[Tuberculosis in the newborn: recrudescence in areas with high endemic HIV infection]. / Tuberculose du nouveau-né: résurgence en milieu de forte endémie de VIH.

Despite the rising prevalence of tuberculosis due in part to the HIV pandemic in Africa, there have been few reports describing neonatal or congenital tuberculosis and its association with maternal HIV infection has been rare. The purpose of this study was to evaluate the clinical and epidemiological features of tuberculosis in newborns from areas with high endemic rates of both tuberculosis and HIV infection. During the 2-year study period all neonates admitted to the Campus Teaching Hospital in Lomé, Togo for differential diagnosis of symptoms compatible with tuberculosis were investigated. The clinical profile of tuberculosis in the newborn was correlated with that of the mother with or without HIV infection. Perinatal tuberculosis was diagnosed in 13 of the 79 newborns investigated including 8 whose mothers were co-infected by HIV and tuberculosis. Seven cases were classified as congenital tuberculosis. The predominant clinical features were respiratory distress (10/13), fever (9/13), hepatomegaly (9/13), intra-uterine growth retardation (8/13), stagnation or loss of weight (6/13), cough (4/13) and splenomegaly (4/13). Diagnosis of maternal HIV and tuberculosis infection was never made prior to newborn admission to our department. Four newborns and two mothers died within 3 months after childbirth. This study on perinatal tuberculosis in children born to mothers with or without HIV infection demonstrates the need for early diagnostic methods, consensual therapeutic protocols, and further study in larger geographical area to specify epidemiologic features and reduce high mortality.

[Follow-up of HIV-infected children receiving antiretroviral therapy in a rural area of Togo]. / Suivi des enfants infectés par le VIH/sida sous traitement antirétroviral en milieu rural au Togo.

OBJECTIVE: To evaluate the monitoring of HIV-infected children receiving antiretroviral therapy in rural areas of Togo and the effectiveness of the treatment. METHODS: This retrospective descriptive study, conducted at the Luis Scrosospi Center in Kouvé from 15 November, 2008, through 14 November, 2009, examined the records of children who had been receiving antiretroviral therapy for at least 6 months. RESULTS: We studied the records of 55 children. The sex ratio was 0.9, and the primary opportunistic infections were respiratory infections and malaria. At treatment initiation, their average age was 6 years and 3 months, the average CD4 T cell count 358/mm(3), and the mean weight 12.9 kg. The hemoglobin level was less than 8 g/dL in 31%. All children received a nutritional kit monthly. The antiretroviral therapy for 52 children was a combination of stavudine, lamivudine, and nevirapine. The adherence rate during the first 12 months was 80% (44/55 children). The mean weight gain was 860 g (below -3SD) at 3 months, 1,550 g (between -3SD and -2SD) at 6 months, and 1 270 g (between -2SD and -1SD) at 12 months of treatment. The severe acute malnutrition rate fell from 60% at treatment initiation to 56% at 3 months, 47% at 6 months, and 25% at 12 months. Also after 12 months, the CD4 T cell count had risen in 60% of the children. The main side effects were peripheral neuropathy (29%) and headaches (18%). Eight children died (14%) during the follow-up. CONCLUSION: Monitoring of HIV-infected children on antiretroviral therapy is possible in Togo's rural areas and should be encouraged for it will help to achieve the Millennium Development Goals.

[Imflammatory myofibroblastic tumour of nose and paranasal sinuses in a little girl of 7-year-old]. / Tumeur myofibroblastique inflammatoire endonasale chez une fillette de 7 ans.

Inflammatory myofibroblastic tumours (IMTs) are clinical and pathological distinct entities with controversial biological entities. IMTs have been described in the lungs, abdomen, retroperitoneum and extremities but rarely in the head and neck region. This case report corresponds to an IMT of the nose and the paranasal sinuses in a little girl of 7 years of age. The computed tomography scan showed an expanding tumoral process without skull destruction. First case report in the west African region, this observation describes the treatment instituted according to the possible care in our medical area, and the treatment when the patient was referred to a centre with efficient technical platform. This case underlines the aggressiveness of this type of tumour: an invasive tumour with local-regional extension and high recurrence potential. Currently, after 2 years, the tumoral process is considered cured after several radical surgical excisions.