Antimicrobial resistance in outpatient Escherichia coli urinary isolates in Dakar, Senegal.

International audienceBACKGROUND: Data regarding the evolution of antimicrobial resistance are needed to suggest appropriate empirical treatment of urinary tract infections (UTI) in developing countries. To assess the antimicrobial susceptibility of Escherichia coli, the predominant pathogen in community-acquired UTI, a prospective multicenter study was carried out in Dakar, Senegal. METHODOLOGY: From February 2004 to October 2006, 1010 non-duplicate E. coli strains were collected from four centres. Antimicrobial susceptibility testing was performed using disk diffusion method according to the recommendations of the CA-SFM (2004). RESULTS: Most of the isolates were resistant to amoxicillin (73.1%), amoxicillin-clavulanic acid (67.5%), cephalothin (55.8%), and trimethoprim/sulfamethoxazole (68.1%). Extended spectrum beta-lactamase was detected in 38 strains. The overall resistance rates to nalidixic acid, norfloxacin and ciprofloxacin were 23.9%, 16.4% and 15.5%, respectively. Most of the strains were susceptible to gentamicin, nitrofurantoin and fosfomycin (respective susceptibility rates, 93.8%, 89.9%, and 99.3%). During this period, a significant decrease in sensitivity was observed for cephalothin, fluoroquinolones and trimethoprim/sulfamethoxazole (p<0.001). CONCLUSIONS: These data suggest that trimethoprim/sulfamethoxazole may no longer be used as empirical treatment for community-acquired UTI in Dakar. In order to preserve the activity of fluoroquinolones for future years, alternatives such as fosfomycin or nitrofurantoin should be considered

Evaluation of the pulse wave velocity in African rheumatoid arthritis subjects

Background: Rheumatoid arthritis is a systemic disease with often fatal vascular events. In addition to traditional cardiovascular risk factors, disease-specific elements contribute to this cardiovascular mortality. The aim of this study was to assess arterial stiffness in rheumatoid arthritis and to determine the factors involved.Methods: We have recruited the black African patients followed in rheumatology and had rheumatoid arthritis diagnosis. Only patients between 18 and 60 years and meeting the American College of Rheumatology criteria were included. All controls were healthy. We evaluated the propagation velocity of the pulse wave finger-toe (PWVft) measured by the pOpmètre®.Results: Present study shows that the PWVft was significantly elevated in over half of patients (55.10%). Besides, the mean patients PWVft was significantly higher than that of the control (respectively 9.40±0.51 and 7.22±0.33 p=0.001). In the patients, no factor was significantly involved in the arterial stiffness, but cons in the control group, the PWVft was significantly correlated with age (p=0.023 and r=0.55).Conclusions: Rheumatoid arthritis patients had higher PWVft compared to controls. Due to the importance of its cardiovascular morbidity and mortality, arthritis requires a regular monitoring element as arterial stiffness, which is currently a major vascular parameter monitoring

Détermination du débit de filtration glomérulaire au cours de la drépanocytose au Sénégal: Schwartz, Cockcroft et Gault, MDRD, CKD-EPI ou JSCCS ?

La détermination du Débit de Filtration Glomérulaire (DFG) est importante chez les drépanocytaires du fait qu’ils constituent un groupe de patients chez lesquels des atteintes rénales sont fréquemment décrites notamment l’hyperfiltration glomérulaire. Dès lors, à une époque où les calculateurs en ligne proposent simultanément différentes formules de détermination du DFG, il serait important d’évaluer au sein d’une population noire africaine drépanocytaire l’équivalence entre ces formules qui ont été développées et validées sur des populations caucasiennes et afro-américaines à DFG normal ou diminué. Ainsi cette étude avait pour but d’évaluer l’interchangeabilité des différentes formules de détermination du DFG en les appliquant à des drépanocytaires. Des enfants et adultes sénégalais drépanocytaires homozygotes ont été alors recrutés et leur DFG calculé. La fréquence de l’hyperfiltration glomérulaire et celle de l’insuffisance rénale ont été calculées à partir des résultats obtenus avec les formules de Schwartz et du CKD-EPI. La concordance des différentes formules a été évaluée avec la méthode Bland-Altman. Au total 56 adultes et 62 enfants ont été inclus dans l’étude. L’insuffisance rénale a été notée chez 1,78% des adultes et 9,68% des enfants ; l’hyperfiltration glomérulaire chez 66,10% des adultes et 25,8% des enfants. Par rapport aux formules de référence (CKD-EPI, Schwartz), tous les biais relevés étaient significativement différents de zéro à l’exception de celui de Cockcroftet Gault qui était statistiquement nul. Les limites de concordance étaient toutes inacceptablement larges par rapport aux limites attendues à l’exception de celles du CKD-EPI sans ajustement sur la race. Ainsi, la formule de Schwartz n’était pas interchangeable avec celle du JSCCS chez les enfants, tout comme celle du CKD-EPI ne l’était pas non plus avec celles du JSCCS, de Cockcroft, du MDRD ou du CKD-EPI sans ajustement sur la race chez les adultes drépanocytaires. &nbsp; English title: Determination of glomerular filtration rate in sickle cell disease in Senegal: Schwartz, Cockcroft and Gault, MDRD, CKD-EPI or JSCCS? Determination of Glomerular Filtration Rate (GFR) is important in patients living with sickle cell disease (SCD) because they constitute a group of patients where kidney dysfunction is frequently described, in particular glomerular hyperfiltration. Therefore, at a time when online calculators simultaneously propose different formulas to estimate GFR, it would be important to evaluate in a black African population living with SCD the equivalence between these formulas which have been developed and validated on Caucasian and African American populations with normal or decreased GFR. Thus, the aim of this study was to evaluate interchangeability of different GFR formulas in a group of patients living with SCD. Homozygous Senegalese sickle cell children and adults were then recruited and their GFR computed using Schwartz and JSCCS in children, Cockcroft and Gault, CKD-EPI with and without adjustment for ethnicity, MDRD and JSCCS formulas in adults. The frequency of glomerular hyperfiltration and renal failure was computed based on the results generated using Schwartz and CKD-EPI formulas. The agreement between formulas was assessed with BlandAltman method. A total of 56 adults and 62 children were included in this study. Renal failure was observed in 1.78% of adults and 9.68% of children; glomerular hyperfiltration in 66.10% of adults and 25.8% of children. Compared with reference formulas (CKD-EPI, Schwartz), all biases found were significantly different from zero except for Cockcroft and Gault formula bias, which was statistically zero. The limits of agreement were all unacceptably wide compared with the expected limits with the exception of CKD-EPI without adjustment for ethnicity. Thus, Schwartz formula would not be interchangeable with JSCCS formula in children, nor was the CKD-EPI formula interchangeable with the JSCCS, Cockcroft and Gault, MDRD or CKD-EPI without adjustment for ethnicity formulas in adults living with sickle cell anemia

Religion and Protective Behaviours towards AIDS in Rural Senegal

Objectives - To describe the association between religion and factors related to sexually transmitted diseases (STD)/AIDS in a country where religious leaders were involved early in prevention. Design - A cross-sectional study conducted in a rural area in central Senegal. Methods - Questionnaire-based interviews of a random sample of 858 adults from the general population aged 15–59 years and in-depth interviews of four religious leaders and 50 people. Results - Seventy-six per cent of the respondents were Muslim, 24% Catholic, 1% Animist and 0.2% Protestant. A total of 86% of men and 87% of women reported religion to be very important to them. Important prevention-related variables were inversely associated with the importance of religion. Men who considered religion to be very important were less likely to cite AIDS as a major health problem [odds ratio (OR) 0.4, P = 0.008] and were less likely to feel at risk of getting HIV (OR 0.5, P = 0.0005). Women who considered religion to be very important were less likely to report an intention to change to protect themselves from AIDS (OR 0.2, P = 0.0001), less likely to report having discussed AIDS with others (OR 0.4, P = 0.01) and much more likely to feel at risk of getting HIV (OR 9.3, P = 10−4). Individuals who considered religion to be very important were not more likely to report intending to or actually having become faithful to protect themselves from AIDS. Conclusion - These findings stress the need to intensify the involvement of religious authorities in HIV/STD prevention at the local level

Religion and protective behaviours towards AIDS in rural Senegal

Objectives - To describe the association between religion and factors related to sexually transmitted diseases (STD)/AIDS in a country where religious leaders were involved early in prevention. Design - A cross-sectional study conducted in a rural area in central Senegal. Methods - Questionnaire-based interviews of a random sample of 858 adults from the general population aged 15–59 years and in-depth interviews of four religious leaders and 50 people. Results - Seventy-six per cent of the respondents were Muslim, 24% Catholic, 1% Animist and 0.2% Protestant. A total of 86% of men and 87% of women reported religion to be very important to them. Important prevention-related variables were inversely associated with the importance of religion. Men who considered religion to be very important were less likely to cite AIDS as a major health problem [odds ratio (OR) 0.4, P = 0.008] and were less likely to feel at risk of getting HIV (OR 0.5, P = 0.0005). Women who considered religion to be very important were less likely to report an intention to change to protect themselves from AIDS (OR 0.2, P = 0.0001), less likely to report having discussed AIDS with others (OR 0.4, P = 0.01) and much more likely to feel at risk of getting HIV (OR 9.3, P = 10−4). Individuals who considered religion to be very important were not more likely to report intending to or actually having become faithful to protect themselves from AIDS. Conclusion - These findings stress the need to intensify the involvement of religious authorities in HIV/STD prevention at the local level

Treponemal Infection Rates, Risk Factors and Pregnancy Outcome in a Rural Area of Senegal

A rural population of east Senegal has been under demographic surveillance for more than 30 years and a high rate of infertility has been reported. The aim of the study is to describe HIV and treponemal infection epidemiology and association with outcome of pregnancy in a population of rural Senegal. A population-based cross-sectional study was conducted among 952 randomly-selected adults of a rural community of Senegal. No participant was found to be infected with HIV, 11% had evidence of past syphilis and 5% of active syphilis. Active syphilis was associated among men with age, long-term mobility and having partners in an urban area in the last 12 months and among women with being divorced or widowed. No association was found between past or active syphilis and abortion or stillbirth but women aged 40 and more with past or active syphilis were significantly more likely to have had no history of gestation than women with no evidence of syphilis infection. In conclusion our results call for more research to understand the epidemiology of treponemal infection and to elucidate types of Treponema pallidum involved

Homozygous Sickle Cell Disease after Age of 40: Follow-Up of a Cohort of 209 Patients in Senegal, West Africa

Objectives. The aim of this study was to describe the morbidity and mortality of homozygous sickle cell disease after the age of 40. Methods. This was a cohort study of 209 patients followed from 1994 to 2022. All hemoglobin electrophoresis-confirmed SS sickle cell patients over 40 years were included. A descriptive study of epidemiological, diagnostic, therapeutic, and evolutionary data was used to assess morbidity and mortality. Results. Sex ratio (M/F) was 0.6. Median age was 47 (41–75). According to morbidity, 95.1% had less than 3 vaso-occlusive crises/year. Acute anemia was the most frequent complication (52.63%). Chronic complications were noted in 32.5%. At diagnosis, mean hemoglobin was 8.1 g/dl ± 1.9, HbS was 86.5 ± 10, and HbF was 9.4 ± 7.6. Number of patients transfused was 66%. We noted that 8.1% of patients died, 29.2% were lost to follow-up, and 62.7% were still being followed up. The risk factors identified for death were geographical origin, comorbidity, high HbS, low HbF, and thrombocytosis. Conclusion. This study shows that homozygous SCD is increasingly becoming an adult disease and that it can be carried into old age in Africa. Advanced age over 40 is marked by an upsurge in chronic complications, making it essential to set up a screening program and to organize multidisciplinary follow-up

Evaluation of the pulse wave velocity in African rheumatoid arthritis subjects

Background: Rheumatoid arthritis is a systemic disease with often fatal vascular events. In addition to traditional cardiovascular risk factors, disease-specific elements contribute to this cardiovascular mortality. The aim of this study was to assess arterial stiffness in rheumatoid arthritis and to determine the factors involved.Methods: We have recruited the black African patients followed in rheumatology and had rheumatoid arthritis diagnosis. Only patients between 18 and 60 years and meeting the American College of Rheumatology criteria were included. All controls were healthy. We evaluated the propagation velocity of the pulse wave finger-toe (PWVft) measured by the pOpmètre®.Results: Present study shows that the PWVft was significantly elevated in over half of patients (55.10%). Besides, the mean patients PWVft was significantly higher than that of the control (respectively 9.40±0.51 and 7.22±0.33 p=0.001). In the patients, no factor was significantly involved in the arterial stiffness, but cons in the control group, the PWVft was significantly correlated with age (p=0.023 and r=0.55).Conclusions: Rheumatoid arthritis patients had higher PWVft compared to controls. Due to the importance of its cardiovascular morbidity and mortality, arthritis requires a regular monitoring element as arterial stiffness, which is currently a major vascular parameter monitoring

Amaryllidaceae Alkaloid Cherylline Inhibits the Replication of Dengue and Zika Viruses

Dengue fever, caused by dengue virus (DENV), is the most prevalent arthropod-borne viral disease and is endemic in many tropical and subtropical parts of the world, with an increasing incidence in temperate regions. The closely related flavivirus Zika virus (ZIKV) can be transmitted vertically in utero and causes congenital Zika syndrome and other birth defects. In adults, ZIKV is associated with Guillain-Barré syndrome. There are no approved antiviral therapies against either virus. Effective antiviral compounds are urgently needed. Amaryllidaceae alkaloids (AAs) are a specific class of nitrogen-containing compounds produced by plants of the Amaryllidaceae family with numerous biological activities. Recently, the AA lycorine was shown to present strong antiflaviviral properties. Previously, we demonstrated that Crinum jagus contained lycorine and several alkaloids of the cherylline, crinine, and galanthamine types with unknown antiviral potential. In this study, we explored their biological activities. We show that C. jagus crude alkaloid extract inhibited DENV infection. Among the purified AAs, cherylline efficiently inhibited both DENV (50% effective concentration [EC50], 8.8 μM) and ZIKV replication (EC50, 20.3 μM) but had no effect on HIV-1 infection. Time-of-drug-addition and -removal experiments identified a postentry step as the one targeted by cherylline. Consistently, using subgenomic replicons and replication-defective genomes, we demonstrate that cherylline specifically hinders the viral RNA synthesis step but not viral translation. In conclusion, AAs are an underestimated source of antiflavivirus compounds, including the effective inhibitor cherylline, which could be optimized for new therapeutic approaches