[Study of names and folklore associated with Mycobacterium ulcerans infection in various endemic countries in Africa]. / Etude des appellations et des représentations attachées à l'infection à Mycobacterium ulcerans dans différents pays endémiques d'Afrique.

The purpose of this article is to present names used for Mycobacterium ulcerans infection (Buruli ulcer) and explain their meanings in various African languages. Representations associated with the disease were also studied. The study approach involved qualitative analysis of information from interviews and literature. Interviews were conducted with the directors of various programs and management centers. Findings from 9 African countries where Buruli ulcer is known to be endemic, i.e., Benin, Cameroon, Congo-Brazzaville, Côte d'Ivoire, Ghana, Uganda, Democratic Republic of Congo, Southern Sudan and Togo, showed that the names used for the disease could be classified into three categories based on the geographical origin of infection, the features of the observed lesions, and aspects of ost often associated with belief in witch-craft, i.e., bad luck, fetishes, and curses. Representation of the disease in different African languages were similar and appear to demonstrate a good understanding of the disease in the countries where Buruli ulcer is prevalent. The impact of the representations of the disease on therapeutic choices and itineraries is also discussed.

Etude des appellations et des representations attachees a l'infection a Mycobacterium ulcerans dans differents pays endemiques d'Afrique

L'objectif de ce travail est de presenter les appellations de l'infection a Mycobacterium ulcerans (ulcere de Buruli) dans les langues africaines et leurs significations. Il vise egalement a explorer les representations attachees a la maladie dans differents pays endemiques d'Afrique. La methodologie utilisee implique l'analyse d' entretiens indivi- duels et de publications scientifiques. Les entretiens individuels ont ete menes aupres de differents chefs de programme et responsables de structures de prise en charge de cette maladie. Les resultats de notre analyse montrent que dans les pays d'Afrique ou l'ulcere de Buruli est endemique (Benin; Cameroun; Congo-Brazzaville; Cote d'Ivoire; Ghana; Ouganda; Republique Democratique du Congo; Sud Soudan et Togo); les appellations de cette maladie peuvent etre classees en trois categories; suivant qu'elles evoquent les origines geographiques de la maladie; les caracteristiques des lesions observees; ou les aspects d'incurabilite et de mystere; en lien avec la sorcellerie. Les representations de cette maladie dans les langues africaines apparaissent identiques et semblent traduire une connaissance relativement bonne de la maladie dans les pays ou l'ulcere de Buruli sevit. L'impact de ces representations influence egalement les types de recours aux soins

Etude des appellations et des representations attachees a l'infection a mycobacterium ulcerans dans differents pays endemiques d'Afrique

L'objectif de ce travail est de presenter les appellations de l'infection a Mycobacterium ulcerans (ulcere de Buruli) dans les langues africaines et leurs significations. Il vise egalement a explorer les representations attachees a la maladie dans differents pays endemiques d'Afrique. La methodologie utilisee implique l'analyse d'entretiens individuels et de publications scientifiques. Les entretiens individuels ont ete menes aupres de differents chefs de programme et responsables de structures de prise en charge de cette maladie. Les resultats de notre analyse montrent que dans les pays d'Afrique ou l'ulcere de Buruli est endemique (Benin; Cameroun; Congo-Brazzaville; Cote d'Ivoire; Ghana; Ouganda; Republique Democratique du Congo; Sud Soudan et Togo); les appellations de cette maladie peuvent etre classees en trois categories; suivant qu'elles evoquent les origines geographiques de la maladie; les caracteristiques des lesions observees; ou les aspects d'incurabilite et de mystere; en lien avec la sorcellerie. Les representations de cette maladie dans les langues africaines apparaissent identiques et semblent traduire une connaissance relativement bonne de la maladie dans les pays ou l'ulcere de Buruli sevit. L'impact de ces representations influence egalement les types de recours aux soins

[Malaria prevalence at delivery in four maternity hospitals of Kinshasa City, Democratic Republic of Congo]. / Prevalence du paludisme à l'accouchement dans quatre maternités de la ville de Kinshasa, République Démocratique du Congo.

In areas with stable transmission, malaria is an alarming threat both for mothers (anemia) and fetus (abortion, premature birth, a birth ponderal deficit, death in utero). Our study aims at estimating the malaria prevalence among parturients and their newborn babies in Kinshasa, Democratic Republic of Congo, in order to conduct the national programme of control. Between September and November 2004, 196 pregnant women aged of 14 to 45 years old (average: 25.8 years) were recruited consecutively from four maternity hospitals in Kinshasa; those who received antimalarial drugs 2 weeks before delivery were not selected. The socio-demographic information and clinical symptoms/signs were obtained by questionnaire. Blood smears were performed on the mother's capillary blood, by placental apposition and with the newborn baby's blood. Smears were stained with Giemsa. 42 out of the 196 parturients (21%) were infected by Plasmodium falciparum. Parasites were found both in capillary blood and placenta of the 37 parturients; in 5 cases, only the placental appositions were positive. Prevalence was higher among primiparae (26.5%) than among multiparae (18.8%) (p = 0.20). 19.7% of the parturients who received an Intermittent Preventive Treatment (IPT) with sulfadoxine-pyrimethamin (SP) were positive. 13 out of the 196 newborn babies had a positive malaria smear. Malaria at delivery is thus a reality in Kinshasa, despite the use of SP as an IPT. The weak protection conferred on the IPT could be explained by the inefficacy of the SP a failing in prenatal record andlor by the low compliance of the mothers with this strategy This is the reason why we strongly recommend a large-scale evaluation of this strategy.

[The contribution of skin autograft in open air in the treatment of the Buruli ulcer]. / Apport de l'autogreffe cutanée à l'air libre dans le traitement de l'ulcère de Buruli.

The Buruli ulcer (BU) rages in a lot of tropical and subtropical countries. In Democratic Republic of Congo, some BU cases were reported between the 50s and 70s. This disease offers resistance to the usual chemotherapy. The only alternative for the treatment remains the surgical one (trimming, wound dressing, graft). The overarching aim of this study, conducted in the province of Lower Congo, is to put forward a surgical therapeutic approach adapted to the precarious conditions met on the ground in our rural areas. The evidence of a Mycobacterium ulcerans infection has been bacteriological and histopathological. The slight skin autograft or "of Davis", in open air or with dressing was performed in 37 patients. After three months this skin autograft in open air has experienced 78.5% of complete healing against 70% for the skin autograft with dressing. The exposure of skin graftings to open air favors an hyperoxygenation which also fights against the Mycobacterium ulcerans, for this latter develops better in an hypoxical area.

Predictors of stroke - associated mortality in Africans.

BACKGROUND: The objective of the study was to examine the association of the stroke-related mortality with gender, age, ethnicity, social class, blood pressure, fibrinogen, selected clinical data and meteorologic parameters in hospitalized Africans. METHODS: A series of 1032 consecutively hospitalized incident cases of acute stroke between 1987 and 1991 was studied. Univariate and multivariate analyses were used to estimate the risk (odds ratio=OR) of stroke mortality for meteorologic parameters on the month before the accident onset and selected sociodemophysiological variables on the day of admission. RESULTS: The variables significantly associated with stroke mortality in multivariate analysis were male sex (OR= 2.3 [1.3 - 4.1]), low social class (OR= 2.0 [1.2 - 4.0]), migrant tribes (OR= 1.7 [1.5 - 1.8]), ischemic stroke (OR= 1.4 [1.2 - 1.6]), heart rate >=100 bpm (OR= 1.1 [1.0 - 1.2]), age > or =60 years (OR= 1.03 [1.01 - 1.06]), systolic blood pressure> 160 mmHg (OR= 1. 02 [1.01 - 1.03]), and fibrinogen > or =400 mg/dl (OR= 1.01 [1.002 - 1. 02]). However, diastolic blood pressure > 90 mmHg and global radiation< 340 Cal/cm(2)/day were significantly (p< 0.05) and inversely associated with stroke mortality. CONCLUSION: Our results indicate that male sex, older age, low social class, migration, ischemic stroke and higher baseline levels of heart rate, systolic blood pressure and fibrinogen are significant predictors of stroke mortality, but lower global radiation and higher diastolic blood pressure are inversely linked.

Resistance aux anti-tuberculeux usuels dans les reprises de traitement a Kinshasa

Cette etude vise a situer le niveau actuel de resistance aux anti-tuberculeux retenus par le programme national de lutte anti-tuberculeux pour les reprises de traitement et a identifier des facteurs susceptibles de l'influencer. Les auteurs ont ainsi analyse retrospectivement la sensibilite a l'isoniazide; l'ethambutol; la rifampicine; la streptomycine et la thiacetasone des souches de Bacilles de Koch (BK) isoles chez 73 patients suivis dans 2 centres de Kinshasa au regard des parametres age; sexe; traitement anterieur; infection VIH; et l'evolution des patients sous traitement. De toutes les souches de BK isolees; seules 8;2 pour cent sont sensibles aux medicaments testes. Pour les autres; 84;9 pour cent resistent a l'Izoniazides; 27;4 pour cent a la Rifampicine; 26;8 pour cent a la Thiacestasone; 9;6 pour cent a la Steptomycine; 5;5 pour cent a l'Ethambutol. Aucune difference significative n'est relevee en fonction du status VIH; seul le regime long semble influencer la multiresistance. Enfin; le traitement par le regime de la categorie II/OMS guerit 71;9 pour cent des cas. Ils concluent que le niveau actuel de la resistance aux differents antituberculeux est eleve pour les cas de reprise de traitement; qu'il n'est pas le statut VIH; et que le regime de traitement preconise par l'OMS donne de bons resultats

Aspects de laboratoire dans l'investigation d'une fièvre hémorragique à virus Ebola

Les symptômes de la fièvre hémorragique à virus Ebola n'ont rien de spécifique; surtout au début de la maladie. La phase prodromale se caractérise par un syndrome grippal; tandis que pendant la phase aigüe; apparaissent une fièvre brutale et prolongée; des céphalées; une asthénie sévère; des arthralgies; des nausées et vomissements. Les symptômes hémorragiques apparaissent plus tard et peuvent consister en : épistaxis; melaena; hématémèse; injection conjonctivale et saignement aux points d'injection. A cause de la ressemblance de ce symptôme avec ceux des infections tropicales les plus courantes telle que le paludisme; la typhoïde et la shigellose; la fièvre hémorragique a virus Ebola (FHE) a été très souvent diagnostiquée avec beaucoup de retard. La diagnostic de laboratoire de la FHE se fait par exclusion de ces maladies et par confirmation du diagnostic par techniques immunologiques; moléculaires (PCR); virologiques (isolement) ou immuno-histochimiques

[Salmonella infections in Kinshasa: the species involved and sensitivity to antibiotics]. / Les infections à Salmonella à Kinshasa: espèces en cause et sensibilité aux antibiotiques.

292 Salmonella strains were isolated between 1986-1988 in the bacteriological unit of the Cliniques Universitaires de Kinshasa (Zaïre). One hundred of these strains were isolated from pediatric samples. The most frequent strains were S typhi, S enteritidis and S typhimurium. S typhi strains were sensitive to all antibiotics tested. The other salmonella serotypes had an increasing resistance to several antibiotics especially ampicillin, streptomycin, tetracyclin and kanamycin. A significant decline was observed with chloramphenicol and sulfamethoxazol-trimetoprim. Stool-isolated strains from children were found to be resistant to all antibiotics in common use in 5/6 cases. In systemic Salmonella infection, treatment with chloramphenicol or sulfamethoxazole-trimetoprim plus gentamycin is probably preferable to any other antibiotic recommended for Salmonella infection.

Clinical isolates of Cryptococcus neoformans from Zaire.

PIP: The incidence of disseminated cryptococcosis among Central Africans with acquired immunodeficiency syndrome (AIDS) may exceed 35%. Of the 2 varieties of Cryptococcus neoformans--neoformans and gattii--it appears that the neoformans variant is the one most frequently associated with AIDS. This assumption is based on the investigation of 47 cryptococcosis isolates into white mice to determine their ability (variety gattii) or inability (variety neoformans) to produce the elongated cells characteristic of the former variety. Of the 7 isolates collected in 1951-1969, 6 were of the gattii biovar. On the other hand, all of the 40 isolates collected after 1969 were of the biovar neoformans, suggesting that the biovar gattii is disappearing from Central Africa.^ieng

Natural colistin resistance in Edwardsiella tarda.

All of 37 recent human isolates of Edwardsiella tarda were resistant to colistin. All strains were resistant to 6.3 mug of sodium colistimethate per ml; 82% of them were resistant to 100 mug/ml. With 34 Salmonella strains, the average minimal inhibitory concentration (MIC) was 1.6 mug of sodium colistimethate per ml. There was virtually no overlapping of MIC values between both groups of bacteria. Using the Kirby-Bauer method and 10-mug colistin disks, inhibition zone diameters were less than 11 mm for all Edwardsiella strains, and larger for all Salmonella strains. An atypical, mannitol-fermenting strain of E. tarda was resistant to colistin. It is concluded that E. tarda is naturally resistant to colistin, that this property may be helpful in differentiation, and that colistin should be tried in enrichment and selective media for the isolation of E. tarda. It was also observed that, under conditions as described, all strains of E. tarda were susceptible to streptomycin and to novobiocin, whereas all strains of Salmonella were resistant.