Abdel Kader Traore

A Randomized Trial of Doxycycline for Mansonella perstans Infection

BACKGROUND Mansonella perstans infection is common in areas of Africa where Wuchereria bancrofti, a causative agent of lymphatic filariasis, is endemic. M. perstans is refractory to standard antifilarial therapies. The recent discovery of bacterial endosymbionts (e.g., wolbachia) in most filarial species, including M. perstans, provides new therapeutic options for reducing microfilaremia. METHODS In an open-label, randomized trial, we recruited subjects with M. perstans microfilaremia, with or without concomitant W. bancrofti infection, from four villages in Mali and randomly assigned them to receive doxycycline, at a dose of 200 mg daily for 6 weeks (106 subjects), or no treatment (110). At 6 months, subjects who were coinfected with W. bancrofti underwent a second random assignment, to treatment with a single dose of albendazole (400 mg) and ivermectin (150 microg per kilogram of body weight) or no treatment. Subjects were monitored daily during the first 6-week study period for adverse events. M. perstans and W. bancrofti microfilarial levels were assessed at 6, 12, and 36 months. RESULTS At 12 months, 67 of 69 subjects who had received treatment with doxycycline only (97%) had no detectable M. perstans microfilariae per 60 microl of blood, as compared with 10 of 63 subjects who had received no treatment (16%) (relative risk, 6.18; 95% confidence interval, 3.63 to 11.89; P<0.001). At 36 months, M. perstans microfilaremia remained suppressed in 48 of 64 subjects who had received treatment with doxycycline only (75%), a finding that was consistent with a macrofilaricidal effect of doxycycline. Vomiting was more frequent in the doxycycline-treated group than in the untreated group (17% vs. 4%). CONCLUSIONS These results are consistent with previous findings that M. perstans harbors the intracellular endosymbiont, wolbachia, and suggest that doxycycline is an effective therapy for M. perstans infection. (ClinicalTrials.gov number, NCT00340691.)

Wuchereria bancrofti transmission pattern in southern Mali prior to and following the institution of mass drug administration

BackgroundThe Global Programme to Eliminate Lymphatic Filariasis (GPELF) was launched in 2000 with the goal of stopping transmission of lymphatic filariasis (LF) through yearly mass drug administration (MDA). Although preliminary surveys of the human population in Mali suggested that Wuchereria bancrofti infection was highly endemic in the Sikasso district, baseline entomological data were required to confirm high levels of transmission prior to the selection of villages in this region for a study of the impact of MDA on transmission of LF by anopheline vectors.MethodsW. bancrofti transmission was assessed in 2001 (pre-MDA) and 2002 (post-MDA) in the Central District of Sikasso in southern Mali by dissection of Anopheles mosquitoes caught using the human landing catch (HLC) method. The relative frequencies and molecular forms of An. gambiae complex were determined.ResultsThe majority (86%) of the anopheline vectors captured were identified as An. gambiae complex, and these accounted for >90% of the entomological inoculation rate (EIR) during both years of the study. There was a dramatic decrease in the number of An. gambiae complex mosquitoes captured and in the An. gambiae complex infectivity rates following MDA, accounting for the observed decrease in EIR in 2002 (from 12.55 to 3.79 infective bites per person during the transmission season). An. funestus complex mosquitoes were responsible for a low level of transmission, which was similar during both years of the study (1.2 infective bites per person during the transmission season in 2001 and 1.03 in 2002).ConclusionsBased on the entomological data from this study, the district of Sikasso was confirmed as an area of high W. bancrofti transmission. This led to the selection of this area for a multi-national study on the effects of MDA on LF transmission by anopheline vectors. Comparison of vector transmission parameters prior to and immediately following the first round of MDA demonstrated a significant decrease in overall transmission. Importantly, the dramatic variability in EIR over the transmission season suggests that the efficacy of MDA can be maximized by delivering drug at the beginning of the rainy season (just prior to the peak of transmission).

Tuberculose périfonéale dans un service de médecine interne en milieu tropical: aspects clinique, biologique et laparoscopique Bamako — Mali

RésuméNotre étude rétrospective avait pour objectifs de déterminer la fréquence de la tuberculose péritonéale, d’en décrire les manifestations cliniques, laparoscopiques et les caractéristiques du liquide d’ascite.Ont été inclus dans cette étude les dossiers des malades présentant à la laparoscopie des granulations et/ou des nodules péritonéaux. Dans tous les cas, l’examen anatomo-pathologique de ces lésions avait confirmé le diagnostic de tuberculose péritonéale. 26 dossiers répondaient aux critères d’inclusion (10 hommes et 16 femmes).La tuberculose péritonéale représentait 4,13 % de l’ensemble des cas de tuberculose. L’âge moyen a été de 37,7 ±15 ans avec des extrêmes à 12 et 65 ans.Les signes cliniques ont été dominés par l’ascite (88,5 %) des cas, l’amaigrissement (53,8 %), l’anorexie (53,8 %), la douleur abdominale (42,2 %), l’asthénie (42,3 %) et la fièvre (42,3 %).L’association des granulations aux nodules a été l’anomalie laparoscopique la plus fréquente: 80,76 % (21/26). L’examen direct avec la coloration de Ziehl Neelson et la culture du bacille de Koch (BK) sur milieu de Lowenstein ont été positifs respectivement dans 50 % (3/6) et 60 % (3/5) des cas.En Afrique, la laparoscopie demeure un examen de choix dans le diagnostic de la tuberculose péritonéale. Elle a permis la mise en évidence de granulations: lésions classiques, mais aussi de nodules péritonéaux pouvant faire discuter des métastases péritonéales.SummaryThe objectives of our retrospective study were to determine peritoneal tuberculosis frequency, to describe its laparoscopic and clinical manifestations and the characteristics of the ascitis fluid.The included patients recorded forms were those presenting granulations and/or peritoneal nodules at laparoscopy. In all cases, the anatomical and pathological examination of these lesions confirmed the diagnosis of peritoneal tuberculosis. Twenty-six patients were included in the study: 10 men and 16 women.Peritoneal tuberculosis occurred in 4.13 % of the tuberculosis total case. The mean age was 37.7 ±15 years from 12 to 65 years. The most important clinical signs were ascitis (88.5 %), weight loss (53,8 %), anorexia (53.8 %), abdominal pain (42.2 %), asthenia (42.3 %) and fever (42.3 %).The association of granulations and nodules was the most laparoscopically frequent abnormality: 80.76 % (21/26). The direct examination with Ziehl Neelson coloration and the bacillus of Koch (BK) culture in Lowenstein media were positive in 50 % (3/6) et 60 % (3/5) respectively.In Africa, laparoscopy remains an examination of choice for the diagnostic of peritoneal tuberculosis. It allows the discovery of granulations: classical lesions but also peritoneal nodules that could be discussed as peritoneal metastasis.

Étiologies du syndrome d'hypertension portale en milieu tropical

RésuméLe syndrome d’hypertension portale (HTP) est fréquemment rencontré dans les services de Médecine à Bamako. Cependant, aucune étude au Mali ne lui a été consacrée; d’où l’intérêt de notre étude dont l’objectif était de déterminer la fréquence de l’HTP et ses différentes etiologies.Nous avons réalisé une étude rétrospective allant de janvier 1990 à décembre 1998 et prospective de janvier à décembre 1999.Les malades ayant une HTP et ayant eu une biopsie hépatique ont été inclus. Les dossiers ne comportant pas de résultats de l’examen anatomopathologique n’ont pas été inclus.Les fragments biopsiques ont été prélevés avec une pince à biopsie au cours de la laparoscopie ou par la ponction biopsie hépatique (PBH) à l’aiguille de Menghini. 206 malades répondaient aux critères d’inclusion: 132 hommes et 74 femmes. L’âge moyen était de 43, 2 +/−15 ans avec des extrêmes à 8 et 80 ans.La fréquence de l’HTP a été de 10,9 % (524/4858).Les étiologies ont été dominées par la cirrhose: 43, 2 % (89/206), le cancer primitif du foie: 18,4 % (38/206) et l’hépatite chronique: 14,5 % (30/206). La bilharziose hépatique a été une étiologie rare dans notre série: 3,4 %.SummaryThe portal hypertension syndrome (PHT) is frequently encountered in the Medicine units in Bamako. Nevertheless, in Mali no study has been dedicated to this subject. Our study is thus of particular interest. It aims at determining the frequency of PHT and its different causes.We carried out a retrospective study from January 1990 to December 1998 and a prospective study from January to December 1999.All patients with PHT who were submitted to a liver biopsy have been included. The files of patients with no histological results have not been included.Biopsy fragments have been collected with a biopsy snare during a laparoscopic examination or by liver puncture biopsy with the Menghini’s needle. 206 patients have been included: 132 males and 74 females. The mean age was 43.2 +/− 15 years with extremes of 8 and 80 years.The frequency of PHT was 10.9 % (524/4858). Cirrhosis was the main cause: 43.2 % (89/206), then the primary liver cancer 18.4 % (38/206) followed by chronic hepatitis: 14,5 % (30/206). Liver bilharzia was rare in our series: 3.4 %.