Diarrhoeagenic microbes by real-time PCR in Rwandan children under 5 years of age with acute gastroenteritis.

Acute gastroenteritis is a main cause of disease and death among children in low-income countries. The causality rates and pathogenic characteristics of putative aetiological agents remain insufficiently known. We used real-time PCR targeting 16 diarrhoeagenic agents to analyse stool samples from children ≤5.0 years old with acute diarrhoea in Rwanda. Among the 880 children (median age 14.2 months; 41% female) at least one pathogen was detected in 92% and two or more agents in 63% of cases. Rotavirus was detected in 36.9%, adenovirus in 39.7%, enterotoxigenic Escherichia coli (ETEC) with genes for labile (eltB) or stable (estA) toxin in 31.3% and 19.0%, E. coli with eae or bfpA genes in 25.2% and 14.2%, Shigella in 17.5% and Cryptosporidium in 7.8%. Rotavirus and ETEC-estA were associated with more severe dehydration than diarrhoea due to other causes. Shigella was associated with bloody stools and higher CRP. Microbial loads (Ct values) of rotavirus, ETEC-estA and Shigella were associated with severity of symptoms. Rotavirus, ETEC-estA and E. coli with bfpA were associated with younger age, Shigella with older age. Antibiotic treatment was given to 42% and was associated with dehydration, fever and CRP, but not with pathogen. We conclude that rotavirus and ETEC-estA were the most important causes of diarrhoea with dehydration, that Shigella caused bloody diarrhoea but less severe dehydration, that microbial loads of rotavirus, ETEC-estA and Shigella were associated with severity of symptoms, and that antibiotic use was frequent and in poor agreement with microbiological findings.

Micronutrients and T-cell subsets: a comparison between HIV-infected and uninfected, severely malnourished Rwandan children.

OBJECTIVE: To determine the levels of CD4+ cells and micronutrients in HIV-infected and uninfected severely malnourished children. DESIGN: Cross-sectional study in two centres. SETTING: Children admitted to the malnutrition units in Kigali and Butare, Rwanda. PATIENTS: A total of 112 children aged 2 months to 5 years presenting with severe malnutrition (weight for height Z- score -3 SD +/- oedema). Fifty-two (46.4%) were HIV-infected. METHODS: CD4+ counts, selenium, zinc and copper levels were measured. The percentage of CD4 cells was calculated as a proportion of total lymphocyte count. RESULTS: The mean age of the 52 HIV-infected children (18 months) was lower than of the 60 uninfected children (26 months) (p=0.01). Six (11.5%) of the HIV-infected had oedematous malnutrition compared with 50% of the uninfected group. The mean (SD) CD4+ count was 1054 (780) in the HIV-infected and 1579 (721) in the uninfected group (p=0.001). The CD4+ count was also significantly lower in the HIV-infected group than in the uninfected group for the ages <12 mths (p=0.09), 12-24 mths (p=0.045) and >36 mths (p=0.001). In HIV-infected children, 17% had severe immunosuppression (<15% CD4+ cells), 33% moderate (15-24%) and 50% had none (>25%) compared with 9%, 12% and 80% in the HIV-uninfected group, respectively (p<0.001). Approximately one-third in both groups had low levels of selenium and zinc and 77% had raised levels of copper. In multivariate analysis there was significant correlation between selenium and CD4+ (r=0.36, p<0.001) in HIV-infected children and no correlation of zinc and copper to CD4+ %. In HIV uninfected children, CD4+ % was related to selenium (r=0.282, p=0.03) and to zinc (r=0.264, p=0.047) but not to copper. CONCLUSIONS: In severely malnourished children with HIV infection, low CD4+ levels are associated mainly with HIV infection. There was no significant difference in levels of selenium, zinc and copper between HIV-infected and uninfected children.

[Antibiotic sensitivity of 299 strains of shigella isolated in Burundi]. / Etude de la sensibilité aux antibiotiques de 299 souches de shigelles isolées au Burundi.

Bacillary dysentery which occurs endemoepidemically in Burundi is currently on the rise and requires close epidemiologic and therapeutic monitoring. Sensitivity tests using 13 antibiotics were performed on 299 strains of shigella isolated at the Biology Laboratory of the Bujumbura University Hospital Center. The technique used to test antibiotic sensitivity was the disc diffusion method described by Chabert et al. Of the 299 strains studied, 250 (83.6%) were species of Shigella dysenteriae type 1. All isolated Shigella bacillus were resistant to ampicillin, sulfamethoxazole-trimethoprim, tetracyclin, and chloramphenicol. Ninety-seven percent of Shigella dysenteriae type 1 serotype presented resistance to nalidixic acid while the 2 serotypes (0.8%) showed partial resistance to pefloxacine and norfloxacine. No resistance was observed to cefotaxim, colistin, and neomycin. Multiresistance of Shigella bacillus isolated in Bujumbura supports involvement of a plasmid mechanisms and suggests that the effectiveness of antibiotherapy against shigellosis is limited. This study suggests that a preventive campaign for bacillary dysentery should be undertaken in Burundi.

[Burundi: knowledge and practices of physicians and nursing personnel about acute respiratory infections in children]. / Burundi: connaissances et pratiques des médecins et du personnel infirmier vis-à-vis des infections respiratoires aiguës de l'enfant.

In order to detect problems in the management of acute respiratory infection in children and to optimize training, a survey was undertaken in 1993 including 9 pediatricians, 27 general practitioners, and 58 nurses in Bujumbura, Burundi. A questionnaire including 15 main items was used. Findings showed a poor understanding of risk factors in 62% of the population, especially among general practitioners and nurses. Clinically 79% were able to make a proper diagnosis of pneumonia. Overtreatment of coryza using antimicrobial, mucolytic, and cough drugs was suspected in 88.8%. Findings were similar with regard to management of pneumonia. Wheezing was treated in accordance with WHO recommendations in only 18% of cases. For acute respiratory infection, 53.6% used penicillin A, 18% used penicillin G, 15.9% used cotrimoxazole and 2.9% used macrolides. The duration of antimicrobial therapy was unnecessarily long for 49.4%. While 70.5% of the population (100% of pediatricians) considered the state of their knowledge and practices to be sufficient, 93.6% (55.6% of pediatricians) indicated that specific training in this field would be useful. This survey suggests that training is needed for health care workers at all levels specifically in the management and prevention of acute respiratory infection in children.

[Aspects of sexually transmissible diseases in young children in Burundi: gonorrhea caused by sexual abuse]. / Un aspect des maladies sexuellement transmissibles chez le jeune enfant au Burundi: les gonococcies secondaires à des sévices sexuels.

The purpose of this study was to demonstrate the existence of sexually transmitted diseases secondary to sexual abuse inflicted on young infants in Black Africa. A total of 230 files involving infants presenting leucorrhea or urethral discharge were reviewed in Bujumbura (Burundi) to select only cases with bacteriologically documented gonorrhea. A total of 2 such cases were identified during the period from 1987 to 1992. There were 20 girls and 5 boys with a mean age of 6.4 years. In 4 cases, rape was proven. In 9 cases the contaminator could not be identified, but in 12 cases medical and legal evidence showed that the alleged authors of sexual abuse was a domestic employee at the child's home. These findings indicated that sexual abuse in children is not an uncommon occurrence in Black Africa and often leads to gonorrhea. The consequences of such abuse are aggravated by the epidemic of human immunodeficiency virus. The authors recommend a practical approach that should be taken whenever sexual abuse is suspected in these countries.

Infection urinaire chez les petits garcons : etude prospective pendant 6 mois au Centre Hospitalier de Libreville

Une etude portant sur les malades hospitalises en pediatrie du 1er janvier 1988 au 15 juillet 1988 fait apparaitre une forte prevalence de l'infection urinaire (43 pour 400 malades hospitalises). S'appuyant sur un prelevement fiable (ponction sus pubienne au dessous de 3 ans); on constate le grande frequence chez les petits garcons; la grande variete des germes retrouves. Les symptomes sont rarement evocateurs et l'infection urinaire asymptomatique. Il existe presque toujours une ou deux maladies ou tares associees. La frequence chez le petit garcon fait discuter la necessite d'une circoncision precoce lorsque la conformation du prepuce favorise un reflux meatique et que les conditions d'hygiene sont defavorables