Lupus: evidence of environmental degradation? Assessment from 60 patients followed up in the Internal Medicine Department at the Libreville University Hospital, Gabon.

Lupus is an autoimmune disease of the connective tissue that occurs predominantly in women and blacks and whose expression is influenced by environmental factors, especially ultraviolet rays. The rising temperature in Gabon for nearly two decades led us to look for correlations between the onset of lupus, the patients' regions of origin, and environmental temperatures before and at diagnosis. retrospective, descriptive, and analytic study conducted in the Department of Internal Medicine of the CHU of Libreville (Gabon), from 01/01/2016 to 31/05/2016, based on the files of patients with diagnosed lupus receiving care in the department since 01/2002. Data collection forms listed for each patients age, sex, occupation, date and season of diagnosis, and place of residence (during childhood, adolescence, and adulthood). We looked for correlations between these data and temperatures, based on meteorological data from the country's seven main weather stations over a period from 1996 to 2015. The study included 53 women and 7 men (sex ratio 0.13), with a mean age of 32.7 +/- 8.9 years. The population included students (n = 25), civil servants (n = 15), the unemployed (n = 8), private-sector employees (n = 6), and shopkeepers (n=6). Diagnoses varied according to season, with 56.6% of the cases in the dry season and 43.4% in the rainy season. From 1 to 4 cases of lupus were diagnosed annually before 2011, 7 each year from 2011 to 2014, and at least 14 per year since 2015. Most patients (62.5%) had spent their childhood, adolescence, and adulthood in the country's capital (industrial zone par excellence), 17.8% in mining regions, and 12.5% in oil-drilling areas. The increase in the number of cases of lupus appears to be correlated with their greater prevalence in regions with higher temperature exposures, that is, in industrial, mining and petroleum regions, which are the regions of greatest exposure among our lupus patients.

Assessment of Imatinib in the treatment of chronic myeloid leukemia in Gabon: a cohort of 17 cases.

The prognosis for chronic myeloid leukemia, the first hematologic malignancy for which successful targeted therapy has been developed, has changed markedly in the West. In developing countries, however, prognosis remains poor, mainly because of lack of access to treatment. The effort made by some nongovernmental organizations to distribute first-generation tyrosine kinase inhibitors free of charge has changed this situation in some regions, notably in sub-Saharan Africa and Gabon in particular. We report the results in a cohort of 17 patients.

[Tuberculosis of the breast: four cases report at the Armies Instruction's Hospital Omar Bongo Ondimba (HIAOBO) in Libreville (Gabon)]. / Tuberculose mammaire : à propos de quatre cas à l'hôpital d'instruction des armées Omar Bongo Ondimba (HIAOBO) de Libreville (Gabon).

Mammary tuberculosis is a rare localization of extra pulmonary tuberculosis. Its frequency increases proportionally with the HIV pandemic. We report four cases of breast tuberculosis diagnosed in the general medicine department of HIAOBO including two with positive HIV serology. It is necessary to know this extra pulmonary form/feature as the differential diagnosis with breast tumors is sometimes difficult.

[Epidemiology of upper gastrointestinal bleeding in Gabon]. / Profil épidémiologique des hémorragies digestives hautes au Gabon.

The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.

[Leptospirosis in Libreville (Gabon): four cases]. / La leptospirose à Libreville (Gabon) : à propos de quatre cas.

OBJECTIVE: Leptospirosis is an endemic disease in tropical countries, where it is characterized by clinical polymorphism. We report four cases of leptospirosis diagnosed at the military hospital of Libreville (Gabon). CASE REPORTS: Four men aged 16 to 31-years-old, were admitted for febrile jaundice, with impaired general condition and pain. All lived in disadvantaged neighborhoods in the capital. In each case, the laboratory workups found hepatic cytolysis, renal failure, hyperleukocytosis, anemia, and an inflammatory state. Serology was negative for hepatitis B and C and for HIV, as was testing for malaria. The failure to respond to presumptive antimalarial treatment suggested leptospirosis, and the diagnosis was confirmed in every case by positive serologies with significant antibody titers. The course was quickly favorable under treatment by an appropriate antibiotic; liver and kidney function returned to normal within a few days. CONCLUSION: In tropical zones, the diagnosis of leptospirosis must be considered in all cases of febrile jaundice, especially when liver and kidney function are impaired.

[Profile of adenopathies in a tropical setting: 78 observations in Gabon]. / Profil étiologique des adénopathies en milieu tropical : soixante-dix-huit observations au Gabon.

OBJECTIVE: To determine the main causes of lymphadenopathies and their clinical characteristics in Gabon. MATERIAL AND METHOD: This retrospective study analyzed the records of patients hospitalized in the medical department at the Military Hospital of Libreville (Gabon) from January 2010 through December 2011 who presented one or more lymphadenopathies. RESULTS: The study included 78 patients (45 men, 33 women), with a mean age of 42.2 ± 15.9 years. Lymphadenopathies were superficial in 67.9% of cases, abdominal in 42% of cases and mediastinal in 24% of cases. Both deep and superficial locations were noted in 26% (20 cases). Weight loss (63%), fever (56%), asthenia (54%), hepatomegaly (26%), and splenomegaly (20%) were the clinical signs most frequently associated with lymphadenopathy. The main diagnoses were tuberculosis (52%, 41 cases) and non-Hodgkin's lymphoma (11%, 9 cases). Infection with human immunodeficiency virus (HIV) was found in 47% of cases. CONCLUSION: Tuberculosis remains the most frequent cause of lymphadenopathy in our setting. HIV testing should be routinely performed in all patients with lymphadenopathy.

[Copper deficiency and peripheral neuropathy as an outcome of gastrectomy]. / Déficit en cuivre et neuropathie périphérique compliquant une gastrectomie.

INTRODUCTION: Bariatric surgery may be indicated in patients with morbid obesity. Peripheral and central neurological complications can occur after bariatric surgery. OBSERVATION: We report a 47-year-old woman who presented with a tetraparesis related to copper deficiency after sleeve gastrectomy for morbid obesity. CONCLUSION: Neurological complications related to copper deficiency can occur after bariatric surgery.

[Morbidity and mortality in HIV-infected patients in the Military Hospital in Libreville (Gabon)]. / Morbimortalité chez les patients infectés par le VIH à l'hôpital militaire de Libreville, Gabon.

OBJECTIVE: To study the morbidity and mortality of HIV-infected patients at the military hospital in Libreville (Gabon). MATERIALS & METHODS: A retrospective study of the clinical records of 289 HIV-positive patients hospitalized in the department of internal medicine between January 2008 and December 2010. RESULTS: The patient's median age was 40 years (range: 18-70). The principal presenting complaints were fever (82%), weight loss (76.47%) and coughing (26.64%). Median time from symptom onset to consultation was 150 days (1-365). The predominant opportunistic diseases were oropharyngeal candidiasis (71.62%), all forms of tuberculosis (26.29%) and cerebral toxoplasmosis (23.87%). The median CD4 lymphocyte count was 177/mm(3 )(1-590). In-hospital mortality was 27.68%. The factors associated with death were long time to consultation and severe immunosuppression (CD4 count <100/mm(3)). CONCLUSION: Despite increased awareness, lateness of diagnosis and thus of treatment persist, and AIDS remains one of the principal causes of morbidity and mortality in Gabon.

[Histoplasmosis: case report from Gabon]. / Histoplasmose : première observation au Gabon.

The purpose of this report is to describe the first case of infection with Histoplasma capsulatum variety duboisii in Gabon, in a patient with HIV infection.

[Multifocal pyomyositis after being hit by a truncheon in Gabon]. / Pyomyosite multifocale après coups de matraque au Gabon.

Pyomyositis is an acute primary bacterial infection of striated muscle. It affects mainly but not only immunocompromised patients, especially in tropical areas. The responsible microbe is often found to be Staphylococcus aureus. We report here the case of an immunocompetent 17-year-old with multifocal pyomyositis from which S. aureus was isolated two weeks after he was hit with a truncheon.

[Multi-resistant tuberculosis at the hôpital d'instruction des armées de Libreville (Gabon) about 16 cases]. / Tuberculose multirésistante à l'hôpital d'instruction des armées de Libreville (Gabon) à propos de 16 cas.

According to WHO estimates, between 1 and 20% of tuberculosis cases in the world are multiresistant. In Gabon, this prevalence is estimated at 1.9%. In this forward-looking study from March 2006 to August 2010, we report 16 cases of multi-resistant tuberculosis out of 24 suspected resistant samples (persistence of the clinical and radiological signs after three months of well conducted treatment with first-line anti-tuberculous drugs). This study is realized in association with the laboratory of mycobacterium of the Percy military teaching hospital, Clamart, France.

[Clinical and radiological features of tuberculosis during HIV infection in Libreville, Gabon]. / Aspects cliniques et radiologiques de la tuberculose au cours de l'infection par le VIH à Libreville, Gabon.

OBJECTIVE: The purpose of this report is to describe the clinical and radiological features of tuberculosis during HIV infection. MATERIALS AND METHODS: This retrospective comparative study was based on review of patients treated between 2006 and 2010 in the Department of Medicine of the Military Hospital in Libreville, Gabon. A total of 156 patients with all types of tuberculosis were included, i.e., a study group of 78 tuberculosis patients co-infected with HIV and a control group of 78 seronegative tuberculosis patients. Analysis was carried out on demographic, clinical and radiological data. RESULTS. Most patients in both groups were male. Mean patient age was 37.1 +/- 10.3 in the seropositive group and 29.5 +/- 11.5 in the seronegative group. Deterioration in general health was quantitatively higher in the seropositive group. Tuberculosis was confined to the lungs in 41% of patients co-infected with HIV and 55% of seronegative patients. Chest x-rays showed more extensive cavitation in seronegative patients. Mixed pulmonary and extrapulmonary disease was observed in 20.5% of seropositive patients and 10.3% of seronegative patients. The CD4 lymphocyte rate was not statistically different between patients with pulmonary versus extrapulmonary tuberculosis. CONCLUSION. Tuberculosis during HIV infection often has an atypical or banal clinical presentation. Radiological findings may be non-distinctive or even normal. For this reason, diagnosis of tuberculosis may be difficult.

[Acute respiratory distress syndrome caused by tropical eosinophilic lung disease: a case in Gabon]. / Syndrome de détresse respiratoire aiguë révélateur d'un poumon éosinophile tropical : une observation au Gabon.

The purpose of this report is to describe the case of a 28-year-old woman in whom acute respiratory distress syndrome (ARDS) following cholecystectomy led to the discovery of eosinophilic lung disease. Outcome was favorable after oxygenotherapy and medical treatment using ivermectin and corticosteroids. The case shows that hypereosinophilic syndrome can be the underlying cause of ARDS.

[Pneumocystis jiroveci pneumonia: first documented case in Libreville, Gabon]. / Pneumonie à pneumocystis jiroveci: premier cas documenté à Libreville (Gabon).

The purpose of this report is to describle the first documented case of pneumocystosis in Gabon. Diagnosis was confirmed based on microbiological methods in a 59-year-old immunodepressed HIV-positive man. Diagnosis was further documented by observation of Pneumocystis jiroveci cysts in the broncho-alveolar lavage (BAL) after Gomori-Grocott color reaction. The patient responded well to treatment with Cotrimoxazole, corticoids and oxygen.

Epileptiform seizures revealing neurocysticercosis: report of two clinical cases in Libreville, Gabon.

Neurocysticercosis (NCC) is the most common helminth infection of the central nervous system. It is caused by the larval form of the tapeworm Taenia solium and is increasingly recognized as a major cause of neurologic disease worldwide. Epilepsy is the usual mode of revelation. Neuroimaging, including computed tomography and magnetic resonance imaging, combined with serodiagnostic techniques have led to this increased recognition. We report on two cases (one co-infected with the HIV) of NCC diagnosed in 2006 and 2008 at the Omar Bongo Ondimba Army Teaching Hospital. New-onset epilepsy revealed the two cases. Medical treatment with albendazole, anti-epileptic drugs and corticosteroids led to full recovery. NCC should be considered in tropical countries as a leading cause of epilepsy. Moreover, NCC should be included in the differential diagnosis of neurologic infections in HIV patients in endemic populations.

[Kikuchi-Fujimoto disease in Gabon. Description of first 2 cases in Gabon]. / Maladie de Kikuchi-Fujimoto: 2 premiers cas au Gabon.

Kikuchi-Fujimoto disease is a rare disorder sometimes associated with systemic lupus. It has rarely been reported in the black African population. The purpose of this report is to describe the first two cases in Gabon. In patients presenting enlarged cervical lymph nodes, it is first necessary to rule out infectious disease. Histology can allow diagnosis by demonstrating necrotizing histiocyte lymphadenitis.

[Neuromeningeal cryptococcosis and AIDS: an 11-case series from Libreville, Gabon]. / Cryptococcose neuroméningée et sida: 11 observations a Libreville, Gabon.

UNLABELLED: Neuromeningeal cryptococcosis occurs mainly in immunodepressed patients and especially AIDS patients. The purpose of this study was to determine the clinical and prognostic features of this severe brain infection. PATIENTS AND METHODS: This retrospective study was carried out on HIV-infected patients hospitalized for cryptococcal meningitis in the internal medicine unit of a military hospital in Libreville, Gabon from January 1, 2006 to November 31, 2009. RESULTS: Eleven cases of cryptococcosis were identified among a total of 290 cases of AIDS. Mean patient age was 39 years. The main clinical manifestation was headache that was either isolated or associated with other cerebral signs. In all cases, cerebrospinal fluid analysis demonstrated a clear aseptic aspect with direct examination after addition of India ink showing the presence of encapsulated yeast cells identified as cryptococcus. The patient was treated with amphotericin B and fluconazole. The mortality rate was 81.8% (9/11 cases). CONCLUSION: Since the manifestations of cryptococcosis during clinical AIDS are non-specific, systematic screening is recommended in AIDS patients. Early treatment could reduce mortality.

[Prevalence of hepatitis B and C virus, HTLV-1 and HIV in type B lymphoproliferative syndromes in Gabon]. / Prévalences des virus des hépatites B et C, de l'HTLV-1 et du VIH dans les syndromes lymphoprolifératifs de type B au Gabon.

B lymphoproliferative disorders (B-LPD) are the most frequent types of lymphoid malignancies encountered in Gabon where HCV, HBV, HTLV-I and HIV are highly prevalent and all known for lymphotropism. Prevalences of HBs Ag, antibodies to HCV, HTLV-I and HIV were compared in 40 patients (21 men, 19 women; 17 < age < 75 years) with newly diagnosed B-LPD (low grade lymphoma = 6, intermediate grade = 21, high grade = 8: chronic lymphocytic leukaemia = 5) and 160 age and sex-matched controls. None of the B-LPD patients had got transfusion or parenteral care from the onset of symptoms to the inclusion day. In the B-LPD group, 13 patients had HBs Ag and antibodies to HCV, HIV and HTLV-1 were detected in 11, 6 and 10 subjects. In monovariate analysis, HBs Ag, antibodies to HIV or HTLV-1 were risk factors for B-LPD but antibodies to HCV were not associated with such diseases. Multivariate analysis showed only a relationship between HBs Ag and B-LPD (OR = 3.86; IC: 1.11-13.48). In such patients, reactivation of B hepatitis by treatment of B-LBD may be an important concern. If a background poor immune system could explain both susceptibility to long standing virus carriage and lymphoma development, a participating action of the HBV in lymphomagenesis could not be excluded.