IntroductionIntestinal parasitic infections are a major public health problem in inter-tropical areas. The aim of our study was to describe the situation in Mahajanga, Madagascar with a particular focus on two protozoa, Dientamoeba fragilis and Blastocystis sp.MethodsThis was a prospective study from February to June 2015. Stool samples from symptomatic hospitalized patients and asymptomatic volunteers were submitted to microscopy and molecular assays in order to detect parasites.ResultsA wide panel of intestinal parasites were identified among the 265 included subjects, protozoa being the most prevalent with 72.8% whereas the prevalence of helminths and microsporidia was of 7.9% and 4.5%, respectively. Blastocystis sp. was the most prevalent protozoa (64.5% of the entire cohort) followed by various amoebas (35.5%) and flagellates (27,5%). We only detected subtypes 1, 2 and 3 of Blastocystis sp. Among the patients positive for D. fragilis (9.4%), 23 carried genotype 1 and 1 genotype 2. For the first time, we detected in 4 human stools the DNA of a recently described protozoon, Simplicimonas similis. Interestingly, subjects living in urban areas harbored significantly more different parasitic species than subjects living in rural areas with a correlation between sanitary level of neighborhood and protozoan infection. However, there was no difference in prevalence of digestive symptoms between parasite-free and parasite-infected subjects, except for Giardia intestinalis which had more symptomatic carriers.DiscussionOur study reveals a high overall parasite prevalence, similar to what had been found in 2003 in the same city and to other prevalence studies conducted in Africa. The poor access of the population to sanitary infrastructures may explain this result. Data from our study provide valuable key for sanitation programs and prevention of fecal-related infectious diseases.

Diphtheria is an infection that has been unreported for more than two decades in Mahajanga. A child, aged 4, presented with a pseudomembranous pharyngitis was associated with a dysphagia. He was from a rural municipality of Ambato Boeny at Mahajanga province and was admitted to the Pediatric Unit of the University Hospital Center. The child was not immunized against diphtheria. A throat swab was performed and cultured, from which Corynebacterium diphtheriae was identified. The strain, of biovar Mitis, was confirmed as diphtheria toxin (DT)-gene positive and produced DT (Elek test). Unfortunately, the child developed cardiac and neurological complications and died of respiratory and heart failure.

Pseudohyperkalemia is common in routine laboratory tests. The objective of the present study is to determine pseudohyperkalemia associated with blood sampling and to analyze other causes that may explain the occurrence of hyperkalemia. A prospective descriptive and analytical study was carried out over a period of 3 months, from November 2020 to January 2021, at the University Hospital Center Professor Zafisaona Gabriel Mahajanga. Samples intended for the determination of plasma potassium, of which the pre-analytical phase could be followed from the blood sampling to their analysis were included. One hundred and twenty nine samples were tracked. Hyperkalemia was observed in 51 cases, or 39.5%. The frequency of pseudohyperkalemia was 27.5% (n = 14). Pseudohyperkalemia predominated on samples from hospitalized patients, where the pediatric department was first (50%, n = 7), followed by the Emergency and Intensive Care Department (42.9%, n = 6). It was more frequent on samples taken by paramedical trainees (78.6%, n = 11). Pseudohyperkalemia associated with tourniquet placement for more than one minute was 42.9% (n = 6). The age of 0 to 15 years and over 60 years, the presence of edema, renal and / or cardiac signs, the use of hyperkalemic drugs, and hospitalization were significantly linked to the occurrence of hyperkalemia (p<0.05). Pseudohyperkalemia must be differentiated from true hyperkalemia. Hyperkalemia should always be confirmed before aggressive treatment.