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Papers by Emmanuel Bissagnene
Santé (Montrouge, France)
To report cases of nosocomial chickenpox in medical staff at an infectious diseases unit in Abidj... more To report cases of nosocomial chickenpox in medical staff at an infectious diseases unit in Abidjan. Four medical students, aged 24, 25, 27 and 30 years, all in contact with an index case at the infectious diseases unit and with one another, developed chickenpox. All had risk factors for chickenpox: no vaccination and no previous contact with the varicella zoster virus. The diagnosis was essentially clinical, and treatment was symptomatic and successful in all cases. Nosocomial chickenpox in non-immunocompromised adults illustrates the problems of lack of vaccination and poor hospital hygiene in resource-limited settings.
Bulletin de la Societe de pathologie exotique, 2008
The chronic forms of malaria are scarce. We report a case of an hyperactive malarious splenomegal... more The chronic forms of malaria are scarce. We report a case of an hyperactive malarious splenomegaly. This case concerns a 69 year-old man residing in a village of Côte d'Ivoire. He had massive splenomegaly type IV. He was admitted in hospital for progressive loss of weight and moderate fever He presented also asthenia, anaemia and regular hepatomegaly. The haematological, biochemical, immunological and radiological exams ruled out trypanosomiasis, visceral leishmaniasis, tuberculosis, bilharziasis diseases and neoplasia process. His age, the massive splenomegaly, the anaemia, the high antimalarial IgM antibodies in immunofluorescence and the favourable response to the prolonged administration of antimalarial treatment led to the diagnosis of hyperactive malarious splenomegaly despite the detection of Plasmodium falciparum in blood. This observation allows to underline the frequency of this possible underestimated chronic form of malaria in Africa and shows the necessity to consid...
Bulletin de la Société de pathologie exotique (1990), 2004
Our retrospective study carried out from 1985 to 1998 in the Unit of Infectious Diseases in Abidj... more Our retrospective study carried out from 1985 to 1998 in the Unit of Infectious Diseases in Abidjan aimed at describing the epidemiological, clinical and prognosis features of severe malaria among native adults. Within 14 years, we have listed 274 cases of severe malaria for 54 098 hospitalizations (0.5%). 164 men and 110 women were recorded (sex-ratio = 1.5), aged of 33 years (16-86), among them 48% were HIV positive. 23% of the patients had already received an antimalarial treatment. The main clinical presentation was cerebral malaria (78%). The other manifestations were respiratory symptoms (13%), kidney failure (11%), anaemia (11%), macroscopic haemoglobinuria (6%), hypoglycaemia (9%), cardiovascular shock (4%). The average parasite load in blood was 27 222 plasmodium/microl (25 000 - 180200). The treatment used was quinine IV (172 patients), and arthemeter (102 patients). The outcome was favourable in 232 cases (84%) and 42 patients died. Prognosis factors identified were age &...
The International Journal of Tuberculosis and Lung Disease, 2014
Annales Françaises d'Anesthésie et de Réanimation, 2002
Severe malaria in expatriates in an intensive care unit in Abidjan (Ivory Coast). Objective: To a... more Severe malaria in expatriates in an intensive care unit in Abidjan (Ivory Coast). Objective: To analyse clinical and prognosis aspects of severe malaria in expatriates hospitalized between 1990 and 1999 in the intensive care unit in Abidjan. Study design: Retrospective survey Methods: According to the World Health Organization's criteria, the retrospective study of severe cases of malaria who received treatment and care at the intensive care unit. Epidemiological, clinical manifestations and evolution were analysed on each patients. Results: 66 upon 927 expatriates hospitalised in the period of the study, had severe malaria with falciparum Plasmodium (7.12%). The average age was 42 years. Eleven patients took prophylactic treatment (17%). The clinical aspects were neurological (83%) followed by renal failure (48%), haemoglobinuria (48%) and hyperparasitemia (59%). During the hospitalisation we recorded 12 deaths (18%). The criteria that were associated with mortality in pejorative order were: coma (RR=8.04), respiratory distress (RR = 5.06), metabolic acidosis (RR = 5.06), shock (RR = 3.67) and convulsions (RR = 2.86). Conclusion: Severe malaria was frequent and associated with high mortality in expatriates who are living in Africa. This study reinsists the necessity of prophylactic treatment to be reinforced in informing the travellers. This study showed frequency and mortality rate of survey of malaria
Médecine et Maladies Infectieuses, 2006
... e Institut de médecine et d'épidémiologie appliquée, fondation internationale Léon-Mba, ... more ... e Institut de médecine et d'épidémiologie appliquée, fondation internationale Léon-Mba, faculté de médecine René-Diderot, hôpital Bichat-Claude-Bernard, rue Henri-Huchard, 75018 Paris, France. ... [2] G. Djomand, T. Roels, T. Ellerbock, D. Hanson, F. Diomandé and B. Monga ...
PLoS ONE, 2012
Background: Cancer is a growing co-morbidity among HIV-infected patients worldwide. With the scal... more Background: Cancer is a growing co-morbidity among HIV-infected patients worldwide. With the scale-up of antiretroviral therapy (ART) in developing countries, cancer will contribute more and more to the HIV/AIDS disease burden. Our objective was to estimate the association between HIV infection and selected types of cancers among patients hospitalized for diagnosis or treatment of cancer in West Africa. Methods: A case-referent study was conducted in referral hospitals in Cô te d'Ivoire and Benin. Each participating clinical ward enrolled all adult patients seeking care for a confirmed diagnosis of cancer and clinicians systematically proposed an HIV test. HIV prevalence was compared between AIDS-defining cancers and a subset of selected non-AIDS defining cancers to a referent group of non-AIDS defining cancers not reported in the literature to be positively or inversely associated with HIV. An unconditional logistic model was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of the risk of being HIV-infected for selected cancers sites compared to a referent group of other cancers. Results: The HIV overall prevalence was 12.3% (CI 10.3-14.4) among the 1,017 cancer cases included. A total of 442 patients constituted the referent group with an HIV prevalence of 4.7% (CI 2.8-6.7). In multivariate analysis, Kaposi sarcoma (OR 62.2 [CI 22.1-175.5]), non-Hodgkin lymphoma (4.0 [CI 2.0-8.0]), cervical cancer (OR 7.9 [CI 3.8-16.7]), anogenital cancer (OR 11.6 [CI 2.9-46.3]) and liver cancer (OR 2.7 [CI 1.1-7.7]) were all associated with HIV infection. Conclusions: In a time of expanding access to ART, AIDS-defining cancers remain highly associated with HIV infection. This is to our knowledge, the first study reporting a significant association between HIV infection and liver cancer in sub-Saharan Africa.
Médecine et Maladies Infectieuses, 1998
Resume Notre etude prospective a concerne 35 cas de meningites purulentes secondaires a une porte... more Resume Notre etude prospective a concerne 35 cas de meningites purulentes secondaires a une ported'entree ORL entre janvier et decembre 1995 au Service des Maladies infectieuses d'Abidjan. L'âge moyen des patients etait de 30 ans avec des extremes de 16 et 68 ans. Le sex-ratio etait de 1,05 pour 51% hommes et 49% femmes. Les portes d'entree etaient sinusiennes (60%), otogenes (34%) et sinusiennes et otogenes (6%). Streptococcus pneumoniae etait le principal germe isole du LCR (83%) mais absent au niveau ORL. Le traitement repose sur l'antibiotherapie associee a la ponction-lavage (15 fois) et a la paracentese (3 fois). Un patient a subi une intervention ORL et trois une intervention neurochirurgicale. La letalite, le taux de complications et de sequelles neuropsychiques etaient respectivement de 23% et de 28,5%.
Médecine et Maladies Infectieuses, 2010
Objectif.-Analyser les prescriptions, la tolérance et l'observance de la prophylaxie antirétrovir... more Objectif.-Analyser les prescriptions, la tolérance et l'observance de la prophylaxie antirétrovirale après expositions non professionnelles au VIH à Abidjan. Méthode.-Nous avons étudié rétrospectivement toutes les chimioprophylaxies antirétrovirales postexpositions non professionnelles au VIH prescrites entre le 1 er janvier 2000 et le 31 décembre 2007. L'analyse a porté sur les types d'expositions, les caractéristiques sociodémographiques des sujets exposés, les prescriptions d'antirétroviraux, l'observance, la tolérance et le suivi postexposition. Résultats.-En huit ans, 128 sujets ont été pris en charge pour expositions non professionnelles au VIH (50 hommes [39 %], 78 femmes [61 %]), avec un âge moyen de 24,8 ans (4-54 ans). Il s'agissait principalement de viols (n = 74), de ruptures de préservatifs (n = 29) et de rapports sexuels occasionnels sans préservatifs (n = 21). Le délai moyen de consultation était de 20,8 heures. La trithérapie postexposition comportait un inhibiteur de protéase dans 93 % des cas ; 80,5 % des sujets ont achevé les 28 jours de traitement, tandis que 18,6 % ont interrompu le traitement et 10,9 % ont été perdus de vue. Les effets secondaires rapportés par 79 sujets exposés (61,7 %) étaient essentiellement digestifs. Au troisième mois, seuls 34 sujets exposés (26,6 %) ont été revus pour le contrôle VIH, sans séroconversion documentée. Conclusion.-Les accidents entraînant une contamination sexuelle potentielle au VIH sont les principales indications de la chimioprophylaxie antirétrovirale (ARV) à Abidjan en dehors des accidents d'exposition au sang (AES) professionnels. Cependant, leur accessibilité devrait être plus étendue dans les unités de premier contact que sont les services d'urgences des grands centres hospitaliers.
The Lancet, 2006
Structured treatment interruptions of highly-active antiretroviral therapy (HAART) might be parti... more Structured treatment interruptions of highly-active antiretroviral therapy (HAART) might be particularly relevant for sub-Saharan Africa, where cost-saving strategies could help to increase the number of patients on HAART. We did a randomised trial of structured treatment interruption in Abidjan, Côte d'Ivoire. HIV-infected adults were randomised to receive continuous HAART (CT), CD4-guided HAART (CD4GT) with interruption and reintroduction thresholds at 350 and 250 cells per mm3, respectively, or 2-months-off, 4-months-on HAART. Primary endpoints were death and severe morbidity (any WHO stage 3 or 4 events and any events leading to death) at month 24. We report data from the CT and CD4GT groups until Oct 31, 2005, when the data safety monitoring board recommended to prematurely stop the CD4GT arm. Analyses were intention-to-treat. This study is registered at ClinicalTrials.gov, number NCT00158405. 326 adults (median CD4 count nadir 272 per mm3) were randomised to the CT or CD4GT groups and followed up for median of 20 months. Incidence of mortality (per 100 person-years) was not different between groups (CT 0.6, CD4GT 1.2; p=0.57). Incidence of severe morbidity (per 100 person-years) was higher in the CDG4T group (17.6) than in the CT group (6.7; p=0.001). The most frequent severe events were invasive bacterial diseases. 79% of severe morbidity episodes occurred in patients with CD4 count 200-500 per mm3. Patients on CD4GT had severe morbidity rates 2.5-fold higher than those on CT. This difference was mainly due to high rates of common diseases in patients with CD4 count 200-500 per mm3. This CD4-guided structured treatment interruption strategy should not be recommended in Abidjan.
Médecine et Maladies Infectieuses, 2010
Médecine et maladies …, 2002
Objectifs-Évaluer le niveau de connaissance des personnels de la santé, la conduite à tenir en ca... more Objectifs-Évaluer le niveau de connaissance des personnels de la santé, la conduite à tenir en cas d'accidents d'exposition au sang (AES) et les mesures de prévention dans les trois Centres Hospitaliers Universitaires (CHU) d'Abidjan. Méthodes-De février à avril 1999, nous avons mené une enquête transversale dans les 3 CHU d'Abidjan. Médecins, infirmiers, et étudiants hospitaliers devaient répondre à un questionnaire anonyme concernant leur profil socio-démographique et leurs antécédents d'AES. Résultats-Sur 936 personnes, 707 (75,5 %) ont répondu. Parmi ceux-ci, 406 (57,4 %) étaient des infirmiers, 184 (26 %) des médecins et 117 (16,6 %) des étudiants hospitaliers. Des antécédents d'AES ont été rapportés dans 60 % des cas. Les piqûres avec aiguilles usagées constituaient l'accident le plus fréquent (44 %). Les infirmiers et les médecins étaient les plus concernés respectivement 22,5 % et 18 %. 86,5 % des accidentés désinfectaient la plaie immédiatement mais seulement 15 % ont déclaré leur accident. Seulement 16 accidentés ont fait une sérologie VIH initiale. 84,6 % reconnaissaient la nécessité de déclarer tout AES, et 70 % connaissaient le principe des mesures d'hygiène universelle. 298 étaient pour une chimioprophylaxie antirétrovirale après exposition au sang d'un patient VIH positif, 28 % pour une trithérapie, 16 % pour une bithérapie et 44,3 % pour une monothérapie sous zidovudine. Conclusion-Le personnel soignants a un risque élevé d'AES, mais la majorité des accidents n'est pas déclarée. L'information doit rtre axéesur le respect des recommandations, l'identification d'un circuit de déclaration, l'importance du suivi systématique des sérologies virales et l'intérêt du traitement prophylactique. 2002 Éditions scientifiques et médicales Elsevier SAS accidents d'exposition au sang / personnel soignant / VIH Summary-Assessment of practice and knowledge of health care workers on occupational exposure to blood (Abidjan, Ivory Coast). Objective-The authors wanted to assess the knowledge of health care workers on management procedures, and infection control measures for accidental exposure to blood (AEB), in the 3 Abidjan teaching hospital. Methods-A cross-sectional study was made from February to April 1999. Physicians, nurses and medical students were requested to answer anonymously a questionnaire on their demographic profile and past percutaneous and mucocutaneous exposure to blood. Results-Nine hundred and thirty six people were solicited but only 707 (75.5%) answered. Four hundred and six (57.4%) were nurses, 184 (26%) were physicians, and 117 (16.6%) were medical students. Overall, 60% of them reported AEB. Needlestick injuries accounted for 44% of reported accidents. The highest frequency of accidents was observed among nurses (22.5%), and physicians (18%). 86.5% of workers having reported an incident claimed to have disinfected the lesion and only 15% reported the accident after injury. 16% had HIV * Correspondance et tirés à part.
Médecine et Maladies Infectieuses, 2010
Médecine et Maladies Infectieuses, 1994
Resume La cryptococcose neuromeningee a pris une importance croissante en Afrique depuis l'av... more Resume La cryptococcose neuromeningee a pris une importance croissante en Afrique depuis l'avenement du SIDA. Entre 1985–1993, nous en avons hospitalise a Abidjan 149 cas, contre 4 cas de 1969 a 1980. Deux malades etaient VIH negatifs, 141 etaient VIH positifs (94,6 %) mais 6 n'avaient pas ete testes. Cliniquement il s'agissait de meningite pure (17,4 %) de meningoencephalite (80,5 %) de forme asymptomatique (2,1 %) et de forme disseminee (8,5 %). La letalite etait de 86,5 %, mais elle etait moins elevee de maniere statistiquement significative pour les protocoles a base de fluconazole seul ou en relais de l'amphotericine (70 %) par rapport a l'amphotericine seule ou associee a la fluorocytosine (90,2 %). Cette etude montre l'importance et les difficultes diagnostiques et therapeutiques actuelles de la cryptococcose en Cote d'Ivoire.
Antiviral Therapy, 2009
Three men (aged 33, 44 and 45 years, CD4(+) T-cell nadir 86 cells/mm(3), 99 cells/mm(3) and 12 ce... more Three men (aged 33, 44 and 45 years, CD4(+) T-cell nadir 86 cells/mm(3), 99 cells/mm(3) and 12 cells/mm(3), respectively) were admitted to the Department of Infectious Diseases (Treichville Hospital, Abidjan, Côte d'Ivoire) for hip pain and impaired mobility. Their last available CD4(+) T-cell counts were 243 cells/mm(3), 245 cells/mm(3) and 8 cells/mm(3), respectively. They had all received antiretroviral therapy for >4 years, including lopinavir/ritonavir for >8 months. The other risk factors were hypertriglyceridaemia (n=3), smoking addiction (n=2), alcohol consumption (n=2) and lipodystrophy (n=1). All three patients had heterozygous haemoglobin AS sickle cell disease (percentage of haemoglobin S 41%, 45% and 50%, respectively). The diagnosis of avascular osteonecrosis of the femoral head (unilateral n=2 and bilateral n=1) was documented by CT scan. Only one patient underwent surgical arthroplasty. In resource-limited settings, avascular osteonecrosis is uneasy to diag...
Cancer Epidemiology, 2015
The consequences of the HIV epidemic on cancer epidemiology are sparsely documented in Africa. We... more The consequences of the HIV epidemic on cancer epidemiology are sparsely documented in Africa. We aimed to estimate the association between HIV infection and selected types of cancers among patients hospitalized for cancer in four West African countries. A case-referent study was conducted in referral hospitals of Benin, Côte d'Ivoire, Nigeria and Togo. Each participating clinical ward included all adult patients seeking care with a confirmed diagnosis of cancer. All patients were systematically screened for HIV infection. HIV prevalence of AIDS-defining and some non-AIDS defining cancers (Hodgkin lymphoma, leukaemia, liver, lung, skin, pharynx, larynx, oral cavity and anogenital cancers) were compared to a referent group of cancers reported in the literature as not associated with HIV. Odds ratios adjusted on age, gender and lifetime number of sexual partners (aOR) and their 95% confidence intervals (CI) were estimated. Among
The New England journal of medicine, Jan 27, 2015
In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis i... more In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 ...
Antivir Ther, 2005
Objective: Neutropenia is the most frequent side effect of cotrimoxazole in sub-Saharan Africa. W... more Objective: Neutropenia is the most frequent side effect of cotrimoxazole in sub-Saharan Africa. We estimated the incidence of haematological disorders during the first 6 months of a zidovudine-containing highly active antiretroviral therapy (HAART) regimen in sub-Saharan African adults receiving cotrimoxazole. Methods: Prospective cohort study in Abidjan, with blood cell count measurement at baseline (HAART initiation), month 1, month 3 and month 6. Results: A total of 498 adults [baseline: 80% currently on cotrimoxazole prophylaxis; median CD4 count 237/mm 3 [interquartile range (IQR) 181;316]; median neutrophil count 1647/mm 3 (IQR 1221;2256); median haemoglobin 113 g/l (IQR 102;122)] started zidovudine (AZT)/lamivudine/efavirenz. During follow-up, 118 patients had a grade 3-4 neutropenia [(56.3/100 person-years (PY)], 23 had a grade 3-4 anaemia (9.6/100 PY) and no cases of grade 3-4 thrombocytopenia. Of the 118 patients with grade 3-4 neutropenia, 86 (73%) had to stop cotrimoxazole because neutropenia persisted, and one (<1%) had to stop AZT because of persistent neutropenia after cotrimoxazole was stopped (neutropenia-related HAART modification: 0.4/100 PY). Of the 23 patients with grade 3-4 anaemia, 11 had to stop AZT (anaemia-related HAART modification: 4.4/100 PY). In patients who stopped cotrimoxazole but not AZT, the median gain in neutrophils at 1 month was +540/mm 3 (IQR +150;+896). Conclusions: At baseline, most patients had a normal neutrophil count and 80% of them were already receiving cotrimoxazole. An unexpectedly high rate of grade 3-4 neutropenia occurred shortly after introduction of AZT. Almost all of the persistent severe neutropenia disappeared after cotrimoxazole was stopped. This suggests an accentuated drug interaction between the two drugs in these sub-Saharan African individuals. Grade 3-4 anaemia was much less frequent, but remained the first cause of AZT discontinuation.
Journal of Infectious …, 2009
Background. A randomized trial was launched in Côte d'Ivoire in 2002 to compare continuous antire... more Background. A randomized trial was launched in Côte d'Ivoire in 2002 to compare continuous antiretroviral treatment (hereafter, "C-ART") to an ART regimen of 2 months off and 4 months on therapy (hereafter, "2/4-ART"). We report the final analysis. Methods. A total of 435 adults who were receiving successful ART ((median CD4 cell count prior to ART, 272 cells/mm 3 ; 88% were receiving a zidovudine-lamivudine-efavirenz regimen) were randomized to receive CART or 2/4-ART. The main primary end point was the percentage of patients with Ͻ350 CD4 cells/mm 3 at 24 months. The sample size ensured 80% power to demonstrate noninferiority (noninferiority bound, Ϫ15%), assuming that 30% of the patients in the CART arm would have Ͻ350 CD4 cells/mm 3. Other end points were mortality, morbidity, cost of care, genotypic resistance, adherence, and toxicity. Results. The percentage of patients with Ͻ350 CD4 cells/mm 3 at 24 months was 5.6% (6 of 107) in the CART arm and 14.6% (46 of 315) in the 2/4-ART arm (lower bound of the 95% CI for the difference, Ϫ14%). Cost was 18% higher in the CART arm, and resistance to nonnucleoside reverse-transcriptase inhibitors (NNRTIs) was 20% higher in the 2/4-ART arm. Other end points were nonconclusive. Conclusions. Although 2/4-ART met the predetermined criteria for noninferiority, the percentage of patients with Ͻ350 CD4 cells/mm 3 in the CART arm was lower than anticipated, which makes the clinical significance of this noninferiority uncertain. In addition, 2/4-ART led to an unacceptable additional risk of selecting for drug-resistant virus. This new argument against episodic ART strategies is also a caveat against any unplanned ART interruptions in Africa, where most patients receive NNRTIs. Trial registration. ClinicalTrials.gov identifier: NCT00158405.
The Lancet. Global health, 2017
Temprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretrovira... more Temprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretroviral therapy (ART; ie, in patients who had not reached the CD4 cell count threshold used to recommend starting ART, as per the WHO guidelines that were the standard during the study period) and 6-month isoniazid preventive therapy (IPT) in HIV-infected adults in Côte d'Ivoire. Early ART and IPT were shown to independently reduce the risk of severe morbidity at 30 months. Here, we present the efficacy of IPT in reducing mortality from the long-term follow-up of Temprano. For Temprano, participants were randomly assigned to four groups (deferred ART, deferred ART plus IPT, early ART, or early ART plus IPT). Participants who completed the trial follow-up were invited to participate in a post-trial phase. The primary post-trial phase endpoint was death, as analysed by the intention-to-treat principle. We used Cox proportional models to compare all-cause mortality between the IPT and no IPT ...
Santé (Montrouge, France)
To report cases of nosocomial chickenpox in medical staff at an infectious diseases unit in Abidj... more To report cases of nosocomial chickenpox in medical staff at an infectious diseases unit in Abidjan. Four medical students, aged 24, 25, 27 and 30 years, all in contact with an index case at the infectious diseases unit and with one another, developed chickenpox. All had risk factors for chickenpox: no vaccination and no previous contact with the varicella zoster virus. The diagnosis was essentially clinical, and treatment was symptomatic and successful in all cases. Nosocomial chickenpox in non-immunocompromised adults illustrates the problems of lack of vaccination and poor hospital hygiene in resource-limited settings.
Bulletin de la Societe de pathologie exotique, 2008
The chronic forms of malaria are scarce. We report a case of an hyperactive malarious splenomegal... more The chronic forms of malaria are scarce. We report a case of an hyperactive malarious splenomegaly. This case concerns a 69 year-old man residing in a village of Côte d'Ivoire. He had massive splenomegaly type IV. He was admitted in hospital for progressive loss of weight and moderate fever He presented also asthenia, anaemia and regular hepatomegaly. The haematological, biochemical, immunological and radiological exams ruled out trypanosomiasis, visceral leishmaniasis, tuberculosis, bilharziasis diseases and neoplasia process. His age, the massive splenomegaly, the anaemia, the high antimalarial IgM antibodies in immunofluorescence and the favourable response to the prolonged administration of antimalarial treatment led to the diagnosis of hyperactive malarious splenomegaly despite the detection of Plasmodium falciparum in blood. This observation allows to underline the frequency of this possible underestimated chronic form of malaria in Africa and shows the necessity to consid...
Bulletin de la Société de pathologie exotique (1990), 2004
Our retrospective study carried out from 1985 to 1998 in the Unit of Infectious Diseases in Abidj... more Our retrospective study carried out from 1985 to 1998 in the Unit of Infectious Diseases in Abidjan aimed at describing the epidemiological, clinical and prognosis features of severe malaria among native adults. Within 14 years, we have listed 274 cases of severe malaria for 54 098 hospitalizations (0.5%). 164 men and 110 women were recorded (sex-ratio = 1.5), aged of 33 years (16-86), among them 48% were HIV positive. 23% of the patients had already received an antimalarial treatment. The main clinical presentation was cerebral malaria (78%). The other manifestations were respiratory symptoms (13%), kidney failure (11%), anaemia (11%), macroscopic haemoglobinuria (6%), hypoglycaemia (9%), cardiovascular shock (4%). The average parasite load in blood was 27 222 plasmodium/microl (25 000 - 180200). The treatment used was quinine IV (172 patients), and arthemeter (102 patients). The outcome was favourable in 232 cases (84%) and 42 patients died. Prognosis factors identified were age &...
The International Journal of Tuberculosis and Lung Disease, 2014
Annales Françaises d'Anesthésie et de Réanimation, 2002
Severe malaria in expatriates in an intensive care unit in Abidjan (Ivory Coast). Objective: To a... more Severe malaria in expatriates in an intensive care unit in Abidjan (Ivory Coast). Objective: To analyse clinical and prognosis aspects of severe malaria in expatriates hospitalized between 1990 and 1999 in the intensive care unit in Abidjan. Study design: Retrospective survey Methods: According to the World Health Organization's criteria, the retrospective study of severe cases of malaria who received treatment and care at the intensive care unit. Epidemiological, clinical manifestations and evolution were analysed on each patients. Results: 66 upon 927 expatriates hospitalised in the period of the study, had severe malaria with falciparum Plasmodium (7.12%). The average age was 42 years. Eleven patients took prophylactic treatment (17%). The clinical aspects were neurological (83%) followed by renal failure (48%), haemoglobinuria (48%) and hyperparasitemia (59%). During the hospitalisation we recorded 12 deaths (18%). The criteria that were associated with mortality in pejorative order were: coma (RR=8.04), respiratory distress (RR = 5.06), metabolic acidosis (RR = 5.06), shock (RR = 3.67) and convulsions (RR = 2.86). Conclusion: Severe malaria was frequent and associated with high mortality in expatriates who are living in Africa. This study reinsists the necessity of prophylactic treatment to be reinforced in informing the travellers. This study showed frequency and mortality rate of survey of malaria
Médecine et Maladies Infectieuses, 2006
... e Institut de médecine et d'épidémiologie appliquée, fondation internationale Léon-Mba, ... more ... e Institut de médecine et d'épidémiologie appliquée, fondation internationale Léon-Mba, faculté de médecine René-Diderot, hôpital Bichat-Claude-Bernard, rue Henri-Huchard, 75018 Paris, France. ... [2] G. Djomand, T. Roels, T. Ellerbock, D. Hanson, F. Diomandé and B. Monga ...
PLoS ONE, 2012
Background: Cancer is a growing co-morbidity among HIV-infected patients worldwide. With the scal... more Background: Cancer is a growing co-morbidity among HIV-infected patients worldwide. With the scale-up of antiretroviral therapy (ART) in developing countries, cancer will contribute more and more to the HIV/AIDS disease burden. Our objective was to estimate the association between HIV infection and selected types of cancers among patients hospitalized for diagnosis or treatment of cancer in West Africa. Methods: A case-referent study was conducted in referral hospitals in Cô te d'Ivoire and Benin. Each participating clinical ward enrolled all adult patients seeking care for a confirmed diagnosis of cancer and clinicians systematically proposed an HIV test. HIV prevalence was compared between AIDS-defining cancers and a subset of selected non-AIDS defining cancers to a referent group of non-AIDS defining cancers not reported in the literature to be positively or inversely associated with HIV. An unconditional logistic model was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of the risk of being HIV-infected for selected cancers sites compared to a referent group of other cancers. Results: The HIV overall prevalence was 12.3% (CI 10.3-14.4) among the 1,017 cancer cases included. A total of 442 patients constituted the referent group with an HIV prevalence of 4.7% (CI 2.8-6.7). In multivariate analysis, Kaposi sarcoma (OR 62.2 [CI 22.1-175.5]), non-Hodgkin lymphoma (4.0 [CI 2.0-8.0]), cervical cancer (OR 7.9 [CI 3.8-16.7]), anogenital cancer (OR 11.6 [CI 2.9-46.3]) and liver cancer (OR 2.7 [CI 1.1-7.7]) were all associated with HIV infection. Conclusions: In a time of expanding access to ART, AIDS-defining cancers remain highly associated with HIV infection. This is to our knowledge, the first study reporting a significant association between HIV infection and liver cancer in sub-Saharan Africa.
Médecine et Maladies Infectieuses, 1998
Resume Notre etude prospective a concerne 35 cas de meningites purulentes secondaires a une porte... more Resume Notre etude prospective a concerne 35 cas de meningites purulentes secondaires a une ported'entree ORL entre janvier et decembre 1995 au Service des Maladies infectieuses d'Abidjan. L'âge moyen des patients etait de 30 ans avec des extremes de 16 et 68 ans. Le sex-ratio etait de 1,05 pour 51% hommes et 49% femmes. Les portes d'entree etaient sinusiennes (60%), otogenes (34%) et sinusiennes et otogenes (6%). Streptococcus pneumoniae etait le principal germe isole du LCR (83%) mais absent au niveau ORL. Le traitement repose sur l'antibiotherapie associee a la ponction-lavage (15 fois) et a la paracentese (3 fois). Un patient a subi une intervention ORL et trois une intervention neurochirurgicale. La letalite, le taux de complications et de sequelles neuropsychiques etaient respectivement de 23% et de 28,5%.
Médecine et Maladies Infectieuses, 2010
Objectif.-Analyser les prescriptions, la tolérance et l'observance de la prophylaxie antirétrovir... more Objectif.-Analyser les prescriptions, la tolérance et l'observance de la prophylaxie antirétrovirale après expositions non professionnelles au VIH à Abidjan. Méthode.-Nous avons étudié rétrospectivement toutes les chimioprophylaxies antirétrovirales postexpositions non professionnelles au VIH prescrites entre le 1 er janvier 2000 et le 31 décembre 2007. L'analyse a porté sur les types d'expositions, les caractéristiques sociodémographiques des sujets exposés, les prescriptions d'antirétroviraux, l'observance, la tolérance et le suivi postexposition. Résultats.-En huit ans, 128 sujets ont été pris en charge pour expositions non professionnelles au VIH (50 hommes [39 %], 78 femmes [61 %]), avec un âge moyen de 24,8 ans (4-54 ans). Il s'agissait principalement de viols (n = 74), de ruptures de préservatifs (n = 29) et de rapports sexuels occasionnels sans préservatifs (n = 21). Le délai moyen de consultation était de 20,8 heures. La trithérapie postexposition comportait un inhibiteur de protéase dans 93 % des cas ; 80,5 % des sujets ont achevé les 28 jours de traitement, tandis que 18,6 % ont interrompu le traitement et 10,9 % ont été perdus de vue. Les effets secondaires rapportés par 79 sujets exposés (61,7 %) étaient essentiellement digestifs. Au troisième mois, seuls 34 sujets exposés (26,6 %) ont été revus pour le contrôle VIH, sans séroconversion documentée. Conclusion.-Les accidents entraînant une contamination sexuelle potentielle au VIH sont les principales indications de la chimioprophylaxie antirétrovirale (ARV) à Abidjan en dehors des accidents d'exposition au sang (AES) professionnels. Cependant, leur accessibilité devrait être plus étendue dans les unités de premier contact que sont les services d'urgences des grands centres hospitaliers.
The Lancet, 2006
Structured treatment interruptions of highly-active antiretroviral therapy (HAART) might be parti... more Structured treatment interruptions of highly-active antiretroviral therapy (HAART) might be particularly relevant for sub-Saharan Africa, where cost-saving strategies could help to increase the number of patients on HAART. We did a randomised trial of structured treatment interruption in Abidjan, Côte d&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Ivoire. HIV-infected adults were randomised to receive continuous HAART (CT), CD4-guided HAART (CD4GT) with interruption and reintroduction thresholds at 350 and 250 cells per mm3, respectively, or 2-months-off, 4-months-on HAART. Primary endpoints were death and severe morbidity (any WHO stage 3 or 4 events and any events leading to death) at month 24. We report data from the CT and CD4GT groups until Oct 31, 2005, when the data safety monitoring board recommended to prematurely stop the CD4GT arm. Analyses were intention-to-treat. This study is registered at ClinicalTrials.gov, number NCT00158405. 326 adults (median CD4 count nadir 272 per mm3) were randomised to the CT or CD4GT groups and followed up for median of 20 months. Incidence of mortality (per 100 person-years) was not different between groups (CT 0.6, CD4GT 1.2; p=0.57). Incidence of severe morbidity (per 100 person-years) was higher in the CDG4T group (17.6) than in the CT group (6.7; p=0.001). The most frequent severe events were invasive bacterial diseases. 79% of severe morbidity episodes occurred in patients with CD4 count 200-500 per mm3. Patients on CD4GT had severe morbidity rates 2.5-fold higher than those on CT. This difference was mainly due to high rates of common diseases in patients with CD4 count 200-500 per mm3. This CD4-guided structured treatment interruption strategy should not be recommended in Abidjan.
Médecine et Maladies Infectieuses, 2010
Médecine et maladies …, 2002
Objectifs-Évaluer le niveau de connaissance des personnels de la santé, la conduite à tenir en ca... more Objectifs-Évaluer le niveau de connaissance des personnels de la santé, la conduite à tenir en cas d'accidents d'exposition au sang (AES) et les mesures de prévention dans les trois Centres Hospitaliers Universitaires (CHU) d'Abidjan. Méthodes-De février à avril 1999, nous avons mené une enquête transversale dans les 3 CHU d'Abidjan. Médecins, infirmiers, et étudiants hospitaliers devaient répondre à un questionnaire anonyme concernant leur profil socio-démographique et leurs antécédents d'AES. Résultats-Sur 936 personnes, 707 (75,5 %) ont répondu. Parmi ceux-ci, 406 (57,4 %) étaient des infirmiers, 184 (26 %) des médecins et 117 (16,6 %) des étudiants hospitaliers. Des antécédents d'AES ont été rapportés dans 60 % des cas. Les piqûres avec aiguilles usagées constituaient l'accident le plus fréquent (44 %). Les infirmiers et les médecins étaient les plus concernés respectivement 22,5 % et 18 %. 86,5 % des accidentés désinfectaient la plaie immédiatement mais seulement 15 % ont déclaré leur accident. Seulement 16 accidentés ont fait une sérologie VIH initiale. 84,6 % reconnaissaient la nécessité de déclarer tout AES, et 70 % connaissaient le principe des mesures d'hygiène universelle. 298 étaient pour une chimioprophylaxie antirétrovirale après exposition au sang d'un patient VIH positif, 28 % pour une trithérapie, 16 % pour une bithérapie et 44,3 % pour une monothérapie sous zidovudine. Conclusion-Le personnel soignants a un risque élevé d'AES, mais la majorité des accidents n'est pas déclarée. L'information doit rtre axéesur le respect des recommandations, l'identification d'un circuit de déclaration, l'importance du suivi systématique des sérologies virales et l'intérêt du traitement prophylactique. 2002 Éditions scientifiques et médicales Elsevier SAS accidents d'exposition au sang / personnel soignant / VIH Summary-Assessment of practice and knowledge of health care workers on occupational exposure to blood (Abidjan, Ivory Coast). Objective-The authors wanted to assess the knowledge of health care workers on management procedures, and infection control measures for accidental exposure to blood (AEB), in the 3 Abidjan teaching hospital. Methods-A cross-sectional study was made from February to April 1999. Physicians, nurses and medical students were requested to answer anonymously a questionnaire on their demographic profile and past percutaneous and mucocutaneous exposure to blood. Results-Nine hundred and thirty six people were solicited but only 707 (75.5%) answered. Four hundred and six (57.4%) were nurses, 184 (26%) were physicians, and 117 (16.6%) were medical students. Overall, 60% of them reported AEB. Needlestick injuries accounted for 44% of reported accidents. The highest frequency of accidents was observed among nurses (22.5%), and physicians (18%). 86.5% of workers having reported an incident claimed to have disinfected the lesion and only 15% reported the accident after injury. 16% had HIV * Correspondance et tirés à part.
Médecine et Maladies Infectieuses, 2010
Médecine et Maladies Infectieuses, 1994
Resume La cryptococcose neuromeningee a pris une importance croissante en Afrique depuis l'av... more Resume La cryptococcose neuromeningee a pris une importance croissante en Afrique depuis l'avenement du SIDA. Entre 1985–1993, nous en avons hospitalise a Abidjan 149 cas, contre 4 cas de 1969 a 1980. Deux malades etaient VIH negatifs, 141 etaient VIH positifs (94,6 %) mais 6 n'avaient pas ete testes. Cliniquement il s'agissait de meningite pure (17,4 %) de meningoencephalite (80,5 %) de forme asymptomatique (2,1 %) et de forme disseminee (8,5 %). La letalite etait de 86,5 %, mais elle etait moins elevee de maniere statistiquement significative pour les protocoles a base de fluconazole seul ou en relais de l'amphotericine (70 %) par rapport a l'amphotericine seule ou associee a la fluorocytosine (90,2 %). Cette etude montre l'importance et les difficultes diagnostiques et therapeutiques actuelles de la cryptococcose en Cote d'Ivoire.
Antiviral Therapy, 2009
Three men (aged 33, 44 and 45 years, CD4(+) T-cell nadir 86 cells/mm(3), 99 cells/mm(3) and 12 ce... more Three men (aged 33, 44 and 45 years, CD4(+) T-cell nadir 86 cells/mm(3), 99 cells/mm(3) and 12 cells/mm(3), respectively) were admitted to the Department of Infectious Diseases (Treichville Hospital, Abidjan, Côte d'Ivoire) for hip pain and impaired mobility. Their last available CD4(+) T-cell counts were 243 cells/mm(3), 245 cells/mm(3) and 8 cells/mm(3), respectively. They had all received antiretroviral therapy for >4 years, including lopinavir/ritonavir for >8 months. The other risk factors were hypertriglyceridaemia (n=3), smoking addiction (n=2), alcohol consumption (n=2) and lipodystrophy (n=1). All three patients had heterozygous haemoglobin AS sickle cell disease (percentage of haemoglobin S 41%, 45% and 50%, respectively). The diagnosis of avascular osteonecrosis of the femoral head (unilateral n=2 and bilateral n=1) was documented by CT scan. Only one patient underwent surgical arthroplasty. In resource-limited settings, avascular osteonecrosis is uneasy to diag...
Cancer Epidemiology, 2015
The consequences of the HIV epidemic on cancer epidemiology are sparsely documented in Africa. We... more The consequences of the HIV epidemic on cancer epidemiology are sparsely documented in Africa. We aimed to estimate the association between HIV infection and selected types of cancers among patients hospitalized for cancer in four West African countries. A case-referent study was conducted in referral hospitals of Benin, Côte d'Ivoire, Nigeria and Togo. Each participating clinical ward included all adult patients seeking care with a confirmed diagnosis of cancer. All patients were systematically screened for HIV infection. HIV prevalence of AIDS-defining and some non-AIDS defining cancers (Hodgkin lymphoma, leukaemia, liver, lung, skin, pharynx, larynx, oral cavity and anogenital cancers) were compared to a referent group of cancers reported in the literature as not associated with HIV. Odds ratios adjusted on age, gender and lifetime number of sexual partners (aOR) and their 95% confidence intervals (CI) were estimated. Among
The New England journal of medicine, Jan 27, 2015
In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis i... more In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 ...
Antivir Ther, 2005
Objective: Neutropenia is the most frequent side effect of cotrimoxazole in sub-Saharan Africa. W... more Objective: Neutropenia is the most frequent side effect of cotrimoxazole in sub-Saharan Africa. We estimated the incidence of haematological disorders during the first 6 months of a zidovudine-containing highly active antiretroviral therapy (HAART) regimen in sub-Saharan African adults receiving cotrimoxazole. Methods: Prospective cohort study in Abidjan, with blood cell count measurement at baseline (HAART initiation), month 1, month 3 and month 6. Results: A total of 498 adults [baseline: 80% currently on cotrimoxazole prophylaxis; median CD4 count 237/mm 3 [interquartile range (IQR) 181;316]; median neutrophil count 1647/mm 3 (IQR 1221;2256); median haemoglobin 113 g/l (IQR 102;122)] started zidovudine (AZT)/lamivudine/efavirenz. During follow-up, 118 patients had a grade 3-4 neutropenia [(56.3/100 person-years (PY)], 23 had a grade 3-4 anaemia (9.6/100 PY) and no cases of grade 3-4 thrombocytopenia. Of the 118 patients with grade 3-4 neutropenia, 86 (73%) had to stop cotrimoxazole because neutropenia persisted, and one (<1%) had to stop AZT because of persistent neutropenia after cotrimoxazole was stopped (neutropenia-related HAART modification: 0.4/100 PY). Of the 23 patients with grade 3-4 anaemia, 11 had to stop AZT (anaemia-related HAART modification: 4.4/100 PY). In patients who stopped cotrimoxazole but not AZT, the median gain in neutrophils at 1 month was +540/mm 3 (IQR +150;+896). Conclusions: At baseline, most patients had a normal neutrophil count and 80% of them were already receiving cotrimoxazole. An unexpectedly high rate of grade 3-4 neutropenia occurred shortly after introduction of AZT. Almost all of the persistent severe neutropenia disappeared after cotrimoxazole was stopped. This suggests an accentuated drug interaction between the two drugs in these sub-Saharan African individuals. Grade 3-4 anaemia was much less frequent, but remained the first cause of AZT discontinuation.
Journal of Infectious …, 2009
Background. A randomized trial was launched in Côte d'Ivoire in 2002 to compare continuous antire... more Background. A randomized trial was launched in Côte d'Ivoire in 2002 to compare continuous antiretroviral treatment (hereafter, "C-ART") to an ART regimen of 2 months off and 4 months on therapy (hereafter, "2/4-ART"). We report the final analysis. Methods. A total of 435 adults who were receiving successful ART ((median CD4 cell count prior to ART, 272 cells/mm 3 ; 88% were receiving a zidovudine-lamivudine-efavirenz regimen) were randomized to receive CART or 2/4-ART. The main primary end point was the percentage of patients with Ͻ350 CD4 cells/mm 3 at 24 months. The sample size ensured 80% power to demonstrate noninferiority (noninferiority bound, Ϫ15%), assuming that 30% of the patients in the CART arm would have Ͻ350 CD4 cells/mm 3. Other end points were mortality, morbidity, cost of care, genotypic resistance, adherence, and toxicity. Results. The percentage of patients with Ͻ350 CD4 cells/mm 3 at 24 months was 5.6% (6 of 107) in the CART arm and 14.6% (46 of 315) in the 2/4-ART arm (lower bound of the 95% CI for the difference, Ϫ14%). Cost was 18% higher in the CART arm, and resistance to nonnucleoside reverse-transcriptase inhibitors (NNRTIs) was 20% higher in the 2/4-ART arm. Other end points were nonconclusive. Conclusions. Although 2/4-ART met the predetermined criteria for noninferiority, the percentage of patients with Ͻ350 CD4 cells/mm 3 in the CART arm was lower than anticipated, which makes the clinical significance of this noninferiority uncertain. In addition, 2/4-ART led to an unacceptable additional risk of selecting for drug-resistant virus. This new argument against episodic ART strategies is also a caveat against any unplanned ART interruptions in Africa, where most patients receive NNRTIs. Trial registration. ClinicalTrials.gov identifier: NCT00158405.
The Lancet. Global health, 2017
Temprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretrovira... more Temprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretroviral therapy (ART; ie, in patients who had not reached the CD4 cell count threshold used to recommend starting ART, as per the WHO guidelines that were the standard during the study period) and 6-month isoniazid preventive therapy (IPT) in HIV-infected adults in Côte d'Ivoire. Early ART and IPT were shown to independently reduce the risk of severe morbidity at 30 months. Here, we present the efficacy of IPT in reducing mortality from the long-term follow-up of Temprano. For Temprano, participants were randomly assigned to four groups (deferred ART, deferred ART plus IPT, early ART, or early ART plus IPT). Participants who completed the trial follow-up were invited to participate in a post-trial phase. The primary post-trial phase endpoint was death, as analysed by the intention-to-treat principle. We used Cox proportional models to compare all-cause mortality between the IPT and no IPT ...