Detection, identification and characterization of extended-spectrum beta-lactamases producing Enterobacteriaceae in wastewater and salads marketed in Ouagadougou, Burkina Faso

Extended spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) represent a threat for failure of empirical antibiotic therapy and are associated with high mortality, morbidity and expenses. The aims of this study was to determine the prevalence of ESBL-PE and multidrug resistant enterobacteria (MDR), enterobacteria profil, investigate the associated resistance in wastewater and salads. After wastewater and salad sampling, enterobacteria was isoled on (EMB + 4μg / L cefotaxim). The stains of Enterobacteriaceae were identified by using biochemical methods and confirmed as ESBL by double-disc synergy test (amoxicillin/clavulanic acid with cefotaxime 30 μg, ceftazidime 30 μg and ceftriaxone 30 μg). Finally, the associated resistance was investigated by testing the susceptibility of the strains by the disc diffusion method. Global prevalence of ESBL-PE was 53.92% (95% CI: 48,2-59,5) (153/293), 61.11% from wastewater and 42.47% from salads. Major ESBL-E was Escherichia coli (73.44%), followed by Klebsiella pneumoniae (21.88%). Resistance to the aminoglycoside , fluroquinolonones and sulfonamides classes were dominant, observed in 53,83%, 93,86% and 98,95% of the isolates, respectively. The frequence of MDR was hight to channel1 (32,40%) and channel2 (26,26%). This study reports very worrying results. There is an urgent need to develop measures to monitor the spread of these multidrug-resistant strains.Keywords: Wastewater, ESBL-PE, Salads, Ouagadougou

Vegetation improvement and soil biological quality in the Sahel of Burkina Faso

Soil living environment contains macro-fauna that play important role in the soil structure and chemical composition, the degradation process of organic matter and in the resilience of ecosystems. Few studies evaluated the impact of the “re-greening” trend observed in the Sahel on soil biological quality. The objective of this study is to assess the impact of the “re-greening” of the Sahel on soil macro-fauna population and diversity. The method of Tropical Soil Biology and Fertility (TSBF) was used to assess macro-fauna abundance and diversity in different land use types (cropland, shallow land, degraded land and forest). Four sites were selected, in the Sahelian zone of Burkina Faso, with contrasted Normalized Difference Vegetation Index (NDVI). In each site, four repetitions were taken for each land use type. In total, 64 plots samples were used to assess the abundance of macro-fauna. Results showed that there were more individuals (64.92%) and higher macro-fauna density in re-greening zones compared to the degrading zones. There was dominance of Arthropoda phylum (60.85%), Insecta class (59.03%) and Isoptera order (46.97%) in macro-fauna population. There were more species in the shallow land and cropland in re-greening zones and all trophic groups are represented in all sites. Despite this abundance, composition and diversity, it was observed that the re-greening processes have not significantly improved soil biological quality. It is concluded that vegetation improvement might be at the beginning stage in the Sahel, especially in croplands, and clear change of soil biological quality is not perceptible but may be tangible in the future.Keywords: Macro-fauna, ecosystem, soil quality, re-greening, degradation

Clinical case: giant solitary neurofibroma of the thigh

The solitary neurofibroma, a benign ectodermal tumor reaching the nerve sheaths, is very rare both in its frequency and its location. Its diagnosis is histo-immunological and its treatment, surgical, consists of a complete resection of the mass due to a degenerative risk tumor. The authors report the case of a 36-year-old patient, admitted for a large tumor of the anterior aspect of the right thigh. Ultrasound and CT revealed the presence of a soft tissue tumor measuring 28 x 15 cm. The resection was performed without damage to the adjacent noble elements. The tumor weighed 7 kg. The histology found a neurofibroma. Benign tumors of the nerve sheath are rare. The neurofibroma is a benign tumor, which can occur in two forms: solitary in young adults or multiple in the context of a Recklinghausen disease. The majority of cases of giant neurofibromatous tumors reported, were almost always isolated localization. TDM or echo-guided biopsy is the only way to confirm preoperative histological diagnosis. The treatment is surgical. However, the tumor infiltrates the fasciculi of the nerve along its course, which could make its resection difficult and dangerous. Thigh localization of the neurofibroma is rare. Complete excision with negative margins is the treatment of choice. In the case reported, one year after surgery, the patient was in good general condition with normal locomotor function

Nesidiocoris tenuis in Burkina Faso: Distribution, predatory capacity and insecticide sensibility

Tuta absoluta (Lepidoptera: Gelechiidae) is a worldwide invasive insect species, considered a major pest of tomato. It has recently established in Burkina Faso, where chemical control remains the only affordable option to limit damage. Nesidiocoris tenuis (Hemiptera: Miridae) is commercialised as a biological agent to control this pest in other parts of the world. But no literature is available on this predator in Burkina Faso. Therefore, in this study, we (1) scoured the country to determine its distribution and abundance in tomato fields, (2) verified its ability to consume T. absoluta eggs in two scenarios: the first one where N. tenuis has to search for the eggs on the plants and the second one in Petri dishes where the eggs are placed and N. tenuis could consume the eggs at will (3) measure the susceptibility of both insects to insecticides (two synthetic insecticides, three bio-bacterial insecticides and eight plant extracts) using the IRAC 022 method. It appears that, N. tenuis was found in 13 regions of the country with very interesting densities in some tomato fields (up to 80 individuals / m2). All stages of N. tenuis consume T. absoluta eggs and the number of eggs consumed depends on the stage of development and mode of egg delivery. When he has to look for some on the leaves, the adults find about 20 eggs to consume per day, while for an availability and consumption at will of eggs, he consumes about 45 eggs per day. Abamectin, emamectin benzoate, spinosad, spinetoram were very toxic for both T. absoluta and N. tenuis. In contrast, biopesticides including Bacillus thuringiensis, neem oil, Cleome viscosa, Ocimum basilicum and Cassia occidentalis were found to be compatible with N. tenuis while controlling T. absoluta. Based on our results, we recommend that through training for growers, they can be shown the importance of N. tenuis in the management of T. absoluta. We therefore recommend the use of biopesticides in combination with N. tenuis in the control of T. absoluta in Burkina Faso.Production Durable Intégrant la Recherche (ProDuIRe

Diagnostic accuracy of cervical cancer screening and screening–triage strategies among women living with HIV-1 in Burkina Faso and South Africa: A cohort study

Background: Cervical cancer screening strategies using visual inspection or cytology may have suboptimal diagnostic accuracy for detection of precancer in women living with HIV (WLHIV). The optimal screen and screen-triage strategy, age to initiate, and frequency of screening for WLHIV remain unclear. This study evaluated the sensitivity, specificity, and positive predictive value of different cervical cancer strategies in WLHIV in Africa. Methods and findings: WLHIV aged 25-50 years attending HIV treatment centres in Burkina Faso (BF) and South Africa (SA) from 5 December 2011 to 30 October 2012 were enrolled in a prospective evaluation study of visual inspection using acetic acid (VIA) or visual inspection using Lugol's iodine (VILI), high-risk human papillomavirus DNA test (Hybrid Capture 2 [HC2] or careHPV), and cytology for histology-verified high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) at baseline and endline, a median 16 months later. Among 1,238 women (BF: 615; SA: 623), median age was 36 and 34 years (p < 0.001), 28.6% and 49.6% ever had prior cervical cancer screening (p < 0.001), and 69.9% and 64.2% were taking ART at enrolment (p = 0.045) in BF and SA, respectively. CIN2+ prevalence was 5.8% and 22.4% in BF and SA (p < 0.001), respectively. VIA had low sensitivity for CIN2+ (44.7%, 95% confidence interval [CI] 36.9%-52.7%) and CIN3+ (56.1%, 95% CI 43.3%-68.3%) in both countries, with specificity for ≤CIN1 of 78.7% (95% CI 76.0%-81.3%). HC2 had sensitivity of 88.8% (95% CI 82.9%-93.2%) for CIN2+ and 86.4% (95% CI 75.7%-93.6%) for CIN3+. Specificity for ≤CIN1 was 55.4% (95% CI 52.2%-58.6%), and screen positivity was 51.3%. Specificity was higher with a restricted genotype (HPV16/18/31/33/35/45/52/58) approach (73.5%, 95% CI 70.6%-76.2%), with lower screen positivity (33.7%), although there was lower sensitivity for CIN3+ (77.3%, 95% CI 65.3%-86.7%). In BF, HC2 was more sensitive for CIN2+/CIN3+ compared to VIA/VILI (relative sensitivity for CIN2+ = 1.72, 95% CI 1.28-2.32; CIN3+: 1.18, 95% CI 0.94-1.49). Triage of HC2-positive women with VIA/VILI reduced the number of colposcopy referrals, but with loss in sensitivity for CIN2+ (58.1%) but not for CIN3+ (84.6%). In SA, cytology high-grade squamous intraepithelial lesion or greater (HSIL+) had best combination of sensitivity (CIN2+: 70.1%, 95% CI 61.3%-77.9%; CIN3+: 80.8%, 95% CI 67.5%-90.4%) and specificity (81.6%, 95% CI 77.6%-85.1%). HC2 had similar sensitivity for CIN3+ (83.0%, 95% CI 70.2%-91.9%) but lower specificity compared to HSIL+ (42.7%, 95% CI 38.4%-47.1%; relative specificity = 0.57, 95% CI 0.52-0.63), resulting in almost twice as many referrals. Compared to HC2, triage of HC2-positive women with HSIL+ resulted in a 40% reduction in colposcopy referrals but was associated with some loss in sensitivity. CIN2+ incidence over a median 16 months was highest among VIA baseline screen-negative women (2.2%, 95% CI 1.3%-3.7%) and women who were baseline double-negative with HC2 and VIA (2.1%, 95% CI 1.3%-3.5%) and lowest among HC2 baseline screen-negative women (0.5%, 95% CI 0.1%-1.8%). Limitations of our study are that WLHIV included in the study may not reflect a contemporary cohort of WLHIV initiating ART in the universal ART era and that we did not evaluate HPV tests available in study settings today. Conclusions: In this cohort study among WLHIV in Africa, a human papillomavirus (HPV) test targeting 14 high-risk (HR) types had higher sensitivity to detect CIN2+ compared to visual inspection but had low specificity, although a restricted genotype approach targeting 8 HR types decreased the number of unnecessary colposcopy referrals. Cytology HSIL+ had optimal performance for CIN2+/CIN3+ detection in SA. Triage of HPV-positive women with HSIL+ maintained high specificity but with some loss in sensitivity compared to HC2 alone

Costs and cost-effectiveness of cervical cancer screening strategies in women living with HIV in Burkina Faso: The HPV in Africa Research Partnership (HARP) study.

INTRODUCTION: This study estimated the costs and incremental cost per case detected of screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) attending HIV clinics in Burkina Faso. METHODS: The direct healthcare provider costs of screening tests (visual inspection with acetic acid (VIA), VIA combined visual inspection with Lugol's iodine (VIA/VILI), cytology and a rapid HPV DNA test (careHPV)) and confirmatory tests (colposcopy, directed biopsy and systematic four-quadrant (4Q) biopsy) were collected alongside the HPV in Africa Research Partnership (HARP) study. A model was developed for a hypothetical cohort of 1000 WLHIV using data on CIN2+ prevalence and the sensitivity of the screening tests. Costs are reported in USD (2019). RESULTS: The study enrolled 554 WLHIV with median age 36 years (inter-quartile range, 31-41) and CIN2+ prevalence of 5.8%. The average cost per screening test ranged from US$3.2 for VIA to US$24.8 for cytology. Compared to VIA alone, the incremental cost per CIN2+ case detected was US$48 for VIA/VILI and US$814 for careHPV. Despite higher costs, careHPV was more sensitive for CIN2+ cases detected compared to VIA/VILI (97% and 56%, respectively). The cost of colposcopy was US$6.6 per person while directed biopsy was US$33.0 and 4Q biopsy was US$48.0. CONCLUSION: Depending on the willingness to pay for the detection of a case of cervical cancer, decision makers in Burkina Faso can consider a variety of cervical cancer screening strategies for WLHIV. While careHPV is more costly, it has the potential to be cost-effective depending on the willingness to pay threshold. Future research should explore the lifetime costs and benefits of cervical cancer screening to enable comparisons with interventions for other diseases

Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment - 10 Countries, 2004-2015.

Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/μL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.*,†,§ To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended "treat-all" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence