A single dose of ciprofloxacin reduces the duration of diarrhea among service members deployed in Africa.

OBJECTIVES: To assess the effectiveness of the adjunction of a one-gram single dose of ciprofloxacin to a symptomatic treatment for the early treatment of uncomplicated diarrhea during military operations of the French service members in Africa. PATIENTS AND METHODS: This phase IV, multicentric, randomized, open-label, controlled trial was conducted in Chad, Mali, and in Central African Republic. A total of 267 French service members having at least one loose stool in the previous 24 hours were enrolled from May 2015 to June 2016. Participants were randomized to receive ciprofloxacin 1 g and a symptomatic treatment (racecadotril 100 mg three times a day and ad libidum oral rehydration solution) or a symptomatic treatment alone. The primary outcome was the duration of the diarrhea. Secondary outcomes were evaluated at the 72-hour endpoint and included recovery status, number of loose stools, frequency and duration of associated symptoms and safety of treatments. RESULTS: Among 267 participants, 242 completed the trial. Participants receiving ciprofloxacin and a symptomatic treatment (n = 124) were significantly more likely to be cured at the endpoint than those who only received a symptomatic treatment (118): 94.4 % versus 74.6 % (OR = 5.7; 95 %CI: [2.4-13.6]; p < 10-3). The antibiotic therapy reduced the average diarrhea duration by 30 % (p = 10-4). Fever at inclusion was associated with a longer episode (HR = 0.61; 95 %CI: [0.41-0.89]; p = 0.012). No adverse event of medications was reported. CONCLUSION: A single dose of ciprofloxacin was effective and safe in treating uncomplicated diarrhea among service members in Africa.

[Acute pericarditis associated with Plasmodium ovale malaria]. / Péricardite aiguë associée a un accès palustre de reviviscence a Plasmodium ovale.

The purpose of this report is to describe a rare case of benign acute pericarditis associated with recurrent Plasmodium ovale malaria. It was observed in a 33-year-old soldier who was stationed in Djibouti after serving several previous stints in West Africa. A favorable clinical outcome was achieved using chloroquin (30 mg/kg on 6 days) in association with NSAID followed by salicylates for one month. Re-examination at one year showed no recurrence. This case shows that Plasmodium ovale malaria must be considered as a potential etiology for acute benign pericarditis in patients with a history of travel to endemic countries.

[Acute liver failure and severe exertional heat stroke: uneasy management in Africa]. / Coup de chaleur d'exercice grave et insuffisance hépatique aiguë: difficultés de prise en charge outre-mer.

Exertional heat stroke (EHS) is a medical emergency defined as tissue injury secondary to a prolonged period of extreme hyperthemia during strenuous physical activity. In the vast majority of cases, EHS is associated with minimal liver involvement with no clinical manifestations. However acute hepatic insufficiency has been reported including a few cases treated by liver transplantation but with poor results suggesting that conservative management is preferable. The purpose of this report is to describe a patient who developed EHS with acute liver insufficiency and multiple organ failure in Djibouti. Despite the remote location and limited medical resources available, full recovery was achieved with conservative therapy and intensive care.

[Morbidity and mortality after intensive care management of hemorrhagic stroke in Djibouti]. / Morbi-mortalité des accidents vasculaires cérébraux hémorragiques après prise en charge en réanimation a Djibouti.

Prospective data on management and outcome of stroke in Africa is scarce. The purpose of this prospective descriptive study is to present epidemiologic, clinical and outcome data for a series of patients with hemorrhagic stroke in Djibouti. All patients admitted to the intensive care unit of the Bouffard Medical-Surgical Center in Djibouti for cerebral hemorrhage documented by CT-scan of the brain were recruited in this study. A total of 18 patients including 16 men were enrolled. The median patient age in this series was 51.5 years [range, 20-72]. The median duration of intensive care was 3 days [range, 1-38]. Mean Glasgow score at time of admission was 9 [range, 3-14]. Five patients were brought in by emergency medical airlift. The main risk factors for stroke were arterial hypertension, smoking, and regular khat use. Mechanical ventilation was performed in 10 patients with a survival rate of 40%. Six patients (33%) died in the intensive care unit. Hospital mortality within one month was 39% and mortality at 6 months was 44.4%. One-year survival for patients with a Glasgow score < or = 7 at the time of admission was 33%. Arterial hypertension, khat use, and smoking appeared to be major risk factors for male Djiboutians. Neurologic intensive care techniques provided hospital mortality rates similar to those reported in hospitals located in Western countries. Functional outcome in local survivors appeared to be good despite the absence of functional intensive care. These data argue against the passive, fatalistic approach to management of hemorrhagic stroke and for primary prevention of cardiovascular risk factors.

[Celiac disease: special features in Africa. Description of 8 cases in Djibouti (horn of Africa)]. / Maladie coeliaque: particularités africaines. A propos de 8 cas à Djibouti.

Celiac disease is poorly documented in intertropical Africa. The purpose of this retrospective report was to describe 8 cases observed at the Groupement Medico-Chirurgical of Bouffard Hospital in Djibouti (Horn of Africa) between January 2003 and January 2006. There were 5 females and 3 males ranging in age from 9 months to 17 years old (mean age: 48 months). Six patients were of Somali ethnic origin and two of Yemenite ethnic origin. Six were classified as middle class and 2 as lower class. All forms were symptomatic associating constant loss of weight with digestive manifestations (diarrhoea and vomiting). Diagnosis of celiac disease was based on the presence of anti-gliadin antibodies IgA and IgG associated with anti-endomysium or anti-transglutaminase antibodies that were measured in six and two cases respectively. Gastroduodenal endoscopy performed in three cases including two with duodenal biopsy demonstrated villous atrophy associated with gross of intra-epithelial lymphocytosis. A gluten-free diet initiated in five patients led to clinical improvement in four cases with a follow-up of 8.25 months. The findings of this study in Djibouti show that celiac disease exists in intertropical Africa. Its presentation is quite similar to elsewhere but diagnosis is more difficult due to poor knowledge about the disease and limited diagnostic facilities. Favourable response to presumptive treatment by a gluten-free diet is an alternative for diagnosis especially in Djibouti where eating habits differ from those in industrialized countries and this type of diet is easier to follow.

[Cryoglobulins: detection, type determination and quantitation. A study of healthy subjects and patients with chronic hepatitis C]. / Cryoglobuline: recherche, typage et quantification. Etude chez le sujet sain et chez des patients atteints d'une hépatite C chronique.

Cryoglobulins are immunoglobulins or immune complexes which precipitate at a temperature lower than 37 degrees C and re-dissolve when rewarmed. So their collection and processing are critical. We describe the methodology used in the biochemical laboratory of Military hospital Laveran (Marseille) for detection determination of type and quantitation of cryoglobulins. In this study, we have found cryoglobulins in 53% of healthy subjects and in 77% of patients with chronic hepatitis C.

[Cryoglobulinemia]. / Les cryoglobulinémies.

Cryoglobulins are immunoglobulins or immune complexes which precipitate at a temperature lower than 37 degrees C and redissolve when rewarmed. Cryoglobulins can be asymptomatic. When not, clinical features are in most cases cutaneous, renal or neurological. Cryoglobulinemia are associated with malignant haematological disorder, connective tissue disease or infection process especially infection with hepatitis C virus. In some case, no aetiology can be found, in theses cases cryoglobulinemia are called primary or essential cryoglobulinemia. For the last ten years it has been widely demonstrated that virus C infection causes the most part of essential cryoglobulinemia.

[Niger: nutritional recuperation and education in a sub-Saharan urban area]. / Niger: activités de récupération et d'éducation nutritionnelle en zone urbaine sahélienne.

Located in Niamey, capital of Niger, a Sub-Saharian country where the rate of acute malnutrition in children is estimated at 16.8 percent, the National Armed Forces Center for Nutritional Rehabilitation and Education has been expanding its activities since 1986. The center offers curative and educational services to the children of military personnel and the population in neighboring districts. These services are regularly scheduled two and a half or three hours each morning five days a week. In 1990 our center received 115 malnourished children detected either during consultations or infant weighing sessions. Twenty-seven presented moderate protein-caloric malnutrition and 28 serious malnutrition. Medium age at admission was 11 months 16 days and medium length of stay was 9.5 days. Long-term recovery was confirmed in 30.5% while 69.5% were lost from follow-up. Keeping a healthbook throughout the weight control period, enforcing coercive measures for military families, organizing a permanent campaign to maintain awareness of nutritional problems, prolonging opening hours to improve access to the center, and above all improving the level of women's education are necessary to improve these results. Primary prevention requires better family planning with a longer interval between births.

[Acute infectious diarrhea: current treatment and perspectives]. / Diarrhées aiguës infectieuses: traitement actuel et perspectives.

Acute infectious diarrhea is a worldwide public health problem. In developing countries it remains a major cause infant mortality despite therapeutic progress, especially with regard to the efficacy of oral rehydration, during the last two decades. Mortality in industrialized countries is much lower and generally stable. In most cases, acute diarrhea is a self-limiting illness that resolves with or without symptomatic treatment in a few days. In view of the high frequency and generally benign course of diarrheal diseases, management must emphasize a cost-effective approach with selective use of available diagnostic methods. The initial approach should be based on the patient's history, physical examination, and risk factors to identify infections that require more specific measures. The purpose of this report is to review currently available drug therapies and to describe treatment guidelines for adolescents and adults with uncompromised immune systems. Early rehydration is still the mainstay of treatment. Use of "etiological" treatment using antimicrobial or antiparasitic agents depends on the severity of disease and risk factors.

[The prevention of neonatal herpes encephalitis: characteristics in a tropical area]. / Prevention de l'encephalite herpetique neonatale: particularites en zone tropicale.

Neonatal herpes infection virus is rare but of poor prognosis. The only way to prevent it, is to practice a prophylactic caesarean section. In medically undeveloped countries, indication of caesarean section should be very prudent because of subsequent risks of uterine rupture. After a short recall about herpes illness, a precise and simple behaviour is proposed.

[Helicobacter pylori infection in developing countries]. / L'infection à Helicobacter pylori dans les pays en dévelopment.

Helicobacter pylori infection is probably the most common bacterial infection in the world. The pathogenicity of this bacteria has been recognized since 1989 in the developed world where prevalence is 20 to 40%. Its role in gastric and duodenal disease is certain and its low recurrence rate justifies eradication. In the developing world prevalence of Helicobacter pylori infection is over 80% with contamination being maximal in children. Transmission is oro-oral and even feco-oral. Crowded living conditions is the determinant factor. Helicobacter pylori infection exhibits special features in developing world. The prevalence of gastroduodenal disease varies according to geographic area independently of the prevalence of Helicobacter pylori infection and stomach cancer is uncommon. In newborns Helicobacter pylori infection seems to be the primary event for chronic malnutrition and diarrhea syndrome with failure to thrive. In practice detection of Helicobacter pylori is difficult in the developing world and presumptive treatment is always followed by recurrence. In the future active or passive immunization will be the solution.

[Eosinophilic gastroenteritis: an example of gastrointestinal toxicity of eosinophils]. / La gastroenterite a eosinophiles: un exemple de la toxicite digestive de l'eosinophile.

Toxicity of polynuclear eosinophils in the digestive tract results from a cascade of immune responses involving various mediators including mastocytes and T-lymphocyte helpers. Polynuclear eosinophils may be implicated in many digestive disorders. This involvement is well established in eosinophilic gastroenteritis which has become the model for study of eosinophil toxicity on the digestive tract. Considered to be of uncertain etiology up until 1998, this mechanism is well illustrated by the case described in this report involving infiltration of all layers of the small intestinal mucosa in a 23-year-old patients who responded well to corticosteroid treatment. This case provides the opportunity to update physiopathologic and therapeutic data concerning this unpredictable syndrome. Current evidence of transition forms from idiopathic hypereosinophilic syndrome casts doubt on the conventional classification of eosinophilic gastroenteritis and underlines the need for careful diagnostic work-up and prolonged follow-up.

[Chronic tropical pancreatitis: a case report]. / La pancréatite chronique tropicale: à propos d'un cas.

The purpose of this report is to describe a case of tropical calcific pancreatitis (TCP). This disease is specific to tropical regions and constitutes the main cause of chronic pancreatitis in children worldwide. It can also be observed in young adults (2nd and 3rd decade). Shortage of dietary lipids during childhood has been implicated in the development of TCP and mutation of the SPINK1 gene has been cited as a predisposing genetic factor. The underlying pathophysiology of TCP is the same as chronic calcific pancreatitis (CCP) due to alcohol abuse. The main features are a sex ratio of 1, absence of alcohol consumption, occurrence of childhood diabetes in one third of cases, low incidence of acidoketosis, and presence of macro-calcifications especially in ducts. In 10% of cases TCP is complicated by pancreatic carcinoma occurring at an early age, located mainly in the body and tail of the pancreas, and having a less favorable prognosis than primary cancer. Treatment of patients with TCP is the same as for patients with CCP due to alcohol abuse. Prevention depends on improvement of nutritional status of the population.

[Imported dengue hemorrhagic fever: aprops of 1 case presenting with signs of acute alithiasic cholecystitis]. / Dengue hémorragique d'importation: à propos d'un cas ayant présenté des signes de cholécystite aiguë alithiasique.

Dengue is prevalent in all subtropical areas. Hemorrhagic forms of the disease were first described in southeast Asia but have now been observed on several continents. Travelers are at risk for infection and the likelihood of imported dengue has grown in relation to volume of air traffic. In developed countries, dengue usually presents in the benign form, but sudden aggravation is always possible. The purpose of this report is to describe a case of imported dengue hemorrhagic fever associated with abdominal pain in a traveler returning from Asia. Radiological findings were suggestive of nonlithiasic cholecystitis. Similar ultrasound feature have been reported by pediatric groups during dengue outbreaks in Asia. Previous findings have shown that bladder involvement is a predictive sign of severe disease and impending shock. Surgery is contraindicated in these patients. Close clinical and laboratory surveillance is necessary due to the high risk of aggravation. The pathogenesis of this severe life-threatening form of the disease is unclear. A possible explanation is involvement of a more virulent strain of virus. Dengue should always be considered after malaria in the differential diagnosis of returning travelers patients presenting fever.

[Unilateral agenesis of the pulmonary artery. Diagnosis and therapeutic management]. / Agénésie unilatérale de l'artère pulmonaire. Diagnostic et prise en charge thérapeutique.

A case of agenesia of the right pulmonary artery was observed. The epidemiological and clinical characteristics of this congenital anomaly as well as treatment were reviewed: Surveillance or surgery?

[Uncommon complication of the use of implantable chambers in oncology]. / Complication inhabituelle de l'utilisation des chambers implantables en oncologie.

The catheter of an implantable chamber migrated into the pulmonary infundibulum in a patient given chemotherapy for bronchogenic cancer. Current management of such cases is to remove the catheter under pulmonary angiography control using a basket system.

Adenocarcinoma of the upper esophagus.

Glandular heterotopia of the upper esophagus is a congenital abnormality that is frequently discovered during upper digestive tract endoscopy (in 0.26-4.9% of cases), but usually with no malignant potential. Indeed, adenocarcinoma of the upper esophagus related to such lesions is a rare entity. We report here the 27th observation of this rare type of tumor in an 87-year-old man complaining of cervical dysphagia. This adenocarcinoma had developed from an area of gastric heterotopia 3 cm below the upper sphincter of the esophagus. The treatment regimen was based on exclusive radiochemotherapy, which led to a complete endoscopic response at the end of treatment. The patient's symptom-free survival was six months and overall survival was 17 months from diagnosis. This case of a rare tumor of the upper esophagus raises the question of whether the detection and surveillance of this type of heterotopia would be useful and, thus, to be recommended.