[Difficulties in the diagnosis of a febrile exanthema of different etiologies in a tuberculous patient in Madagascar]. / Difficultés diagnostiques d'un exanthème fébrile d'étiologies différentes chez une même patiente tuberculeuse à Madagascar.

This article illustrates the difficulties in the treatment of tuberculosis through the case of a patient with tuberculosis presenting with a haemophagocytic syndrome, severe drug hypersensitivity and a dissemination of the disease. A month after tuberculosis chemotherapy was started, Mrs. R.S, aged 45 years, presented with febrile exanthema, confusion, multiple lymph nodes enlargement/polyadenopathy, bi-cytopenia and a severe hepatic cytolysis. The haemophagocytic syndrome was confirmed by a myelogram and had shown a good response to the administration of methylprednisolone. Tuberculosis chemotherapy was stopped for a month and when resumed, there was a recurrence of the febrile exanthema without haematologic abnormalities but a moderate hepatic cytolysis. The association of haemophagocytic syndrome with tuberculosis is a rare occurrence. It was important to differentiate drug hypersensitivity and recurrence of haemophagocytic syndrome, as the sole treatment interruption was sufficient to heal the patient during the second febrile rash. Corticotherapy, discontinuation of tuberculostatic treatment and a very progressive reintroduction of antituberculosis drugs was successful though it caused the dissemination of the tuberculosis disease.

[Nutrition and infection]. / Nutrition et infection.

Undernutrition leads to a global immune deficiency. What is the influence of undernutrition on the occurence and development of an infectious disease? How does an infection act on nutritional state of a patient? Is it possible to improve nutritional state by treating an infection and inversely, is it possible to prevent the arrival of an infectious disease by improving nutritional state? This article summarizes answers to these questions and takes up the subject of infectious complications related to nutritional treatment and parenteral nutrition in particular. Some exemples of pharmaconutrition are also mentioned.

[Madagascar: public health situation on the "Big Island" at the beginning of the 21st century]. / Madagascar: la situation sanitaire dans la Grande ile au début du XXIe siècle.

The main public health issue in Madagascar at the beginning of the 21st century still involves transmissible infectious diseases including re-emerging diseases such as bubonic plague and emerging diseases such as HIV/AIDS, dengue fever and Chikungunya virus infection. Health and hygiene especially access to clean water is still poor especially in rural areas. No improvement in the public health situation with regard to malaria, schistomosomiais or cysticercosis as well as non-infectious diseases such as protein-energy malnutrition is expected within the next decade.

[Community-acquired pneumonia: attitude case of treatment failure]. / Pneumonie: que faire en cas d'echec de traitement?

It can be determined that for nearly one out of five patients hospitalized for a community-acquired pneumonia the empirical treatment chosen will fail. Those for whom the treatment failed face a bad outcome with a mortality rate as a high as 43%. Most causes of failure can be attributable to the patient rather than to the antibiotic or to the pathogen. The studies related to treatment failure show that resistance of the causal agent to antibiotic is rarely the cause, as opposed to discordant therapy (causal agent not covered by chosen antibiotherapy), which plays an important role. In these studies the multivariate analysis were able to show that concordant therapy (causal agent covered by chosen antibiotherapy), vaccination against influenza, monocytosis and old age were possible protective factors against treatment failure.

Goat's milk as a substitute for cow's milk in undernourished children: a randomized double-blind clinical trial.

OBJECTIVE: This paper compares the effects of goat's milk and cow's milk on weight gain and fat absorption, in children with overt malnutrition. METHODS: Thirty hospitalized malnourished children aged from 1 to 5 years were included in a randomized double-blind trial. The children were fed either goat or cow's milk with a randomized will defined composition, added with vegetable oil, sugar, vitamins and minerals o achieve 1,000 kcal/liter. Children were offered 100 kcal/kg on the first day, with a regular daily increase in energy intake thereafter that reached 200 kcal/kg per day on the tenth day. RESULTS: Both groups of children had the same degree of malnutrition on inclusion. The mean weight-for-height Z score was -1.7 in both groups. One death with candidiasis occurred in the goat's milk group. Weight gain was similar in both groups: 8.5 g/kg/day (SE = 1.37) with goat's milk and 7.8 (SE = 1.9) with cow's milk. There was no significant difference in HEM intake: 157 ml/kg/day (SE = 4), vs 162 (SE = 4) for goat and cow's milk, respectively. Fat absorption coefficients on the 15th day of treatment were also similar in both groups. CONCLUSION: These results suggest that goat's milk has a nutritional value similar to that of cow's milk and could be used as an alternative to cow's milk for rehabilitating undernourished children.

[First cases of cholera observed in children at the Befelatanana General Hospital--Antananarivo University Hospital Center (Madagascar)]. / Premiers cas de choléra observés chez l'enfant à l'Hôpital général de Befelatanana--Centre Hospitalier Universitaire d'Antananarivo (Madagascar).

Ravages caused by cholera among children are well known. The disease invaded Madagascar in 1999 May. This retrospective study reported the first childhood cholera cases. The survey was carried out at the Befelatanana Hospital during the period of cholera outbreak from April 23th to July 31st. The purpose of the study was to specify clinical, epidemiological and bacteriological characteristics of the disease. 5 out of 178 suspected cholera cases were less than 15 years old. 2 young girls out these 5 children, inhabitants of Antananarivo-City were hospitalized for acute diarrhoea with serious dehydratation. Their disease was confirmed by bacteriology. Vibrio cholera O1 strain, serovar Ogawa was identified. Epidemiological investigation allowed to identify the contamination modal in the file no 1. The authors conclude that cholera is an important problem of public health in developing country like Madagascar. Disease control needs environmental sanitation and good individual hygiene practices.