Many countries in Africa are now confronted with the dilemma of shifting drug policies for uncomplicated falciparum malaria from chloroquine, which has become largely ineffective, to a new first-line drug and amodiaquine is one of the possible options. A multicentre, open-label randomized controlled trial of amodiaquine 30 mg/kg vs chloroquine 25 mg/kg over 3 days was performed in Senegal, Cameroon, Gabon, and Burkina Faso between 1996 and 1998 and patients were followed-up for 14 days. Sensitivity of isolates in vitro and whole blood levels of chloroquine and amodiaquine were also measured. The primary efficacy parameter was parasitological clearance on day 14 (parasitological success). The secondary efficacy parameter was absence of signs/symptoms of malaria on day 14 (clinical success). Among the 364 patients randomized and receiving the assigned treatment (chloroquine n = 185, amodiaquine n = 179), 137 and 139, respectively, reached the primary endpoint. Amodiaquine proved significantly more effective than chloroquine. The summary odds ratio (95% CI) was 7.79 (4.54-13.35) for parasitological success, and 6.3 (3.4-11.68) for clinical success. Sensitivity in vitro and chloroquine blood levels were good predictors of chloroquine failure. Amodiaquine remains effective for treating uncomplicated falciparum malaria in areas of West and Central Africa where chloroquine resistance is prevalent. However, measures should be taken to protect the lifespan of amodiaquine where the drug is introduced for use.

Adolescent↗

PubMedDate not supplied

[Intestinal parasitosis in the inhabitants of a suburban zone in which the groundwater is polluted by nitrates of fecal origin (Yeumbeul, Senegal)].

This study was carried out in 1997 to 1998, to determine the prevalence of intestinal parasite infestations due to groundwater pollution at Yeumbeul, Senegal, and to follow the progression of parasite infestations following anti-parasite treatment. The study included 705 people living in a suburban zone in which the water table was polluted with nitrates of fecal origin. These individuals consumed either well water or water from springs. The overall prevalence of parasite infestation was 42.26%, but varied significantly with age (p < 0.001). Individuals who consumed well water were more frequently infested than those who consumed spring water, but the difference was not significant (p > 0.3). Giardia and Entamoeba coli were the most frequently isolated parasites, with Giardia predominating in the 0 to 9 year age-group. There was no significant correlation between the prevalence of the various parasites and indicators of water pollution (R2 = 0.0566 for nitrates and 0.1086 for fecal coliform bacteria). Similarly, no correlation was found with water pollution factors such as the depth of the water table (R2 = 0.027) and the distance between the wells and the latrines (R2 = 0.00007). Following specific treatment, the prevalence of parasite infestation fell to 30.81%. This indicates the limitations of drug treatment, which is always used alone to combat intestinal parasites, in the face of possible reinfestation.

Adolescent↗

PubMedDate not supplied

[Treatment of rheumatoid polyarthritis with methotrexate in Dakar: efficacy, tolerance and cost].

Methotrexate (MTX), which has been used for years in cancer treatment, is now being proposed as a first-line treatment for rheumatoid arthritis (RA), despite its potential side effects. The aim of this study was to investigate the short-term efficacy, safety and relative cost of low-dose MTX for the treatment of RA. We carried out an open, nonrandomized trial in which patients received a 7 mg injection of MTX once per week, with clinical and biological follow up. A single physician performed the weekly assessments, which involved evaluation of the duration of morning stiffness, the number of night awakenings, the number of painful and swollen joints and Ritchie's index. Blood cell count and erythrocyte sedimentation rate were determined monthly. Twelve RA patients were enrolled in the trial, over a mean treatment period of 356 +/- 175 days. A significant improvement was observed in all variables except the number of swollen joints. Ritchie's index decreased from a mean of 31.8 +/- 11.85 to 6.5 +/- 8.98 (p<1.6 x 10- 4). Minor adverse reactions were observed but none indicated treatment withdrawal: 6 cases of nausea, 2 of a moderate increase in transaminase activity, 1 of bronchitis, in which the responsibility of MTX was not definitely established and 3 cases in which hemoglobin levels decreased. The monthly cost of the treatment, including the drug itself and laboratory tests, is lower than that of gold salt injection. Three issues of key importance in our region were investigated in this study: 1) the possible desire to become pregnant of female patients undergoing MTX treatment. In addition, some of the young and unmarried patients did not understand or appreciate the contraceptive effects of the treatment; 2) poor compliance with the treatment due to limited financial resources. Many patients did not regularly attend for their follow-up appointments and many stopped taking the medication. One third of the patients were lost to follow-up during this study; 3) the prevalence of chronic hepatitis, which may limit the use of MTX in our region. Serological tests should be performed before the treatment is started and a liver biopsy is recommended for patients with chronic hepatitis B or C.

Adult↗

PubMedDate not supplied

[Malaria in the central health district of Dakar (Senegal). Entomological, parasitological and clinical data].

We previously investigated malaria in the southern health district of the city of Dakar, which includes the oldest neighborhoods. In this study, we investigated malaria in the central health district, corresponding to the central area of the conurbation. The study was carried out at 12 sites, from March 1996 to February 1997. The sites were selected such that the entire district was covered and included 2 sites in the shanty town and three in an old village that has been absorbed into the city. We carried out prospective monthly entomological analyses with a view to identifying the vectors and the mode of transmission of malaria. We also carried out clinical and parasitological follow up to determine the incidence of parasitemia and of bouts of malaria. Insects were collected overnight from humans and the insects remaining the next morning in 10 bedrooms in the health district were collected. For clinical and parasitological follow up, families were visited at home once per week and their clinical state was assessed. Blood smears were taken to facilitate the detection of bouts of malaria. Body temperature was measured and we checked for the presence of organisms in the blood systematically during the last weekly visit of each month. For a total of 308 collections at night from human volunteers and 1,395 bedroom collections of residual fauna, we obtained 12,879 Culicidae females, 199 (1.5%) of which were anopheles mosquitoes, with Culex quinquefasciatus accounting for 98% of the remaining mosquitoes. As in the southern district, A. arabiensis was the only species of the A. gambiae complex collected. Anopheles mosquitoes accounted for only 0.3 bites per man per night and 0.07 females per room. They were therefore poorly represented in this district and were not detected at all at five sites. They were found in large numbers only during the rainy season, especially in September, when they accounted for 2.25 bites per man per night and 0.3 females per room at 3 sites in an undeveloped zone in which 81.4% of all the anopheles mosquitoes were collected. The parturition frequency of the biting females was 32.6% and that of the females collected in houses was 50.0%. None of the A. arabiensis females dissected (98.5% of those collected) carried Plasmodium sporozoites. The clinical and parasitological follow up concerned 2,583 individuals, aged from 1 month to 80 years, from 285 families resident in Dakar who volunteered for the study; 41.9% of these individuals were less than 15 years old and 92.2% had been living in Dakar for more than 2 years. Thick and thin blood smears taken monthly showed the frequency of the parasite to be 1.0% and that of gametocytes to be 0.1%. P. falciparum was the only parasite detected in the subjects. Plasmodium infections were observed in all age groups, with a frequency of 0.4% (adults over the age of 20 years) to 1.6% (children under two years of age). Parasitized subjects were detected in every month of the study, with a frequency of 0.4% (in January) to 1.9% (in December). The largest number of cases detected in a three-month period (38.8% of all cases) was that for October to December, the three-month period immediately after the rainy season (July to September). Parasite frequency, which was no higher than 1. 2% at 10 sites, was clearly higher at two sites in the shanty town (3.8 and 6.8%), mostly inhabited by immigrants from rural areas. At the end of the study year, satisfactory weekly follow up was considered to have been achieved for 1,067 of the participants. The annual incidence of parasitemia in this cohort was 5.1% and that of malaria was 2.4%. Incidence did not vary significantly with age and was between 1.8% and 7.6% for parasitemia and between 0.8% and 3.5% for malaria. However, significant differences in incidence were observed between areas. Incidence was higher at the two sites in the shanty town, with rates of 12.1% and 36.5% for parasitemia and 6.1% and 15.9% for malaria. (ABSTRACT TR

Adolescent↗

PubMedDate not supplied

[Epidemiological, clinical and progressive aspects of asthma observed at Bamako, Mali].

We carried out a prospective study of 106 of the 752 asthmatic patients attending the outpatient clinic of Point G Hospital, Bamako, between December 1997 and November 1998. We analyzed data for 61 patients whose lung function was assessed by measurement of peak expiratory flow. The frequency of asthma was 14.9%, suggesting regular progression of the disease. There were slightly more women than men (55.7% women) in the study population and the mean age of the patients was 31 years. Most of the patients (65.5%) were recruited in the dry season (November to May). Based on peak expiratory flow measurements, intermittent asthma was the most frequent type of asthma observed (37.8%), followed by moderate persistent asthma (34.4%), mild persistent asthma (18%) and severe persistent asthma (9.8%). The mean cost per episode of asthma was $36 (US) and the mean cost per patient was $432 (US) per year. In 52.45% of cases, the drugs required were available and the patient had access to them. They were available but not accessible in 26.22% of cases. To improve the management of asthma in countries with limited financial resources, generic drugs should be made available.

Adolescent↗

PubMedDate not supplied

[Methotrexate, liver and rheumatoid arthritis in tropical areas].

Rheumatoid arthritis (RA) is a common disease in tropical areas. Methotrexate which has become the main first-line treatment in western countries is increasingly used in tropics. Well documented liver toxicity of methotrexate led the American College of Rheumatology to provide guidelines about monitoring patients. In endemic areas of hepatitis B and C methotrexate may interfere with the natural history of these infections and exarcerbate liver damage, on the other hand, RA causes extra-articular manifestations which are rare and exceptionnally serious in the liver. The most important hepatic disorders associated with RA are: intrahepatic portal hypertension without cirrhosis, amyloidosis, drug hepato-toxicity and viral interferences. - Intrahepatic portal hypertension Several cases of portal hypertension without cirrhosis have been reported. Most cases were related to Nodural Regenerative Hyperplasia (NRH) which is made of diffuse nodules of hepatocytes without fibrosis. The pathogenesis of this entity is unknown. Distal vascular changes and abnormal perfusion of liver are mentioned. Presentation is cholestasis in one third of cases. Portal hypertension has no particularity and may cause esophageal variceal bleeding. NRH is closely associateed with Felty's syndrome. - Amyloidosis Hepatic amyloidosis is a classical complication of RA even rare. It is a secondary amyloidosis of AA type. Hepatic injury is generally silent and renal symptoms are dominant. - Drug hepatotoxicity Several medications used in the management of RA are potentially hepatotoxic : salicylates, nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, gold, sulfasalazine and methotrexate above all. Methotrexate hepatotoxicity is well documented in carcinology with high doses but also in psoriasis patients treated with low doses. Hepatic damage related to methotrexate includes elevation of aminotransferases, portal fibrosis and cirrhosis. But data on methotrexate toxicity show small risk of serious liver disease in RA patients. Long duration of therapy and age (> 60 years) have been found to be independent risk factors for the development of hepatic disease. Other identified risk factors are alcohol intake, diabetes, obesity and prior history of hepatitis B or C. The American College of Rheumatology has published guidelines about monitoring patients for liver toxicity. Hepatic tests and Hepatitis B and C serologic studies are recommended before starting treatment with methotrexate. Liver biopsy is only recommended in case of alcoholism, prolonged abnormalities of aminotransferases and chronic hepatitis B or C infection. - Methotrexate and hepatitis B or C infection These infections are endemic in tropical areas. Chronic hepatitis B or C is a contra indication for methotrexate therapy, due to the immuno-suppressive effect of the drug. Positive ELISA tests to C virus must be confirmed with RIBA tests to avoïd false positive tests which have been reported in Africa. The "healthy" HBs Ag carrier state is not in theory a contra indication for methotrexate therapy but the risk of hepatitis B reactivation needs a close monitoring. The biological tests required for are sophisticated and quite impossible in routine practice in tropical areas. So HBs Ag carrier state is usually incompatible with methotrexate treatment. Studies would be useful to prove that in endemic areas of viral hepatitis B and C as in western countries, methotrexate is enough safe to become the main first-line treatment of rheumatoid arthritis.

Amyloidosis↗

PubMedDate not supplied

[Malaria morbidity in the urban environment. Study of 353 fever attacks].

The authors make a study of malaria morbidity in Dakar during October and November 1988 in Dakar where malaria is endemic but with a pick in pathophoresis during the rainy season. Out of 353 surveyed cases of malaria, 110 were carriers of Plasmodium falciparum, i.e., 31%. Mean parasitic density was 7462 red cells/mm3 and more than an half of patients got an higher density. Parasitic density was higher in children (0-14 years old) than in adults, but with no significant indication. Malaria fever represents 20.4% of all types of fever observed and was the first cause to consult during the rainy season. Whatever threshold of parasitic density selected parasitologic criterion may be in order to identify a malaria fever, percentage of diagnosis misinterpretation linked up to clinical examination was always higher than 30%.

Adolescent↗

PubMedDate not supplied

[Malaria morbidity in rural and urban areas in Senegal].

During September and November 1987, the authors surveyed the incidence of malaria fever in populations of a rural zone in Casamance and in adults as outpatients in an urban area. In these regions, the malaria is endemic with a recrudescence during the rainy season from July to October. In rural zone, 169 persons were examined. The malaria fevers represented 7.1% of the consultations and 23.3% of fevers. Differences were significantly observed between the parasitic densities of febrile and afebrile patients.

Adolescent↗

PubMedDate not supplied

[Parasitologic investigation in a severe community in Sine (Senegal)].

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Adolescent↗

PubMedDate not supplied

[Keratinophilic telluric Gymnoascacae from Senegal].

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Ascomycota↗