Background: Sickle cell disease is one of the most common monogenic diseases in the world, affecting approximately 70 million people, 80% in sub-Saharan Africa and 1 in 10 in Senegal. Sickle cell anemia causes functio...Background: Sickle cell disease is one of the most common monogenic diseases in the world, affecting approximately 70 million people, 80% in sub-Saharan Africa and 1 in 10 in Senegal. Sickle cell anemia causes functional asplenia (associated with repeated thrombosis of splenic vessels), resulting in increased susceptibility to infection. However, several studies have reported differences in the spectrum of bacterial infections in malaria-endemic areas. Therefore, we proposed to conduct a study to determine the rate of positive blood cultures and the bacteriological spectrum in sickle cell patients. Materials and Method: This is a descriptive cross-sectional study of blood culture samples from patients who received a request for hemoglobin electrophoresis as part of their treatment at the Principal’s hospital in Dakar. The study took place from January 2008 to December 2021. For each patient, we collect demographic information, including age, gender, and the service from which the analysis request originated. Data were collected in the laboratory’s computer system and entered into Microsoft Excel (2007). Statistical analyzes were performed using Epi-Info 7 software. Results: Our study included 1419 patients. The most common types of hemoglobin profiles were: normal profile (n = 1025), AS profile (n = 283), SS profile (n = 104), SC profile (n = 7). This corresponds to the proportions of 72%, 20%, 0.5% and 7.5% for the profiles Normal, AS, SC and SS. The male proportion was 61.1%, 61.5%, 57.1, respectively %, 55.8% for Normal, SA, SC, and SS profiles. A total of 19,090 individual blood culture bottles were collected from 1419 impatient patients as follows: Normal profile (n = 18,042 bottles), AS profile (n = 677 culture bottles), SS profile (n = 362 bottles). The majority of blood culture orders come from pediatric services, accounting for 70% of the total number of orders. Of 19,090 vials examined in this current study, 19.6% developed a positive blood culture. Overall, the most commonly isolated bacteria were Staphylococci (41.1%), Enterobacteriaceae (36.7%), Bacillaceae (10.2%), unfermented (6.30%), Streptococci (5.01%), and a small proportion of yeast (0.75%). There is no significant difference in bacterial spectrum between the SS profile and the normal profile of individuals (p = 0.104). Coagulase-negative staphylococci accounted for 32%, 24%, and 40% of the species isolated in the normal AS and SS profiles. respectively. Coagulase-negative staphylococci were the most commonly isolated organisms in SS. Group E and sptagged streptococci each account for less than 2% of the organisms isolated in SS. Pneumococci were not found. Bacillus accounts for 25% of isolates in SS subjects compared to 9% in normal and AS subjects, respectively. Pseudomonas aeruginosa and Burkholderia cepacia then make up 10% of the isolates in the subjects of the SS profile as non-fermenters. Conclusion: Our study shows that enterobacteria and staph are prevalent in people with sickle cell disease. There is no significant difference in bacterial spectrum between SS subjects compared to subjects with a normal profile. The rarity of Streptococcus pneumoniae in bacteremia isolates underlines the need for further studies with larger patient numbers to better understand the spectrum of bacterial infections in patients with sickle cell disease in West Africa.展开更多
Hemoglobinosis C occurs mainly in Africa and America with a high frequency in West Africa. In Senegal, homozygous hemoglobinopathy CC constitutes a very rare profile of which only 3 cases are followed in the clinical ...Hemoglobinosis C occurs mainly in Africa and America with a high frequency in West Africa. In Senegal, homozygous hemoglobinopathy CC constitutes a very rare profile of which only 3 cases are followed in the clinical hematology department of Dakar. The 1<sup>st</sup> case is a 49-year-old female patient, with notion of 1<sup>st</sup> degree consanguinity, and a long history of abdominal pain who presented a poorly tolerated anemic syndrome and splenomegaly. The biological assessment showed moderate anemia (7.6 g/dL) with microcytic hypochromia and a CC profile (HbC = 99.2%;HbA2 = 0.8%) on hemoglobin electrophoresis. The second case was a 22-year-old female patient with a notion of 2<sup>nd</sup> degree consanguinity who presented a Chauffard triad. The haemogram showed mild anaemia (11 g/dL), microcytic and hypochromic. Hemoglobin electrophoresis confirmed a CC profile (HbC = 95.3%;HbA2 = 4.7%). The third patient was 27 years old, with a history of diffuse abdominal pain and 2<sup>nd</sup> degree consanguinity. The haemogram and haemoglobin electrophoresis confirmed the CC profile (HbC = 94.6%;HbA2 = 5.4%). The negativity of the Emmel test in front of this presentation suggestive of sickle cell disease means that this type of hemoglobinopathy is diagnosed late in our regions. We therefore recommend the systematic performance of hemoglobin electrophoresis in the presence of any chronic hemolytic anemia.展开更多
Multiple myeloma (MM) is both a complex and heterogeneous disease. Cytogenetic and molecular abnormalities lead to resistance to treatment and transformation to plasma cell leukemia, which is defined by the presence i...Multiple myeloma (MM) is both a complex and heterogeneous disease. Cytogenetic and molecular abnormalities lead to resistance to treatment and transformation to plasma cell leukemia, which is defined by the presence in circulating blood of plasma cells over 2 G/L, or more than 20% of leukocytes. It is an uncommon hematological malignancy with a poor prognosis. Against this backdrop, we report an observation of multiple myeloma transformed into plasma cell leukemia diagnosed at the Hôpital Principal de Dakar (HPD) that occurred on a 64-year-old man with a history of thyroidectomy followed for multiple myeloma presenting with Salmon et Durie stage IIIA and ISS stage I. Despite a marked improvement in management strategy, myeloma remains an almost invariably incurable disease. However, the development of genetic and molecular biomarkers is necessary to improve its prognosis.展开更多
Macrophage activation syndrome (MAS) is linked to inappropriate stimulation of macrophage cells in the bone marrow and lymphoid system, resulting in abnormal phagocytosis of figurative blood elements and the release o...Macrophage activation syndrome (MAS) is linked to inappropriate stimulation of macrophage cells in the bone marrow and lymphoid system, resulting in abnormal phagocytosis of figurative blood elements and the release of pro-inflammatory cytokines. It is a rare and serious hyper-inflammatory condition of diagnostic and therapeutic emergency. MAS is characterized by non-specific clinical and laboratory signs associated with images of hemophagocytosis. MAS is either “primary” (familial or pediatric forms), or “secondary/reactive” to infection, neoplasia, or autoimmune disease. Hemopathies dominate MAS secondary to neoplasia. B-type acute lymphoblastic leukemia (ALL) is a hematological malignancy characterized by the proliferation and accumulation of B lymphoid progenitors, blocked at an early stage of differentiation, leading to suppression of polyclonal hematopoiesis and subsequent development of signs associated with bone marrow failure. In this context, we report the observation of a macrophage activation syndrome (MAS) associated with ALL, diagnosed at Hôpital Principal de Dakar/Senegal, in a 69-year-old patient with a well-controlled type 2 diabetes under oral antidiabetic therapy (OAD) and good general condition.展开更多
Background: Chronic hepatitis B virus (HBV) infection is one of the largest public health problems with nearly 350 million chronic carriers and 500,000 deaths each year. These deaths are most often associated with dis...Background: Chronic hepatitis B virus (HBV) infection is one of the largest public health problems with nearly 350 million chronic carriers and 500,000 deaths each year. These deaths are most often associated with disease progression to cirrhosis or hepatocellular carcinoma, which some studies have shown is associated with long-term viral replication in chronic carriers. Viral load quantification, a key element of disease management, is expensive and difficult to access. Viral load plays a crucial role in patient classification and treatment initiation. Four years after the implementation of viral load platform, the objective of this study was to assess viral load profile in HBs chronic carriers in a sub-Saharan Hospital and to determine the potential impact of this distribution on preventive and therapeutic strategies against hepatitis B infection. Materials and Method: The study was carried out between April 2016 and October 2020 in the laboratory of the PRINCIPAL Hospital in Dakar. All patients referred for HBV DNA viral load testing following a positive AgHBs test were included. Incomplete medical records were excluded from the study. Only the first quantification test performed on each patient is recorded. DNA extraction was performed with COBAS AmpliPrep (Roche Molecular Systems, Inc., Branchburg, NJ, USA). Amplification was performed using COBAS TaqMan48 (Roche Molecular Systems, Inc., Branchburg, NJ, USA). Data were collected from the laboratory’s computer system and entered into Microsoft Excel (2007). Statistical analyzes were performed using Epi-Info 7 software. Results: A total of 3002 patients, 76.1% (2285/3002) men and 33.9% (717/3002) women, were included in the study. Young adults were most represented among the subjects (23.2%) and (20.1%) in the age groups 25 - 30 and 30 - 35. The majority (52.7%) of patients had viral loads between 20 and 2000 IU. Patients with undetectable viral loads and patients with viral loads below 20 IU comprised 14.6% and 7.53% of the study population, respectively. Patients with viral loads between 2000 and 20,000 IU/ml and those with viral loads greater than 20,000 IU/ml represented 16.3% and 8.89% of the study population, respectively. Viral load was higher in males than females, with corresponding median and interquartile ranges of 2.7 log IU (2.2, 2.75) and 2.23 log IU (2.1, 2.4) (p Conclusion: This study shows a successful implementation of virus quantification in the context of resource-constrained countries. The second finding of this study is the high prevalence of adolescents with high plasma viral loads, indicating the need for additional investigations to initiate therapy. The large population with a low HBV replication rate points to the problem of financing follow-up care for chronically infected people. Studying this population in the context of an unknown genomic profile indicates the need to deepen virological laboratory testing through a sequencing platform. Finally, regular viral load reporting in major hospital cities could be a powerful and accessible management tool for hepatitis B programs in resource-constrained countries.展开更多
Background: Over the past two decades, blood transfusion safety has made significant advances in the fight against infectious diseases. However, hepatitis B is still a problem in blood banks due to its high endemicity...Background: Over the past two decades, blood transfusion safety has made significant advances in the fight against infectious diseases. However, hepatitis B is still a problem in blood banks due to its high endemicity in Senegal. In this context, we proposed to first determine the prevalence of HBs antigen (HBsAg) in regular and new blood donors. Second, to determine the influence of the number of blood donations on the prevalence of hepatitis B. Materials and Method: We conducted a retrospective transversal study using data from all blood donations received at the Principal Hospital of Dakar Blood bank from July 2007 to December 31, 2021. Hepatitis B testing was carried out with Automaton E411 (Roche Diagnostics). For all donors, information on age, sex, hepatitis B serology, and the number of donations was collected through the lab’s computer system. Data entry and statistical analysis were performed with Epi-info version 7. Results: HBsAg carriers were identified in 4311 primary donors, corresponding to a prevalence of 12.39% (IC 95% = 12.04 - 12.74). The prevalence of the HBsAg antigen was higher in men (12.9%) than in women (6.85%). Men are twice as likely to be infected with HBV as women (OR = 2.00 (IC 95% = 1.85 - 2.17)). The highest prevalence (12.4%) was found in young adults (23 - 29) years old. After 10 donations, the prevalence of the HBs antigen was stable at around 1%. Individuals with a single blood donation and individuals with 2 to 5 blood donations are 9 and 7 times more likely to carry the HBs antigen than regular donors (more than 10 blood donations), respectively. Conclusion: Our results demonstrate the endemic nature of hepatitis B in Senegal. On the other hand, the non-negligible prevalence of the virus in first-time donors reminds us of the need for continuous improvement in donor selection. These first-time donors, particularly young adults, are important indicators of transmission of the virus to the general population. This study also demonstrates the need to develop strategies to maintain the pool of regular donors, which represent significant barriers to the spread of hepatitis B.展开更多
文摘Background: Sickle cell disease is one of the most common monogenic diseases in the world, affecting approximately 70 million people, 80% in sub-Saharan Africa and 1 in 10 in Senegal. Sickle cell anemia causes functional asplenia (associated with repeated thrombosis of splenic vessels), resulting in increased susceptibility to infection. However, several studies have reported differences in the spectrum of bacterial infections in malaria-endemic areas. Therefore, we proposed to conduct a study to determine the rate of positive blood cultures and the bacteriological spectrum in sickle cell patients. Materials and Method: This is a descriptive cross-sectional study of blood culture samples from patients who received a request for hemoglobin electrophoresis as part of their treatment at the Principal’s hospital in Dakar. The study took place from January 2008 to December 2021. For each patient, we collect demographic information, including age, gender, and the service from which the analysis request originated. Data were collected in the laboratory’s computer system and entered into Microsoft Excel (2007). Statistical analyzes were performed using Epi-Info 7 software. Results: Our study included 1419 patients. The most common types of hemoglobin profiles were: normal profile (n = 1025), AS profile (n = 283), SS profile (n = 104), SC profile (n = 7). This corresponds to the proportions of 72%, 20%, 0.5% and 7.5% for the profiles Normal, AS, SC and SS. The male proportion was 61.1%, 61.5%, 57.1, respectively %, 55.8% for Normal, SA, SC, and SS profiles. A total of 19,090 individual blood culture bottles were collected from 1419 impatient patients as follows: Normal profile (n = 18,042 bottles), AS profile (n = 677 culture bottles), SS profile (n = 362 bottles). The majority of blood culture orders come from pediatric services, accounting for 70% of the total number of orders. Of 19,090 vials examined in this current study, 19.6% developed a positive blood culture. Overall, the most commonly isolated bacteria were Staphylococci (41.1%), Enterobacteriaceae (36.7%), Bacillaceae (10.2%), unfermented (6.30%), Streptococci (5.01%), and a small proportion of yeast (0.75%). There is no significant difference in bacterial spectrum between the SS profile and the normal profile of individuals (p = 0.104). Coagulase-negative staphylococci accounted for 32%, 24%, and 40% of the species isolated in the normal AS and SS profiles. respectively. Coagulase-negative staphylococci were the most commonly isolated organisms in SS. Group E and sptagged streptococci each account for less than 2% of the organisms isolated in SS. Pneumococci were not found. Bacillus accounts for 25% of isolates in SS subjects compared to 9% in normal and AS subjects, respectively. Pseudomonas aeruginosa and Burkholderia cepacia then make up 10% of the isolates in the subjects of the SS profile as non-fermenters. Conclusion: Our study shows that enterobacteria and staph are prevalent in people with sickle cell disease. There is no significant difference in bacterial spectrum between SS subjects compared to subjects with a normal profile. The rarity of Streptococcus pneumoniae in bacteremia isolates underlines the need for further studies with larger patient numbers to better understand the spectrum of bacterial infections in patients with sickle cell disease in West Africa.
文摘Hemoglobinosis C occurs mainly in Africa and America with a high frequency in West Africa. In Senegal, homozygous hemoglobinopathy CC constitutes a very rare profile of which only 3 cases are followed in the clinical hematology department of Dakar. The 1<sup>st</sup> case is a 49-year-old female patient, with notion of 1<sup>st</sup> degree consanguinity, and a long history of abdominal pain who presented a poorly tolerated anemic syndrome and splenomegaly. The biological assessment showed moderate anemia (7.6 g/dL) with microcytic hypochromia and a CC profile (HbC = 99.2%;HbA2 = 0.8%) on hemoglobin electrophoresis. The second case was a 22-year-old female patient with a notion of 2<sup>nd</sup> degree consanguinity who presented a Chauffard triad. The haemogram showed mild anaemia (11 g/dL), microcytic and hypochromic. Hemoglobin electrophoresis confirmed a CC profile (HbC = 95.3%;HbA2 = 4.7%). The third patient was 27 years old, with a history of diffuse abdominal pain and 2<sup>nd</sup> degree consanguinity. The haemogram and haemoglobin electrophoresis confirmed the CC profile (HbC = 94.6%;HbA2 = 5.4%). The negativity of the Emmel test in front of this presentation suggestive of sickle cell disease means that this type of hemoglobinopathy is diagnosed late in our regions. We therefore recommend the systematic performance of hemoglobin electrophoresis in the presence of any chronic hemolytic anemia.
文摘Multiple myeloma (MM) is both a complex and heterogeneous disease. Cytogenetic and molecular abnormalities lead to resistance to treatment and transformation to plasma cell leukemia, which is defined by the presence in circulating blood of plasma cells over 2 G/L, or more than 20% of leukocytes. It is an uncommon hematological malignancy with a poor prognosis. Against this backdrop, we report an observation of multiple myeloma transformed into plasma cell leukemia diagnosed at the Hôpital Principal de Dakar (HPD) that occurred on a 64-year-old man with a history of thyroidectomy followed for multiple myeloma presenting with Salmon et Durie stage IIIA and ISS stage I. Despite a marked improvement in management strategy, myeloma remains an almost invariably incurable disease. However, the development of genetic and molecular biomarkers is necessary to improve its prognosis.
文摘Macrophage activation syndrome (MAS) is linked to inappropriate stimulation of macrophage cells in the bone marrow and lymphoid system, resulting in abnormal phagocytosis of figurative blood elements and the release of pro-inflammatory cytokines. It is a rare and serious hyper-inflammatory condition of diagnostic and therapeutic emergency. MAS is characterized by non-specific clinical and laboratory signs associated with images of hemophagocytosis. MAS is either “primary” (familial or pediatric forms), or “secondary/reactive” to infection, neoplasia, or autoimmune disease. Hemopathies dominate MAS secondary to neoplasia. B-type acute lymphoblastic leukemia (ALL) is a hematological malignancy characterized by the proliferation and accumulation of B lymphoid progenitors, blocked at an early stage of differentiation, leading to suppression of polyclonal hematopoiesis and subsequent development of signs associated with bone marrow failure. In this context, we report the observation of a macrophage activation syndrome (MAS) associated with ALL, diagnosed at Hôpital Principal de Dakar/Senegal, in a 69-year-old patient with a well-controlled type 2 diabetes under oral antidiabetic therapy (OAD) and good general condition.
文摘Background: Chronic hepatitis B virus (HBV) infection is one of the largest public health problems with nearly 350 million chronic carriers and 500,000 deaths each year. These deaths are most often associated with disease progression to cirrhosis or hepatocellular carcinoma, which some studies have shown is associated with long-term viral replication in chronic carriers. Viral load quantification, a key element of disease management, is expensive and difficult to access. Viral load plays a crucial role in patient classification and treatment initiation. Four years after the implementation of viral load platform, the objective of this study was to assess viral load profile in HBs chronic carriers in a sub-Saharan Hospital and to determine the potential impact of this distribution on preventive and therapeutic strategies against hepatitis B infection. Materials and Method: The study was carried out between April 2016 and October 2020 in the laboratory of the PRINCIPAL Hospital in Dakar. All patients referred for HBV DNA viral load testing following a positive AgHBs test were included. Incomplete medical records were excluded from the study. Only the first quantification test performed on each patient is recorded. DNA extraction was performed with COBAS AmpliPrep (Roche Molecular Systems, Inc., Branchburg, NJ, USA). Amplification was performed using COBAS TaqMan48 (Roche Molecular Systems, Inc., Branchburg, NJ, USA). Data were collected from the laboratory’s computer system and entered into Microsoft Excel (2007). Statistical analyzes were performed using Epi-Info 7 software. Results: A total of 3002 patients, 76.1% (2285/3002) men and 33.9% (717/3002) women, were included in the study. Young adults were most represented among the subjects (23.2%) and (20.1%) in the age groups 25 - 30 and 30 - 35. The majority (52.7%) of patients had viral loads between 20 and 2000 IU. Patients with undetectable viral loads and patients with viral loads below 20 IU comprised 14.6% and 7.53% of the study population, respectively. Patients with viral loads between 2000 and 20,000 IU/ml and those with viral loads greater than 20,000 IU/ml represented 16.3% and 8.89% of the study population, respectively. Viral load was higher in males than females, with corresponding median and interquartile ranges of 2.7 log IU (2.2, 2.75) and 2.23 log IU (2.1, 2.4) (p Conclusion: This study shows a successful implementation of virus quantification in the context of resource-constrained countries. The second finding of this study is the high prevalence of adolescents with high plasma viral loads, indicating the need for additional investigations to initiate therapy. The large population with a low HBV replication rate points to the problem of financing follow-up care for chronically infected people. Studying this population in the context of an unknown genomic profile indicates the need to deepen virological laboratory testing through a sequencing platform. Finally, regular viral load reporting in major hospital cities could be a powerful and accessible management tool for hepatitis B programs in resource-constrained countries.
文摘Background: Over the past two decades, blood transfusion safety has made significant advances in the fight against infectious diseases. However, hepatitis B is still a problem in blood banks due to its high endemicity in Senegal. In this context, we proposed to first determine the prevalence of HBs antigen (HBsAg) in regular and new blood donors. Second, to determine the influence of the number of blood donations on the prevalence of hepatitis B. Materials and Method: We conducted a retrospective transversal study using data from all blood donations received at the Principal Hospital of Dakar Blood bank from July 2007 to December 31, 2021. Hepatitis B testing was carried out with Automaton E411 (Roche Diagnostics). For all donors, information on age, sex, hepatitis B serology, and the number of donations was collected through the lab’s computer system. Data entry and statistical analysis were performed with Epi-info version 7. Results: HBsAg carriers were identified in 4311 primary donors, corresponding to a prevalence of 12.39% (IC 95% = 12.04 - 12.74). The prevalence of the HBsAg antigen was higher in men (12.9%) than in women (6.85%). Men are twice as likely to be infected with HBV as women (OR = 2.00 (IC 95% = 1.85 - 2.17)). The highest prevalence (12.4%) was found in young adults (23 - 29) years old. After 10 donations, the prevalence of the HBs antigen was stable at around 1%. Individuals with a single blood donation and individuals with 2 to 5 blood donations are 9 and 7 times more likely to carry the HBs antigen than regular donors (more than 10 blood donations), respectively. Conclusion: Our results demonstrate the endemic nature of hepatitis B in Senegal. On the other hand, the non-negligible prevalence of the virus in first-time donors reminds us of the need for continuous improvement in donor selection. These first-time donors, particularly young adults, are important indicators of transmission of the virus to the general population. This study also demonstrates the need to develop strategies to maintain the pool of regular donors, which represent significant barriers to the spread of hepatitis B.
