Materno-fetal outcomes in pre eclampsia in a rural hospital of Antananarivo Madagascar

Background: Pre-eclampsia is a human-pregnancy-specific disease defined as the occurrence of hypertension and significant proteinuria in a previously healthy woman on or after the 20th week of gestation. It is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. The aim of this study is to determine the prevalence of pre-eclampsia and to evaluate its maternal and fetal outcomes in a rural area.Methods: This is a cross-sectional study carried out at the Bejofo Mahitsy hospital. It is a District Hospital Referral Center, which is located on the outskirts of the capital, 32 km from Antananarivo, Madagascar. This work was carried out during 24 months, from January 2014 to December 2016. We have included all hospitalized pregnant patients with SBP ≥140 or DBP ≥90mmHg, significant proteinuria> 300mg/24H with or without edema.Results: During this period, we recorded 97 cases of pre-eclampsia, frequency of 1.68%. The mean age of the parturient was 28 years old and 46.39% of the patients were primiparous. At the admission to the hospital, 37 (38,14%) did not show any particular signs. Concerning the severe high blood pressure, 47 pregnant patients (48,46%) had SBP greater than 160 mm Hg and 26 womens (26,80%) had DBP greater than 110 mm Hg. Caesarean section was the method of delivery widely adopted in 74.22 %. Maternal morbidity was represented by eclampsia in 21.65%, Retroplacentary Hematoma in 3% and HELLP syndrome in 4.12%. Fetal morbidity was important with 35% of premature newborns, 25.77% was small for gestational age and 12.37% was with neonatal asphyxia. Intra uterine fetal mortality was found in 11.34% and the perinatal mortality rate was 8.73%.Conclusions: There is a high frequency of pre-eclampsia in our setting and the consequences of pre-eclampsia for neonatal mortality and morbidity outcome are alarmingly high pre-eclampsia. Prevention necessarily involves quality prenatal follow-up such as screening, early and appropriate care of hypertension during pregnancy

Atypical form of early neonatal infection with Salmonella enterica: case report with literature review

Salmonella are rarely responsible for neonatal or perinatal infection. An annual incidence of 75/100000 births are reported in the USA. The authors present a case of a newborn with neonatal salmonellosis in the context of maternal infection in the days preceding the birth, documented retrospectively. This is a case of a 38-week male infant born via spontaneous vaginal delivery. There was a premature rupture of the membranes (13 hours). The mother gave a history of fever and diarrhea of ten days prior to delivery. She had fever of 38.3°C during labor. Prophylactic antibiotic treatment with amoxicillin was established. Thirty-two hours after birth, the baby developed fever, lethargy, and was not accepting feeds. On admission, physical examination showed fever, tachycardia, correct blood pressure and isolated jaundice. The blood count found a leukopenia, a thrombocytopenia, a CRP at 35mg/l. Parenteral antibiotic therapy with cefotaxime and amikacin was started. Apyrexia is obtained after 48 hours of intravenous treatment. Stool culture of the newborn grew after 48 hours and for the mother after 3 days. The germ identified was Salmonella enterica Serovar 4,5,12:i:-. Blood cultures were performed on the mothers and the baby, but the cultures were negative. The baby responded and was discharged on the 15th day of delivery. The mother’s condition was complicated by a Guillan Barré syndrome that required a transfer to neurology. Neonatal salmonellosis may have non-specific clinical symptoms. Management is based on early antibiotic therapy with a third-generation cephalosporin as first-line therapy. The measure in preventing the spread of infection in the neonatology is essential to avoid secondary cases

Neonatal infections with multidrug-resistant ESBL-producing E. cloacae and K. pneumoniae in Neonatal Units of two different Hospitals in Antananarivo, Madagascar

Background: We investigated the molecular mechanism of ß-lactam resistance in extended-spectrum ß-lactamase (ESBL)-producing Enterobacterial strains isolated in neonatal units of different hospitals in Anatnanarivo, Madagascar.Methods: Bacteria were identified by standard biochemical methods, disc diffusion antibiograms and Etest. Resistance genes were sought by PCR. Strains were characterized by Rep- PCR (Diversilab), plasmid analysis and rep-typing.Results: From April 2012 to March 2013, 29 ESBL-producing E. cloacae and 15 K. pneumoniae were isolated from blood culture (n = 32) or gastric samples (n = 12) performed at day 0 or 2 from 39/303 newborns suspected of early neonatal infection. These infants were treated with expanded spectrum cephalosporins, due to lack of carbapenems, leading to a high mortality rate (45 %). Isolates recovered were all, but 4, multidrug resistant, particularly to fluoroquinolones (FQ) except for 21 E. cloacae isolates. Isolates produced TEM-1 and CTX-M-15 ß-lactamases and their genes were located on several self- transferable plasmids of variable sizes sizes that could not be linked to a major plasmid incompatibility group. E. cloacae isolates belonged to 6 Rep-types among which two counted for 11 isolates each. The FQ resistant E. cloacae isolates belonged to one clone, whereas the FQ susceptible E. cloacae isolates belonged to four clones. The K. pneumoniae isolates belonged to 9 Rep-types among which one included five isolates.Conclusion: This study is the first molecular characterization of ESBL- producing isolates from neonatology units in Madagascar, a country with limited epidemiological data. It revealed an important multi-clonal dissemination of CTX-M-15- producing isolates reflecting both the high community carriage and the very early nosocomial contamination of the neonates

Neonatal infections with multidrug-resistant ESBL-producing E. cloacae and K. pneumoniae in Neonatal Units of two different Hospitals in Antananarivo, Madagascar

Background: We investigated the molecular mechanism of ß-lactam resistance in extended-spectrum ß-lactamase (ESBL)-producing Enterobacterial strains isolated in neonatal units of different hospitals in Anatnanarivo, Madagascar.Methods: Bacteria were identified by standard biochemical methods, disc diffusion antibiograms and Etest. Resistance genes were sought by PCR. Strains were characterized by Rep- PCR (Diversilab), plasmid analysis and rep-typing.Results: From April 2012 to March 2013, 29 ESBL-producing E. cloacae and 15 K. pneumoniae were isolated from blood culture (n = 32) or gastric samples (n = 12) performed at day 0 or 2 from 39/303 newborns suspected of early neonatal infection. These infants were treated with expanded spectrum cephalosporins, due to lack of carbapenems, leading to a high mortality rate (45 %). Isolates recovered were all, but 4, multidrug resistant, particularly to fluoroquinolones (FQ) except for 21 E. cloacae isolates. Isolates produced TEM-1 and CTX-M-15 ß-lactamases and their genes were located on several self- transferable plasmids of variable sizes sizes that could not be linked to a major plasmid incompatibility group. E. cloacae isolates belonged to 6 Rep-types among which two counted for 11 isolates each. The FQ resistant E. cloacae isolates belonged to one clone, whereas the FQ susceptible E. cloacae isolates belonged to four clones. The K. pneumoniae isolates belonged to 9 Rep-types among which one included five isolates.Conclusion: This study is the first molecular characterization of ESBL- producing isolates from neonatology units in Madagascar, a country with limited epidemiological data. It revealed an important multi-clonal dissemination of CTX-M-15- producing isolates reflecting both the high community carriage and the very early nosocomial contamination of the neonates

Atypical form of early neonatal infection with Salmonella enterica: case report with literature review

Salmonella are rarely responsible for neonatal or perinatal infection. An annual incidence of 75/100000 births are reported in the USA. The authors present a case of a newborn with neonatal salmonellosis in the context of maternal infection in the days preceding the birth, documented retrospectively. This is a case of a 38-week male infant born via spontaneous vaginal delivery. There was a premature rupture of the membranes (13 hours). The mother gave a history of fever and diarrhea of ten days prior to delivery. She had fever of 38.3°C during labor. Prophylactic antibiotic treatment with amoxicillin was established. Thirty-two hours after birth, the baby developed fever, lethargy, and was not accepting feeds. On admission, physical examination showed fever, tachycardia, correct blood pressure and isolated jaundice. The blood count found a leukopenia, a thrombocytopenia, a CRP at 35mg/l. Parenteral antibiotic therapy with cefotaxime and amikacin was started. Apyrexia is obtained after 48 hours of intravenous treatment. Stool culture of the newborn grew after 48 hours and for the mother after 3 days. The germ identified was Salmonella enterica Serovar 4,5,12:i:-. Blood cultures were performed on the mothers and the baby, but the cultures were negative. The baby responded and was discharged on the 15th day of delivery. The mother’s condition was complicated by a Guillan Barré syndrome that required a transfer to neurology. Neonatal salmonellosis may have non-specific clinical symptoms. Management is based on early antibiotic therapy with a third-generation cephalosporin as first-line therapy. The measure in preventing the spread of infection in the neonatology is essential to avoid secondary cases

Epidémies de peste urbaine à Majunga, côte ouest de Madagascar : résumé

In August 1991, an epidemic of urban plague broke out in Majunga, a port on the western coast of Madagascar. As the first resurgence of the disease in this area in 70 years, the episode was a dramatic reminder of the ubiquity of the disease and layed low the falsely reassuring idea that plague was confined to well known centers of high altitude. After the epidemic had claimed 12 victims, 21 patients suffering from bubonic plague and 7 cases of pneumonic plague, it was brought under control by treating exposed subjects and introducing antivectorial measures. Transmission to man continued in the shape of sporadic cases of bubonic plague until April 1992 and a total number of 41 probable or confirmed bacteriological cases (not counting those deceased) were recorded out of 2020 suspected cases. The history of the disease related almost all these cases to the highly populated and unsanitary neighbourhood of Marolaka, situated on the edge of the Betsiboka estuary, and which has kept semi-rural characteristics. Its murine population had practically disappeared, decimated by an epizootic in early July. Out of the two captured sets of two #Rattus rattus (41 fleas per animal) and two #R. norvegicus each, three were carriers of the bacillus. Numerous shrew-mice (#Suncus murinus) occupied the zone and three tested positive to the direct bacteriological test. For the insectivore, the mean #Xenopsylla cheopis index 4 (n=16), rising to 26 in positive animals. The discovery of a plague infested rat carrying #X. cheopis and the persistence of #P. irritans after insecticide treatments, led us to doubt the efficiency of the antivectorial fight that had been undertaken. Risk of endemization was referred to. After a period of quiet of 3 years, isolated cases were detected in March and May 1995, followed by a new epidemic between July 1995 and March 1996. 617 clinical suspects of bubonic plague were notified... (D'après résumé d'auteur