Syndrome De Guillain-Barré Chez L’enfant Dans Un Contexte A Ressources Limitées : A Propos De Deux Observations Au CHU Sylvanus Olympio De Lomé - TOGO

Guillain-Barré syndrome is rare in children. With polyvalent immunoglobulins the management and prognosis has been significantly improved with complete recovery rate exceeding 80%. We report the cases of two children who completely recovered after Guillain-Barré syndrome in the absence of immune globulin. He was a 12 year old daughter and an infant of 17 months male who presented a progressive ascending motor deficit, dysphonia with difficulty swallowing, difficulty breathing, areflexia. A albumino-cytological dissociation was found in the study of cerebrospinal fluid in both cases. Electromyography in the girl had confirmed a axono-form myelin. Retroviral serology was negative in both cases. Other serology (Campylobacter jejuni, Cytomegalovirus, Epstein Barr, ZIKA), the dosage of anti-ganglioside antibodies and brain imaging had not been made. The immunoglobulins are not available in our work context, we conducted a symptomatic management. Complete healing was achieved with a 4-month decline

Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study

BACKGROUND: Nutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa. METHODS: In 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d'Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention. RESULTS: Overall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d'Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767). CONCLUSIONS: This intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV. TRIAL REGISTRATION: PACTR202001816232398 , June 01, 2020, retrospectively registered

PLoS Med

INTRODUCTION: Access to antiretroviral therapy (ART) is a global priority. However, the attrition across the continuum of care for HIV-infected children between their HIV diagnosis and ART initiation is not well known. We analyzed the time from enrollment into HIV care to ART initiation in HIV-infected children within the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium. METHODS AND FINDINGS: We included 135,479 HIV-1-infected children, aged 0-19 years and ART-naive at enrollment, between 1 January 2004 and 31 December 2015, in IeDEA cohorts from Central Africa (3 countries; n = 4,948), East Africa (3 countries; n = 22,827), West Africa (7 countries; n = 7,372), Southern Africa (6 countries; n = 93,799), Asia-Pacific (6 countries; n = 4,045), and Latin America (7 countries; n = 2,488). Follow-up in these cohorts is typically every 3-6 months. We described time to ART initiation and missed opportunities (death or loss to follow-up [LTFU]: last clinical visit >6 months) since baseline (the date of HIV diagnosis or, if unavailable, date of enrollment). Cumulative incidence functions (CIFs) for and determinants of ART initiation were computed, with death and LTFU as competing risks. Among the 135,479 children included, 99,404 (73.4%) initiated ART, 1.9% died, 1.4% were transferred out, and 20.4% were lost to follow-up before ART initiation. The 24-month CIF for ART initiation was 68.2% (95% CI: 67.9%-68.4%); it was lower in sub-Saharan Africa-ranging from 49.8% (95% CI: 48.4%-51.2%) in Central Africa to 72.5% (95% CI: 71.5%-73.5%) in West Africa-compared to Latin America (71.0%, 95% CI: 69.1%-72.7%) and the Asia-Pacific (78.3%, 95% CI: 76.9%-79.6%). Adolescents aged 15-19 years and infants <1 year had the lowest cumulative incidence of ART initiation compared to other ages: 62.2% (95% CI: 61.6%-62.8%) and 66.4% (95% CI: 65.7%-67.0%), respectively. Overall, 49.1% were ART-eligible per local guidelines at baseline, of whom 80.6% initiated ART. The following children had lower cumulative incidence of ART initiation: female children (p < 0.01); those aged <1 year, 2-4 years, 5-9 years, and 15-19 years (versus those aged 10-14 years, p < 0.01); those who became eligible during follow-up (versus eligible at enrollment, p < 0.01); and those receiving care in low-income or lower-middle-income countries (p < 0.01). The main limitations of our study include left truncation and survivor bias, caused by deaths of children prior to enrollment, and use of enrollment date as a proxy for missing data on date of HIV diagnosis, which could have led to underestimation of the time between HIV diagnosis and ART initiation. CONCLUSIONS: In this study, 68% of HIV-infected children initiated ART by 24 months. However, there was a substantial risk of LTFU before ART initiation, which may also represent undocumented mortality. In 2015, many obstacles to ART initiation remained, with substantial inequities. More effective and targeted interventions to improve access are needed to reach the target of treating 90% of HIV-infected children with ART

Mortality and losses to follow-up among adolescents living with HIV in the IeDEA global cohort collaboration

Introduction: We assessed mortality and losses to follow-up (LTFU) during adolescence in routine care settings in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. Methods: Cohorts in the Asia-Pacific, the Caribbean, Central, and South America, and sub-Saharan Africa (Central, East, Southern, West) contributed data, and included adolescents living with HIV (ALHIV) enrolled from January 2003 and aged 10 to 19 years (period of adolescence) while under care up to database closure (June 2016). Follow-up started at age 10 years or the first clinic visit, whichever was later. Entering care at <15 years was a proxy for perinatal infection, while entering care ≥15 years represented infection acquired during adolescence. Competing risk regression was used to assess associations with death and LTFU among those ever receiving triple-drug antiretroviral therapy (triple-ART). Results: Of the 61,242 ALHIV from 270 clinics in 34 countries included in the analysis, 69% (n = 42,138) entered care <15 years of age (53% female), and 31% (n = 19,104) entered care ≥15 years (81% female). During adolescence, 3.9% died, 30% were LTFU and 8.1% were transferred. For those with infection acquired perinatally versus during adolescence, the four-year cumulative incidences of mortality were 3.9% versus 5.4% and of LTFU were 26% versus 69% respectively (both p < 0.001). Overall, there were higher hazards of death for females (adjusted sub-hazard ratio (asHR) 1.19, 95% confidence interval (CI) 1.07 to 1.33), and those starting treatment at ≥5 years of age (highest asHR for age ≥15: 8.72, 95% CI 5.85 to 13.02), and in care in mostly urban (asHR 1.40, 95% CI 1.13 to 1.75) and mostly rural settings (asHR 1.39, 95% CI 1.03 to 1.87) compared to urban settings. Overall, higher hazards of LTFU were observed among females (asHR 1.12, 95% CI 1.07 to 1.17), and those starting treatment at age ≥5 years (highest asHR for age ≥15: 11.11, 95% CI 9.86 to 12.53), in care at district hospitals (asHR 1.27, 95% CI 1.18 to 1.37) or in rural settings (asHR 1.21, 95% CI 1.13 to 1.29), and starting triple-ART after 2006 (highest asHR for 2011 to 2016 1.84, 95% CI 1.71 to 1.99). Conclusions: Both mortality and LTFU were worse among those entering care at ≥15 years. ALHIV should be evaluated apart from younger children and adults to identify population-specific reasons for death and LTFU

Le traitement de la gangrène de fournier : à propos de 64 cas

Objective: to describe and to analyze the therapeutic modalities of the gangrene of the genital rea treated in Tokoin Teaching Hospital of Lome.Patients and Method: sixty four patients having a gangrene of the genital area and treaty of 1993 to 2008 have been taken in charge by a resuscitation followed of a necrosectomy and a diversion colic or urinary according to the cases; trianantibiotherapy, has completed the surgery. The wound dressings were done the following days either.Results: The death rate in our set was of 28, 13%. HIV infection, diabetes, malnutrition, advanced age, ano-rectal lesions and the delay of hold in charge constituted in our set the elements of bad prognosis.Conclusion: Gangrene of the genital area, though uncommon remain serious affection, of which the prognosis will not be improved if a diagnosed early, with an appropriated management.Keywords: Fournier&#8217;s gangrene, necrosectomy, necrotizing fasciitis, treatmentJ. Rech. Sci. Univ. Lom&#233; (Togo), 2012, S&#233;rie D, 14(1) : 119-12

Alimentation des nourrissons reçus a la vaccination au Togo

Introduction : l’amélioration de l’état nutritionnel, de la santé et du développement desnourrissons dépend des pratiques de leur alimentation. L’objectif de notre étude a étéd’évaluer l’alimentation des nourrissons de 2 à 6 mois apparemment sains reçus envaccination dans le service de pédiatrie du CHU Sylvanus Olympio (SO) de Lomé selonles recommandations de l’UNICEF pour l’alimentation.Matériel et méthodes : il s’est agi d’une étude transversale réalisée du 10 mai au 12novembre 2012 dans l’unité de vaccination du service de pédiatrie du CHU (SO) deLomé. Le logiciel WHO Anthro version 3.2.2. de l’OMS pour déterminer l’étatnutritionnel de chaque patient a été utilisé. Les données ont été enregistrées et analyséespar le logiciel EPI info version 3.5.1. Le test de Khi carré a été utilisé avec un seuilsignificatif &lt; 0,05.Résultats : Il a été évalué 621 nourrissons dont l’âge médian était de 2,53 mois.L’allaitement était pratiqué dans 599 cas (96,5 %). Le taux de mise au sein dans lespremières 24 heures était donc de 68,8 %. La pratique de l’allaitement a été évaluée chez289 couples mère-nourrisson. Une bonne pratique de l’allaitement dans 53 cas (18,3%)et un taux d’alimentation artificielle de 3,6 % ont été notés. L’eau a été introduite dansl’alimentation de 133 nourrissons (21,5%). Du jus de fruit a été donné à 9 nourrissons(1,5%), de la tisane à 13 nourrissons (2,1%) et de la bouillie à 16 nourrissons (2,6%). Letaux d’allaitement maternel exclusif des nourrissons de moins de 3 mois était de 71,3%.Ce taux a été de 69,9% chez les plus de 3 mois.Conclusion : la bonne pratique de l’alimentation chez le nourrisson de 2 à 6 mois dépenddes connaissances de leurs parents. Il s’avère nécessaire de donner les conseilsalimentaires aux mères de nourrissons à chaque contact avec le système de santé.Mots clés : alimentation, nourrissons sains, vaccination

Vaccination contre l’hepatite B chez les patients infectes par le VIH au chu Sylvanus Olympio

Objectif : Les objectifs de notre étude étaient de décrire les profils d’immunisation contre le VHB des patients VIH positifs non porteurs d’Ag HBs et d’identifier les patients successibles d’être vaccinés contre l’hépatite B.Matériels et méthodes : Il s’était agi d’une étude transversale, descriptive qui s’était déroulée du 1er octobre 2011 au 31 janvier 2012 chez des patients infectés par le VIH sous traitement antirétroviral depuis au moins six mois. Notre étude s’était déroulée à l’hôpital du jour du service d’infectiologie du CHU Sylvanus Olympio (SO) de Lomé.Résultats : La recherche de l’AgHBs sur les 1222 échantillons collectés a révélé 117 positifs, soit une prévalence globale de 9,6%. La recherche des Ac anti-HBs et anti HBc totaux réalisée chez les 1105 patients négatifs à l’AgHBs a montré que 20,1% des patients n’étaient pas immunisés contre le VHB ; seulement 0,4% des patients avaient été vaccinés.Conclusion : Cette étude confirme la forte prévalence du portage chronique de l’AgHBs chez les personnes vivant avec le VIH et l’insuffisance de la vaccination contre le VHB chez les patients co-infectés.Mots clés : co-infection, VHB, VIH, marqueurs VHB

Denutrition aiguë severe a l’hopital pediatrique de Dapaong (Togo)

Introduction : la dénutrition aiguë sévère demeure un problème majeur de santé publique dans les pays en développement avec une disparité régionale. Le but de cette étude était de décrire le profil épidémiologique, clinique, évolutif et les problèmes de la prise en charge de la dénutrition aiguë sévère en milieu hospitalier.Matériel et méthode : Il s’agissait d’une étude descriptive et analytique portant sur les cas de dénutrition aiguë sévère enregistrés à l’hôpital pédiatrique de Dapaong du 1er janvier au 31st décembre 2009.Résultats : Nous avons recensé 150 cas de dénutrition aiguë sévère soit une fréquence hospitalière de 4,85 % avec 48 cas de kwashiorkor et 102 cas de marasme. Le nombre maximal de cas de dénutrition correspondait aux périodes de soudure. L’âge moyen des enfants était de 23 mois. Leur sex-ratio était de 1,17. Le périmètre brachial à l’admission était inférieur à 110 mm chez 100 (66,67 %) enfants. Les principaux motifs d’hospitalisation étaient la fièvre (90%), la diarrhée (87 %), l’amaigrissement (81 %), la toux (32 %), les vomissements (31 %), et l’anorexie (24 %). Un poids pour taille inférieur à - 3 z-scores était noté chez 91 enfants à l’admission contre 28 enfants à la sortie. Le gain pondéral était plus rapide chez les enfants atteints de marasme que ceux atteints de kwashiorkor. Le séjour moyen à l’hôpital était de 2 semaines chez 93,8 % des enfants atteints de kwashiorkor contre 85,3 % des enfants atteints de marasme. Le taux de létalité était de 4,6 %. Le taux d’évasion était de 16,7 %.Conclusion : le taux de la dénutrition aiguë sévère est corrélé au degré de la pauvreté dans cette région. Une convergence des efforts en matière de sensibilisation de la population et de la mobilisation des ressources financières par le gouvernement et les partenaires sociaux permettrait une lutte efficace contre la dénutrition aiguë sévère.Mots-clés : dénutrition aiguë sévère, enfants de 0 à 5 ans, Togo, Afrique

Suppuration intracranienne d’origine sinusienne chez l’enfant: a propos d’une observation au CHU de Lome (togo)

Les suppurations intracrâniennes (SIC) regroupent les abcès et empyèmes intracrâniens. La porte d’entrée otorhinolaryngologique (ORL) est la plus fréquente en pédiatrie. Ces affections devenues rares, sont graves et constituent à la fois une urgence diagnostique et thérapeutique. Nous présentons le cas d’une adolescente de 14 ans ayant présenté une association empyème sous dural et abcès frontal dont la porte d’entrée était une pansinusite. Malgré le retard diagnostique et thérapeutique, l’évolution a été globalement favorable avec des séquelles à type de dysarthrie et de monoparésie du membre supérieur droit.Mots clés: empyème cérébral, sinusite, enfant, TogoEnglish Title: Intracranial suppuration of sinus origin in children: about an observation at the teaching hospital of Lome (Togo)English AbstractIntracranial suppurations (ICS) include intracranial abscesses and empyemas. The otolaryngological entrance door is the most common in pediatrics. These conditions become rare, are serious and constitute both a diagnostic and therapeutic emergency. We present the case of a 14-year-old girl who presented an association with empyema under dural and frontal abscess whose front door was a pansinusitis. Despite the diagnostic and therapeutic delay, the evolution was generally favorable with sequelae like dysarthria and monoparesis of the right upper limb.Keywords: cerebral empyema, sinusitis, child, Tog

Cout direct hospitalier de l’osteomyelite aiguë chez l’enfant drepanocytaire au CHU Sylvanus Olympio de Lome : Direct hospital costs of acute osteomyelitis in children with sickle cell disease

Objectif : Évaluer le coût global moyen de la prise en charge de l’Ostéomyélite Aigüe (OA) chez un enfant drépanocytaire.Méthode : Étude rétrospective sur la période du 1er janvier 2008 au 30 novembre 2019, portant sur 23 dossiers de patients drépanocytaires pris en charge pour OA dans le service de pédiatrie du CHU Sylvanus Olympio.Résultats : L’âge moyen des patients était de 7 ans ± 4 ans avec des extrêmes de 15 mois et 17 ans. Le membre inférieur droit était le plus touché par l’OA (n=10). Dix-huit patients ont été hospitalisés et 5 patients traités en ambulatoire. Le coût global moyen de la prise en charge de l’OA était de 144 796,522 ± 48 785,034 francs CFA (84 310 - 250 855 francs CFA). Le coût global moyen était dominé par le coût du traitement antibiotique (26,8%), le coût du traitement de relai (23,8%), le coût des frais d’hospitalisation (17,90%) et le coût des examens paracliniques (14,80%).Conclusion : Le coût global moyen de la prise en charge de l’OA chez l’enfant drépanocytaire au CHU Sylvanus Olympio est très onéreux comparé au niveau de vie du togolais. Il a représenté 5 fois le SMIG au Togo. Objective: To assess the average overall cost of managing acute osteomyelitis in children with sickle cell disease.Method: Retrospective study of 23 sickle cell patients treated for acute osteomyelitis in the paediatric ward of the CHU Sylvanus Olympio from 1 January 2008 to 30 November 2019.Results: The mean age of the patients was 7 years ± 4 years with extremes of 15 months and 17 years. The right lower limb (n=10) was the most affected by acute osteomyelitis. Eighteen patients were hospitalized and 5 patients were treated as outpatients. The average overall cost of management of acute osteomyelitis was 144 796.522 ± 48 785.034 CFA francs (84 310 – 250 855 CFA francs). The average overall cost was dominated by the cost of antibiotic treatment (26.8%), the cost of follow-up treatment (23.8%), the cost of hospitalization (17.90%) and the cost of paraclinical examinations (14.80%).Conclusion: The average overall cost of treating acute osteomyelitis in children with sickle cell disease at the Sylvanus Olympio University Hospital is very expensive compared to the standard of living of Togolese people. It represented 5 times the minimum wage in Togo