Urgences neurologiques (UN) : affections entraînant une perte plus ou moins complète de la conscience, des fonctions de la vie de relation et une participation marquée de la vie végétative.
...L’objectif de cette étude était de contribuer à l’amélioration de la prise en charge efficace des UN à l’HASIGUI.
Il s’agissait d’une étude prospective, transversale de type descriptif d’une période de 6 mois allant du 1er mai au 31 octobre 2016 et a porté sur tous les patients admis au Service des urgences médicochirurgicales (SUMC) puis transférés au service de neurologie pour une manifestation neurologique mettant en jeu leur pronostic vital et ou fonctionnel.
Au total, 106 sur 1254 cas étaient des UN (8 %). L’âge moyen était de 54 ans avec un sex-ratio de 0,92. Nous avons observé (83,02 %) de déficit moteur suivi des troubles du langage (54,72 %). Les facteurs de risque cardiovasculaires dominants étaient l’HTA et le diabète. Nous avons observé 80,18 % d’AVC suivi de la compression médullaire aiguë (5,66 %) et de la polyradiculonévrite aiguë (2,83 %) durant cette étude.
Sur 231 cas d’urgences neurologiques, 106 ont été hospitalisés (8 %). Les extrêmes d’âge étaient 17 et 95 ans. Les AVC étaient de 80,18 %, dominés par les AVC Ischémiques (61 cas). Suivaient la compression médullaire aiguë (5,66 %) et la polyradiculonévrite aiguë (2,83 %).
Les UN sont des pathologies graves pouvant entraîner une morbi-mortalité non négligeable si leur prise en charge médicale n’est pas optimale dès les 1res heures.
La prise en charge des AVC à la phase aiguë demeure une préoccupation en Afrique subsaharienne. La disponibilité du scanner dans notre hôpital a amélioré les interventions de cette extrême urgence ...médico-chirurgicale.
Définir le plus précocement possible les critères pertinents d’orientation des patients atteints d’AVC aigus à partir de l’Unité des soins intensifs neurologiques, afin d’optimiser la prise en charge.
Il s’agissait d’une étude rétrospective de 3ans (juin 2012 à mai 2014) concernant les dossiers de 416 patients qui avaient été hospitalisés en Neurologie, pour AVC confirmé au scanner cérébral. L’examen clinique comportait : la réalisation des scores de NIHSS pour les infarctus cérébraux, de Glasgow pour les hémorragies et l’infarctus massif, l’index de Barthel évaluant la récupération motrice. Les bilans à visée étiologique étaient réalisé. L’évolution clinique sous traitement avait été notée.
L’âge moyen était 48,9ans L’intervalle de temps entre la survenue de l’AVC et l’admission en neurologie était de 4h à 24h chez 21,15 % ; inférieur ou égale à 72h dans 28,36 % et de 50,48 % au-delà de72h. Le score de NIHSS était réalisé chez 316(75,9 %) des patients et le Glasgow dans 24 % (100)37,2 %. Le scanner cérébral montrait 58,4 % d’hypodensité ; 31,2 % d’hyperdensité, normal dans 10,3 %. La biologique montrait 2 cas de polyglobulie, 49 d’hyperglycémie, l’hypercholestérolémie chez 198 patients. Le décès était de 23 %.
Le score NIHSS évaluait les AVCI à la phase aiguë ; le Glasgow dans les troubles de la vigilance avec volumineux infarctus ou d’hémorragie cérébrale. Les performances observées de notre cohorte, relèveraient de l’application du protocole en cours, et à l’évaluation sommative des soins neurologiques dans notre service ; afin que la thrombolyse soit réalisée en 2015 à Conakry.
Cette étude replace l’intérêt des scores d’évaluation en urgence neurovasculaire en Afrique subsaharienne, et appuie la réalisation de la thrombolyse avec efficacité et efficience, au sein de nos unités neurovasculaires.
Depuis mars 2014 la Guinée vit une épidémie de fièvre hémorragique à virus ebola, dont cinq des convalescents issus du centre de traitement ebola de Conakry, avaient consulté en neurologie adulte ...pour des crises d’épilepsie.
Décrire les présentations cliniques et électriques observées chez nos cinq convalescents d’ebola, afin de leur assurer une meilleure prise en charge thérapeutique (médicamenteuse et psychologique) et une insertion sociale.
Nous rapportons cinq observations colligées entre mai et septembre 2014. L’examen clinique neurologique, l’électroencéphalographie, le scanner cérébral sans et après injection intraveineuse du produit de contraste et le bilan sanguin (numération de la formule sanguine, goutte épaisse, glycémie, transaminases et chimie des urines) étaient pratiqués chez tous les patients. Une expertise psychologique des convalescents avait été demandée près de la psychologue de l’équipe des Médecins Sans Frontière.
Les extrêmes d’âge étaient 22ans et 55ans ; 3 femmes, 2 hommes. 3 cas de crises inaugurales au CTE. Après le CTE, 2 cas de crises frontales, 3 cas de crises temporales étaient observées. Trois cas d’atrophie corticale temporale et 2 cas d’atrophie frontale au scanner. L’EEG retrouvait un aplatissement dans 3 cas et dans 2 cas des activités bi- et triphasiques. Le syndrome inflammatoire était de règle. L’évolution était favorable sous phénobarbital 100mg.
La singularité de nos observations tenait au fait que, nos patients n’étaient pas épileptiques avant cette épidémie. Les crises morphéiques et temporales (mâchonnement, sensation de mort imminente et d’angoisse), corrélées aux anomalies de l’électroencéphalographie, ainsi qu’à l’existence de lésions cérébrales, pourraient expliquer l’agressivité du virus zaïre qui est le plus dangereux des cinq variétés de virus ebola jusqu’alors connues.
Cette étude replace l’intérêt de rechercher les anticorps anti-ebola et anticorps anti-lassa, chez la plupart des patients avec épilepsie de survenue récente, vivant dans les zones touchées après cette épidémie.
Institut d’épidémiologie et de neurologie tropicale Limoges, MSF de France, LFCE.
Abstract
Background
Longitudinal analyses are needed to better understand long-term Ebola virus disease (EVD) sequelae. We aimed to estimate the prevalence, incidence, and duration of sequelae and to ...identify risk factors associated with symptom occurrence among EVD survivors in Guinea.
Methods
We followed 802 EVD survivors over 48 months and recorded clinical symptoms with their start/end dates. Prevalence, incidence, and duration of sequelae were calculated. Risk factors associated with symptom occurrence were assessed using an extended Cox model for recurrent events.
Results
Overall, the prevalence and incidence of all symptoms decreased significantly over time, but sequelae remained present 48 months after Ebola treatment center discharge with a prevalence of 30.68% (95% confidence interval CI 21.40–39.96) for abdominal, 30.55% (95% CI 20.68–40.41) for neurologic, 5.80% (95% CI 1.96–9.65) for musculoskeletal, and 4.24% (95% CI 2.26–6.23) for ocular sequelae. Half of all patients (50.70%; 95% CI 47.26–54.14) complained of general symptoms 2 years’ postdischarge and 25.35% (95% CI 23.63–27.07) 4 years’ post-discharge. Hemorrhage (hazard ratio HR, 2.70; P = .007), neurologic (HR 2.63; P = .021), and general symptoms (HR 0.34; P = .003) in the EVD acute phase were significantly associated with the further occurrence of ocular sequelae, whereas hemorrhage (HR 1.91; P = .046) and abdominal (HR 2.21; P = .033) symptoms were significantly associated with musculoskeletal sequelae.
Conclusions
Our findings provide new insight into the long-term clinical complications of EVD and their significant association with symptoms in the acute phase, thus reinforcing the importance of regular, long-term follow-up for EVD survivors.
Prevalence of all sequelae of Ebola virus disease survivors decreased over time, but remained present 48 months after Ebola treatment center discharge. Sequelae were related to symptoms present during the acute phase of the disease.
A robust epidemic-prone disease surveillance system is a critical component of public health infrastructure and supports compliance with the International Health Regulations (IHR). One digital health ...platform that has been implemented in numerous low- and middle-income countries is the District Health Information System Version 2 (DHIS2). In 2015, in the wake of the Ebola epidemic, the Ministry of Health in Guinea established a strategic plan to strengthen its surveillance system, including adoption of DHIS2 as a health information system that could also capture surveillance data. In 2017, the DHIS2 platform for disease surveillance was piloted in two regions, with the aim of ensuring the timely availability of quality surveillance data for better prevention, detection, and response to epidemic-prone diseases. The success of the pilot prompted the national roll-out of DHIS2 for weekly aggregate disease surveillance starting in January 2018. In 2019, the country started to also use the DHIS2 Tracker to capture individual cases of epidemic-prone diseases. As of February 2020, for aggregate data, the national average timeliness of reporting was 72.2%, and average completeness 98.5%; however, the proportion of individual case reports filed was overall low and varied widely between diseases. While substantial progress has been made in implementation of DHIS2 in Guinea for use in surveillance of epidemic-prone diseases, much remains to be done to ensure long-term sustainability of the system. This paper describes the implementation and outcomes of DHIS2 as a digital health platform for disease surveillance in Guinea between 2015 and early 2020, highlighting lessons learned and recommendations related to the processes of planning and adoption, pilot testing in two regions, and scale up to national level.
Chronic cutaneous ulcers caused potentially by several pathogens are of increasing concern in endemic tropical countries, including Guinea in West Africa, in rural populations exposed to aquatic ...environments during recreational, domestic, or agricultural activities. By plotting 1,011 cases of chronic cutaneous ulcers classified under the name Buruli ulcer in 24 of 33 Guinea health districts (72%) between 2018 and 2020 against the gold map and gold-panning map of Guinea, we revealed a significant spatial association between chronic cutaneous ulcer foci and gold-panning foci (P < 0.05), but not with nongold-panning foci (P = 0.12) in Guinea. Gold panning should be listed as an additional economic activity exposing populations to chronic cutaneous ulcers. Further research may aim to clarify whether any geological and biologic factors underlie such an association, besides the possibility that the unprotected skin of gold panners may be exposed to opportunistic, pathogen-contaminated environments in gold-panning areas.
Following WHO guidelines, microscopy is the gold standard for malaria diagnosis in endemic countries. The Parasitology-Mycology laboratory (LPM) is the National Reference Laboratory and is currently ...undergoing ISO 15189 accreditation. In this context, we assessed the performance of the laboratory by confirming the reliability and the accuracy of results obtained in accordance with the requirements of the ISO 15189 standards. This study aimed to verify the method of microscopic diagnosis of malaria at the LPM, in the Aristide Le Dantec hospital (HALD) in Dakar, Senegal.
This is a validation/verification study conducted from June to August 2020. Twenty (20) microscopic slides of thick/thin blood smear with known parasite densities (PD) selected from the Cheick Anta Diop University malaria slide bank in Dakar were used for this assessment. Six (6) were used to assess microscopists' ability to determine PD and fourteen (14) slides were used for detection (positive vs negative) and identification of parasites. Four (4) LPM-HALD microscopists read and recorded their results on prepared sheets. Data analysis was done with Microsoft Excel 2010 software.
A minimum threshold of 50% concordance was used for comparison. Of the twenty (20) slides read, 100% concordance was obtained on eight (8) detection (positive vs negative) slides. Four (4) out of the six (6) parasite density evaluation slides obtained a concordance of less than 50%. Thirteen (13) out of the fourteen (14) identification slides obtained a concordance greater than 50%. Only one (1) identification slide obtained zero agreement from the microscopists. For species identification a concordance greater than 80% was noted and the microscopists obtained scores between 0.20 and 0.4 on a scale of 0 to 1 for parasite density reading. The microscopists obtained 100% precision, sensitivity, specificity and both negative and positive predictive values.
This work demonstrated that the microscopic method of malaria diagnosis used in the LPM/HALD is in accordance with the requirements of WHO and ISO 15189. Further training of microscopists may be needed to maintain competency.
Abstract Background Drug resistance in Plasmodium falciparum is a major threat to malaria control efforts. Pathogen genomic surveillance could be invaluable for monitoring current and emerging ...parasite drug resistance. Methods Data from two decades (2000–2020) of continuous molecular surveillance of P. falciparum parasites from Senegal were retrospectively examined to assess historical changes in malaria drug resistance mutations. Several known drug resistance markers and their surrounding haplotypes were profiled using a combination of single nucleotide polymorphism (SNP) molecular surveillance and whole genome sequence based population genomics. Results This dataset was used to track temporal changes in drug resistance markers whose timing correspond to historically significant events such as the withdrawal of chloroquine (CQ) and the introduction of sulfadoxine-pyrimethamine (SP) in 2003. Changes in the mutation frequency at Pfcrt K76T and Pfdhps A437G coinciding with the 2014 introduction of seasonal malaria chemoprevention (SMC) in Senegal were observed. In 2014, the frequency of Pfcrt K76T increased while the frequency of Pfdhps A437G declined. Haplotype-based analyses of Pfcrt K76T showed that this rapid increase was due to a recent selective sweep that started after 2014. Discussion (Conclusion) The rapid increase in Pfcrt K76T is troubling and could be a sign of emerging amodiaquine (AQ) resistance in Senegal. Emerging AQ resistance may threaten the future clinical efficacy of artesunate-amodiaquine (ASAQ) and AQ-dependent SMC chemoprevention. These results highlight the potential of molecular surveillance for detecting rapid changes in parasite populations and stress the need to monitor the effectiveness of AQ as a partner drug for artemisinin-based combination therapy (ACT) and for chemoprevention.
The 2014-2016 Ebola virus disease outbreak revealed the fragility of the Guinean public health infrastructure. As a result, the Guinean Ministry of Health is collaborating with international partners ...to improve compliance with the International Health Regulations and work toward the Global Health Security Agenda goals, including enhanced case- and community-based disease surveillance. We assessed the case-based disease surveillance system during October 1, 2015-March 31, 2016, in the Boffa prefecture of Guinea. We conducted onsite interviews with public health staff at the peripheral (health center), middle (prefectural), and central (Ministry of Health) levels of the public health system to document leadership structure; methods for maintaining case registers and submitting weekly case reports; disease surveillance feedback; data analysis; and baseline surveillance information on four epidemic-prone diseases (cholera, meningococcal meningitis, measles, and yellow fever). The surveillance system was simple and paper-based at health centers and computer spreadsheet-based at the prefectural and central levels. Surveillance feedback to stakeholders at all levels was infrequent. Data analysis activities were minimal at the peripheral levels and progressively more robust at the prefectural and central levels. Reviewing the surveillance reports from Boffa during the study period, we observed zero reported cases of the four epidemic-prone diseases in the weekly reporting from the peripheral to the central level. Similarly, the national District Health Information System 2 had no reported cases of the four diseases in Boffa but did indicate reported cases among all four neighboring prefectures. Based on the assessment findings, which suggest low sensitivity of the case-based disease surveillance system in Boffa, we recommend additional training and support to improve surveillance data quality and enhance Guinean public health workforce capacity to use these data.
Summary Background The high number of survivors from the 2013–16 west African outbreak of Ebola virus disease (EVD) has raised several new issues: long-term clinical complications, psychosocial ...consequences, risks of EVD reactivation, and secondary transmission due to viral persistence in body fluids. We aimed to assess long-term clinical, psychosocial, and viral outcomes in EVD survivors in Guinea. Methods In this multidisciplinary observational cohort study, we recruited patients aged 1 year or more in four sites in Guinea (Donka National Hospital, Conakry; Macenta Prefectoral Hospital, Macenta; N'zérékoré Regional Hospital, N'zérékoré; and Forécariah Prefectoral Hospital, Forécariah) following discharge from any Ebola treatment centre in Guinea. Eligible patients had had laboratory-confirmed EVD and had then been declared clear of the virus in the blood. All consenting patients were included, with no exclusion criteria. Trained clinicians assessed patients at enrolment to the cohort, recording clinical symptoms and signs of depression. We did routine blood examinations and examined viral persistence in body fluids using RT-PCR. We did psychological evaluations using questionnaires developed for different age groups. Follow-up is planned to 2 years, and here we present findings at enrolment. Findings Between March 23, 2015, and July 11, 2016, we recruited 802 patients, of whom 360 (45%) were male, 442 (55%) were female; 158 (20%) were younger than 18 years. The median age was 28·4 years (range 1·0–79·9, IQR 19·4–39·8). The median delay after discharge was 350 days (IQR 223–491). The most frequent symptoms were general symptoms (324 40% patients), musculoskeletal pain (303 38%), headache (278 35%), depression (124 17% of 713 responses), abdominal pain (178 22%), and ocular disorders (142 18%). More adults than children had at least one clinical symptom (505 78% vs 101 64%, p<0·0003), ocular complications (124 19% vs 18 11%, p=0·0200), or musculoskeletal symptoms (274 43% vs 29 18%, p<0·0001). A positive RT-PCR in semen was found in ten (5%) of 188 men, at a maximum of 548 days after disease onset. 204 (26%) of 793 patients reported stigmatisation. Ocular complications were more frequent at enrolment than at discharge (142 18% vs 61 8% patients). Interpretation Post-EVD symptoms can remain long after recovery and long-term viral persistence in semen is confirmed. The results justify calls for regular check-ups of survivors at least 18 months after recovery. Funding INSERM/Reacting, the French Ebola Task Force, and Institut de Recherche pour le Développement.
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