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Background: Chronic renal failure is a worldwidepublic health issue. In Madagascar, this condition of heavy care is a medical challenge in a low-income country. In 2016, an estimated 8,000 - 10,000 people with kidney failure and only 1.26% have access to hemodialysis. About 30 patients were able to access live organ transplantation abroad.Our objectives are to set up an HLA histocompatibility laboratory providing HLA typing, search for anti-HLA antibodies, and crossmatch. Evaluate the available structures of the Immunology laboratory. Look for partner laboratories for more specialized research. Materials and methods: The Joseph Ravoahangy Andrianavalona University Hospital Immunology Laboratory is equipped with a conventional PCR and real-time PCR platform, an ELISA immunoassay platform, and inverted fluorescence microscope. Results: The techniques to be implemented in Madagascar for the HLA Laboratory are the HLA typing of the donor and the recipient by the PCRSSP and microlymphocytotoxicity (LCT) technique. The search for anti-HLA antibodies will be done by ELISA and LCT and crossmatch in LCT.We have created cooperation with the Réunion France histocompatibility laboratory for the identification of recipient and donor HLA antibodies and crossmatch by Luminex. Conclusion: The presence of HLA platform in Madagascar will allow preparing the establishment of a future kidney transplant in the country but also for improved management of patients waiting on abroad transplant list in regards of donor selection and post-transplant monitoring. Keywords: Kidney transplant, HLA laboratory, Developing country, Madagascar

Les troubles de l'hémostase sont fréquemment observés en réanimation. L'objectif de cette étude est d'en déterminer l'incidence, les étiologies et la prise en charge pour en diminuer le risque de morbi-mortalité. Etude rétrospective sur une période de huit mois en réanimation chirurgicale du CHUA HUJRA. Les dossiers étudiés étaient ceux contenant tous les premiers bilans d'hémostase lors de l'admission du patient en réanimation, avec un âge supérieur à 15 ans. Etaient exclus les dossiers des post opérés (malade ayant subi une intervention chirurgicale). Les dossiers retenus pour l'étude étaient ceux qui ont présenté une ou plusieurs anomalies au niveau du bilan d'hémostase. Cent cinquante-cinq dossiers ont été colligés dont 20,64% ont présenté un trouble de l'hémostase. Les patients de sexe féminin (53,12%) étaient les plus concernés, avec une population âgée en moyenne de 4919 ans. Trois patients (9,37%) ont présenté une notion de diathèse hémorragique à l'interrogatoire. Les différents troubles de l'hémostase étaient: une diminution du taux de prothrombine (100%), un taux de céphaline activé allongé (78,12%), un international normalized ratio élevé (43,75%) et des thrombopénies (40,62%). Chez 3,12% de ces cas, des accidents hémorragiques ont survenu. La plupart de ces troubles de l'hémostase étaient présents au décours d'hémorragies digestives (46,87%) dont la prise en charge était constituée par l'administration de vitamine K1 (68,75%) et de transfusion de plasma frais congelé (65,62%). D'autres pathologies ont été également incriminées. Une incidence de 15,62% de mortalité a été retrouvée. L'existence des troubles de l'hémostase en réanimation constitue un facteur pronostique imposant un dépistage et une prise en charge précoces et adéquats pour pouvoir en réduire le taux de mortalité.

Introduction: onychomycosis is defined as a fungal infection of the nails. They represent the main cause of onychopathy. They constitute a public health problem because of their increased prevalence in the world ranging between 20 to 30%. However, they remain under documented in Madagascar. This study was conducted in order to determine the mycological profile of onychomycosis diagnosed in the Parasitology Mycology laboratory of CHU-JRA. Methods: a descriptive retrospective study was taken over a 13-year period from June 2005 to December 2018. The data presenting onychomycosis on the mycological outcome register were included in the study. Results showing the presence of fungi on direct examination and / or culture were considered positive. Results: during the study period, a prevalence of 17.75% (180/1014) was observed. The age of our patients ranged from 3 to 76 years. Women were the most affected in 68.34% (n = 123) with a sex ratio of 0.46. Onychomycosis was localized in 64.65% of the fingers (n = 128). Simultaneous involvement of the hands and feet was found in 10% of the cases (n = 18). Candida albicans (C. albicans) was the most isolated in 33.03% (n = 71) of cases, followed by other species of Candida (24.65%, n = 53) and Trichophyton spp (9.3%, n=17). Mixed infections associating dermatophytes, Yeasts and molds were found in 23.33% (n = 42) of the cases. Conclusion: this is the first investigation dealing with onychomycosis in Madagascar. These data may be useful for future research and in the development of preventive and educational strategies. [ABSTRACT FROM AUTHOR]

To the Editor: The Indian Ocean was free of cholera for decades, until January 1998, when an outbreak was detected in Comoros Islands (1). On March 23, 1999, the Malagasy [...]

Background: False positivity in blood screening may cause unnecessary deferral of healthy donors and exacerbate blood shortages. An international multicenter study was conducted to estimate the frequency of HCV and HIV false seropositivity in seven African countries (Burundi, Cameroon, Democratic Republic of Congo, Madagascar, Mali, Mauritania, and Niger).Study Design and Methods: Blood donations were tested for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) with rapid detection tests (RDTs), third-generation enzyme immunoassays (EIAs), or fourth-generation EIAs. HCV (456/16,613 [2.74%]) and HIV (249/16,675 [1.49%]) reactive samples were then confirmed with antigen/antibody assays, immunoblots, and nucleic acid testing. Partial viral sequences were analyzed when possible.Results: The HCV reactivity rate with RDTs was significantly lower than with EIAs (0.55% vs. 3.52%; p < 0.0001). The HIV reactivity rate with RDTs was lower than with third-generation EIAs (1.02% vs. 2.38%; p < 0.0001) but similar to a fourth-generation assay (1.09%). Only 16.0% (57/357) and 21.5% (38/177) of HCV and HIV initial reactive samples, respectively, were repeatedly reactive. HCV and HIV infections were confirmed in 13.2% and 13.7%, respectively, of repeated reactive donations. The predominant HCV genotype 2 and 4 strains in West and Central Africa showed high genetic variability. HIV-1 subtype CRF02_AG was most prevalent.Conclusion: High rates (>80%) of unconfirmed anti-HCV and anti-HIV reactivity observed in several sub-Saharan countries highlights the need for better testing and confirmatory strategies for donors screening in Africa. Without confirmatory testing, HCV and HIV prevalence in African blood donors has probably been overestimated. [ABSTRACT FROM AUTHOR]

Background: In Madagascar, the last study on sickle cell disease (SCD) was done in the early 1980s. The country is known as endemic for malaria and respiratory infections. The main objective of this study was to estimate the prevalence of SCD; the secondary objective was to evaluate its association with malaria and respiratory infections. Methods: This is a cross-sectional study which was carried out in a rural village in the south east coast of Madagascar between May 2011 and November 2013. Participants were children aged between 2-59 months presenting with fever measured by axillary temperature ⩾37.5 °C at inclusion. Genotyping of haemoglobin S was done by PCR and malaria was diagnosed by Rapid Diagnostic Test. Research for viral and atypical bacterial respiratory pathogens was performed on nasopharyngeal swabs. Uni-and multivariate polytomous logistic regression was done to assess associations between microbiological results and SCD status, with HbAA phenotype as reference. Results: A total of 807 children were analysed. Prevalence of SCD among febrile children was 2.4% (95% CI, 1.5-3.7%) and that of SCT was 23.8% (95% CI, 20.9-26.9%). There was no difference in the prevalence of malaria infection according to haemoglobin status (p = 0.3). Rhinovirus (22.5%), adenovirus (14.1%), and bocavirus (11.6%) were the most common respiratory pathogens detected. After univariate analysis, patients with SCD were more frequently infected by parechovirus (p = 0.01), while patients with SCT were more prone to RSV A or B infection (p = 0.01). After multivariate analysis, HbAS phenotype was associated with higher risk of RSV A and B infection compared to HbAA (adjusted OR = 1.9; 95% CI: 1.2-3.1, p = 0.009), while HbSS phenotype was associated with higher risk of parechovirus infection (adjusted OR = 6.0; 95% CI: 1.1-31.3, p = 0.03) compared to HbAA, independently of age, gender, period per quarter, and the other viruses. Conclusion: The prevalence of SCD among under-five children presenting with fever was high in the study population. No association was found between SCT and malaria but few viruses, especially parechovirus, seem to play an important role in the occurrence of pneumoniae among SCD patients. [ABSTRACT FROM AUTHOR]

Background: Studies on the possible influence of periodontal disease on preterm birth (PB) and/or low birth weight (LBW) remain inconclusive especially due to the difficulty of assessing the numerous pregnancy risk factors. The aim of this study is to compare periodontal parameters in non-smoking pregnant women in Madagascar. Methods: A cohort study with 204 pregnant women (mean age: 25.6 years) was conducted in public prenatal care health clinics in Madagascar. Socioeconomic and obstetric information was obtained. Periodontal parameters, such as periodontal probing depth and clinical attachment loss (AL), were recorded during the second semester of pregnancy. Results: The mean gestational age was 37.8 weeks. At delivery, 42 newborns (20.6%) were PBs (<37 weeks) and 22 newborns (10.8%) were of LBW (<2,500 g). Nine (4.4%) newborns were PBs and of LBW (PLBW), and 149 newborns (73%) were of normal birth. The mean plaque index and papillary bleeding index were significantly higher (P <0.05 and P <0.001, respectively) in the PB group than in the normal birth group. Periodontitis (at least three sites from different teeth with clinical AL ≥4 mm) was significantly associated with PB (P<0.001), LBW (P<0.001), and PLBW (P<0.01). The rates of periodontitis were considerably higher in PB (78.6%), LBW (77.3%), and PLBW (77.8%) groups than in the full-term (8.6%), normal weight (16.5%), and normal birth (2.7%) groups. Conclusion: The strong association among periodontitis, PB, and LBW in this study highlights the need to consider the periodontal status of pregnant women in Madagascar. J Periodontol 2010;81:205-213. [ABSTRACT FROM AUTHOR]

Presents information on computer viruses and the spread of tetracycline-resistant Vibrio cholerae strains. Categories of computer malware; Discussion on the control of computer contagion through having a knowledge of infectious diseases; Isolation of the Vibrio cholerae strain in Madagascar.

Background and Objectives Materials and Methods Results Conclusion The World Health Organization (WHO) African Region accounts for 94% of malaria cases globally, with variability recognized within endemic regions. To determine the detection rate of Plasmodium RNA in blood donors resident in malaria‐endemic areas, samples from three African countries were tested using a Plasmodium nucleic acid test.Whole blood (WB) samples collected from routine donors in Cameroon, Madagascar and Mali were shipped frozen to the United States. Samples were tested individually from WB lysates with the Procleix Plasmodium assay (transcription‐mediated amplification [TMA]). Reactive samples were considered either repeat reactive or initial reactive only, depending on TMA‐retest results. When available, matching plasma samples were tested for Plasmodium antibodies by enzyme immunoassay (EIA).Plasmodium repeat reactivity ranged from 41% (91/223 tested) in Cameroon to 12% (26/216) in Mali and 1% (3/249) in Madagascar. Initially reactive samples, where reactivity did not repeat, were identified from Cameroon (5/223; 2%) and Mali (2/216; 1%). The matched‐plasma subgroup had EIA reactivity ranging from 86% (113/131 tested) in Cameroon to 59% (10/17) in Mali and 27% (68/248) in Madagascar.Plasmodium ribosomal RNA (rRNA) detection and antibody rates varied greatly in the three countries studied. Detection of Plasmodium rRNA can provide an additional tool to address malaria risk in blood donors. [ABSTRACT FROM AUTHOR]

Objectives We wanted to update the distribution of community-acquired uropathogens and to estimate their susceptibility profile to newly available antibiotics in Antananarivo (Madagascar). Materials and methods We conducted a 3-year preliminary study (2011–2013) on bacteria isolated from the urine of patients at the Laboratory of Training and Research in Medical Biology (Antananarivo). Results Three hundred and fifty-seven pathogens were isolated: 234 (65.55%) Gram-negative bacilli and 123 (34.45%) Gram-positive cocci. The most commonly isolated bacteria were Escherichia coli (89 strains) followed by Staphylococcus aureus (48 strains). Thirty-three percent of Gram-negative bacilli were resistant to 3CG. Forty percent of Klebsiella pneumoniae strains were significantly resistant to imipenem ( P = 0.01). Conclusions The increased resistance to newly available antibiotics and the increased rate of Gram-positive cocci strains require a drastic surveillance of antibiotic resistance to ensure appropriate empirical treatment. [ABSTRACT FROM AUTHOR]

Background and objectives Hepatitis B virus (HBV) infection is a major public health problem in Madagascar. Its severity is related to the risk of chronicity, especially in case of neonatal contamination. Our objectives were to investigate the prevalence of HBV infection among pregnant patients at the Befelatanana obstetrics and gynecology teaching hospital department (BOGTH) by detecting HBsAg and to evaluate the risk of HBV mother to child transmission by screening for HBeAg. Methods We conducted a 6-month prospective study in the BTHOGD from February 2012 to July 2012. All pregnant patients consulting for antenatal care were screened for HBV serologic markers. Results The prevalence of HBsAg was 1.9% (20 out 1050 screened patients). The average age was 26.51 years (25–30 years). Most patients tested were unaware of their hepatitis B status and only 0.38% had been vaccinated before pregnancy. Only 1 (5%) of the 20 patients with HBsAg was positive for HBeAg. Conclusion Hepatitis B is very frequent in pregnant patients in Madagascar and it is recommended that all pregnant patients be routinely screened for HBsAg. This screening of maternal infection would allow applying prophylactic measures to neonates to decrease the risk of disease chronicity. [ABSTRACT FROM AUTHOR]

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of infections. It is well recognized that nasal carriage of S. aureus represents a potent and increasingly prevalent risk factor for subsequent S. aureus infection. However, in Madagascar no data exist concerning this nasal carriage of S. aureus. Methodology: Nasal swabs from 304 different patients attending the Laboratory of Training and Research in Medical Biology of Madagascar were cultured for methicillin sensitive (MSSA) and MRSA. Results: One hundred and sixteen patients had S. aureus in their noses (38.16 ± 5.46%) of whom 45 (14.80 ± 3.99%) had MRSA. A risk factor for MSSA nasal carriage included a history of hospitalization when antibiotics were administered (odds ratio [OR] 2.25, 1.09 - 4.64). Among MRSA nasal isolates, high rate of resistance to other antibiotics was observed, particularly for trimethoprim-sulfamethoxazole (68.89%), erythromycin (66.67%) and ofloxacin (53.33%). Conclusion: Our data showed a high rate of MRSA nasal carriage and a high rate of multidrug resistance. A strategic policy against the spread of multidrug resistant strains is desirable. [ABSTRACT FROM AUTHOR]

Monoclonal gammopathies are common abnormalities and their incidence increases with age. They are detected in roughly 3 % of people older over 50 years and up to 7 % of those over 70 years. Multiple myeloma (MM) is characterized by the proliferation of plasma cells within the bone marrow and excess secretion of monoclonal immunoglobulins. In Madagascar, late performance of biological examinations such as serum protein electrophoresis overestimates MM rates. We studied 54 patient records between March 2009 and January 2015 in the biology laboratory of the Joseph Ravoahangy Andrianavalona university hospital in Antananarivo (Madagascar). Monoclonal gammopathy was associated with multiple myeloma in most cases (88.9 %). Patients' median age was 64.2 years. Men were slightly more affected than women. It is discovered most frequently due to bone symptoms (83.3 %), and anemia is always present. Monoclonal gammopathy is mostly IgG. The bone marrow study showed medullary plasmacytosis. This disease appears most often in the elderly and has a slight male predominance. Bone marrow cytology is mandatory for diagnosis.