ADÉNOPATHIES CERVICO-FACIALES EN ODONTO STOMATOLOGIE: ÉTUDE DE 82 OBSERVATIONS.

Objectif : étudier les adénopathies cervico-faciales en rapport avec la tuberculose dans notre pratique Odonto-stomatologique. Matériels et Méthodes : Nous avons réalisé une étude rétrospective sur une période de quatre ans (janvier 2007 à décembre 2010), au Centre Hospitalier Universitaire d’Odontostomatologie (CHU OS) de Bamako, sur des cas successifs d’adénopathies cervico-faciales. L’IDRT et l’anatomopathologie de la pièce biopsique ont servi pour le diagnostic étiologique de la tuberculose. Les données ont été recueillies à partir des dossiers médicaux et saisies puis analysées avec le logiciel Epiinfo.fr 6.0. Résultats : Les lésions ont concerné 82 patients dont 37 hommes (45,1%) avec un sex ratio de 0,82. La tranche d’âge la plus représentée a été celle de 20 et 29 ans (28%). Le siège anatomique privilégié était la région cervicale avec 34,14%.Nos patients ont bénéficié d’une radiographie thoracique dans 90,20% des cas. L’IDRT a été effectuée chez 72% des patients et l’adénite tuberculeuse caséo- folliculaire a été retrouvée dans 8,50% des cas. Conclusion : Notre étude a révélé une prévalence de 0,31% d‘adénopathies cervico-faciales dont 80,50% était d’origine tuberculeuse. Devant toute adénopathie cervico-faciale dans une zone d’endémie tuberculeuse, une IDRT et un examen anatomopathologique de la biopsie ganglionnaire devrait être systématique pour la prise en charge précoce de la tuberculose

Canadian Experiment for Soil Moisture in 2010 (CanEX-SM10): Overview and Preliminary Results

The Canadian Experiment for Soil Moisture in 2010 (CanEx-SM10) was carried out in Saskatchewan, Canada from 31 May to 16 June, 2010. Its main objective was to contribute to Soil Moisture and Ocean salinity (SMOS) mission validation and the pre-launch assessment of Soil Moisture and Active and Passive (SMAP) mission. During CanEx-SM10, SMOS data as well as other passive and active microwave measurements were collected by both airborne and satellite platforms. Ground-based measurements of soil (moisture, temperature, roughness, bulk density) and vegetation characteristics (Leaf Area Index, biomass, vegetation height) were conducted close in time to the airborne and satellite acquisitions. Besides, two ground-based in situ networks provided continuous measurements of meteorological conditions and soil moisture and soil temperature profiles. Two sites, each covering 33 km x 71 km (about two SMOS pixels) were selected in agricultural and boreal forested areas in order to provide contrasting soil and vegetation conditions. This paper describes the measurement strategy, provides an overview of the data sets and presents preliminary results. Over the agricultural area, the airborne L-band brightness temperatures matched up well with the SMOS data. The Radio frequency interference (RFI) observed in both SMOS and the airborne L-band radiometer data exhibited spatial and temporal variability and polarization dependency. The temporal evolution of SMOS soil moisture product matched that observed with the ground data, but the absolute soil moisture estimates did not meet the accuracy requirements (0.04 m3/m3) of the SMOS mission. AMSR-E soil moisture estimates are more closely correlated with measured soil moisture

Implementing Preventive Chemotherapy through an Integrated National Neglected Tropical Disease Control Program in Mali

Neglected tropical diseases (NTDs) are a group of chronic infections that affect the poorest group of the populations in the world. There are currently five major NTDs targeted through mass drug treatment in the affected communities. The drug delivery can be integrated to deliver different drug packages as these NTDs often overlap in distribution. Mali is endemic with all five major NTDs. The integrated national NTD control program was implemented through the primary health care system using the community health center workers and the community drug distributors aiming at long-term sustainability. After a pilot start in three regions in 2007 without prior examples to follow on integrated mass drug administration, treatment for the five targeted NTDs was gradually scaled up and reached all endemic districts by 2009, and annual drug coverage in the targeted population has since been maintained at a high level for each of the five NTDs. Around 10 million people received one or more drug treatments each year since 2009. The country is on the way to meet the national objectives of elimination or control of these diseases. The successes and lessons learned in Mali are valuable assets to other countries looking to start similar programs

First Detection of Leishmania major DNA in Sergentomyia (Spelaeomyia) darlingi from Cutaneous Leishmaniasis Foci in Mali

Leishmania major complex is the main causative agent of zoonotic cutaneous leishmaniasis (ZCL) in the Old World. Phlebotomus papatasi and Phlebotomus duboscqi are recognized vectors of L. major complex in Northern and Southern Sahara, respectively. In Mali, ZCL due to L. major is an emerging public health problem, with several cases reported from different parts of the country. The main objective of the present study was to identify the vectors of Leishmania major in the Bandiagara area, in Mali. Methodology/Principal Findings: An entomological survey was carried out in the ZCL foci of Bandiagara area. Sandflies were collected using CDC miniature light traps and sticky papers. In the field, live female Phlebotomine sandflies were identified and examined for the presence of promastigotes. The remaining sandflies were identified morphologically and tested for Leishmania by PCR in the ITS2 gene. The source of blood meal of the engorged females was determined using the cyt-b sequence. Out of the 3,259 collected sandflies, 1,324 were identified morphologically, and consisted of 20 species, of which four belonged to the genus Phlebotomus and 16 to the genus Sergentomyia. Leishmania major DNA was detected by PCR in 7 of the 446 females (1.6%), specifically 2 out of 115 Phlebotomus duboscqi specimens, and 5 from 198 Sergentomyia darlingi specimens. Human DNA was detected in one blood-fed female S. darlingi positive for L. major DNA. Conclusion: Our data suggest the possible involvement of P. duboscqi and potentially S. darlingi in the transmission of ZCL in Mali

Feasibility of Onchocerciasis Elimination with Ivermectin Treatment in Endemic Foci in Africa: First Evidence from Studies in Mali and Senegal

The control of onchocerciasis, or river blindness, is based on annual or six-monthly ivermectin treatment of populations at risk. This has been effective in controlling the disease as a public health problem, but it is not known whether it can also eliminate infection and transmission to the extent that treatment can be safely stopped. Many doubt that this is feasible in Africa. A study was undertaken in three hyperendemic onchocerciasis foci in Mali and Senegal where treatment has been given for 15 to 17 years. The results showed that only few infections remained in the human population and that transmission levels were everywhere below postulated thresholds for elimination. Treatment was subsequently stopped in test areas in each focus, and follow-up evaluations did not detect any recrudescence of infection or transmission. Hence, the study has provided the first evidence that onchocerciasis elimination is feasible with ivermectin treatment in some endemic foci in Africa. Although further studies are needed to determine to what extent these findings can be extrapolated to other areas in Africa, the principle of onchocerciasis elimination with ivermectin treatment has been established

Tuberculosis drug resistance in Bamako, Mali, from 2006 to 2014.

BACKGROUND: Although Drug resistance tuberculosis is not a new phenomenon, Mali remains one of the "blank" countries without systematic data. METHODS: Between 2006 and 2014, we enrolled pulmonary TB patients from local TB diagnostics centers and a university referral hospital in several observational cohort studies. These consecutive patients had first line drug susceptibility testing (DST) performed on their isolates. A subset of MDR was subsequently tested for second line drug resistance. RESULTS: A total of 1186 mycobacterial cultures were performed on samples from 522 patients, including 1105 sputa and 81 blood samples, yielding one or more Mycobacterium tuberculosis complex (Mtbc) positive cultures for 343 patients. Phenotypic DST was performed on 337 (98.3%) unique Mtbc isolates, of which 127 (37.7%) were resistant to at least one drug, including 75 (22.3%) with multidrug resistance (MDR). The overall prevalence of MDR-TB was 3.4% among new patients and 66.3% among retreatment patients. Second line DST was available for 38 (50.7%) of MDR patients and seven (18.4%) had resistance to either fluoroquinolones or second-line injectable drugs. CONCLUSION: The drug resistance levels, including MDR, found in this study are relatively high, likely related to the selected referral population. While worrisome, the numbers remained stable over the study period. These findings prompt a nationwide drug resistance survey, as well as continuous surveillance of all retreatment patients, which will provide more accurate results on countrywide drug resistance rates and ensure that MDR patients access appropriate second line treatment

Failure to Recognize Nontuberculous Mycobacteria Leads to Misdiagnosis of Chronic Pulmonary Tuberculosis

BACKGROUND: Nontuberculous mycobacterial (NTM) infections cause morbidity worldwide. They are difficult to diagnose in resource-limited regions, and most patients receive empiric treatment for tuberculosis (TB). Our objective here is to evaluate the potential impact of NTM diseases among patients treated presumptively for tuberculosis in Mali. METHODS: We re-evaluated sputum specimens among patients newly diagnosed with TB (naïve) and those previously treated for TB disease (chronic cases). Sputum microscopy, culture and Mycobacterium tuberculosis drug susceptibility testing were performed. Identification of strains was performed using molecular probes or sequencing of secA1 and/or 16S rRNA genes. RESULTS: Of 142 patients enrolled, 61 (43%) were clinically classified as chronic cases and 17 (12%) were infected with NTM. Eleven of the 142 (8%) patients had NTM disease alone (8 M. avium, 2 M. simiae and 1 M. palustre). All these 11 were from the chronic TB group, comprising 11/61 (18%) of that group and all were identified as candidates for second line treatment. The remaining 6/17 (35.30%) NTM infected patients had coinfection with M. tuberculosis and all 6 were from the TB treatment naïve group. These 6 were candidates for the standard first line treatment regimen of TB. M. avium was identified in 11 of the 142 (8%) patients, only 3/11 (27.27%) of whom were HIV positive. CONCLUSIONS: NTM infections should be considered a cause of morbidity in TB endemic environments especially when managing chronic TB cases to limit morbidity and provide appropriate treatment