[Non tuberculous mycobacterial infections in children with AIDS in Abidjan (Ivory Coast)].
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AIDS-Related Opportunistic Infections↗
Biomedical subjects
F Rouet
Publications and source records attributed to F Rouet.
Respiratory manifestations in HIV-infected children pre- and post-HAART in Abidjan, the Ivory Coast.
Among children infected with human immunodeficiency virus (HIV), respiratory diseases are a frequent cause of morbidity and mortality. This review describes respiratory manifestations of paediatric HIV infection before and after the beginning of HAART in Abidjan, Ivory Coast. In an observational cohort, HIV infected children had quarterly clinical visits and a day-clinic available all week for ill children. CD4 and viral load were measured at baseline and every 6 months thereafter. All children with a CD4 percentage below 25% were prescribed daily cotrimoxazole prophylaxis. Ninety-eight children (of a total of 282) were recruited before HAART and treated during the follow-up, there were 56 boys and 42 girls, with a mean age of 6.2 years at inclusion. The mean percentage of CD4 before HAART was 8.7%. Twelve children had a history of pulmonary tuberculosis and five were on antituberculosis treatment at inclusion. Fifty-one per cent presented with abnormalities on chest X-ray at inclusion. Before initiation of HAART, respiratory manifestations represented 32.4% of morbidity events and the incidence for 100 child/months was 9.29 for URTI, 15.2 for bronchitis, 6.07 for LRTI, 0.71 for tuberculosis and 0.36 for Pneumocystis carinii. After the initiation of HAART, respiratory manifestations represented 40.9% of all morbidity events and the incidence for 100 child/months was 5.35 for URTI, 9.48 for bronchitis, 2.17 for LRTI and 0.16 for tuberculosis. During HAART treatment, the incidence of respiratory infections decreased dramatically compared to before the antiretroviral treatment. However, respiratory events still represented 40% of all events occurring following the start of HAART therapy.
Anti-Infective Agents↗
Epidemiologic study of the association between human T-cell lymphotropic virus type 1 and Strongyloides stercoralis infection in female blood donors (Guadeloupe, French West Indies).
This case control study was conducted among female blood donors in Guadeloupe. A total of 85 HTLV-1 positive subjects were matched by age (+/- 5 years) in a 1:3 ratio to 255 HTLV-1 negative controls. The mean age was 48.5 and 48.9 years respectively. Ethnic, environmental and socio-economic risk factors were studied. Four risk factors were found independently associated with HTLV-1 seropositivity: Strongyloides stercoralis antibodies (OR = 3.6, CI 1.8, 7.3), low socio-economic status (OR = 2.0 CI 1.0, 4.0), low educational level (OR = 2.0 CI 1.0, 4.0) and agricultural activity (OR = 2.8 CI 1.4, 5.6). This logistic regression analysis demonstrates the reality of the association between HTLV-1 carriers and Strongyloides stercoralis, and its association with socio-economic and environmental risk factors.
Animals↗
Field evaluation of an improved assay using a heat-dissociated p24 antigen for adults mainly infected with HIV-1 CRF02_AG strains in Côte d'Ivoire, West Africa.
The aim of this study was to evaluate the heat-dissociated p24 antigen (HD p24 Ag) assay as an alternative low-cost tool for diagnosis of HIV-1 infection and quantitation of HIV-1 RNA levels in African adults mainly infected with HIV-1 CRF02_AG strains. One hundred seventeen plasma specimens were obtained from HIV-1-seropositive subjects enrolled in the ANRS 1220 PRIMO-CI cohort (Abidjan, Côte d'Ivoire, West Africa). Results of the HD p24 Ag assay were comparable with those of HIV-1 RNA levels quantified in the same antibody-positive plasma samples by the Amplicor HIV-1 Monitor assay (1.5 version; Roche Diagnostics, Indianapolis, IN): sensitivity, 95.7% versus 96.6%, respectively; specificity (evaluated with samples from 75 seronegative subjects), 94.7% versus 100%, respectively. HD p24 Ag and HIV-1 RNA assays were weakly correlated (Spearman coefficient correlation, r = 0.33; P < 0.001) except for HIV-1 RNA levels of >/=5 log10 copies/mL (r = 0.62; P < 0.001). Quantitation of HD p24 antigenemia in 76 plasma specimens from 14 patients treated with highly active antiretroviral therapy demonstrated weaker changes during treatment than those observed with the HIV-1 RNA assay. Follow-up of infected patients using both markers showed different results. The reliability of the HD p24 Ag assay is questionable for clinical and biologic management as a surrogate tool for measurement of HIV-1 RNA levels in Africa.
Adolescent↗
[Cards of information and informed consent. Proposal of 14 information cards for plastic and aesthetic surgery].
Obligation to deliver full information and obtaining enlightened assent are now, for the whole French practitioner, a necessary preliminary to each operation. Henceforth, in case of suit, the practitioner must prove the reality and the quality of preoperatoire information. The National Medical French Council (CNOM) called scientific societies attention to propose to their members some index standard cards, corresponding to mail medical and surgical records. The National Agency for Accreditation and Evaluation in Health (Anaes) defined the main characteristics of these documents. The authors propose fourteen information cards corresponding to the most currently operations of plastic and aesthetic surgery. They will being clear and simple, wtih a large agreement, strictly informative and yearly up to date. They have the label and therefore the scientific guarantee of French Society of Plastic Reconstructive and Aesthetic Surgery.
France↗
A case-control study of risk factors associated with human T-cell lymphotrophic virus type-I seropositivity in blood donors from Guadeloupe, French West Indies.
BACKGROUND AND OBJECTIVES: An age- and gender-specific distribution characterizes human T-cell lymphotrophic virus type-I (HTLV-I) seropositivity in Guadeloupe (French West Indies). Further epidemiological studies are required to identify other possible risk factors associated with this retroviral infection. MATERIALS AND METHODS: A nested case-control study was conducted between 1997 and 1999 among blood donors. A total of 102 HTLV-I-positive subjects were matched (at a ratio of 1 : 3) by gender, age (+/-5 years) and donor status (new or regular) to 306 HTLV-I-negative controls. Information was obtained through a questionnaire assessing both environmental and behavioural variables. RESULTS: Factors independently associated with HTLV-I infection included a low level of education [odds ratio (OR) 6.61, confidence interval (CI) 2.89-15.15], black ethnicity (OR 3.28, CI 1.01-10.65), two or more sex partners in the previous 3 years (OR 2.43, CI 1.16-5.10), early age at first sexual intercourse (0.84 risk reduction per additional year, CI 0.76-0.93), a history of sexually transmitted diseases (OR 2.29, CI 1.0-5.34) and positive Chlamydia serology (OR 1.95, CI 1.03-3.68). CONCLUSION: These data provide a wide spectrum of features associated with HTLV-I seropositivity, especially sexual risk factors. It strongly suggests that heterosexual intercourse is an important route of HTLV-I transmission in Guadeloupe, even among low-risk populations such as blood donors.
Adult↗
Early diagnosis of paediatric HIV-1 infection among African breast-fed children using a quantitative plasma HIV RNA assay.
OBJECTIVE: To evaluate the performance of a quantitative plasma HIV-1 RNA assay for HIV infection diagnosis among African breast-fed children. METHODS: Serial plasma specimens collected in the first week, at day 45-90, 6 months and 9-12 months of age from HIV-exposed children born to HIV-1-infected women enrolled in the DITRAME ANRS 049a perinatal intervention trial (Abidjan, Côte d'Ivoire) were tested for HIV-1 plasma RNA using a branched DNA (bDNA) assay. Sensitivity and specificity of this RNA test were assessed in comparison with a qualitative DNA polymerase chain reaction (PCR) performed on the same blood samples and allowing a reliable detection of the predominant subtype A. RESULTS: Among 91 samples from 53 infected children which tested positive by DNA PCR, the sensitivity of the bDNA test was 100% [95% confidence interval (CI), 96.0-100.0] at < or = 8 days (n = 19), 6-12 weeks (n = 43), 6 months (n = 26), and 9-12 months (n = 3). The median plasma HIV-1 RNA viral load ranged from 242 000 copies/ml at < or = 8 days to more than 500 000 copies/ml at day 45-90 and at 6 months. Of 106 specimens from 106 uninfected children who were DNA PCR- negative at month 3 or 6 of age, HIV-1 RNA was undetectable in 103, yielding an overall specificity for the bDNA test of 97.2% (95% CI, 92.0-99.4). The viral load in the three remaining samples with false-positive results was low (410, 937 and 3752 copies/ml, respectively). CONCLUSIONS: The quantitative bDNA assay appears a suitable tool for early, reliable and easy diagnosis of paediatric HIV-1 infection among a population of African breast-fed children.
Africa↗
Dengue fever: a harmful disease in patients with thrombocytopenia?
We describe 2 patients with autoimmune thrombocytopenic disease who developed classic dengue fever associated with serious bleeding and extremely low platelet counts (1000 cells/mm(3) and 3000 cells/mm(3), respectively). Such patients should be properly advised as to the possibility that common dengue fever may substantially enhance their risk for hemorrhagic complications.
Adult↗
HIV-1 infection and malaria parasitaemia.
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Antimalarials↗
Seroprevalence of human herpes virus 8 antibody in populations at high or low risk of transfusion, graft, or sexual transmission of viruses.
BACKGROUND: The routes of transmission of human herpes virus 8 (HHV-8) remain unclear. In particular, HHV-8 transmission by blood components and organ transplantation is still debated and raises public health issues. The objective of this study was to determine the prevalence of anti-HHV-8 in selected populations of persons or patients with or without risk factors for the transmission of viral infections, in order to determine the routes of HHV-8 transmission. STUDY DESIGN AND METHODS: A total of 1431 persons or patients at low or high risk of sexually, blood-, or graft-transmitted viral infections were tested by means of a standardized immunofluorescence serologic assay detecting anti-HHV-8. RESULTS: The persons or patients could be classified into three distinct groups according to anti-HHV-8 prevalence: a low prevalence group (0.0% to 5.0%), including healthy blood donors, healthy pregnant women, multiply transfused patients with thalassemia major, and IV drug users; an intermediate prevalence group (5.0% to 20.0%), including organ donors, kidney transplant recipients, and multiply transfused patients with sickle cell disease; a high prevalence group (>20.0%), including HIV-negative persons at high risk of sexually-transmitted viral infections, and HIV-infected homosexual men and heterosexuals. CONCLUSION: The sexual route appears to be the main route of HHV-8 transmission; bloodborne transmission of HHV-8, if it exists, is rare. In contrast, organ transplantation recipients might be exposed to HHV-8 transmission by the transplanted organ, which raises the issue of systematic screening of organ donors.
Adult↗
Serological, epidemiological, and molecular differences between human T-cell lymphotropic virus Type 1 (HTLV-1)-seropositive healthy carriers and persons with HTLV-I Gag indeterminate Western blot patterns from the Caribbean.
To investigate the significance of serological human T-cell lymphotropic virus type 1 (HLTV-1) Gag indeterminate Western blot (WB) patterns in the Caribbean, a 6-year (1993 to 1998) cross-sectional study was conducted with 37,724 blood donors from Guadeloupe (French West Indies), whose sera were routinely screened by enzyme immunoassay (EIA) for the presence of HTLV-1 and -2 antibodies. By using stringent WB criteria, 77 donors (0.20%) were confirmed HTLV-1 seropositive, whereas 150 (0.40%; P < 0.001) were considered HTLV seroindeterminate. Among them, 41.3% (62) exhibited a typical HTLV-1 Gag indeterminate profile (HGIP). Furthermore 76 (50.7%) out of the 150 HTLV-seroindeterminate subjects were sequentially retested, with a mean duration of follow-up of 18.3 months (range, 1 to 70 months). Of these, 55 (72.4%) were still EIA positive and maintained the same WB profile whereas the others became EIA negative. This follow-up survey included 33 persons with an HGIP. Twenty-three of them (69.7%) had profiles that did not evolve over time. Moreover, no case of HTLV-1 seroconversion could be documented over time by studying such sequential samples. HTLV-1 seroprevalence was characterized by an age-dependent curve, a uniform excess in females, a significant relation with hepatitis B core (HBc) antibodies, and a microcluster distribution along the Atlantic coast of Guadeloupe. In contrast, the persons with an HGIP were significantly younger, had a 1:1 sex ratio, did not present any association with HBc antibodies, and were not clustered along the Atlantic façade. These divergent epidemiological features, together with discordant serological screening test results for subjects with HGIP and with the lack of HTLV-1 proviral sequences detected by PCR in their peripheral blood mononuclear cell DNA, strongly suggest that an HGIP does not reflect true HTLV-1 infection. In regard to these data, healthy blood donors with HGIP should be reassured that they are unlikely to be infected with HTLV-1 or HTLV-2.
Adolescent↗
Human T-cell lymphotropic virus Type I association with Strongyloïdes stercoralis: a case control study among Caribbean blood donors from Guadeloupe (French West Indies).
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Adult↗
Geographical clustering of human T-cell lymphotropic virus type I in Guadeloupe, an endemic Caribbean area.
Between January 1989 and December 1996, 59,426 blood donors from Guadeloupe (French West Indies) were screened for antibodies to human T-cell lymphotropic virus type I (HTLV-I). Of these, 195 were confirmed as being positive for HTLV-I, yielding an overall prevalence of 0.33% [95% confidence interval (CI) 0.28-0.38]. On multiple logistic regression analysis, risk factors for HTLV-I were female gender [odds ratio (OR) 1.8; CI 1.3-2.4], increasing age (30-39 years, OR 2.2, CI 1.4-3.4; 40-49 years, OR 3.1, CI 2.1-4.7; > or =50 years, OR 5.6, CI 3.6-8.6) and positive hepatitis B core antibodies (OR 2.0; CI 1.5-2.8). HTLV-I seropositivity was also significantly associated with current residence in certain areas, highlighting microgeographic clustering: individuals living along the Atlantic Facade of Guadeloupe, which is a traditional sugar cane plantation area where Africans were brought during slave trading, were at increased risk for HTLV-I infection (OR 1.9; CI 1.3-2.7) compared with other areas in Guadeloupe devoted to other activities. Our report of HTLV-I cluster identification in Guadeloupe probably reflects both its low spread and its highly intrafamilial restricted transmission within this endemic Caribbean population.
Adolescent↗
Human T-lymphotropic virus type I among blood donors from Guadeloupe: donation, demographic, and biologic characteristics.
BACKGROUND: Epidemiologic data on human T-lymphotropic virus type I (HTLV-I) in Guadeloupe (French West Indies) are scant. STUDY DESIGN AND METHODS: From January 1989 to December 1996, 59,426 blood donors were screened by enzyme immunoassay for antibodies to HTLV-I. All repeatedly reactive samples were confirmed by Western blot. Temporal trends in HTLV-I seropositivity rates were examined during the study period. A multivariate analysis of donation, demographic, and biologic characteristics was performed. RESULTS: Of the screened blood donors, 195 were confirmed as seropositive, for an overall prevalence of 0.33 percent (95% CI 0.28-0.38). A marked decrease in overall HTLV-I prevalence with time (from 0.47% in 1989 to 0.13% in 1996) was observed, which can be explained mainly by the decreasing percentage of recruited new donors during the study period. Four independent risk factors for HTLV-I were identified: new donor status (odds ratio [OR] 12.5), female sex (OR 1.7), increasing age (30-39 years: OR, 2.4; 40-49 years: OR, 3.7; >50 years: OR 6.6), and positive antibodies to hepatitis B virus core antigen (OR, 1.7). Selection of specific locations for blood collection was inversely associated with HTLV-I (OR 0.5). CONCLUSION: New donor status, advancing age, female sex, and positivity for hepatitis B virus core antibodies were the major factors associated with HTLV-I infection in Guadeloupe.
Blood Donors↗
[Surveillance of iatrogenic complications in a department of cardiology. Thoughts about a preventive strategy].
A study was made of iatrogenic complications (IC) occurring in the department of cardiology of the Nantes Teaching Hospital Group between May 31, 1990 and June 1, 1991. One hundred and fifty eight IC were seen during this period, i.e. an annual incidence of 4.4%. There were 4 deaths following and IC, i.e. an annual mortality rate of 0.11%. Five other IC had serious though non-fatal consequences. Taken in general, IC appeared to be benign and of various origins. Drugs were responsible for almost half of IC and invasive investigations for one third. Application of a simple and single preventive approach is difficult in view of the diversity of causes. The solution lies in part in awareness and education concerning the problem, in which a permanent register system like ours certainly has a role to play.
Adult↗