Medical students are a key group within the healthcare system, yet their risk of SARS-CoV-2 infection remains poorly characterized in Mali. Understanding seroprevalence in this population is essential to inform infection control, vaccination strategies, and decisions regarding in-person training. To assess the seroprevalence of anti-SARS-CoV-2 antibodies among unvaccinated medical students in Bamako, Mali, and to evaluate the association with hospital exposure levels. A cross-sectional study was conducted from February to March 2022 among 300 medical students. Participants were stratified by clinical exposure: first-year (pre-clinical), externs, and interns. Blood samples were collected to detect IgA, IgM, and IgG antibodies against SARS-CoV-2 using rapid diagnostic tests, and neutralizing antibodies were assessed in seropositive individuals. Self-reported adherence to barrier measures was recorded. Relative risks (RR) of seropositivity were calculated by exposure level. Overall seroprevalence was 18

Objectives:We aimed to determine the prevalence of dengue among febrile patients in Bamako and explore its seasonal and demographic variations. Methods:We conducted cross-sectional surveys in July 2021 and February 2022 among febrile patients seeking care at four community health centers in Bamako. Febrile patients were enrolled, and blood samples were tested for dengue using rapid diagnostic tests and polymerase chain reaction. Results:A total of 325 patients were enrolled (175 in July and 150 in February). The overall prevalence of dengue in communes V and VI of Bamako was 16.9%. Females were more represented (66.2%). The median age of the participants was 20 years (interquartile range: 8-30). Adult age (≥18 years) was the only factor significantly associated with an increased risk of dengue infection (odds ratio = 3.2; 95% confidence interval: 1.1-9.4). Conclusions:The prevalence of dengue (16.9%) in communes V and VI suggests that dengue is endemic in Bamako, with a predominance among young adults and females. Adult age was identified as the only significant factor associated with increased risk. Further studies are needed for more insight into the dynamics of dengue transmission and to guide public health actions, particularly those targeting the adult population, to reduce dengue transmission in Bamako.

RÉSUMÉ La cryptococcose est une mycose rare et sévère, fréquente chez les patients en déficit profond de l’immunité cellulaire. La cryptococcose cutanée est caractérisée par un polymorphisme clinique responsable d'une dissémination systémique. Nous rapportons ici un cas de cryptococcose disséminée à localisation neuro-méningée et cutanée chez un patient immunodéprimé au VIH, hospitalisé au CHU du Point G de Bamako. Le diagnostic de la cryptococcose disséminée à localisation neuro-méningée et cutanée a été retenu devant les arguments cliniques, microbiologiques et histologiques. Il a été traité avec succès par un protocole alternatif à base de fluconazole. ABSTRACT Cryptococcosis is a rare and severe mycosis, common in patients with deep deficiency of cellular immunity. Cutaneous cryptococcosis is characterized by clinical polymorphism occurring during systemic release. Hereby, we report a case of neuromeninged and skin-localized disseminated cryptococcosis in an immunocompromised HIV patient hospitalized at the CHU Point G in Bamako. The diagnosis of disseminated cryptococcosis with neuro-meningeal and cutaneous localization was retained before clinical, microbiological and histological arguments. He was successfully treated with an alternative fluconazole protocol.

Introduction: Malaria is a health threat in sub-Saharan Africa, where Plasmodium is not tested in blood bags. Our objective was to determine the prevalence of plasmodial carriage in blood bags and the associated factors, and the involvement of these bags in the occurrence of malaria in recipients. Methods: From 1st April to 30th November, 2020, we conducted a prospective cross-sectional study of 348 blood bags stored at 4 degrees C in Bamako. Using SPSS 21.0 software, statistical analyses were performed using a binary logistic regression model with a significance threshold of p < 0.05 and the odds ratio (OR) framed by its 95% confidence interval (CI). Results: During this period, 348 blood bags were transfused into 108/152 hospitalised patients, generating a transfusion frequency of 71.1%, with a prevalence of plasmodial carriage of 22%. Among the 54 initially malaria-negative recipients, all 20 (37%) who received malaria-positive blood bags and slept under long-acting insecticide-treated nets (LLINs) developed malaria. We recorded 33.3% deaths. Donor age <= 34 years (p = 0.011; OR = 2.55[CI.95% = 1.25-5.23]), replacement donation (p = 0.000; OR = 0.04[CI.95% = 0.0-0.19]) and not regular use of LLINs by donors (p = 0.048; OR = 0.53[CI.95% = 0.29-1]) were factors associated with plasmodial carriage of blood bags. CD4 count<200 cells/mm3 (p = 0.002; OR = 0.2[CI.95% = 0.10-0.52]), severe anaemia (p = 0.034; OR = 0.26[CI.95% = 0.10-0.90]) and decompensated anaemia (p = 0.034; OR = 3.88[CI.95% = 1.11-13.56]) were factors independently associated with recipient death. Conclusion: The prevalence of plasmodial carriage among blood donors is increasing in Mali. Transfusion malaria is a reality to be feared, with the risk increasing with the level of malaria endemicity of the blood donor.

The use of antimicrobials without microbiological proof is frequent and contributes to the emergence of resistance. The aim was to identify the organisms isolated during laboratory examinations and the type of antimicrobials consumed by patients hospitalized to Infectious Diseases’ Clinic. This is a cross-sectional and analytical study, carried out from January 1 to December 31, 2017 in the Infectious Diseases Department of Point “G” Teaching Hospital in Mali. All biological specimens from patients during the study period were analyzed. In total, 322 patients benefited from microbiological test, with a mean age of 40.9 ± 12.2 years (range 15 and 74 years) with a sex ratio of 0.93. Only 5.6% of patients were HIV negative. In all participants, a total of 658 microbiological specimen were taken, 224 (34.0%) identified at least one pathogen including bacteria in more than a half of the cases (58.5%). On the report of bacteriological analysis, the most frequently identified organisms were Mycobacterium tuberculosis (42.2%) mainly in sputum; Escherichia coli (24.2%) and Klebsiella pneumoniae (7.8%) commonly in urine and Gardnerella vaginalis (7.0%) exclusively in vaginal secretions. Candida albicans (5/8) and Cryptococcus neoformans (3/8) were the most common fungi while Plasmodium falciparum (96.4%) represented the parasite frequently found in blood. From a therapeutic standpoint, 1143 antimicrobials were prescribed to 322 admitted patients, i.e. 3.55 anti-infectives per patient. Antibiotics (excluding tuberculosis drugs), antiparasitics and antifungals represented respectively 46.2%; 18.8% and 15.1% of anti-infectives. Antibiotic therapy was effective in 274 (85.1%) patients and among them, only 76 (27.7%) cases were based on microbiological evidence. Antibiotics are the most widely used antimicrobials in an infectious disease department. Empiric treatments are common but must be minimized by the search for microbiological evidence.

Background: The regression of post-vaccination immunity with age exposes elderly subjects to certain infectious diseases, in particular tetanus. The aim was to compare the clinical and prognostic features of tetanus according to the age of patients. Methodology: Analytical study of the files of patients hospitalized for tetanus in the Infectious Diseases Department at Point “G” University Teaching Hospital from 2013 to 2019 with retrospective collection. According to age, three groups of patients were formed: group I (<18 years), group II (18 - 59 years) and group III (≥60 years). The study variables were socio-demographic, clinical and prognostic. The One-way ANOVA and Chi-square statistical tests were applied with a significance level p = 0.05. Results: In total, 202 cases of tetanus were recorded or 7.3% of admissions. The mean age was 41.9 ± 15.6 years (range, 6 and 85 years) with a sex ratio of 19.2. According to the age grouping, group II was predominant (79.2%) followed by group III (14.9%) with respective mean ages of 39.2 ± 10.6 and 67.3 ± 6.5 and sex ratio of 39 and 29. Workers (33.3%), farmers (25.8%), traders (19.7%) and drivers (7.1%) represented the most important occupations most at risk. Clinically, bad general condition (p < 0.001), trismus (p = 0.001), dysphagia (p = 0.009) and complications during hospitalization (p = 0.028) were seen more frequently in group III patients compared to younger ones. From a prognostic point of view, patients in group III were at greater risk to develop a severe form of tetanus (p = 0.021) with higher mortality compared to other age groups (p < 0.001). Conclusion: Tetanus is more prevalent in men. Complications and mortality increase with age. It is important to include booster immunization of adults in existing national programs in order to reduce disease-related morbidity and mortality in this age group.

Background: Fahr syndrome associates a set of neuropsychiatric manifestations with bilateral calcifications in the basal ganglia and phosphocalcic disorders.Neuromeningeal cryptococcosis can be present in its manifestations, neuropsychic disorders with or without meningeal signs.The objective was to describe a rare association between Fahr syndrome and neuromeningeal cryptococcosis which can be expressed by the same clinical symptomatology in the context of co-infection with the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV).Presentation: A 37-year-old patient without pathological history, who presented behavioral disorders that led to a fight with those around her and a psychiatric consultation.Then, she was hospitalized in the infectious diseases Department upon discovery of her HIV status and viral hepatitis B.She was logorrheic with behavioral disturbances and subsequently presented with tonic-clonic convulsions.Laboratory tests and imaging have concomitantly discovered Fahr syndrome due to pseudohypoparathyroidism and neuromeningeal cryptococcosis.The correct management of these two pathologies enabled stabilization of the patient's clinical condition with regular monitoring for HIV-HBV coinfection.Conclusion: Farh syndrome and neuromeningeal cryptococcosis are two different entities but sometimes similar symptoms and risk factors.Treatment of metabolic disorders combined with anticryptococcal therapy improved the prognosis.

BACKGROUND:Routine monitoring of HIV-1 Viral Load (VL) is important in patients on Antiretroviral Therapy (ART) management. Access to HIV VL remains a challenge in resource-limited settings, especially in rural areas. Universal access to VL requires more simplified and less restrictive alternatives to current conventional VL methods. The objective of this study was to evaluate the performance of the new rapid (2-hour turnaround time) Xpert HIV-1VL technique compared to Roche TaqMan and Abbott RT m2000 for HIV-1 RNA quantification in HIV- infected patients.STUDY DESIGN:We conducted a cross-sectional study in patients seen for routine VL monitoring between August and November 2018 in a HIV care site in Bamako. The performance of the Xpert HIV-1 VL assay was evaluated against the Roche TaqMan assay and Abbott m2000 RT assay. Performance, utility and reliability/reproducibility were verified using accuracy, sensitivity, specificity, positive and negative predictive values, Diagnostic Odds Ratio (DOR), Kappa coefficient, Pearson correlation coefficient, and Bland-Altman analysis.RESULTS:The Xpert assay compared well with the two current referral assays (Roche TaqMan and Abbott m2000 RT assays). Compared to Roche TaqMan assay the sensitivity was 93.10%, specificity (97.01%) and accuracy (95.20%), the correlation coefficient of Pearson (r) was 0.98 (p <0.01). Bland-Altman analysis showed a mean difference of 0.18 log10 cp/mL; (Standard Deviation) SD=0.33. Compared to the Abbott m2000 RT, the sensitivity, the specificity and the accuracy were respectively 93.44%; 92% and 92.65%. The Xpert HIV-1 VL assay showed a good correlation with a correlation coefficient of Pearson, r=0.99 (p <0.001). The overall mean difference in the HIV-1 VL values obtained by Xpert HIV-1 VL and Abbott m2000 RT assays was 0.08 log10 cp/mL; SD=0.30.CONCLUSION:Xpert HIV-1 VL showed a good performance compared to Roche TaqMan and Abbott m2000 RT. With the rapid test results (less than 2 h) and ease of testing individual specimens, the Xpert HIV-1 VL assay could be an effective alternative for HIV VL monitoring in resource-limited settings.

Acknowledgments We thank the Center de Recherche et Formation (SEREFO) team members for their support. We also thank the clinical staff, Souleymane Diallo, Sounkalo Dao, Samba Diop, Bindongo P.P. Dembele, Hamadoun Kassambara, Drissa Goita, and Ousmane M’baye for their efforts in patient recruitment; and the laboratory staff, Guindo Oumar, Djeneba Dabitao, Hama Diallo, Yeya D.S. Sarro, Mariam Tall, Nadie Coulibaly, and Bourahima Kone for patient screening and timely completion of all laboratory results. We also thank Mark Parta for help with the spoligotyping assay, Ousmane Koita for editorial help, and Christian Yoder for supporting the construction of the Biosaftey Level 3 laboratory.

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.

Measles is a highly contagious acute febrile eruptive disease. It can be prevented through vaccination. The aim of this study was to determine the epidemiological, clinical, and therapeutic features of measles cases hospitalized at Point "G" University Teaching Hospital. It was a retrospective study to review the medical files of patients hospitalized for measles between January 2010 and May 2011 at the Infectious Diseases Department of the Point "G" University Teaching Hospital. During the study period, 31 patients (6.4%) were treated for measles, and the majority of cases were seen in April months (20 cases) and May months (5 cases). The most affected age group was 9 - 59 months (58.1%) with a sex ratio of 1.38. The majority of patients (64.5%) consulted at least two health facilities before their hospitalization in Point “G” with an average of 5.3 ± 3.6 days from unset to the hospitalization. Measles immunization was not effective in 16 out of 26 patients and nearly one-third (29.0%) had familial contact measles case. Febrile rash, present in all patients, was associated with cough (96.8%), rhinitis (77.4%) and/or conjunctivitis (77.4%). Pneumonia was the most common complication (83.9%) followed by comorbidities such as gastroenteritis (29%), malnutrition (9.7%) and oral candidiasis (9.7%). Amoxicillin and ceftriaxone were the antibiotics frequently used against complications. Patients were hospitalized for an average of 6.9 ± 4.2 days, and no death was recorded. This study revealed that pneumonia was the main complication leading to hospitalization of patients. For a better control of measles, we need to fully respect the immunization schedule which is a guarantee for vaccine efficacy.

To the Editor: Mycobacterium tuberculosis has >36 identified genotype families (1). Four genotypes cause 35% of documented cases of active tuberculosis (TB): Beijing (10%–11%), Latin American–Mediterranean (9.3%), Haarlem (7.5%), and the X clade (7%) (1,2) The Beijing clade strains, reported in 1995 from the People’s Republic of China, are widely recognized as highly pathogenic with a possible predilection for multidrug resistance (3). Predominant in Asia, these strains have been documented in other parts of the world (1,4,5). The virulence, propensity to become resistant, and distinct geographic distribution of the Beijing clade suggest it may have some adaptive advantage in producing disease in humans. Limited data suggest that its presence in Africa is low (2,4,5). In Bamako, Mali, 2 patients with active pulmonary TB came to the research clinic at Point G Hospital, affiliated with the University of Bamako Medical School, for recruitment under a US National Institute of Allergy and Infectious Diseases’ institutional review board–approved protocol. The first patient, a previously healthy 34-year-old man, sought treatment in March 2008. He had a 3-month history of fever, cough, shortness of breath, and left-sided chest pain; respiratory rate of 24/min; temperature of 36.8oC; and pulse rate of 68/min. He weighed 60 kg. His leukocyte count was 8,700 cells/μL, and he was positive for HIV-1 with a CD4+ T-cell count of 468 cells/μL. He reported contact with persons from other countries in Africa, China, and other parts of Asia. Chest radiograph showed a cavitary lesion on the left upper lobe and opacities throughout the left lung. Three sputum samples collected 3 days apart were digested and decontaminated with N-acetyl-L-cysteine, 4% NaOH; concentrated by high-speed centrifugation; stained with auramine-rhodamine; and evaluated by using fluorescent microscopy. The many acid-fast bacilli (AFB) seen were identified by using nucleic acid probes (AccuProbe, Gen-Probe, San Diego CA, USA). Antimycobacterial drug susceptibility was determined by using a manual indirect susceptibility test (mycobacterial growth indicator tube, AST SIRE System; BBL, Becton Dickinson, Franklin Lakes, NJ, USA) showed the isolate sensitive to isoniazid (0.1 μg/mL), rifampin (1.0 μg/mL), and ethambutol (3.5 μg/mL) but resistant to streptomycin (0.8 μg/mL). Spoligotyping using a commercially available kit (Spoligotyping Isogen Life Science, De Meern, the Netherlands) showed characteristics of the Beijing clade (Appendix Figure, panel A) (6). The patient began treatment with the standard first-line regimen of isoniazid, rifampin, pyrazinamide, and ethambutol fixed-dose combination (Svizera Laboratory, Mumbai, India) according to Malian National Guidelines. Follow-up sputum samples at 13 and 18 weeks of treatment were smear- and culture-negative for AFB. The second patient, a 28-year-old woman, sought treatment in July 2008. For 1 year, she had received first-line and retreatment regimens that failed to clear her sputum of AFB. She had begun second-line treatment for multidrug-resistant disease 2 days earlier. She had a history of fever, cough, and weight loss; temperature of 37.1oC; heart rate of 104 beats/min; respiratory rate of 24/min; and blood pressure of 90/60 Hg mm. She weighed 49 kg. Leukocyte count was 9,400 cells/μL. Serologic results for HIV-1 and -2 were negative. Chest radiograph showed a right apical cavitary lesion and a fibrotic lesion in the right middle lung field. She did not recall any exposure to TB. She worked as an assistant at a local telephone center. Two sputum samples, processed as described above, were positive for, and Gen-Probe testing confirmed, M. tuberculosis. According to antimycobacterial susceptibility testing, the strain was resistant to isoniazid (0.1 μg/mL), rifampin (1.0 μg/mL), ethambutol (3.5 μg/mL), and streptomycin (0.8 μg/mL). Spoligotyping confirmed the strain as Beijing clade, and restriction fragment length polymorphism (7) confirmed that it differed from that of patient 1 (Appendix Figure, panel B). The relevance of different genotypes, such as the Beijing clade, to disease progression is being studied. Evidence indicates the genotype may factor in transmission or pathogenesis. In a study in Cape Town, South Africa, disease produced by the Beijing clade increased exponentially over time, suggesting a possible pathogenic advantage; although most cases were drug susceptible, the likelihood of unsuccessful treatment was greater than for non-Beijing variants (8). Although the Beijing clade does not appear to have greater propensity than non-Beijing genotypes for acquiring resistance, certain variants within the group that become multidrug resistant may be more likely to acquire such resistance. Beijing strains particularly may tend to acquire resistance more easily than others under conditions of suboptimal treatment (9). In Cape Town during 2000–2003, the Beijing clade as a cause of disease in children increased from 13% to 33%, suggesting a selective advantage in transmissibility and disease production (10). These cases highlight the need to diagnose disease and resistance early and to begin appropriate treatment in TB-endemic countries. Knowledge of circulating strains and their resistance patterns is essential to developing effective programs to curtail the spread of TB within the country and the region; in this era of globalization, it is required for the successful control of TB worldwide.

Multiple HIV-1 subtypes and circulating recombinant forms (CRFs) are known to cocirculate in Africa. In West Africa, the high prevalence of CRF02_AG, and cocirculation of subtype A, CRF01_AE, CRF06_cpx, and other complex intersubtype recombinants has been well documented. Mali, situated in the heart of West Africa, is likely to be affected by the spread of recombinant subtypes. However, the dynamics of the spread of HIV-1 recombinant subtypes as well as nonrecombinant HIV-1 group M subtypes in this area have not been systematically assessed. Herein, we undertook genetic analyses on full-length env sequences derived from HIV-1-infected individuals living in the capital city of Mali, Bamako. Of 23 samples we examined, 16 were classified as CRF02_AG and three had a subsubtype A3. Among the remaining HIV-1 strains, CRF06_cpx and CRF09_cpx were each found in two patients. Comparison of phylogenies for six matched pol and full-length env sequences revealed that two strains had discordant subtype/CRF designations between the pol and env regions: one had A3 pol CRF02_AG env and the other had CRF02_AG pol A3 env. Taken together, our study demonstrated the high prevalence of CRF02_AG and complexity of circulating HIV-1 strains in Mali. It also provided evidence of ongoing virus evolution of CRF02_AG, as illustrated by the emergence of more complex CRF02_AG/A3 intersubtype recombinants in this area.