[Chronic abdominal pain and fever in an Ivoirian woman: Mycobacterium avium-intracellulare duodenitis in an AIDS patient in Abidjan, Cote d'Ivoire]. / Douleurs abdominales chroniques et fièvre chez une ivoirienne.

Duodenal infection by Mycobacterium avium-intracellulare is a common opportunistic disease in HIV-infected patients. Individuals with CD4 counts <50 cells/mm3 are at highest risk. The main symptoms are diarrhea, abdominal pain, weight loss, and fever. Endoscopic examination shows various abnormalities including disseminated nodules that may be yellowish, whitish, or pinkish in color. Other mucosal lesions may be found such as erosion, erythema, or friable edematous aspect. Since these findings are non-specific, it is important to obtain biopsy specimens for histological and microbiological examination. The most common histologic features are atrophic mucosa resembling Whipple's disease with strongly positive PAS staining. The presence of BARR in macrophages is typical of MAI. Diagnosis is based on identification of the bacteria using either conventional culture techniques or polymerase chain reaction (PCR). Differential diagnosis includes other gastrointestinal infections associated with AIDS, i.e., microsporidiosis, cryptosporidiosis, giardiosis, anguillulosis, CMV, and isoporosis. The course of the disease is usually unfavorable even with antibiotic treatment. The purpose of this report is to describe a case of duodenitis due to atypical mycobacterial infection in a 30-year-old woman who was seropositive for human immunodeficiency virus. She was hospitalized due to fever with deterioration of her general condition (more than 10% of body weight loss) and chronic abdominal pain with inflammation. Diagnosis of MAI was confirmed by biopsy and Ziehl-Neelsen coloration. The patient was treated with rifampicine, isoniazide, ethambutol, and pyrazinamide in association with stavudine, lamuvidine and efavirenz. Despite improvement of general condition, fever persisted and the patient died after 40 days of treatment.

Emergence of Buruli ulcer disease in the Daloa region of Cote d'Ivoire.

Recent reports have suggested increases in Buruli ulcer (BU), an infection caused by Mycobacterium ulcerans in west Africa. In 1991, we conducted surveillance for BU in a rural area of Cote d'Ivoire and identified 312 cases of active or healed ulceration. A case-control study was then performed to investigate risk factors for this infection. The rate of illness did not appear to differ between males and females (5.2% versus 7.5%; P = 0.11). The highest rate of illness was seen in the 10-14-year-old age group (143 cases per 1,000 population). New cases increased more than three-fold between 1987 and 1991, and local prevalence of BU was as high as 16.3%. Twenty-six percent of persons with healed ulcers had chronic functional disability. Participation in farming activities near the main river in the region was identified in the case-control study as a risk factor for infection (odds ratio [OR] for each 10-min decrease in walking distance between the fields and the river = 1.52, 95% confidence interval [CI] 1.01, 2.28, P = 0.046). Wearing long pants was protective (OR 0.20, 95% CI 0.06, 0.62, P < 0.005). We conclude that the incidence of BU is increasing rapidly in Cote d'Ivoire. Specific causes of this increase were not identified, but wearing protective clothing appeared to decrease the risk of disease.

[Helicobacter pylori infections in children in the tropical zone. Endoscopic and histological aspects]. / Infection à Helicobacter pylori chez l'enfant en zone tropicale. Aspects endoscopiques et histologiques.

AIMS: To assess the endoscopic and histological aspects of Helicobacter pylori (H. pylori) infection in children in a prospective study. PATIENTS AND METHODS: One hundred and four children (6 months-15 years old), with digestive symptoms admitted to the Pediatric Department of the National Hospital of Ouagadougou between February Ist and October 31 1996, underwent upper digestive endoscopy with fundic and antral biopsies for histological and bacteriological analysis. RESULTS: Endoscopy was normal in 80 cases (77%). No lesion was specific of H. pylori infection. Nodular gastritis was observed in 3% of the cases only. Duodenal ulcers were seen in 3 children (3%). 83% of the children had chronic antral gastritis, associates with H. pylori in 95% of the cases. The lesions were follicular gastritis (45%), mild atrophic gastritis (38.5%) and lymphocytic gastritis (1%). Follicular gastritis was more pronounced in the antrum than in the fundus. CONCLUSION: The high prevalence of early H. pylori infection and chronic gastritis in children contrasts with the rarity of gastric cancer in black Africa. Protective factors or peculiar strains should be searched for.

[Human chronic gastritis associated with non-Helicobacter pylori spiral organisms (Gastrospirillum hominis). Four cases and review of the literature]. / Gastrite chronique associée chez l'homme à la présence de germes spiralés non-Helicobacter pylori (Gastrospirillum hominis). Présentation de 4 cas avec revue de la littérature.

Four cases of human active chronic gastritis associated with Gastrospirillum hominis, a recently described spiral shaped organism are presented. These 4 cases originated from a series of 1976 consecutive gastric biopsies, i.e. a prevalence of 0.25 percent in our material, are compared with Helicobacter pylori prevalence of 45 percent. Histopathological findings were chronic active gastritis with mild or no atrophy. Electron microscopy showed spiral bacteria with terminal flagellae, identical to those previously described in the literature. These bacteria have not yet been cultured; similar organisms are found in many animal species, and it seems that they do not provoke gastric inflammation. Gastrospirillum hominis could be responsible for cases of Helicobacter pylori negative chronic gastritis in man, but its pathogenicity remains to be demonstrated.

[Evaluation of the health status of 0-to-4-year-old children in an urban community of Abidjan]. / Evaluation de l'état clinique des enfants de 0 à 4 ans dans une commune urbaine d'Abidjan.

During summer 1985 a survey was realized in an administrative territorial division of Abidjan (2 M. residents) in Ivory Coast. Four thousand households were randomly selected (EPI*/WHO model) including 653 children, from 0 to 4 years old. Mothers were interviewed and children examined. Seventeen per cent of children were below the weight curve standardised for Ivory Coast, 8% had a ratio arm diameter on head diameter lower or level of 0.27 and 54% a ratio between 0.28 and 0.31. Diarrhoea was noted among 10% of children, bronchopneumopathy among 44.7%, rhinitis among 53.6% and otitis 15.4%. The interview of mothers confirmed these results; in addition it appeared that 3% of children have had measles in the preceding month. The diarrhoeas and ORL infections prevalence is linked with the lack of drinking water at home, the IRA prevalence with community habitat; ORL infections are more frequent among children from illiterate mothers. The authors think that an amelioration of this situation is possible only by socio-economic progress for families (the work over lunch generalisation would be already an important progress) and putting the specific accent on measles immunization (the incidence rate of measles didn't changed since 1978 in spite of EPI application).

[Epidemiological aspects of meningitis in the north of the Ivory Coast]. / Eléments d'épidémiologie des méningites dans le nord de la Côte-d'Ivoire.

Classically, the North of Ivory Coast is not part of the "meningitis belt". However, recent health statistics put in light some recent outbreaks in this part of the country, the last one in the years 1983-1985. The authors have studied this last outbreak and it can be foreseen that these epidemics will appear again as in the more Northern countries. Therefore it is desirable to set up a monitoring system to better organize the fight against this disease.

Concurrent superficial squamous cell carcinoma of the esophagus and early gastric adenocarcinoma. Report of a case.

We report a patient with concurrent superficial carcinomas of the esophagus and stomach. The tumors occurred in a 68-year-old woman. The esophageal tumor was an intramucosal squamous cell carcinoma, and the gastric tumor an intramucosal adenocarcinoma, type III in the Japanese classification of early gastric cancer. This is the first reported case of associated superficial esophageal and gastric cancers originating from a Western country. Such an association may be more frequent than realized, and therefore it is important to examine both the stomach and esophagus if a patient has one of these tumors.