Facteurs etiologiques des pneumopathies communautaires bacteriennes chez les sujets ages au Centre Hospitalier Universitaire Tokoin (Togo)

Objectif: Décrire les facteurs étiologiques des pneumopathies communautaires bactériennes non tuberculeuses chez les sujets âgés de 60 ans et plus au CHU-Tokoin au Togo.Patients et méthode: Il s’agissait d’une étude rétrospective réalisée dans le service de Maladies Infectieuses et de Pneumologie du CHU-Tokoin (Lomé) du 1er janvier 2003 au 31 décembre 2008. Les patients étaient retenus sur la base des arguments cliniques, radiographiques, bactériologiques et évolutifs. Ainsi tout dossier de patient âgé de 60 ans et plus pris en charge dans le service pour une infection pulmonaire à l’exception de la tuberculose a été considéré comme sujet d’étude. Les résultats bactériologiques étaient issus des examens cytobactériologiques (ECB) de la ponction pleurale, de l’expectoration et de l’hémoculture. Le test VIH pour la recherche de l’infection avait été réalisé chez les patients qui avaient donné leur accord.Résultats: Quatre vingt neuf (89) cas soit 11,1 % de pneumopathies bactériennes du sujet âgé ont été enregistrés. Quarante huit (54 %) avaient une mauvaise hygiène buccodentaire. Le sexe ratio homme/femme a été de 1,23. Vingt six soit 29,21 % ont été tabagiques .Vingt deux patients (25 %) ont bénéficié d’une antibiothérapie trois mois avant leur hospitalisation. Seize (35 %) des 46 patients qui ont accepté le test VIH avaient une infection par le VIH associée. Six patients étaient sous chimio prophylaxie au cotrimoxazole dans le cadre de la prise en charge de l’infection par le VIH. Le tableau clinique a été dominé par la toux (85,39 %), dyspnée 59,55 %, la douleur thoracique 57,30 %, fièvre 51,68 %, douleurs thoraciques 57,30 % et parfois l’altération de l’état général 28,09 %. Streptococcus pneumoniae, Klebsiella pneumoniae étaient les plus rencontrés. Toutes les souches de pneumocoque et Klebsiella étaient sensibles au ceftriaxone, amoxicilline-acide clavulanique, ciprofloxacine et à l’amoxicilline dans 50 % des cas pour le pneumocoque, Cinq souches de pneumocoque et trois de klebsiella étaient résistantes au cotrimoxazole. En première intention la bi antibiothérapie (Amoxicilline plus gentamicine) a été choisie dans 72 % des cas.Mots clés: Pneumopathies, sujet âgé, facteurs étiologiques, TogoEnglish AbstractObjective: Describe etiologic factors of bacterial community pneumonia among person old than 60 years and more in Infectious Diseases and Pneumology Service (CHU-Tokoin) of Togo.Material and methods: We retrospectively reviewed the records of hospitalized for community-acquired pneumonia among elderly persons in the service of Infectious Diseases and Pneumology (CHU-Tokoin, Togo). The patients were retained on the basis of clinical, radiographic, bacteriological and prognostic argument. Between January 1st 2002 and December 31st 2005 inpatient dossiers were identified. So all file of patient aged of 60 years and older admitted in the service for a pulmonary infection has been considered like topic of survey. The tuberculosis cases were excluded. The bacteriological results were descended of the exams cytobacteriological (ECB) of the pleural puncture, the expectoration and the haemoculture The HIV test had been achieved among the patients who had given their agreement.Results: Eighty nine (89) cases (11.1%) of elderly person with bacterial pneumopathies have been recorded in the service. Forty eight (54%) had bad mouth hygiene. The sex ratio (man / woman) was of 1.23. Twenty six, either 29.21% have smoked. Twenty two patients (25%) had used antibiotherapy three months before their hospitalization. Sixteen (35%) of 46 patients who accepted HIV test had an HIV infection. Six patients were under cotrimoxazole’s prophylaxis. The clinical picture has been dominated by the cough (85.39%), dyspnea 59.55%, the thoracic pain 57.30%, fever 51.68%, thoracic pains 57.30% and the general status alteration 28.09%. Streptococcus pneumoniae, Klebsiellas pneumoniae were the more accounted for pneumopathies. All pneumococcus and Klebsiella were sensitive to the ceftriaxone, amoxicillin-clavulanate, ciprofloxacine. Fifty percent (50%) of pneumococcus’s cases were also sensitive to amoxicillin.Five stumps of pneumococcus and three of klebsiella were resistant to the cotrimoxazole. In first intention the bi antibiothérapie (Amoxicilline plus gentamicine) has been chosen in 72% of the cases.Keywords: Pneumopathy, elderly persons, Tog

Modern contraceptive use among HIV-infected women attending HIV care centres in Togo: a cross-sectional study

International audienceIntroduction Contraceptive use among HIV-infected women in Togo is poorly documented. We aim at assessing the prevalence of modern contraceptive use and associated factors among HIV-infected women in Togo. Design Cross-sectional study. Setting The study was conducted in five HIV care centres in the Centrale and Kara regions in Togo. Participants We included 461 HIV-positive women aged between 15 and 49 years and who were sexually active. Main outcome measure The outcome variable was HIV-infected women who were using modern contraceptive methods. Results A total of 461 HIV-infected women were interviewed, with an average age of 34.3 (+/- 7.1). Among them, 332 (73.1%) women reported using contraceptive methods, mostly condom alone (74.7%) or in combination with hormonal contraceptive (16.9%). In multivariate analysis, education level (primary: adjusted OR (aOR)=1.99, 95% CI (1.05 to 3.76); secondary level and higher: aOR=3.95, 95% CI (2.03 to 7.67)), WHO clinical stage (stage II: aOR=0.7, 95% CI (0.37 to 1.33)), follow-up in private care facilities (aOR=2.54, 95% CI (1.22 to 5.29)) and having a child (aOR=2.51, 95% CI (1.41 to 4.5)) were associated with higher contraceptive use, while marital status (living in union: aOR=0.45, 95% CI (0.28 to 0.74)) and WHO stages III and IV (aOR=0.47, 95% CI (0.24 to 0.94)) were associated with lower contraceptive use. Conclusion About three-quarters of sexually active HIV-infected women in Togo were using contraceptive methods, and private health facilities favoured this contraceptive use. It is important to strengthen the implementation of interventions to increase the incentives for HIV-infected women to use contraception in Togo

Emergence of Lassa Fever Disease in Northern Togo: Report of Two Cases in Oti District in 2016

International audienceBackground: Lassa fever belongs to the group of potentially fatal hemorrhagic fevers, never reported in Togo. The aim of this paper is to report the first two cases of Lassa fever infection in Togo.Case presentation: The two first Lassa fever cases occurred in two expatriate's health professionals working in Togo for more than two years. The symptoms appeared among two health professionals of a clinic located in Oti district in the north of the country. The absence of clinical improvement after antimalarial treatment and the worsening of clinical symptoms led to the medical evacuation. The delayed diagnosis of the first case led to a fatal outcome. The second case recovered under ribavirin treatment.Conclusion: The emergence of this hemorrhagic fever confirms the existence of Lassa fever virus in Togo. After a period of intensive Ebola virus transmission from 2013 to 2015, this is an additional call for the establishment and enhancement of infection prevention and control measures in the health care setting in West Africa

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA).We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region.Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3).This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population