Severe malaria among children in a low seasonal transmission area, Dakar, Senegal: influence of age on clinical presentation.

The influence of age on the clinical presentation of severe malaria and especially on its 2 most commonly encountered manifestations, cerebral malaria and severe anaemia, has been retrospectively examined in 161 children (< 16 years old) admitted to the paediatric department of Hôpital Principal de Dakar from 1 January 1990 to 29 February 1996. They lived in Dakar and its suburbs, a region of Senegal where the malaria transmission rate is very low. Cases were defined by at least one of the World Health Organization criteria of severe malaria and the presence of Plasmodium falciparum in blood smears. Severe anaemia was present in 73.1%, 52.1% and 26.2% cases of severe malaria among children aged 0-3 years, 4-7 years and 8-15 years, respectively (P < 0.0001). The frequency of cerebral malaria was 11.3%, 28.2% and 60.6%, respectively, in the same age groups (P < 0.0001). Severe anaemia and cerebral malaria were associated in 8.7% of the cases of severe malaria. The fatality rate was significantly lower in cases of severe anaemia without cerebral malaria (3%) than in cases of cerebral malaria without severe anaemia (17.5%; P < 0.02). Among young children, severe anaemia was associated with brief hyperparasitaemia or with prolonged lower parasitaemia. Other things being equal, older children had a lower risk of severe anaemia. The results suggest that the high prevalence of severe anaemia in young children, even in an area of very low endemicity, depends more on age and parasitaemia than on the transmission level.

Extensive genetic diversity of Plasmodium falciparum isolates collected from patients with severe malaria in Dakar, Senegal.

While some genetic host factors are known to protect against severe Plasmodium falciparum malaria, little is known about parasite virulence factors. We have compared the genetic characteristics of P. falciparum isolates collected from 56 severe malaria patients and from 30 mild malaria patients recruited in Hôpital Principal, Dakar, Senegal. All isolates were typed using polymerase chain reaction amplification of polymorphic genetic loci (MSP-1, MSP-2, HRP1, GLURP, CSP, RESA, and the multigene family Pf60). The complexity of infections was lower in severe than in mild malaria and the parasite genetic diversity in both groups was very large. No specific genetic make-up was associated with severity; there were, however, marked differences in allele frequencies in both groups, with a prevalence up to 60% of MSP-2 alleles specifically observed in the severe malaria isolates. In addition, the presence of MSP-1/RO33 alleles was significantly associated with a higher plasma level of tumour necrosis factor alpha receptor 1 (P < 0.05), a reported indicator of severity in human malaria. These results point to potential differences in the genetic characteristics of parasites inducing severe versus mild pathology.

Malaria and urbanization in central Africa: the example of Brazzaville. Part V: Pernicious attacks and mortality.

The current incidence of pernicious attacks and of mortality due to malaria were studied in Brazzaville. The results of this study, which concerned all the medical units of the town, were analysed in terms of previous studies on the epidemiology of malaria transmission in the various districts of the town. It was estimated that the annual incidence of pernicious attacks in children in Brazzaville is 1.15 per thousand between 0 and 4 years, 0.25 per thousand between 5 and 9 years and 0.05 per thousand between 10 and 14 years. The annual mortality due to malaria was estimated at 0.43 per thousand between 0 and 4 years and 0.08 per thousand between 5 and 9 years. These values are about 30 times lower than those expected from the results of previous studies of the mortality due to malaria in intertropical Africa. Whereas considerable differences in intensity of malaria transmission exist in the different districts of Brazzaville, the incidence of pernicious attacks and the resulting mortality are remarkably unvarying whatever the level of transmission. In particular, similar results were observed for the sector Mfilou-Ngamaba-Ngangouoni, where malaria is holoendemic with over 100 infective bites per person per year and a parasite rate of 80.95% in schoolchildren, and the central sector of Poto-Poto-Ouenze-Moungali, where malaria is hypoendemic with less than one infective bite per person every three years and a parasite rate of less than 4% in schoolchildren. These results are discussed in terms of previous observations in urban and surrounding rural areas.(ABSTRACT TRUNCATED AT 250 WORDS)

[Nosocomial septicemias due to multiresistant enterobacteria: preliminary considerations in 32 cases observed in the African hospital environment]. / Septicémies nosocomiales à enterobactéries multirésistantes aux antibiotiques: considérations préliminaires à propos de 32 cas observés in milieu hospitalier africain.

In hospital settings in Africa the many other concerns of sanitary officials and the lack of available resources often make hospital hygiene and nosocomial infection secondary problems. To illustrate the importance of these issues in an African pediatric setting, this report describes a series of 32 cases of nosocomial septicemia that occurred within a 2-month period in the Pediatric Department of Principal Hospital in Dakar. There were 10 deaths. The infecting organisms were similar to those observed in industrial countries. Klebsiella Pneumoniae was identified in 16 cases, Escherichia coli in 5, and an association of both bacteria in 5. A profile of beta-lactamase enzymes with a classic epidemiologic spectrum was observed in 15 of 21 strains of Klebsiella pneumoniae and in 3 of 10 strains of Escherichia coli. The authors discuss the conditions that may have encouraged the outbreak of septicemia, regret the lack of a service to monitor hospital hygiene, and propose prophylactic measures using laboratory tests that are feasible in a hospital setting in Africa.

[Is drepanocitic trait asymptomatic? (author's transl)]. / Les porteurs du trait drépanocytaire sont-ils asymptomatiques?

With regard to its distribution the drepanocytic trait has a slight pathological incidence and does not appreciably alter the vital prospect. It is not, still, completely asymptomatic and may be, in special pathophysiological conditions, a morbidity and even lethality risk factor. Its connexions with various other diseases should be considered.

[Severe malaria in children from the seasonal low-transmission zone of Senegal: effect of age on the clinical manifestations]. / Paludisme grave de l'enfant en zone de transmission saisonnière basse au Sénégal: influence de l'âge sur les manifestations cliniques.

The influence of age on the clinical presentation of severe malaria and especially on its two most commonly encountered manifestations, cerebral malaria and severe anaemia, has been retrospectively examined in 161 children (< 16 years old) admitted in the paediatric department of Hospital Principal de Dakar from January 1st 1990 to February, 29th 1996. They lived in Dakar and its suburbs, a region of Senegal were the malaria transmission rate is very low. Cases were defined by at least one of the World Health Organization criteria of severe malaria and the presence of Plasmodium falciparum in blood smears. Severe anaemia was present in 73.1%, 52.1% and 26.2% cases of severe malaria among children aged 0-3 years, 4-7 years and 8-15 years, respectively, (p < 0.0001). The frequency of cerebral malaria was 11.3%, 28.2% and 60.6% in the same age groups, respectively, (p < 0.0001). Severe anaemia and cerebral malaria were associated in 8.7% of the cases of severe malaria. The fatality rate was significantly lower in cases of severe anaemia without cerebral malaria (3%) than in cases of cerebral malaria without severe anaemia (17.5%; p < 0.02). Among young children, severe anaemia was associated with brief hyperparasitaemia or with prolonged lower parasitaemia. Other things being equal, older patients had a lower risk of severe anaemia. The results suggest that the high prevalence of severe anaemia in young children, even in an area of very low endemicity, depends more on age and parasitaemia than on the transmission level.

[Acute acalculous gallbladder disease in children: acute cholecystitis or acute gallbladder distension (author's transl)]. / Pathologie vésiculaire aiguë non lithiasique de l'enfant: cholécystite aiguë ou distension vésiculaire aiguë (à propos de 2 cas).

Acute acalculous gallbladder disease is rarely encountered in children. Two observations permit a review of its clinical, diagnostic, and therapeutic aspects. Acute acalculous cholecystitis and acute gallbladder distension present clinically in a similar fashion, although, in the latter the fever is usually absent and there is a history of episodic pain. The pathogenesis of these affections remains uncertain but generalized infection and anomalies of the cystic duct seem to be favoring circumstances. The diagnosis, rarely initially made, could be confirmed by oral cholecystography showing an non visualized gallbladder. Surgery is necessary in order to confirme or refute the diagnosis. The therapeutic approach can be either the simple drainage of the gallbladder or a cholecystectomy. Due to the risk of allowing a cervicocystic obstacle persist, it seems that a cholecystectomy, which is well tolerated by the child, would be preferable.

[Infantile diarrheal diseases in Madagascar: bacterial, parasitologic and viral study]. / Les maladies diarrhéiques infantiles à Madagascar: etude bactérienne, parasitaire et virale.

From November 1988 to October 1989, an etiological study showed off the prevalence and the part of several enteropathogen agents which are not yet studied in MADAGASCAR. 1,523 stool's samples from 884 children with diarrhea and 639 children without diarrhea from 0 to 14 years old have been investigated. A bacterial, parasitical or viral etiology was found from 36.3% of diarrheic children and 11.2% of healthy children. The three agents the most frequently identified from children with diarrhea are EPEC (10.5%), Campylobacter jejuni (10.3%) and rotavirus (10%) and associations of two or three pathogen agents are frequent (6.2%).

[Results of brain tomography in acute lymphoblastic leukemia in children]. / Résultats de la tomométrie encéphalique dans les leucemies aiguës lymphoblastiques de l'enfant.

Computerised axial tomography (CAT scan) was performed in 22 children with acute lymphoblastic leukaemia and in 13 the results were normal. In the other nine, various lesions were observed; namely intra-parenchymal lesions of density of (3 cases, one of which was calcified), intra-parenchymal lesions of decreased density (2 cases) and ventricular dilatation (7 cases). The role of the disease and of the treatment (intra-thecal methotrexate, cranial irradiation) in the development of these lesions is discussed. The CAT scan is an excellent method of monitoring the neurological problems in acute lymphoblastic leukaemia.