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Characteristics, Management, and Outcomes of Tetanus Cases in a Referral Center in Senegal, between 2010 and 2017

Advances in Infectious Diseases 2023年第3期13卷 375-388页

作者： Daouda Thioub Ndeye Aissatou Lakhe Khardiata Diallo Mbaye Papa Latyr Junior Diouf Catherine Sarr Ndeye Amy Sarr Aboubakar Sidikh Badiane Mamadou Seck Ndeye Maguette Fall Viviane Marie Pierre Cisse-Diallo daye ka Moussa Seydi Louise Fortes Department of Infectious and Tropical Diseases Fann National University Hospital Dakar Senegal Department of Infectious and Tropical Diseases Dalal Jamm National Hospital Guediawaye Senegal

Tetanus is an infection caused by Clostridium tetani. The disease has been described from the earliest medical literature. Despite this old knowledge, the existence of a vaccine, and the progress made in pathophysiology and treatment, tetanus remains a real public health problem, particularly in developing countries. Tetanus in children and adults is still a frequent cause of hospitalization in the Infectious and Tropical Diseases Department (SMIT) of the Fann National University Hospital (CHNU). We conducted this study with the main objective of carrying out a situational analysis of tetanus at SMIT from 2010 to 2017. We recorded 706 cases of tetanus in a total of 8123 hospitalized patients. The median age of the patients was 23 years [1 - 90 years]. The sex ratio (M/F) was 4/1. More than half (58.78%) came from suburban areas. The population was most frequently made up of students (24%) or manual workers (22.1%). At least one comorbidity was present in 107 patients (15.15%). The absence of a vaccination record was found in 99.56%. The main portal of entry was integumentary (83.3%), post-circumcision (5.7%) and otogenous (4%). Tetanus was generalized in 93.9% of cases. The main signs of tetanus found were trismus and dysphagia. Patients were most frequently classified as stage II (78.7%). Antibiotic therapy was based on metronidazole (51.41%). Anti-tetanus serotherapy was carried out by sub-occipital administration in 97.6%. Tracheostomy was performed in 48 patients. Complications occurred in 226 patients (32.01%). The main complications were respiratory (53.98%), infectious (45.13%) and cardiovascular (41.59%). The average delay in hospitalization was 3.6 ± 3.4 days. The mean length of hospital stay was 11.9 ± 8.2 days. The hospital case-lethality rate was 18.98%. Despite the decline in cases over the years in our country, tetanus remains a public health problem because of its prevalence, severity, and lethality.

关键词： Tetanus Management Outcomes Senegal

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Neuro-meningeal Tuberculosis in Adult Senegalese Patients: Profile and Outcome of Cases Diagnosed at a Referral Service, from 2015 to 2020

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Case Reports in Clinical Medicine 2023年第8期12卷 270-278页

作者： Daouda Thioub Viviane Marie Pierre Cisse-Diallo Papa Latyr Junior Diouf Ndeye Aissatou Lakhe Agbogbenkou TeviDéla-dem Lawson Aboubakar Sidikh Badiane Ndeye Maguette Fall Khardiata Diallo-Mbaye daye ka Sylvie Audrey Diop Moussa Seydi Infectious and Tropical Diseases Department of Fann National University Hospital Dakar Senegal Health Sciences Training and Research Unit Iba Der Thiam University Thiès Senegal

Background: Among patients treated for tuberculosis, 2% to 5% have a Central Nervous System (CNS) lesion, and its frequency rises to 10% in HIV-infected patients. Neuro-meningeal tuberculosis (NMT) is responsible for death and severe permanent neurological damage. This poor prognosis requires early diagnosis and rapid initiation of specific treatment. Unfortunately, the great clinical polymorphism and the lack of specificity of radiological and biological signs are frequently responsible for a delay in diagnosis and management. Senegal is one of the African countries where tuberculosis has remained a concern until now. And there are no studies carried out on this subject. Objective: The objective of this study was to describe the profile and outcome of Neuro-meningeal tuberculosis (NMT) cases diagnosed at the infectious diseases department (SMIT) of Fann University Hospital in Dakar, (referral service for management of tuberculosis). Methods: We carried out a retrospective, descriptive and analytical study, reviewing medical records of adults diagnosed with NMT at the SMIT of Fann Hospital from January 2015 to December 2020. Results: We collected 55 cases of NMT. The median age was 38 years [range 16 - 77 years]. The sex ratio (M/F) was 3.23. HIV patients represented 41.82% of cases. A history of tuberculosis was found in 25.5% of cases. The delay in consultation was greater than one month in 60% of patients. Headaches were the most constant reason for consultation (94.55%). Meningeal signs were present in 94.55% of patients, and consciousness disorders and intracranial hypertension were present in 63.64% and 56.36% respectively. Nerve palsy was found in 38.18%. CSF was clear in 81.64%. GeneXpert MTB/RIF in CSF was performed in 33 patients and was positive in 4 patients. Brain CT was abnormal in 72.09% of cases. Tuberculoma, hydrocephalus and meningeal contrast enhancement were the main lesions. The neuro-meningeal localization was associated with a pulmonary form i

关键词： Neuro-meningeal Outcome Profile Senegal Tuberculosis

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Prevalence of Hypertension and Associated Factors in Patients Living with HIV Followed at the Ambulatory Treatment Center (CTA) of Fann National University Hospital in Dakar

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Health 2017年第4期9卷 727-737页

作者： Ndeye Fatou Ngom Gueye daye ka Alioune Badara Tall Kine Ndiaye Abdoul Aziz Ndiaye Viviane Marie Pierre Cisse Aissata Guindo Ndeye Méry Dia Badiane Sylvie Audrey Diop Noel Magloire Manga Cheikh Tidiane Ndour Moussa Seydi Ambulatory Treatment Center Fann University Teaching Hospital Dakar Senegal Department of Infectious Diseases Fann University Teaching Hospital Dakar Senegal Department of Community Health Alioune Diop University Bambey Senegal

Introduction: The efficacy of antiretroviral therapy in people living with HIV (PLHIV) has been associated with an important increase in metabolic disorders, such as hypertension (HTA). This work allowed us to estimate the prevalence of hypertension in PLHIV and to describe associated factors. Methods: A retrospective, descriptive and analytical study was carried out based on the records of people living with HIV followed at the Ambulatory Treatment Center (CTA), from January 1st 1998 to 31st, December 2014. The WHO criteria were used to diagnose hypertension. Data entry was performed using ESOPE software and data analysis was done using Epi Info software version 3.5.3. A multiple logistic regression was used to identify the risk factors associated with hypertension. Results: During the study period, 3624 patients followed at CTA were included of which 1184 patients (32.7%) had hypertension. The average age was 47. 3 years ±10.5 years, with a sex ratio of 0.7. The most common opportunistic infections at diagnosis were tuberculosis (14.9%) and oral candidiasis (15.3%). The HIV infection was advanced (stage 3 or 4 of WHO classification) for 39% of cases. Overweight and obesity was found in 19.1%. Only 17.6% were treated by protease inhibitors. Higher average age (OR:1,05;IC [1.04 - 1.05], p = 0.000001), higher average BMI (OR:5,3;IC [3.3 - 8.5], p = 0.00001), WHO clinical stage I-II (OR:1,4;IC [1.2 - 1.6], p = 0.00003), and ARV treatment (OR:2,5;IC [1.7 - 3.7], p = 0.000001) are associated with the occurrence of hypertension. Conclusion: The prevalence of hypertension was high among PLHIV and associated factors were: advanced age, high BMI, WHO clinical stages I and II and antiretroviral therapy. Hence, the interest of a systematic screening of hypertension and others cardiovascular risk factors particularly in patients under ARV antiretroviral therapy.

关键词： Hypertension (HTA) HIV Infection Senegal

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Enterobacterial Infections Diagnosed at the Clinic of Infectious Diseases of Fann Hospital (2013-2014) Dakar, Senegal

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Advances in Infectious Diseases 2018年第4期8卷 217-228页

作者： Khardiata Diallo Mbaye Ndèye Aissatou Lakhe Khadime Sylla Rahmatoulahi Ndiaye Viviane Marie Pierre Cissé Diallo daye ka Aminata Massaly Alassane Dièye Louise Fortes Déguénonvo Cheikh Tacko Diop Cheikh Tidiane Ndour Masserigne Soumaré Moussa Seydi Clinic of Infectious Diseases Fann National University Hospital Dakar Senegal Laboratory of Parasitology-Mycology Faculty of Medicine Cheikh Anta Diop University Dakar Senegal CommunityHealthDepartment Health and SustainableDevelopment Training Unit and Research Alioune Diop University Bambey Senegal

Introduction: Entero bacteria are mainly found in the gut of man and animals. The frequent acquisition of antibiotic resistance mechanisms explains why they are the bacteria most often implicated in human infectious pathology. It is estimated to be involved in 50% of sepsis, 60% of enteritis, 70% of urinary tract infection case. Objective: To determine the prevalence of enterobacterial infections diagnosed at Fann Infectious Diseases Clinic, and describe their epidemiological, clinical, therapeutic and evolutionary aspects. Patients and Methods: This is a retrospective and descriptive study, on patients hospitalized from January 2013 to December 2014, at Fann Infectious Diseases Clinic, with bacteriological confirmation of an enterobacteria infection. Results: A total of 129 cases were collected during the study period. The average age was 41 years, and female were predominant (60%) with a sex ratio of 0.67. Comorbidity was found in 88.4% of the cases, most of which were HIV infection. The most common clinical signs were infectious syndrome (53.49%) and general impairment (40.31%). The main gateway was urinary (55.8%). Samples were monomicrobial in 76.7% of cases. Klebsiella and Escherichia were the most common and 68.7% of the subjects had probabilistic treatment. Most enterobacterial strains were resistant to third generation cephalosporins (C3G), aminoglycosides to ciprofloxacin and cotrimoxazole. Aside from 4% of them, all were sensitive to imipenem. Conclusion: The advent of antibiotics has brought hope in the treatment of enterobacterial infections. However, an increase in their resistance to the usual antibiotics has been noted in recent years. As a result, the fight against antibiotic resistance must be a priority.

关键词： Dakar Enterobacteria Infections Senegal

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Incidence and Factors Associated with the Switch to the Second Line Antiretroviral Treatment at the Ambulatory Treatment Center (CTA) in Dakar

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Health 2016年第14期8卷 1566-1575页

作者： Ndeye Fatou Ngom-Gueye Gilbert Batista Abdoul Aziz Ndiaye Assane Diouf ka. daye Alioune Badara Tall Awa Diouf Kine Ndiaye Makhtar Ndiaga Diop Mountaga Dia Cheikh Tacko Diop Awa Gaye Cheikh Tidiane Ndour Moussa Seydi Lamine Gueye Bernard Marcel Diop Papa Salif Sow Ambulatory Treatment Center Fann University Teaching Hospital Dakar Senegal Department of Community Health Alioune Diop University Bambey Senegal Department of Infectious Diseases Fann University Teaching Hospital Dakar Senegal

Introduction: Over the past years, efforts have been made to expand access to antiretroviral combinations (cART) in low-income countries. However, major concerns are noted with drug resistance emergence, as treatment failure result and need to introduce a second line treatment, more expensive and difficult to implement. The objective was to study the incidence of switch to second line, reasons for switch and risk factors using a cohort of people living with HIV in an Ambulatory Treatment Center in Dakar. Methodology: This was a cohort study of people living with HIV under cART from January 2004 to December 2013. Naive patients monitored for at least six months, regardless of their profile and regimen with baseline CD4 counts Results: The median age of the 827 patients included was 44 [IQR = 18 - 78]. The switch to second-line treatment was observed in 72 patients (8.7%) after an average of 38.5 months of follow-up. The overall incidence rate of switch to second line of antiretroviral treatment was 1.59 per 100 persons-years. Most of changes in first-line treatment were motivated by virological failures (n = 60, 83.3%) under treatment with AZT/3TC/NVP (n = 25, 34.7%) or AZT/3TC/EFV21 (29.2%). 9.7% of switch occurred after immunological failure, 1.4% after clinical failure, 4.2% after severe toxicity and 1.4% was not documented. Predictive factors identifying failures at the end of the multivariate analysis were age Conclusions: In total, CTA identified a low incidence rate of treatment failure of the first line of treatment. Associated risk factors were age 3 and high viral load at treatment initiation.

关键词： Incidence Associated Factors Switch to 2nd Line cART CTA Dakar

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Characteristics of Liver Abscess in Department of Infectious Diseases at Fann Teaching University Hospital in Dakar, Senegal

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Advances in Infectious Diseases 2018年第1期8卷 23-31页

作者： Viviane Marie Pierre Cisse Diallo Louise Fortes Deguenonvo Noel Magloire Manga daye ka Sylvie Audrey Diop Abdoulaye Seck Ndeye Aissatou Lakhe Khardiata Diallo Mbaye Assane Diouf Ndeye Mery Dia Badiane Ndeye Fatou Ngom Gueye Cheikh Tacko Diop Masserigne Soumare Cheikh Tidiane Ndour Moussa Seydi Infectious and Tropical Diseases Department Fann Teaching University HospitalDakarSenegal Department of Health Ziguinchor UniversityZiguinchorSenegal Department of Health Thies UniversityThiesSenegal Pasteur Institute Dakar DakarSenegal Department of Health Gaston Berger UniversitySaint LouisSenegal Fann Teaching University Hospital in Dakar DakarSenegal

Introduction: Abscesses of the liver are due to an infection of bacterial, parasitic or fungal origin. Through amoebiological imaging and serology, their diagnosis was facilitated. The aim of this study was to determine the epidemiological, clinical, diagnostic and evolutionary aspects of these liver abscesses at the Department of Infectious and Tropical Diseases in Fann Teaching University Hospital. Patients and Methods: This was a retrospective and descriptive study, based on records of patients hospitalized for abscess of the liver over a period of 8 years, from January 1, 2008 to December 31, 2015. Results: We collected 20 cases of abscesses including 12 cases of confirmed amoebic abscesses and 5 cases of pyogenic abscesses. The mean age of the patients was 43.15 ± 15.12 years. There were 18 men and 2 women. The average hospital stay was 32 days. The most common clinical signs were abdominal pain (100%), fever (75%), hepatomegaly (80%). A leukocytosis greater than 12,000 Gb/mm3 was found in 13 patients. The amoebic serology was positive in 71% of cases and negative in 29% of cases. No germ was isolated from the blood culture. On hepatic ultrasound the abscess was unique in 90%. Treatment was exclusively medical in 11 patients (55%). The trend was favorable in 85% of cases. Conclusion: The incidence of liver abscesses has significantly decreased. It is important to develop diagnostic tools better in the case of pyogenic abscesses.

关键词： Amoebic Liver Abscess Pyogenic Abscess Dakar Senegal

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Risk Factors for COVID-19 Related Death during the First Three Waves of the Pandemic in an Epidemic Treatment Center at Dakar, Senegal

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Advances in Infectious Diseases 2023年第2期13卷 117-131页

作者： Moustapha Diop Papa Samba Ba Viviane Marie Pierre Cisse Ndèye Aissatou Lakhe Betty Fall Moustapha Lo Ndong Essomba Bruce Wembulua Fatimata Wone Becaye Fall Khardiata Diallo-Mbaye daye ka Louise Fortes Ousmane Faye Ndongo Dia Khalifa Ababacar Wade Abdou Rajack Ndiaye Amadou Alpha Sall Moussa Seydi Mame Thierno Dieng Epidemic Treatment Center Dakar Principal Hospital Dakar Senegal Infectious and Tropical Diseases Department FANN Teaching Hospital Dakar Senegal Psychiatry Department Dakar Principal Hospital Dakar Senegal Internal Medicine Department Deido District Hospital Douala Cameroon Dalal Jamm Hospital Dakar Senegal Federation of Laboratories Dakar Principal Hospital Dakar Senegal Pasteur Institute of Dakar Dakar Senegal Anesthesia-Resuscitation Department Dakar Principal Hospital Dakar Senegal Dakar Principal Hospital Dakar Senegal

Introduction-Objective: COVID-19 is a highly transmissible but often mild viral infection. However, some patients can present severe COVID-19 and subsequently die. The aim of the present study was to assess the risk factors for COVID-19 related death during the first three waves of the disease at the Epidemic Treatment Center (ETC) of Dakar Principal Hospital (DPH). Method: We conducted a descriptive and analytical perspective survival study from April 4, 2020 to September 25, 2021, including adult patients with COVID-19, hospitalized at the ETC of DPH. Log Rank test and multivariate Cox model were performed to identify risk factors for death. Results: We included 556 COVID-19 patients with mean age of 57 ± 17 years and a male-to-female ratio of 1.26. The number of deaths during one month of follow-up was 41, representing a cumulative risk of 7.4%. The log Rank test showed that being from the third wave (p = 0.0056), advanced age (p = 0.00098), presence of at least one comorbidity (p = 0.034), High blood pressure (p = 0.024), d-dimer level ≥ 1000 IU/L (p Conclusion: Our study showed that elderly and third-wave of COVID-19 patients were more at risk to die. Knowledge of risk factors for COVID-19 related death could improve the prognosis of these patients.

关键词： COVID-19 Waves Death Risk Factors Dakar

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Epidemiological, Clinical and Outcome Aspects of Care-Related Tetanus in Dakar, Senegal

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Advances in Infectious Diseases 2022年第2期12卷 230-240页

作者： Viviane Marie Pierre Cisse Ndèye Fatou Ngom Gueye Louise Fortes Imelda Mickelina Thoo Aminata Massaly Khardiata Diallo Mbaye daye ka Ndèye Aissatou Lakhe Assane Diouf Ndèye Maguette Fall Daouda Thioub Aboubakry Sidikh Badiane Latyr Junior Diouf Alassane Sarr Sylvie Audrey Diop Cheikh Tidiane Ndour Masserigne Soumaré Moussa Seydi Infectious and Tropical Diseases Department Fann Teaching University Hospital Dakar Senegal Department of Community Health Alioune Diop University Bambey Senegal Department of Health Thies University Thies Senegal

Introduction: Tetanus portals of entry are numerous. Amongst these, the carerelated portals of entry are rarely reported. The aim of the study was to describe the epidemiological, clinical and outcome aspects and identify the factors associated with death from care-related tetanus. Patients and Methods: This is a retrospective study of descriptive and analytical purposes. Data were collected from the medical records of patients admitted to the Infectious and Tropical Diseases Department of the National University Hospital Center (CHNU) of Fann in Dakar for care-related tetanus during the period ranging from 1 January 2009 to 31 December 2016. Care-related tetanus was defined as any case of tetanus occurring after a surgical procedure, including circumcisions performed even outside a health facility. Results: In eight years, 50 cases of care-related tetanus were recorded. Care-related tetanus accounted for 6.7% of hospitalized tetanus cases. The mean age of patients was 21 ± 22 years, with a male predominance (sex ratio: 6.14). The procedure had been performed in most cases, either in a health facility in 22 patients (44%) or at home in 16 patients (32%), and occurred after circumcision. In 62% of cases the portal of entry was urological, followed by orthopedic surgery (14%) and visceral surgery (10%). The procedures performed were dominated by circumcision (31 cases), limb amputation (3 cases) and inguinal hernia repair (2 cases). Tetanus was immediately generalized on admission in all patients. Eighty-four percent (84%) of patients were admitted with Mollaret stage II. Cardiovascular (11 cases), infectious (10 cases) and respiratory (9 cases) complications were the most frequent. The hospital case fatality rate was 24%. Factors associated with death were female gender (p = 0.03), age between 15 - 60 years (p = 0.02), incubation time Conclusion: Care-related tetanus remains a concern in poor income countries, particularly in Senegal. The drop of these cases will req

关键词： Tetanus Care Surgery Dakar Senegal

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