[About a Case of Febrile Gastroenteritis Due to Strongyloidiasis in a Gabonese Patient Treated for Lupus]. / A propos d'un cas de gastro-entérite fébrile due à une anguillulose chez une patiente gabonaise traitée pour un lupus.

Srongyloidiasis can sometimes be a source of diagnostic wandering in a patient with an autoimmune disease living in a tropical environment, despite systematic deworming with albendazole (400 mg/day/3 days), prior to the starting of a corticotherapy. We report an observation of a febrile gastroenteritis complicated by signs of intra and extracellular dehydration, in a 37-year-old lupus patient, including duodenal biopsies, and stool parasitology, which led to the diagnosis of strongyloidiasis effectively treated by ivermectin per os (two doses) of 200 micrograms/kg, once every 2 weeks apart), following failure of a first 5-days course of albendazole (400 mg/day).

L'anguillulose peut parfois être source d'errance diagnostique chez un patient porteur d'une maladie auto-immune vivant en milieu tropical, et ce malgré un déparasitage systématique par l'albendazole (40 mg/jour / 3 jours), avant la mise en route d'une corticothérapie. Nous rapportons une observation de gastroentérite fébrile, compliquée de signes de déshydratation intra et extracellulaire, chez une patiente lupique de 37 ans, dont les biopsies duodénales, et la parasitologie des selles ont conduit au diagnostic d'anguillulose traitée efficacement par ivermectine per os (2 doses de 200 microgrammes/kg, en prise unique à 2 semaines d'intervalle l'une de l'autre). Ce traitement faisait suite à l'échec d'un premier traitement par 5 jours d'albendazole (400 mg/jour).

Treatment of chronic inflammatory rheumatism by biotherapy in Gabon : eligibility and follow-up of the first 8 patients in sub-Saharan Africa.

OBJECTIVE: to clarify the eligibility criteria for biotherapies in patients with chronic inflammatory rheumatism (CIR) in sub-Saharan Africa and to describe the characteristics of the first 8 patients treated with biotherapy in Gabon. MATERIALS AND METHODS: Patients who responded inadequately to treatments by cDMARDs (EULAR criteria) had a face-to-face interview to inform them about and obtain their consent to biotherapy for at least 3 months, with details of the cost and side effects of each available biotherapy and a certificate of "necessity of biotherapy". The inclusion and follow-up of patients took place in the outpatient rheumatology consultations at the University Hospital of Libreville (Gabon) between January 2010 and December 2016. RESULTS: Of the 30 patients who failed cDMARDs and required biologic treatment, 8 (26.6%) were able to start a biotherapy: 4 men and 4 women with rheumatoid arthritis (n = 4.50%), spondyloarthritis or psoriatic rheumatism (n = 2.25% each). The biotherapy was etanercept (n = 4, 50%), adalimumab, golimumab, infliximab and rituximab (n = 1, 12.5% each). The average duration of the biotherapy was 27.4 months (9-54). Biotherapy was stopped in 4 cases (50%), one each (12.5%) for multifocal tuberculosis, pregnancy, financial reasons, and remission. CONCLUSION: Our study shows that biotherapies, which are currently very expensive, can be prescribed in Africa provided that the usual recommendations are followed strictly. Here, access to biotherapies is only possible through private insurance and the rheumatologist must play the role of facilitator for needy and consenting patients.

Rhumatologie en Afrique noire francophone et à Madagascar : état des lieux sur les rhumatologues, les pathologies rhumatologiques, les moyens diagnostiques et thérapeutiques en 2015

Objectif : Dresser l'état des lieux de la rhumatologie en Afrique Noire Francophone (ANF) sur le nombre de rhumatologues, les pathologies rhumatologiques, les moyens diagnostiques et thérapeutiques.Patients et méthodes : Etude transversale par interview auprès de rhumatologues africains pour connaître le nombre de rhumatologues, les moyens diagnostiques et thérapeutiques dans chaque pays entre juin 2014 et juin 2015. Revue de la littérature par recherche avec les mots "rheumatic diseases ; africa" sur Medline, "Médecine d'Afrique noire" électronique, "Médecine et santé tropicale" et "Société des pathologies exotiques". Les données concernaient les pays d'ANF jusqu'en juin 2015 hormis le Burundi, la République Démocratique du Congo et le Rwanda. Celles du Gabon concernaient 6050 rhumatisants vus entre janvier 2009 et décembre 2014 dans le service de médecine interne du centre hospitalier et universitaire de Libreville.Résultats : Pour une population totale de 182,14 millions d'habitants, il y avait 50 rhumatologues soit une densité de 0,03 rhumatologue pour 100.000 habitants. La pathologie la plus fréquente était l'arthrose. La goutte et les infections étaient les premières causes d'arthrites respectivement au Burkina Faso, au Congo Brazzaville, au Gabon et au Bénin, au Cameroun, en Côte d'Ivoire, au Togo. Les rhumatismes inflammatoires chroniques les plus fréquents étaient la polyarthrite rhumatoïde au Burkina Faso, au Cameroun, au Congo Brazzaville et les spondylarthrites par arthrites réactionnelles en Côte d'Ivoire, au Gabon, au Togo. La radiographie et le MTX étaient disponibles dans chaque pays. Il y avait 21 IRM, soit un appareil pour 8,673 millions d'habitants. Les biothérapies type Adalimumab et Etanercept respectivement à 1.710,36 et 1.733,23 € par mois au Gabon, restaient exceptionnellement utilisées.Conclusion : L'état des lieux de la rhumatologie en ANF en 2015 révèle surtout l'extrême carence en rhumatologues dans ces pays, principalement du fait de l'absence de formations locales dans cette spécialité

Leptospirose, une étiologie de fièvre prolongée peu diagnostiquée. A propos d'une observation

Les conditions bio-climatiques prédisposent à la transmission de la leptospirose au Gabon. Paradoxalement, cette affection est rarement voire peu diagnostiquée par les praticiens de ce pays. Nous rapportons une observation de leptospirose révélée par une fièvre au long cours

[Socioeconomic aspects and management of chronic hepatitis B and C in Libreville, Gabon]. / Aspects socioéconomiques de la prise en charge des hépatites chroniques B et C à Libreville (Gabon).

INTRODUCTION: Viral hepatitis remains a major public health problem in the sub-Saharan region. Diagnosis is often made at an advanced stage after a long period with few or no symptoms. Late diagnosis impedes optimal management. MATERIALS AND METHODS: All patients treated for documented chronic hepatitis B or C from January 2001 to December 2009 were identified and the cost of their treatment was estimated. Data examined included socioeconomic information, circumstances surrounding diagnosis, cost of work-up, cost of curative treatment (pegylated interferon + ribavirin for hepatitis C and lamivudine for hepatitis B), and overall cost of support. RESULTS: The study included 146 patients (65 women, 81 men) with a mean age of 34 years. Hepatitis was type B in 89 patients, type C in 51, and type B/C coinfection in 6 patients. The estimated cost of work-up was 483 USD for type B and 507 USD for type C. The cost of curative treatment was 1569 USD for type B and 7842 USD for type C. The estimated cost of support was 407 USD. The total cost of management was 2459 USD for type B and 8757 USD for type C. Only 9 patients received optimal treatment, and it resulted in curing 3 of the 4 with hepatitis B and 4 of the 5 with hepatitis C. During treatment, progression to cirrhosis occurred in two patients, one with hepatitis B and one with hepatitis C. CONCLUSION: Financial constraints frequently prevent patients in Gabon with hepatitis B and C from receiving optimal care. The creation of a national healthcare system in 2008 may lead to cost reductions and improve management of this disease in a predominantly young population.

[Castleman's disease: first case in Gabon]. / Maladie de Castleman: première observation au Gabon.

Castleman's disease is an atypical lymphoproliferative disorder characterized by hyperplasia of lymphoid structures with vascular proliferation. It has rarely been diagnosed in black African populations. The purpose of this report is to describe the first case in Gabon. The patient was a 47-year-old black African man. Outcome was fatal.

[Association myositis and hepatocellular carcinoma: one case and review of literature]. / Association myopathie inflammatoire et hépatocarcinome : à propos d'une observation et revue de la littérature.

Association inflammatory myopathies and tumors are not fortuitous but association with hepatocellular carcinoma is rarely reported in literature. We described a case of association polymyositis hepatocellular carcinoma in 37-year-old black African patient, with fatal issue.

[Kikuchi-Fujimoto disease in Gabon. Description of first 2 cases in Gabon]. / Maladie de Kikuchi-Fujimoto: 2 premiers cas au Gabon.

Kikuchi-Fujimoto disease is a rare disorder sometimes associated with systemic lupus. It has rarely been reported in the black African population. The purpose of this report is to describe the first two cases in Gabon. In patients presenting enlarged cervical lymph nodes, it is first necessary to rule out infectious disease. Histology can allow diagnosis by demonstrating necrotizing histiocyte lymphadenitis.

[Lupus, corticosteroid treatment and opportunistic infection: 26 cases in Gabon]. / Corticothérapie et infections opportunistes dans une cohorte de 26 lupus au Gabon.

Opportunistic infection is frequent in lupus patients. Susceptibility is inherent in the lymphopeniant nature of the disease and enhanced by the use of immune-suppressing agents (alone or in combination) for optimal disease control. The purpose of this retrospective series of lupus patients diagnosed based on the criteria of the American College of Rheumatology (ACR) was to assess the frequency of opportunistic infection in a high-risk epidemiological area. A total of 26 patients (24 women, 2 men) with a mean age of 28.8 years were identified. Systematic review carried infectious before the steroid and in light of the local endemicity (HBs Ag, hepatitis C serology, HIV + Rx Thorax IDR) coupled with blood cultures was non-contributory, without waking the tank or during the introduction treatment. With a mean follow-up of 3.6 years (range, 0.83 to 9.91), only one case of tuberculosis was observed with fatal outcome. Our study indicates that the prevalence of opportunistic infections in the Lupus under treatment in a high-risk area for infectious diseases was low. This finding suggests that the risk of infectious complications secondary to corticosteroid therapy in sub-Saharan zone is acceptable provided that surveillance is performed on a regular basis.

[Elevated C reactive protein rate in 23 black African patients with systemic lupus erythematosus and without opportunistic infectious disease]. / Valeur prédictive de l'augmentation de la protéine C réactive dans le lupus systémique en l'absence d'infection intercurrente chez le patient noir africain à travers une série de 23 lupus systémiques.

INTRODUCTION: CRP rarely increases during systemic lupus exacerbations. MATERIALS AND METHODS: This retrospective study of patients with systemic lupus diagnosed according to ACR criteria examined all patients with no intercurrent infectious disease and responding to corticosteroid treatment and compared the patients with normal and with significantly elevated (> or = 30 mg/l) CRP. RESULTS: 23 black patients (22 women, 1 man) were selected and classified in two groups: group I with CRP > 30 mg/l (n = 12) and the controls, group II, with normal CRP (n =11). In group I, mean CRP was 279 mg/l. Four patients had isolated pericarditis, and one pericarditis associated with pleurisy. Nine patients had no cardiovascular risk factors or abnormal liver function enzymes. Antinuclear antibodies were specific for anti-DNA (n= 8), anti-Sm (n = 2), anti-RNP (n = 1), and anti-SSA (n = 1). In group II, seven patients had pericarditis, and nine had no cardiovascular risk factors or liver function results. Antinuclear antibodies were specific for anti-DNA (n = 9), anti-Sm (n = 1) and unknown (n = 1). DISCUSSION: The paucity of data about black Africans in the literature makes it difficult to interpret these results in terms of their specificity for this population or as a typical profile of elevated CRP without infectious disease. CONCLUSION: In absence of a specific profile for patients with elevated CRP without intercurrent infectious disease, we consider the possibility of a subgroup of the black population that may be particularly vulnerable and express CRP more easily.