The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Facial Hyperpigmentation during Imatinib Therapy for Gastrointestinal Stromal Tumor

We report a rare case of facial hyperpigmentation during imatinib therapy for a gastrointestinal stromal tumor

Les colites médicamenteuses : revue de la littérature

La fréquence des colites médicamenteuses est souvent sous estimée. Les médicaments les plus souvent incriminés sont les antibiotiques et les anti-inflammatoires non stéroïdiens (AINS). Dans ce travail, nous avons classé les colites en fonction des principaux médicaments responsables tout en traitant la symptomatologie clinique, la physiopathologie, les complications et l’évolution. Nous y décrivons les colites aux antibiotiques, aux AINS, aux laxatifs, aux agents vasoconstricteurs, aux oestroprogestatifs, à la chimiothérapie et les colites microscopiques médicamenteuses. Ces dernières constituent une entité à part, dont l’origine peut être idiopathique, infectieuse ou médicamenteuse, sa physiopathologie est mal connue et le diagnostic positif ne peut être qu’histologique. En dehors des colites pseudomembraneuses où l’imputabilité médicamenteuse est relativement simple, dans les autres cas la chronologie, le tableau clinique, endoscopique et histologique sont très variables et rarement spécifiques. Ainsi, devant le nombre élevé de médicaments pouvant induire une colite, il ne faut pas oublier de penser à l’origine médicamenteuse et ce essentiellement en l’absence d’une cause évidente pouvant expliquer l’apparition d’une colite

Serious Adverse Drug Reactions in Older Adults Notified to Pharmacovigilance

Purpose. To report the serious adverse drug reactions (ADRs) in older adults notified to pharmacovigilance, to identify the incriminated drugs and to search for risk factors of occurrence. Methods. A retrospective study including 106 serious adverse drug reactions notified to pharmacovigilance in patients aged of 65 years and more, over a period of 16 years. Imputation was established according to the French method and seriousness according to the World Health Organisation (WHO) criteria. Results. Adverse drug reactions were essentially systemic. Incriminated drugs were mainly antibiotics, allopurinol and cardio-vascular drugs. Gender, age and number of administered drugs did not seem to be risk factors of serious ADRs occurrence. Among older adults, 4% died further to a serious ADRs. Conclusion. Systemic notification to pharmacovigilance will allow a better analysis of risk factors of serious ADRs occurrence and to insure safety and health to the older adults

Bullous Eruption Associated With Dihydropyridines With Cross Reactivity

The spectrum of cutaneous eruptions associated with dihydropyridines is extensive, varying from exanthemas to severe adverse events. We report a case of bullous eruption, one month after starting nicardipine and lercanidipine. The same symptoms recurred few days after taking nitrendipine

Érythème pigmenté fixe aux antihistaminiques H1 : à propos de 2 cas et revue de la littérature

Nous décrivons deux cas d’érythèmes pigmentés fixes, l’un dû à la phéniramine et l’autre à la loratadine