AR represented 61.4% and 69.3% respectively. Sensitization was indenpendently associated with younger age, rhinoconjunctivitis in the past and reaction to non-specific triggers factors. The results of individuals exposed to flour dust revealed that, the 12-months prevalence of rhinitis, rhinoconjunctivitis, wheezing and nocturnal cough was of 46.0%, 15.8%, 10.6% and 7.5% respectivelyamong all respondents. Compared to the controls, rhinitis, rhinoconjunctivitis and nocturnal cough were significantly more prevalent in workers directly exposed to flour dust. 37.5% of all respondents showed positive SPT results with DPT and cockroaches being the most prevalent allergens. Sensitization to storage mite was found more prevalent among workers directly exposed than controls, while positive SPT to pollen mix, sunflower pollen and crab were more prevalent inthe control group. In multivariate analysis, belonging to the directly exposed group and the presence of a flour mill in the neighborhood significantly increased the risk of having airway disease. Mice in the house increased the risk of both sensitization and airway diseases. Conclusion The present work revealed a high prevalence of allergic diseases in Kinshasa, especially in urban areas compared to rural parts. A substantial portion of the population and patients showed sensitization to at least one allergen. DPT and cockroaches constituted the most prevalent allergen sources. Allergic diseases were associated with many factors. It is important to increase awareness toward allergic disorders and to ensure adequate management and prevention. Keywords: prevalence, rhinitis, rhinoconjunctivitis, wheezing, itch-rash, sensitization, flour dust, Kinshasastatus: publishe

Prevalence and determinants of allergic diseases in a Congolese population

Allergic rhinitis (AR) is increasing worldwide, but little is known about AR in Africa. We aimed to establish the prevalence of AR and related allergic diseases, to classify AR according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines, and to determine factors associated with allergy in Congo. We conducted a cross-sectional clustered survey of the population of 8 randomly chosen health zones of Kinshasa. Information was collected on demographics, home environment, participant characteristics, atopic history, and allergic symptoms. Skin-prick testing (SPT) was done. Of 1508 screened individuals, 1412 (5-83 years of age) were interviewed and 1005 underwent SPT. Of the participants, 65.6% and 34.4% lived in urban and rural areas, respectively. Mean (± standard deviation [SD]) of age was 29 (±16) years and 52% were female. The 12-month prevalence of rhinitis, rhinoconjunctivitis, wheeze, and skin itch-rash was 30.8%, 24.4%, 15.4%, and 6.2%, respectively. Rhinoconjunctivitis and wheeze were more prevalent in urban than rural individuals. Of skin-tested respondents, 23.2% showed positive results, with mainly Dermatophagoides pteronyssinus and cockroach being involved. AR and non-AR prevalence was reported in 13.9% and 27.9%, respectively. Of AR individuals, 59.7% and 48.0% expressed moderate to severe and persistent symptoms, respectively. Independent determinants of having any allergic diseases in multivariate analysis were active smoking, presence of cockroach in home, history of atopy in siblings, personal history of atopy, using straw or herb mattress, and positive SPT responses. This study revealed a high prevalence of allergic diseases in Congolese individuals. It is important to increase awareness toward allergic disorders and to ensure adequate managemen

Sensitization rate and clinical profile of Congolese patients with rhinitis

In the African continent, the sensitization pattern and clinical profile are unknown in patients with rhinitis/rhinosinusitis attending the outpatient ear, nose, and throat (ENT) clinics. We therefore aimed to analyze the clinical characteristics of rhinitis/rhinosinusitis patients in Democratic Republic of Congo (DRC), classify allergic rhinitis (AR) according to the Allergic Rhinitis and Its Impact on Asthma criteria, and evaluate the sensitization profile and its associated factors. From January to May 2009, 423 patients with rhinitis symptoms attending the Outpatient ENT clinic of the University Hospital and Saint Joseph Hospital of Kinshasa were evaluated for allergy symptoms, severity, and duration of symptoms and underwent skin-prick tests (SPTs) for a panel of 15 allergens. Of 423 patients 35.2% had positive SPT results, with 40.9% showing polysensitization. Dermatophagoides pteronyssinus (DPT) (68.5%) and cockroach (36.2%) were the most common allergens among sensitized patients. Patients with rhinitis/rhinosinusitis mainly presented in decreasing order with sneezing, facial pain/pressure, nasal obstruction, postnasal discharge, nose itching, clear nasal discharge, and eye itching. Persistent and moderate/severe AR represented 61.4 and 69.3%, respectively. Sensitization was independently associated with younger age, rhinoconjunctivitis, and reaction to nonspecific trigger factors. In conclusion, 35.2% of patients attending the ENT Outpatient Clinic in DRC for rhinitis problems had a positive SPT to at least one allergen, with mainly DPT and cockroach allergens being involved; and a substantial portion showed persistent and moderate/severe AR. Therefore, allergy should not be neglected as an etiologic factor in rhinologic disease in the African continent.status: publishe

Sensitization rate and clinical profile of Congolese patients with rhinitis

In the African continent, the sensitization pattern and clinical profile are unknown in patients with rhinitis/rhinosinusitis attending the outpatient ear, nose, and throat (ENT) clinics. We therefore aimed to analyze the clinical characteristics of rhinitis/rhinosinusitis patients in Democratic Republic of Congo (DRC), classify allergic rhinitis (AR) according to the Allergic Rhinitis and Its Impact on Asthma criteria, and evaluate the sensitization profile and its associated factors. From January to May 2009, 423 patients with rhinitis symptoms attending the Outpatient ENT clinic of the University Hospital and Saint Joseph Hospital of Kinshasa were evaluated for allergy symptoms, severity, and duration of symptoms and underwent skin-prick tests (SPTs) for a panel of 15 allergens. Of 423 patients 35.2% had positive SPT results, with 40.9% showing polysensitization. Dermatophagoides pteronyssinus (DPT) (68.5%) and cockroach (36.2%) were the most common allergens among sensitized patients. Patients with rhinitis/rhinosinusitis mainly presented in decreasing order with sneezing, facial pain/pressure, nasal obstruction, postnasal discharge, nose itching, clear nasal discharge, and eye itching. Persistent and moderate/severe AR represented 61.4 and 69.3%, respectively. Sensitization was independently associated with younger age, rhinoconjunctivitis, and reaction to nonspecific trigger factors. In conclusion, 35.2% of patients attending the ENT Outpatient Clinic in DRC for rhinitis problems had a positive SPT to at least one allergen, with mainly DPT and cockroach allergens being involved; and a substantial portion showed persistent and moderate/severe AR. Therefore, allergy should not be neglected as an etiologic factor in rhinologic disease in the African continen

Sensitization Rate and Clinical Profile of Congolese Patients with Rhinitis

In the African continent, the sensitization pattern and clinical profile are unknown in patients with rhinitis/rhinosinusitis attending the outpatient ear, nose, and throat (ENT) clinics. We therefore aimed to analyze the clinical characteristics of rhinitis/rhinosinusitis patients in Democratic Republic of Congo (DRC), classify allergic rhinitis (AR) according to the Allergic Rhinitis and Its Impact on Asthma criteria, and evaluate the sensitization profile and its associated factors. From January to May 2009, 423 patients with rhinitis symptoms attending the Outpatient ENT clinic of the University Hospital and Saint Joseph Hospital of Kinshasa were evaluated for allergy symptoms, severity, and duration of symptoms and underwent skin-prick tests (SPTs) for a panel of 15 allergens. Of 423 patients 35.2% had positive SPT results, with 40.9% showing polysensitization. Dermatophagoides pteronyssinus (DPT) (68.5%) and cockroach (36.2%) were the most common allergens among sensitized patients. Patients with rhinitis/rhinosinusitis mainly presented in decreasing order with sneezing, facial pain/pressure, nasal obstruction, postnasal discharge, nose itching, clear nasal discharge, and eye itching. Persistent and moderate/severe AR represented 61.4 and 69.3%, respectively. Sensitization was independently associated with younger age, rhinoconjunctivitis, and reaction to nonspecific trigger factors. In conclusion, 35.2% of patients attending the ENT Outpatient Clinic in DRC for rhinitis problems had a positive SPT to at least one allergen, with mainly DPT and cockroach allergens being involved; and a substantial portion showed persistent and moderate/severe AR. Therefore, allergy should not be neglected as an etiologic factor in rhinologic disease in the African continent

A multicenter real-life study on the multiple reasons for uncontrolled allergic rhinitis

Background: : Recent data show uncontrolled disease in 35% of allergic rhinitis (AR) patients on medical treatment. The reasons for uncontrolled disease can arbitrarily be divided into disease-related, diagnosis-related, treatment-related, and patient-related factors. However, the relative importance of these factors in uncontrolled disease remains speculative. This explorative study aimed at determining the factors causing uncontrolled AR on four different continents worldwide, identifying the most common reasons for uncontrolled disease in AR. Methods: : Patients with uncontrolled AR (n = 430) were asked to fill out a questionnaire and underwent a clinical examination at the outpatient clinic in five university outpatient clinics (Leuven [Belgium], Beijing [China], Kinshasa [Congo], Bangalore [India], and Philadelphia [US]). Two independent physicians evaluated the reason or multiple reasons for uncontrolled disease. The study was coordinated from the University Hospital of Leuven. Results: : In uncontrolled AR patients, 76% of patients showed two or more reasons for uncontrolled disease according to the physicians’ evaluation. Disease-related factors (64%) were considered most often the reason for uncontrolled disease, followed by treatment- (56%), patient- (54%), and diagnosis-related (47%) factors. There is limited variability in observations across different centers worldwide. Conclusion: : We here define the multiple reasons for uncontrolled AR across different continents, with disease-related factors being most frequently associated with uncontrolled disease. A better understanding of uncontrolled disease will guide us in defining strategies to improve AR care