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Introduction : L’objectif de l’étude était d’évaluer l'impact de la durée de la raideur matinale rapportée par le patient sur l'évaluation de l'activité de la polyarthrite rhumatoïde. Matériels et méthodes : L’étude QUEST-RA (Quantitative Standard monitoring of patients with Rheumatoid Arthritis) est une étude transversale multinationale inspirée de l'étude finlandaise, menée par des rhumatologues publics et privés au Maroc pendant la période allant de janvier 2008 à décembre 2010. Un pré-questionnaire comportant des informations sociodémographiques, cliniques et paracliniques a été rempli pour chaque patient. La durée de la raideur matinale (RM) a été évaluée depuis le réveil des patients jusqu'à l'amélioration maximale de la douleur. Quatre groupes ont été constitués en fonction de l'activité de la maladie. Nous avons effectué une analyse de corrélation pour établir la relation entre la raideur matinale et l'activité de la maladie sur la base du DAS28. Une analyse de régression linéaire a été utilisée pour identifier les déterminants de cette relation. Résultats : L'âge moyen de nos patients était de 48,82 ± 12,72 ans, avec une prédominance féminine (87,3%). La durée médiane de la maladie était de 6 ans (3-12). Le DAS28 moyen était de 4,93 ± 1,68, la durée moyenne de la sclérose en plaques était de 60 (30-90) minutes. Une corrélation significative a été notée entre le DAS28 (r = 0,318), l’EVA fatigue (r = 0,343), l’EVA global (r = 0,315), la VS (r = 0,144) et la durée de la raideur matinale (tous p < 0,05). Plus de deux tiers de nos patients avaient une activité sévère 43% et 98% d'entre eux avaient une durée de raideur matinale supérieure à 60 minutes. La durée de la raideur matinale chez les patients ayant une activité sévère était différente de celle des sujets des autres groupes (p< 0,0001). En analyse univariée et multivariée et en ajustant les facteurs confondants, le DAS28 augmente de 8,6 à 10,2 lorsque la durée de la raideur matinale augmente d'une minute. Conclusion : Notre étude suggère que la raideur matinale rapportée par les patients influence l'activité de la maladie évaluée par le DAS28.

Background: MDR-TB is a major threat to global TB control. In 2015, 580,000 were treated for MDR-TB worldwide. The worldwide roll-out of GeneXpert MTB/RIF® has improved diagnosis of MDR-TB; however, in many countries laboratories are unable to assess drug resistance and clinical predictors of MDR-TB could help target suspected patients. In this study, we aimed to determine the clinical factors associated with MDR-TB in Bamako, Mali. Methods: We performed a cross-sectional study of 214 patients with presumed MDR-TB admitted to University of Bamako Teaching Hospital, Point-G between 2007 and 2016. We calculated crude and adjusted odds ratios for MDR-TB disease diagnosis using SPSS. Results: We found that age ≤40 years (OR = 2.56. 95% CI: 1.44–4.55), two courses of prior TB treatment (OR = 3.25, 95% CI: 1.44–7.30), TB treatment failure (OR = 3.82, 95% CI 1.82–7.79), sputum microscopy with 3+ bacilli load (OR = 1.98, 95% CI: 1.13–3.48) and a history of contact with a TB patient (OR = 2.48, 95% CI: 1.11–5.50) were significantly associated with confirmation of MDR-TB disease. HIV was not a risk factor for MDR-TB (aOR = 0.88, 95% CI: 0.34–1.94). Conclusion: We identified several risk factors that could be used to identify MDR-TB suspects and prioritize them for laboratory confirmation. Prospective studies are needed to understand factors associated with TB incidence and clinical outcomes of TB treatment and disease. Keywords: Multi-Drug Resistant Tuberculosis, Risk factors, Mali

Abstract Background Drug resistant tuberculosis presents a major public health challenge. Case presentation We present here the first two patients diagnosed with extensively drug resistant tuberculosis in Bamako, Mali. Genotypic findings suggest possible nosocomial transmission from the first patient to the second one, resulting in superinfection of the second patient. After being diagnosed with extensively drug resistant tuberculosis in August 2016, the patients only started receiving appropriate treatment 10 months later. Conclusion The identification of these patients highlights the need for improved diagnostic and treatment algorithms for better surveillance and management of drug resistance in Mali. In the interest of these as well as future patients suffering from resistant tuberculosis, all steps recommended for programmatic management of drug resistant tuberculosis must be urgently prioritized in order to strengthen the multidrug resistant tuberculosis program.

Introduction : L'objectif était de déterminer la fréquence, les aspects cliniques et thérapeutiques des infections du site opératoire (ISO) chez les césariennes itératives (utérus cicatriciels) versus césariennes systématiques (utérus sains). Matériel et méthode : Etude rétrospective et comparative du 1er janvier 2013 au 31 décembre 2017. Tous les cas de césariennes itératives et systématiques avec infections du site opératoire ont été inclus. L'analyse des données a été effectuée sur le logiciel SPSS. Le khi2 avec un seuil significatif de p < 0,05 a été utilisé. Résultats : Au total sur 10281 césariennes, 4318 étaient itératives et 5923 systématiques. Les infections du site opératoire ont été retrouvées chez 540(5,25%) dont 180 itératives et 360 systématiques (p=0,0000). L'âge moyen était de 26 ans. Conformément aux politiques, normes et procédures en vigueur au Mali, toutes les patientes césarisées ont été soumises à une antibioprophylaxie systématique à base d'Amoxicilline. La suppuration superficielle a été retrouvée chez 115(64%) utérus cicatriciels contre 192(53,33%) utérus sains (p=0,019). 170(94,44%) utérus cicatriciels et 304(84,44%) utérus sains étaient de la classe II de risque d'Altemeier avec p=0,000. 170(94,44%) utérus cicatriciels et 304(84,44%) utérus sains avaient le score zéro de NNISS. Staphylocoques sp et Escherichia coli ont été isolés respectivement dans 31,44%(77) et 16,94%(53). L'antibiothérapie était adaptée à l'antibiogramme. La durée moyenne d'hospitalisation était de 17,5 jours. Aucun décès maternel n'a été enregistré liés aux ISO. Conclusion : les ISO post césariennes restent élevées en commune V de Bamako.

Background: To identify strains of Mycobacterium tuberculosis complex (MTBc) circulating in Bamako region during the past 10 years. Methods: From 2006 to 2016, we conducted a cross-sectional study to identify with spoligotyping, clinical isolates from tuberculosis (TB)-infected patients at different stages of their treatments in Bamako, Mali. Results: Among the 904 suspected TB patients included in the study and thereafter tested in our BSL-3 laboratory, 492 (54.4%) had MTBc and therefore underwent spoligotyping. Overall, three subspecies, i.e., MTB T1 (31.9%) and MTB LAM10 (15.3%) from lineage 4 and M. africanum 2 (16.8%) from lineage 6 were the leading causes of TB in Bamako region during the past 10 years. Other spoligotypes such as MTB T3, MTB Haarlem 2, MTB EAI3, and MTB family 33 were also commonly seen from 2010 to 2016. Conclusion: This study showed a high genetic diversity of strains isolated in Bamako region and highlights that M. tuberculosis T1 strain was the most prevalent. Furthermore, the data indicate an increasing proportion of primary drug resistance overtime in Bamako.

Objective: The objective of this study is to describe the etiological profile of patients with cervical lymphadenopathy in relation to tuberculosis in our practice Odonto-stomatologique. Materials and Methods: We conducted a retrospective study over a period of four years at the University Hospital of Stomatology Odonto (CHU OS) Bamako. The successive cases of cervical lymphadenopathy of tuberculous origin confirmed by skin test (TST) to tuberculin 10 units or lymph node biopsy for histological referred. Data were collected from medical records and entered and analyzed with the software Epiinfo.fr 6.0 Results: The lesions involved 82 patients including 37 men (45.1%) with a sex ratio of 1.21. The age group most represented was that of 20 and 29 years (28%). The anatomic region was privileged bilateral cervical (57.30%).Our patients underwent chest radiography in 90.20% of cases. The IDR was performed in 72% of patients and tuberculous lymphadenitis and follicular caseo was found in 8.50% of cases. Conclusion: Our study revealed a prevalence of 0.31% of cervical-facial adenopathies of which 80.50% was tuberculous. In the case of tuberculous endemic tuberculous adenopathy, an IDRT and anatomopathological examination of the lymph node biopsy should be systematic for the early management of tuberculosis

Session: Tuberculose Session: Microbiologie clinique Session: Epidémiologie Parasitaire

BACKGROUND: Nontuberculous mycobacterial (NTM) infections cause morbidity worldwide. They are difficult to diagnose in resource-limited regions, and most patients receive empiric treatment for tuberculosis (TB). Our objective here is to evaluate the potential impact of NTM diseases among patients treated presumptively for tuberculosis in Mali. METHODS: We re-evaluated sputum specimens among patients newly diagnosed with TB (naïve) and those previously treated for TB disease (chronic cases). Sputum microscopy, culture and Mycobacterium tuberculosis drug susceptibility testing were performed. Identification of strains was performed using molecular probes or sequencing of secA1 and/or 16S rRNA genes. RESULTS: Of 142 patients enrolled, 61 (43%) were clinically classified as chronic cases and 17 (12%) were infected with NTM. Eleven of the 142 (8%) patients had NTM disease alone (8 M. avium, 2 M. simiae and 1 M. palustre). All these 11 were from the chronic TB group, comprising 11/61 (18%) of that group and all were identified as candidates for second line treatment. The remaining 6/17 (35.30%) NTM infected patients had coinfection with M. tuberculosis and all 6 were from the TB treatment naïve group. These 6 were candidates for the standard first line treatment regimen of TB. M. avium was identified in 11 of the 142 (8%) patients, only 3/11 (27.27%) of whom were HIV positive. CONCLUSIONS: NTM infections should be considered a cause of morbidity in TB endemic environments especially when managing chronic TB cases to limit morbidity and provide appropriate treatment.