ABSTRACT
We report two cases of severe dengue fever in persons returned from stays in endemic areas during the summer outbreak of 2010. Both presented a hemorrhagic syndrome associated with primary hemostasis disorders, neutropenia, and severe hepatic cytolysis without any hepatocellular insufficiency. Three days after hospitalization, the first patient's AST and ALT levels rose to 80 and 12 times the upper reference values respectively, and the second patient's to 12 and 7 times those values. The second also presented signs of hemodynamic shock. Our observations suggest that the combination of severe hepatic cytolysis and hemostatic disorders may be a predictive marker of the severity of dengue fever. The pathophysiologic mechanisms explaining this severity remain unknown.
Subject(s)
Liver Diseases/etiology , Severe Dengue/complications , Adult , Female , Humans , Severe Dengue/diagnosis , Severity of Illness IndexABSTRACT
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.
Subject(s)
Neurocysticercosis/complications , Seizures/etiology , Taenia solium/immunology , Adrenal Cortex Hormones/therapeutic use , Adult , Albendazole/therapeutic use , Animals , Antibodies, Helminth/analysis , Anticestodal Agents/therapeutic use , Female , Gabon , HIV Infections/complications , Humans , Male , Neurocysticercosis/diagnostic imaging , Neurocysticercosis/drug therapy , Phenobarbital/therapeutic use , Seizures/diagnostic imaging , Seizures/drug therapy , Taenia solium/isolation & purification , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The purpose of this study was to evaluate management of HIV-infected/AIDS patients within the framework of the ACCESS program at Center N 3 over a 4-year period. This retrospective single-center study included HIV-positive patients treated at the Jeanne Ebori Foundation in Libreville, Gabon between January 2002 and December 2005. The active file included 749 patients, i.e., 436 undergoing antiretroviral therapy and 313 with intention to treat. The population consisted mainly of city dwellers. Mean patient age was 38.8 years with a female predominance (sex ratio, 0.8). The highest incidence of infection was observed in the 20- to 30-year age group. Socioeconomic position was low in 63.2 % of patients. Clinical suspicion (67%) was the main reason for testing. In order of frequency, symptoms defined according to the WHO criteria were classified as stage B (33.5 %) and stage C (27.1%). Opportunistic infections were observed in 95% of cases: fungal: 57%, bacterial: 30.7%, and viral: 7.3%. Tritherapy, i.e., 2INTI + 1INNTI (72.9%) and 2INTI+1 IP (17.1%), was used in most cases. Treatment led to clinical improvement with a gradual, steady, and sustained increase in CD4 lymphocyte count. Adverse events were noted including gastrointestinal reactions (16%), neurological manifestations (12%), and general symptoms (12%). Concurrent disturbances in lipid levels and liver function were noted. Overall outcome was positive with a decrease in mortality from 39.2% (M0-M6) to 2.7% (M30-M36). The findings of this study show that improvement in socioeconomic conditions and availability of adequate diagnostic and therapeutic resources at management centers to obtain long-term control of HIV infection are still current issues.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Antiretroviral Therapy, Highly Active/methods , HIV Infections/diagnosis , HIV Infections/drug therapy , AIDS-Related Opportunistic Infections/mortality , Adult , Antiretroviral Therapy, Highly Active/adverse effects , CD4 Lymphocyte Count , Female , Foundations , Gabon/epidemiology , HIV Infections/mortality , HIV-1/drug effects , HIV-2/drug effects , Humans , Male , Medical Records , Middle Aged , Retrospective Studies , Risk Factors , Social Class , Survival Analysis , Treatment OutcomeABSTRACT
The purpose of this study was to determine the frequencies of opportunistic diseases among AIDS patients at the Jeanne Ebori Foundation (JEF) in Libreville, Gabon. A total 6313 file of patients treated in the internal medicine unit between 1994 and 1998 were analyzed. Findings showed that the main diseases related to AIDS classified according to seroprevalence were as follows: purigo (100%), cerebral toxoplasmosis (100%), oral candidiaisis (88%), bacteremia (87.8%), shingles (84.6%), minor salmonelosis (72%), and tuberclosis. The main diagnoses unrelated to AIDS at the JEF according to seroprevalene were typhoid (9.4%), common pneumonia (28%), bacterial meningitis (26.3%, hepatitis B (20.0%), and malaria (14%). In addition to these diseases there were nine cases of Kaposi's sarcoma, four cases of isosporosis, two cases of cryptococcosis, two cases of herpes Varicella, one case of cryptosporidiosis, and one case of isosporosis. The incidence of opportunistic disease was high in our study and must be taken in drug procurement.
Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/diagnosis , Adolescent , Adult , Female , Gabon/epidemiology , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
During the last outbreak of Ebola virus haemorrhagic fever that occurred concurrently in Gabon and Congo, several primary foci were identified in the Ogooue Ivindo province (Northeast Gabon), where previous outbreaks had occurred. A 48-year-old woman living in Franceville located 580 Km from the epicentre presented fever with haemorrhagic signs. She was evacuated to Libreville where Ebola infection was suspected. Diagnosis was confirmed at the Centre International de Recherches Médicales of Franceville on the basis of detection of specific antibodies. Symptoms had already subsided by the time diagnosis was documented. An epidemiological investigation was undertaken to identify the source of contamination and detect secondary cases. No human or nonhuman primate source of contamination could be formally identified. Direct contact with the virus reservoir could not be ruled out. No secondary cases were detected. The favourable outcome, absence of secondary, and failure to identify a source of contamination suggest that epidemiologically undefined cases may go unnoticed during and outside of outbreaks.
Subject(s)
Disease Outbreaks , Hemorrhagic Fever, Ebola/epidemiology , Data Collection , Female , Gabon/epidemiology , Humans , Middle AgedSubject(s)
Candidiasis/diagnosis , HIV Seropositivity/complications , Adult , Candidiasis/complications , Female , HumansABSTRACT
This retrospective study of patients treated between 1992 and 1996 was undertaken as a preliminary step to identifying the main bacterial causes of diarrheal disease in Libreville, Gabon. A total 371 files showing positive stool cultures were analyzed. From an epidemiological standpoint, data showed that the high risk population was young people of both sexes. The incidence of diarrhea was correlated with climatic conditions with an endemic-epidemic pattern characterized by peak activity during the rainy season. In the vast majority of cases, the underlying etiology was gastroenteritis due to invasive organisms. The most commonly identified agents were salmonellae (46.6%) and Shigellae (44.2%). Treatment should focus on rehydration. Fluoro-quinolones were the most commonly indicated drugs for antimicrobial treatment but cotrimoxazole was often useful. In general, the prognosis of bacterial diarrhea is favorable provided that it is treated early and concurrent conditions are taken into account.
Subject(s)
Bacterial Infections/microbiology , Diarrhea/microbiology , Acute Disease , Adult , Anti-Infective Agents/therapeutic use , Bacterial Infections/drug therapy , Diarrhea/drug therapy , Diarrhea/epidemiology , Dysentery, Bacillary/diagnosis , Dysentery, Bacillary/epidemiology , Feces/microbiology , Female , Fluoroquinolones , Gabon/epidemiology , Humans , Male , Retrospective Studies , Salmonella Infections/diagnosis , Salmonella Infections/epidemiology , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
This retrospective study (1992-1996) was carried out in the Internal Medicine Department of the Jeanne Ebori Foundation at Libreville. We analyzed 351 files with the aim of counting the numbers of cases of various opportunistic infections and estimating the frequencies of these infections. The prevalence of seropositivity for HIV was 27.7% in the hospital population. Young adults from modest socioeconomic backgrounds were found to consult at stage IV of the infection. Oropharyngeal candidiasis (37%), zona (18.5%), salmonellosis (18.2%) and tuberculosis (14.5%) were the most frequently diagnosed opportunistic infections. Intestinal parasitoses, cryptococcosis, radiculomeningitis, cerebral toxoplasmosis and visceral fungal infections were diagnosed less frequently. The prevalence of Kaposi's sarcoma was 6.3%. Most of the opportunistic infections encountered were treatable but the mortality rate was high (11.7%) due to late diagnosis, the lack of availability of drugs and the poor economic conditions of the population.
Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/diagnosis , Adolescent , Adult , Age Factors , Aged , Anti-Infective Agents/therapeutic use , Cross-Sectional Studies , Female , Gabon/epidemiology , HIV Seropositivity , Humans , Male , Middle Aged , Occupations , Retrospective Studies , Sex Factors , Socioeconomic FactorsABSTRACT
We carried out a retrospective study of 150 files of patients suffering from typhoid or paratyphoid fever, confirmed bacteriologically, between January 1992 and December 1996 at Libreville. Young adults were the most frequently affected. These infections were associated with unstable living conditions and lack of cleanliness. Neurological (17%), digestive (12%) and cardiovascular (3%) complications were the principal factors aggravating the disease. The following serotypes were identified: Salmonella typhi (47%), S. paratyphi B (25%), S. paratyphi C (20%) and S. paratyphi A (8%). Salmonellosis was associated with schistosomiasis (13%), nematodiasis (2.3%), sickle-cell anemia (7%) and HIV infection (8%). The mortality rate was 3.3%. Fluoroquinolones are the molecules of choice for treating typhoid and paratyphoid fevers.
Subject(s)
Paratyphoid Fever/epidemiology , Typhoid Fever/epidemiology , Adolescent , Adult , Age Factors , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Cefotaxime/administration & dosage , Cefotaxime/pharmacology , Cefotaxime/therapeutic use , Cephalosporins/administration & dosage , Cephalosporins/pharmacology , Cephalosporins/therapeutic use , Chloramphenicol/pharmacology , Drug Resistance, Microbial , Female , Gabon/epidemiology , Humans , Male , Middle Aged , Ofloxacin/administration & dosage , Ofloxacin/pharmacology , Ofloxacin/therapeutic use , Paratyphoid Fever/diagnosis , Paratyphoid Fever/drug therapy , Pefloxacin/administration & dosage , Pefloxacin/pharmacology , Pefloxacin/therapeutic use , Penicillin Resistance , Penicillins/pharmacology , Salmonella paratyphi A/drug effects , Salmonella typhi/drug effects , Sex Factors , Time Factors , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage , Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Typhoid Fever/diagnosis , Typhoid Fever/drug therapyABSTRACT
Amoebiasis and tuberculosis are common in Gabon. International travel, cultural exchanges, changing immigration and climate of tropical provide an ideal environment for these pathogenic organisms. However, the unexpected survival of these two pathologies in the same patient is exceptional.
Subject(s)
Amebiasis/complications , Amebiasis/diagnosis , Lung Abscess/complications , Lung Abscess/diagnosis , Lung Diseases, Parasitic/complications , Lung Diseases, Parasitic/diagnosis , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnosis , Adult , Alcoholism/complications , Amebiasis/drug therapy , Anti-Infective Agents/therapeutic use , Antitubercular Agents/therapeutic use , Causality , Drug Therapy, Combination , Gabon , Humans , Lung Abscess/drug therapy , Lung Diseases, Parasitic/drug therapy , Male , Metronidazole/therapeutic use , Travel , Tropical Climate , Tuberculosis, Pulmonary/drug therapy , Urban Health/statistics & numerical dataSubject(s)
Hemorrhagic Fever, Ebola/diagnosis , Hemorrhagic Fever, Ebola/therapy , Infectious Disease Transmission, Patient-to-Professional , Medical Staff, Hospital , Nursing Staff, Hospital , Adult , Fatal Outcome , Female , Gabon , Hemorrhagic Fever, Ebola/transmission , Humans , Male , South Africa , Transportation of PatientsABSTRACT
We conducted a retrospective review to specify the frequency, identify the aetiological factors of bacterial meningitis in adults (BMA) and to evaluate the therapeutic protocol used. This study was conducted on 85 (BMA) cases of hospitalised patients between January 1991 and December 1995 (5 years) on our service. The BMA represented 3% of all admissions for infectious diseases at the Foundation Jeanne Ebori in Libreville. It occurred in an endemosporadic fashion. All patients were Black Africans with an average age of 33 years (range: 16-60 years). Males predominated by a ratio of 2.4. Tha patients were seen late in the evolution of the disease, as shown by the folloxing clinical signs: neuropsychic problems (100%), 25 patients (29%) were in a profound coma, 5 (6%) had a hemiplegia, 2 (2%) an hypoacousie and 1 (1%) seizure. Aetiological factors were found in 17 cases (20%) to be in the ORL sphere (sinusitis: n = 8, ear infection: n = 4), pneumopathies (n = 4) and one case of breach dure-mere. The predominant germ was pneumocoque, isolated in 55 cases (65%), 15 cases had a LCR clear (18%). Bacteria gram negative (6%) were identified in the immunocompromised HIV. Third generation cephems had an efficiency higher than beta lactamines: 83% against 73%. The mortality was 18%; 3% of the remaining patients had neurological deafness. The seriousness of the results of this survey calls for the urgent implementation of a surveillance programme.