Rift Valley Fever Outbreak, Mauritania, 2012

Severe malaria in adults is not well studied in Sahelian Africa. Clinical features and mortality associated with severe Plasmodium falciparum malaria in adult patients hospitalized in Kiffa, southern Mauritania, were analysed. Patients over 15 years old admitted for severe malaria between August 2016 and December 2019 were included in the present retrospective study. The World Health Organization (WHO) criteria were used to define severe malaria. The presenting clinical characteristics and outcome were compared. Of 4266 patients hospitalized during the study period, 573 (13.4%) had a positive rapid diagnostic test for malaria, and 99 (17.3%; mean age, 37.5 years; range 15–79 years; sex-ratio M/F, 2.1) satisfied the criteria for severe malaria. On admission, the following signs and symptoms were observed in more than one-fourth of the patients: fever (98%), impairment of consciousness (81.8%), multiple convulsions (70.7%), cardiovascular collapse (61.6%), respiratory distress (43.4%), severe anaemia ≤ 80 g/L (36.4%), haemoglobinuria (27.3%), and renal failure (25.3%). Patients were treated with parenteral quinine or artemether. Fourteen (14.1%) patients died. Multiple convulsions, respiratory distress, severe anaemia, haemoglobinuria, acute renal failure, jaundice, and abnormal bleeding occurred more frequently (P < 0.05) in deceased patients. Mortality due to severe falciparum malaria is high among adults in southern Mauritania. An adoption of the WHO-recommended first-line treatment for severe malaria, i.e. parenteral artesunate, is required to lower the mortality rate associated with severe malaria.

We report three severe cases of hemorrhagic form of Rift Valley Fever which have been observed in the Hospital of Aïoun (two cases) and in the regional hospital of Tidjikdja (one case). The disease manifested itself by an infectious syndrome, an early infectious syndrome (on the second day) with onset of hemorrhagic complications and disorder of consciousness ranging from an agitation to deep coma. The biological examinations showed a severe anemia. Multiple organ failures were also observed. Of the three patients treated one died. Therefore, the management of both suspected and confirmed cases must be initiated as soon as possible in order to control organ damages and prevent fatality. There is no specific treatment. The importance of the epidemiological survey must be emphasized to avoid outbreaks and control any epidemic due to this virus.

Article accepté le 20/11/2014 L a rage est une zoonose majeure due à un virus appartenant au genre Lyssavirus. Elle est responsable d'une encéphalomyélite presque toujours mortelle [1-5]. Elle est transmise à l'homme par morsure, griffure ou léchage d'animaux infectés [1, 2]. Selon l'Organisation mondiale de la santé (OMS), la rage est au dixième rang des maladies infectieuses mortelles, responsable de 55 000 décès par an dans le monde [2], dont 25 000 sur le continent africain [6]. C'est un problème de santé publique dans de nombreux pays africains dont le Burkina Faso [4, 7-9]. La lutte contre cette maladie se heurte, d'une part, à la méconnaissance, voire l'ignorance des populations vis-à-vis de la rage, et d'autre part à la faible accessibilité, aussi bien géographique que financière, des vaccins et des immunoglobulines antirabiques [2, 10]. Pourtant, depuis les travaux de Pasteur, la rage est une maladie évitable par la mise en oeuvre d'une prophylaxie postexposition, à effectuer dès que possible devant toute morsure suspecte. Nous présentons deux cas probables de rage chez des enfants, qui permettent de rappeler l'actualité de cette infection de pronostic redoutable dans notre pays. Ces cas rappellent

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