Tuberculosis in children in Togo: epidemiology, diagnosis, treatment, and outcome.

INTRODUCTION: Tuberculosis (TB) remains one of the most lethal communicable diseases in the world, according to the World Health Organization (WHO). New strategies must be implemented to meet targets for 2035. OBJECTIVE: Describe the epidemiological and therapeutic aspects of tuberculosis in children in Togo. MATERIALS AND METHODS: This retrospective, multicenter, descriptive cross-sectional study examined the files of children younger than 15 years who were diagnosed with TB and treatment in the Maritime region from 2008 to 2011. RESULTS: The study included 74 children aged 0-15 years, for an average of 18 cases of childhood tuberculosis annually. Pulmonary tuberculosis (38 cases) was the most common. TB-HIV co-infection was found in 14.9% of cases. Boys accounted for more than half of the patients. The age range of 11-15 years accounted for the highest proportion of cases (41.9%). The most common treatment was a combination of 2RHZE and 4RH (25 children, 33.8%). Laboratory monitoring was satisfactory. In all, 56 (75.7%) children were cured, and 14 (18.2%) lost to follow-up, while 3 (4%) died (all with TB/HIV). CONCLUSION: Active testing for HIV infection is essential in children with TB, because the combination of the two can be lethal.

[Rapid regression of infantile haemangioma with 2% propranolol ointment]. / Régression rapide d'un hémangiome infantile sous propranolol topique à 2 %

BACKGROUND: Oral propranolol produces dramatic results in severe infantile haemangioma. We report a case of rapid and significant regression of an infantile haemangioma in infant treated topically with 2% propranolol ointment. PATIENTS AND METHODS: A female infant aged 11 weeks was seen as an outpatient for two infantile haemangiomas on the front of the left knee and the vulva. After parental consent was given, the child was treated with a topical preparation of 2% propranolol ointment prepared by the pharmacy. Regression was rapid and on the 45th day, lesion size had been reduced by an estimated 75%. No adverse effects were observed. DISCUSSION: Topical propranolol appears to be effective and safe for the treatment of superficial haemangiomas. Clinical trials are required to determine the optimal dosage and pharmaceutical form, method of use and treatment duration.

[Chylous ascites, a revealing sign of peritoneal tuberculosis in an 11-month-old infant]. / Ascite chyleuse révélatrice d'une tuberculose péritonéale chez un nourrisson de 11 mois.

Chylous ascites is rare in children. We report on a case of chylous ascites in an 1-month-old infant in Togo. The infant had been appropriately vaccinated, had normal growth and psychomotor development, and he was living in a rural area. He had fever that had started 3 months earlier and persisted despite various treatments with antimalarials and antibiotics. Then progressively abdominal pain with abdominal distension developed, while lactescent ascites was discovered after puncture. The patient was referred to the Lomé teaching hospital for advanced management. Intradermic reaction to tuberculin (IRD) was positive (16 mm). Chylous ascites liquid analysis revealed apparently lymphocytic pleocytosis. Culture on special milieu allowed isolation of Mycobacterium tuberculosis. The clinical course was favorable with antituberculosis treatment. Peritoneal tuberculosis should be suspected in endemic areas in the case of a persistent fever with abdominal bloating and effusion, whatever the patient's age and the nature of ascites liquid.

[What remains today of neonatal conjunctivitis in prefecture of Kozah in Togo?]. / Que reste-t-il aujourd'hui des conjonctivites néonatales dans la préfecture de la Kozah au Togo ?

AIM: The purpose of this study is to screen the neonatal conjunctivitis in order to evaluate its incidence and especially to seek for the causative germs. PATIENTS AND METHODS: We have realized cross-sectional study in three health centers of the prefecture of Kozah from March 24 to May 12, 2009. All the newborns followed in these centers are examined in the search of signs of conjunctivitis. A biological diagnosis of conjunctival secretions was carried out at the suspect newborns. RESULTS: During the study period, 348 newborns were examined including 185 boys and 163 girls corresponding to a sex-ratio (M/F) of 1.1. The middle age was 3.7 days. Twenty-eight newborns presented conjunctivitis, that is to say a rate of incidence of 8%. The cases of conjunctivitis were observed the first four days of life in 39.3% of cases. Eighteen of the newborns presenting conjunctivitis were vaginal deliveries (64.3%) against ten (35.7%) by caesarian. All the mothers of the ill newborns had a syndrome of sexually transmissible infection (STI) during the third quarters of pregnancy. After biological diagnosis, Staphylococcus aureus was found in 25% of the cases. CONCLUSION: Despite the common herd of neonatal conjunctivitis prophylaxis by Crede's method, its remains in the prefecture of Kozah. In hope for neonatal conjunctivitis eradication, treatment of STI on pregnant women associated to education and communication on the prevention of the infection in neonatal health care centers and at home by hygiene rule application are necessary.

[Evaluation of the glycemia of low-weight newborns within the 24th hour of life at Lomé University Hospital (Togo)]. / Évaluation de la glycémie des nouveau-nés de petits poids avant la 24(e) heure de vie au CHU-Tokoin de Lomé

OBJECTIVE: To assess the glycemia of low-weight newborns (LWNBs) during their first 24h of life as well as their mother's glycemia. PATIENTS AND METHOD: This was a cross-sectional prospective study within a case-control group, conducted at Lomé University Hospital (nationwide main hospital) from January to May 2006. One hundred thirty-nine LWNBs and 150 eutrophic term newborns (ETNBs), 98 mothers of LWNBs (MLWNBs), and 145 mothers of ETNBs (METNBs) were screened and monitored on glycemia dosage. RESULTS: The average glycemia level of the LWNBs (0.34 ± 0.27g/l) was significantly greater than the ETNBs' glycemia level (0.30 ± 0.14 g/l); it was nearly the same for the mean glycemia level of the MLWNBs (0.82 ± 0.2g/l) and the METNBs (0.77 ± 0.1g/l). Neonatal hypoglycemia during the first 24h of life was less frequent (RR=0.8) in the LWNBs (61.15%) than in the ETNBs (80%). The positive correlation between gestational age and glycemia was higher in the ETNBs (r=0.17) than in the LWNBs (r=0.07). This positive correlation between birthweight and glycemia was lower in the LWNBs (r=0.17) compared to the ETNBs (r=0.37); this was not the case within the group of the ETNBs (r=0.02) compared to the group of the LWNBs (r=0.34) concerning the correlation between the glycemia of mothers and newborns. CONCLUSION: The early hypoglycemia was much greater in the ETNBs compared to the LWNBs. Therefore, it is necessary to systematically start breastfeeding all newborns within their first hours of life whatever their gestational age, in order to solve these metabolic disorders.

[What do we know about trachoma in the economically weakest infantile population of Kara in Togo?]. / Que savons-nous de la prévalence du trachome dans la population infantile économiquement défavorisée de la region de Kara au Togo?

PURPOSE: To describe the distribution of the trachoma in the infantile population of Kara region. MATERIALS AND METHODS: A descriptive cross sectional investigation has been achieved in 6 sanitary districts of Kara's region in November 2009. In each of the 2 villages of the sanitary area of every peripheral health unit (PHU), 15 schoolchildren aged of 6 to 9 years then 35 children of the community aged of 1 to 5 years have been examined to search signs of trachoma with the help of a lamp wipes coupled of a binocular loupe (2.5X magnification). RESULTS: To the total 10,100 children have been examined in 202 villages of the sanitary areas of 101 PHU. Among the 7070 children aged of 1-5 years, 289 presented trachomatous inflammation follicular (TF) and 131 trachomatous inflammation intense (TI), corresponding to a prevalence rate of 5.94%. Among the 3030 schoolchildren, 68 presented TF and 62 TI corresponding to 4.29% prevalence rate. The prevalence rate of the active trachoma was of 5.44% in the infantile population of this region. CONCLUSION: This investigation could confirm that active trachoma still exists in this region. Another investigation will be carried out to determine the prevalence of trachoma among the adult subjects in order to have a more complete data base in view of further action for trachoma elimination in this region.