Efficacy of chloroquine-proguanil malaria prophylaxis in a non-immune population in Bangui, Central African Republic: a case-control study.

A case-control study was conducted to evaluate the efficacy of the combination of chloroquine plus proguanil as malaria prophylaxis in a non-immune population living in the Central African Republic. Cases were patients presenting with a malaria attack confirmed by a positive blood film and/or an HRP2 positive antigen test at the Pasteur Institute of Bangui. Two control subjects were included per case: one was a relative or close friend and the other was matched to the patient with respect to the length of stay. A questionnaire assessing malaria prophylaxis habits and malarial risk factors over the 2-month period prior to inclusion in the study was given to 48 cases and 96 controls. A conditional logistic regression was used to identify risk factors. The efficacy of the chloroquine plus proguanil regimen was found to be high (95.5%, 95% CI 74.0-99.2%) in this country known for high chloroquine resistance. Our data lend some support to the use of chloroquine plus proguanil in Bangui, and the protective efficacy of chloroquine plus proguanil should now be studied prospectively as part of a randomised controlled trial of various prophylactic drugs.

[Contribution of biochemical tests in the diagnosis of the nervous phase of human African trypanosomiasis]. / Apport des examens biochimiques dans le diagnostic de la phase nerveuse de la trypanosomose humaine africaine.

The stage of human African trypanosomiasis (HAT) is important to define precisely as far as it is directly related to the type of treatment used. The beginning of the neurological involvement is difficult to find out because there is no known specific clinical or biological sign. This study is trying to look for a precise marker and has been realized in Congo. 70 subjects with parasitologically confirmed HAT and 70 controls are included. The stage of HAT is determined according to the classical definition on the field using the cerebrospinal fluid (CSF) cell count: less than 5 cells/microliters for the first stage (P1), more than 5 cells/microliters for the second stage (P2). The blood analysis has included: glucose, urea, creatinine, sodium, potassium, calcium, chloride, phosphorus, uric acid, total bilirubin, unconjugated bilirubin, total cholesterol, triglycerides, total proteins, aspartate aminotransferase, alanine aminotransferase, creatinine phosphokinase, alkaline phosphatase, gamma-glutamyltransferase, immunoglobulins M and G, C3c fraction of complement, transferrin, seromucoid alpha 1, haptoglobin and albumin. In CSF we have analyzed IgM, IgG, protein levels and the bloodbrain barrier (BBB) impairment. The comparison between the subjects and their controls, the subjects in P1 and in P2, the CSF cell count and the other CSF alterations show the interest of the IgM level in CSF and the BBB impairment to identify subjects in P2. However there is a low gradation in the biological disturbances and not a precise threshold point. Nevertheless it seems reasonable to raise the CSF cell count level to 20 cells/microliters to define the beginning of the nervous involvement.

[The distribution of sleep and wakefulness in human African trypanosomiasis]. / Distribution du sommeil et de la veille dans la trypanosomose humaine africaine.

Last century, patients with human African trypanosomiasis were described as sleepy by day and restless by night, and physicians referred to this condition as sleeping sickness. Such a description could have evoked a disturbance of circadian rhythms. However, it is only in 1989 that the first 24-hour recording was performed by our team in Niamey (Niger) in a patient with sleeping sickness. The patient was a Niger-born farm worker who had contracted the disease near Gagnoa (Côte d'Ivoire). Polysomnographic recordings (electroencephalogram, EEG, electrooculogram, electromyogram, electrocardiogram, buccal and nasal airflow, and chest respiratory movements) showed a disappearance of the circadian distribution of sleep and wakefulness, which tended to occur evenly throughout day and night, with a sleep-wake alternation of approximately 80 minutes. Two investigations were conducted thereafter. The first one was done at Daloa (Côte d'Ivoire) in 8 patients who were recorded during two 24-hour periods, with and without hourly blood samples; the second at Brazzaville (Congo) in 10 patients recorded for 24 hours before and after treatment with melarsoprol. All patients were at the stage of early meningoencephalitis. At Daloa, polysomnographic recordings were taken on two 8-channel EEG machines (Alvar Minihuit, and T3-ECEM), as well as on a portable Oxford Medilog 9000 system from the same electrodes. Sleep and wake structure was altered in the most severely sick patient, the EEG trace being loaded with slow waves. Stages 1 and 2, and stages 3 and 4 could not be distinguished from one another. In the other patients, all sleep stages were easily scored. No difference was seen between recordings, regarding blood collection.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the level of endemic tuberculosis in a survey of Banqui (Central African Republic)]. / Evaluation du niveau d'endémie tuberculeuse par enquête tuberculinique dans la ville de Bangui (République Centrafricaine).

A cluster sample survey on tuberculosis has been carried out in Bangui in February 1988. The bimodal distribution of the diameters of IDR on children aged between 5 to 9, gives evidence of a circulation of some non typical mycobacteriae and enables to fix the limit of positivity at 14 mm. The prevalence rate of the tuberculotic infection is 7.9 +/- 1.7% in the surveyed children population at school. The annual risk of infection is evaluated at 1.09% that ranks the Centrafrican Republic in the countries with a low prevalence rate.

[Where is the focus of human trypanosomiasis in Mossaka (Congo)]. / Où en est le foyer de trypanosomiase humaine de Mossaka (Congo)?

The Mossaka focus of sleeping sickness (on the Sangha, Cuvette area, in Congo) has been progressing dramatically for last years. In 1989, after a prospection we had accomplished in the focus, we had insisted on the priority to limit an extension of the disease. Since then the situation get worse, regarding to the number of patients detected (74 in 1987, 171 in 1989, 200 in 1991) and the concerned population. The number of villages where we detected patients is raised from 3 in 1987 to 12 in 1989 and 17 in 1991. If measures are not taken quickly, we can await a dramatic extension of lower Sangha focus.

[Distribution and importance of sites of Glossina fuscipes fuscipes Newstead 1910 in the agglomeration of Bangui (Central Africal Republic)]. / Distribution et importance des gîtes a Glossina fuscipes fuscipes Newstead, 1910 dans l'agglomération de Bangui (République Centrafricaine).

The authors review urban sites of Glossina fuscipes fuscipes in the suburbs of Bangui and propose a classification of these sites. Among them, two isolated breeding sites are characterized by a high density of tsetse and a close man/fly contact. To prevent a possible reactivation of the historical sleeping sickness focus of Bangui-Bimbo, a tsetse control programme in these two sites is necessary.

[Tuberculous allergy in a population of 3-to-23-month-old children in Bangui (Central African Republic)]. / Etude de l'allergie tuberculinique dans une population d'enfants âgés de 3 à 23 mois à Bangui (Republique Centrafricaine).

In 1986, vaccinal allergy has been looked for by tuberculin RT 23 intradermal reaction within a random group of 354 Central African Children aged of 3 to 23 months and immunized in the Mother and Child Care Services in Bangui in the framework of the Enlarged Vaccination Program, with the same B.C.G. strain during their postnatal period. Percentage of intradermal reactions equivalent or superior to 6 mm get down with time, of progressive but fast mode from 56.2 p.c. in the age group of 3 to 5 months to 20.2 p.c. in the ones of 12 to 23 months. Nevertheless, the authors recommend B.C.G. immunization in urban milieu during the postnatal period because of the strong vaccinal protection one get, but recommend also a systematic booster injection during the second year of childhood.

[Lymphoma of the cecum]. / Linfoma del ciego.

A description is offered of a toxic and febrile young patient with diarrheic syndrome of twenty days evolution secondary to extranodal lymphoma of cecal location. A concomitant immunity deficit--selective IgA deficit--appeared in the form of chronic mucocutaneous candidiasis and discoid lupus, and in the absence of familial antecedents. As a result of this case study, an association of gastrointestinal lymphoma of unusual location with an underlying immune disorder, the literature was reviewed.

[Syncopes and brief spells of feeling faint: value of Holter monitoring?]. / Syncopes et malaises brefs: utilité du Holter?

A retrospective study of Holter monitoring of 250 patients referred for syncope and short spells of dizziness suspected of being cardiac in origin was undertaken to assess the diagnostic value of the investigation. The arrhythmias observed were classified in 3 groups, significant, suspect and physiological with respect to their true or potential severity and to previously reported results of Holter monitoring in healthy subjects. The following arrhythmias were classified as significant: supraventricular tachycardia with a ventricular rate greater than or equal to 200 bpm; sustained ventricular tachycardia (greater than 30 s and greater than or equal to 150 bpm), bradycardia (less than bpm), sinus arrest (waking greater than 2 s sleeping greater than or equal to 6 s), complete AV block with wide QRS complexes and pacemaker dysfunction. The following arrhythmias were classified as suspect: paroxysmal supraventricular tachycardia with a ventricular rate less than 200 bpm, salvos of ventricular tachycardia (120 greater than 150 bpm); R/T phenomenon and doublets (greater than or equal to 50/24 hours), sinus arrest of 2 to 6 seconds during sleep, complete AV block with narrow QRS complexes or second degree Mobitz II block. This classification led to a diagnosis of certitude in 20 patients (5.7%) with significant arrhythmias concomitant with syncope or a minor form in only 5 cases, supraventricular tachycardia (4 cases), ventricular tachycardia (4 cases), AV block (5 cases), sinus arrest (3 cases), pacemaker dysfunction (4 cases); a diagnosis of presumption in 74 patients (21.1%) with suspect arrhythmias in the absence of syncope or minor equivalent.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anti-malaria chemical prophylaxis in Europeans and anti-Plasmodium fluorescence antibodies]. / Chimioprophylaxie antipaludique de l'européen et anticorps fluorescents anti-Plasmodium.

The authors recorded clinical histories and tested serum for the presence of malaria fluorescent antibodies in 160 healthy Europeans who had been living for more than 4 weeks in West or Central Africa. Malaria or fever of unknown origin occurred in 37 of 50 subjects who were careless about taking prophylactic drugs while abroad. Out of 110 people regularly taking suppressive amino-4-quinoline therapy, 21 had presented febrile attacks but serological tests were only positive in 8 cases. Positive serological reactions at low titers were obtained in 3 subjects with no history of past infection and who had faithfully taken suppressive medications. These results confirm the value of the malaria immunofluorescence test for the detection of occult malaria in blood donors outside endemic areas, and explain the necessity to consider previous regular, irregular or absent chemoprophylaxis before interpreting the serological results of a febrile patient returning from overseas.