[Primary amebic meningoencephalitis: 1st case observed in Madagascar]. / Méningo-encéphalite primitive à amibes libres: 1er cas observé à Madagascar.

The primary amebic meningoencephalitis is an acute suppurative infection that involves both the brain and the meninges. It is caused by Naegleria fowleri and is a very rare and fulminating condition, so far nearly always fatal. We report the first case in the area of Southern part of Indian Ocean that occured in a 7-year old French boy living in Madagascar. It is assumed that the disease was contracted by swimming in warm fresh water in a lake of the Madagascar east coast. Clinical signs began 10-12 days after exposure, associating headache, vomiting and pyrexia (39-40 degrees C). Upon admission in a Madagascar hospital, the patient was started on antibiotics, that did not control the disease and soon presented with a loss of consciousness and a delirium. He was transferred to Reunion island (Centre Hospitalier Départemental Félix-Guyon), where the diagnosis of primary amebic meningoencephalitis was confirmed. Therefore, he was started on high-dose of intraspinal amphotericin B, IV amphotericin B lipid complex and tetracycline. He developed myocarditis, diabetes insipidus, deep coma and subsequently died a week later. The diagnosis of amebic meningoencephalitis was based on: -- the cerebrospinal fluid examination that confirmed the diagnosis of purulent meningitis: 420 leucocytes (76% polynuclears, 14% lymphocytes), 90 red blood cells, and showed 50 ameboid trophozoites per 100 leucocytes, approximately 20 microm in size. -- the flagellate transformation test in distilled water showed two anterior flagellas that confirmed the genus Naegleria.

[Haemophilus influenzae, the second cause of bacterial meningitis in children in Madagascar]. / Haemophilus influenzae, deuxième cause des méningites bactériennes de l'enfant à Madagascar.

The Haemophilus influenzae b is one of the main germs causing bacterial meningitis in children in countries where the vaccine anti-Haemophilus influenzae b is not widely used. In Madagascar, no epidemiological study on this germ has been carried out. The objective of this research is to assess the role of Haemophilus influenzae meningitis in Antananarivo and to determine its epidemiological aspects and evolution. A multicentric study coordinated by the Institut Pasteur de Madagascar included all children less than 15 years old with infectious syndromes associated to a syndrome of meningial irritation and/or convulsion and/or coma. These children were admitted in the pediatric service of the three main hospitals in Antananarivo from June 1998 and June 2000. A lumbar puncture was performed on each child; the cerebrospinal fluid was set aside for cytobacterial and biochemical controls completed with an antimicrobial sensitivity testing and a soluble antigens research. Out of 160 case studies, the Haemophilus influenzae b arrives at the second place among the agents causing bacterial meningitis in children. This type of bacteria is the source of 32% of meningitis after the Streptococcus pneumoniae (34%). It affects 96% of children less than two years old, with a maximal frequency before the age of one year. The lethality rate is 28.6% and the neurological sequelae were observed in 31.4% of patients. Haemophilus influenzae is sensitive to the third generation cephalosporins but shows high resistance to chloramphenicol (42%), amoxicillin (29%) and gentamicin (22%). The relatively high frequency as well as the high lethality rate caused by the Haemophilus influenzae b meningitis, affecting selectively the children under two years old, bring in the need to introduce the anti-Haemophilus influenzae b vaccine in the national vaccination program in Madagascar. This vaccine has proved to be efficient in many countries where it has been used. Furthermore, in the probabilistic treatment of bacterial meningitis in children, the third generation cephalosporins should be used in the first place.

La tuberculose chez les enfants de moins de 11 ans : resistance primaire et variants genetiques dominants de Mycobacterium tuberculosis a Antananarivo

"Childhood tuberculosis : primary resistance and genotypes of dominant Mycobacterium tuberculosis in Antananarivo"" : Tuberculosis during childhood is often due to Mycobacterium tuberculosis primo-infection. Tuberculosis is highly prevalent in Madagascar and most people are infected during childhood. Our objectives were to evaluate the primary resistance of M. tuberculosis and to determine the genotypes responsible for recent infection in the population. Thus we studied 142 isolated strains from 97 children (66 with pulmonary tuberculosis and 31 with extra-pulmonary tuberculosis) recruited in different health centers in Antananarivo from 1997 to 2000. Excepting one strain resistant to isoniazide; all strains were susceptible to the four antibiotics (streptomycin; isoniazid; ryfampicin and ethambutol). This result confirms the low rate of primaryresistance reported during the two surveys in 1994-1995 and 1999-2000. 67 strains of 1997-2000 were typed with the genetic marker IS6110; 44 has been assigned to 13clusters containing each 2 to 8 similar strains. Some IS6110 clusters have already been reported in 1994-1995. Some genotypes observed in 1994-1995 seemed to have disappeared in 1997-2000. (As the rate of the frequency of some genetic variants according to the period are more likely due to a difference in strain virulence). Since there is minimal antibiotic resistance versus M. tuberculosis in Madagascar; one can not explain the appearence or disappearence of certain variants because of drug resistance. Rather; this is due to the virulence of the various M. tuberculosis strains."

[Non-tubercular bacterial meningitis in children in Antananarivo, Madagascar]. / Les méningites bactériennes non tuberculeuses de l'enfant à Antananarivo, Madagascar.

OBJECTIVE: To determine the bacterial causal agents of meningitis and their pattern of resistance, in children more than one month to 14 years of age. METHODS: A 2 years, prospective study (June 1998 to June 2000) on bacterial meningitis in children was carried out in the main hospitals in Antananarivo. The enrollment criteria upon admission were fever with symptoms of meningitis and/or convulsions and/or coma. A lumbar puncture was systematically performed in each child. The aspect of the cerebrospinal fluid was described, the level of protein and glucose estimated, soluble antigens measured. Following the examination of a Gram straining, an aliquot of the fluid was cultured on specific medium. Antimicrobial sensitivity testing of isolated pathogens was performed. RESULTS: Bacterial meningitis was confirmed in 119 children: 95 (80%) and 111 (93%) were less than 12 and 24 months of age, respectively. The sex distribution was 1:1. Three predominant microorganisms were identified: Streptococcus pneumoniae (45%), Haemophilus influenzae b (43%) and Neisseria meningitidis (10%) of which ten of 12 cases were belonging to serogroup B. The other microorganisms isolated were E. coli (2%). S. pneumoniae were found to be sensitive to penicillin G and H. influenzae were found to be sensitive to the third generation cephalosporins. Seven percent of the S. pneumoniae strains were mildly resistant (R + I) to chloramphenicol and between 29 and 50% to aminoglucosides. A moderate resistance against gentamicin and amoxicillin was found in 22-29% of the H. influenzae strains. The mortality rate was high (31%) and among the surviving children 30% presented with neurosensitive disorders. CONCLUSION: According to these data we may recommend the inclusion of vaccination against H. influenzae in the children immunization program in Madagascar. The early diagnosis and treatment with appropriate antibiotics, such as third generation of cephalosporins, are other critical measures to be taken in order to reduce the risk of developing severe complications associated to bacterial meningitis.

[Tuberculosis in children less than 11 years old: primary resistance and dominant genetic variants of Mycobacterium tuberculosis in Antananarivo]. / La tuberculose chez les enfants de moins de 11 ans: résistance primaire et variants génétiques dominants de Mycobacterium tuberculosis à Antananarivo.

Tuberculosis during childhood is often due to Mycobacterium tuberculosis primo-infection. Tuberculosis is highly prevalent in Madagascar and most people are infected during childhood. Our objectives were to evaluate the primary resistance of M. tuberculosis and to determine the genotypes responsible for recent infection in the population. Thus we studied 142 isolated strains from 97 children (66 with pulmonary tuberculosis and 31 with extra-pulmonary tuberculosis) recruited in different health centers in Antananarivo from 1997 to 2000. Excepting one strain resistant to isoniazide, all strains were susceptible to the four antibiotics (streptomycin, isoniazid, ryfampicin and ethambutol). This result confirms the low rate of primary resistance reported during the two surveys in 1994-1995 and 1999-2000. 67 strains of 1997-2000 were typed with the genetic marker IS6110, 44 has been assigned to 13 clusters containing each 2 to 8 similar strains. Some IS6110 clusters have already been reported in 1994-1995. Some genotypes observed in 1994-1995 seemed to have disappeared in 1997-2000. (As the rate of the frequency of some genetic variants according to the period are more likely due to a difference in strain virulence). Since there is minimal antibiotic resistance versus M. tuberculosis in Madagascar, one can not explain the appearance or disappearance of certain variants because of drug resistance. Rather, this is due to the virulence of the various M. tuberculosis strains.

["Silence, people are dying..." The Damergou famine, an examination of the facts]. / "Silence on meurt ..." la famine dans le Damergou à l'épreuve des faits.

This study illustrates the importance of rapid and rigorous nutritional surveys to evaluate precarious nutritional situations in the context of media uproar. It was performed in July 1993 in the Damergou district of Tanout in the Zinder department of Niger. In October 1992, the early warning system (SAP for Service d'alerte précoce) in the department reported and evaluated the food production deficit in the district. A food aid strategy was implemented according to these findings, and food was distributed from May. During June, 1993, a non-governmental organisation (NGO) used a tabloid press report to dramatise the situation, and declare that 75% of the children were malnourished, and that there were 56,000 people starving and unable to move to look for food. An international aid spiral of bidding and outbidding followed, based on simple presumption, probably justified, but not verified. The first surveys sent from the headquarters were unable to make any reliable evaluations or pertinent recommendations. The departmental health office then performed a rapid anthropometric nutritional survey (RANS) using a representative sample of the population. The survey was a cluster survey involving 29 villages and including 1,088 children between the ages of 6 months and 6 years old and their mothers. The 29 villages account for 10% of the population of the district. The findings were as follows: 2.8% of the families had emigrated since the harvest. The average price of a tiya (approximately 2.5 kg) of millet was 183 FCFA (French African Francs), the normal price at this time of year. The reserve of animal stock was 8.6 heads per family, inconsistent with massive destocking.(ABSTRACT TRUNCATED AT 250 WORDS)

[Association of Moebius syndrome and hypopituitarism due to a midline anomaly. A case report]. / Association d'un syndrome de Moebius et d'un hypopituitarisme par anomalie de la ligne médiane. A propos d'un cas.

A 14 year old patient had both Moebius anomalad with arthrogryposis and growth hormone deficiency due to a midline defect. This combination suggests an abnormality in the organization of the neural crest and homologous neural tube segment.

Correlation and validation of alternative methods to the Draize eye irritation test (OPAL project).

A multicentre study of alternative methods to the Draize eye irritation test, involving six different laboratories was organized by OPAL (Oeuvre Pour l'Assistance aux Animaux de Laboratoire). Forty chemicals (including solvents, surfactants, acids, bases, and others) were selected for testing by three methods, namely Griffith's test (a low-volume eye irritation test on rabbits), the hen's egg chorioallantoic membrane (HET-CAM) assay for the evaluation of hyperaemia, haemorrhage and coagulation, and neutral red uptake by SIRC cells for the assessment of cytotoxicity. Each method was used in two or three laboratories. Intralaboratory reproducibility was good for each laboratory with values, for error, close to 10%. Interlaboratory agreement was also good, particularly for the cell culture method, a quantitative and objective technique. Griffith's test correlated well with the Draize test (r = 0.846; n = 37), while for the HET-CAM test (r = 0.670; n = 32) and the cell culture method (r = 0.579; n = 32) the correlation was satisfactory. A more complete statistical analysis is currently under way to confirm and extend these preliminary findings.

[Serious acute hepatocellular insufficiency in children: EEG prognostic features]. / Insuffisance hépato-cellulaire aiguë grave de l'enfant: aspects EEG pronostiques.

Fulminant Hepatic Failure (FHF) in children leads to 60 to 90% of mortality without age influence, depending on the studies. Twenty-two children with this disease had daily EEG, 15 died, seven survived. The neurological electroclinical study evidenced a stereotyped evolution of the EEG anomalies which were not age-related, but correlated to clinical stages of coma and to severe coagulation disorders; 5/22 children with clinical and/or EEG convulsive disorders died. One child exhibited triphasic slow waves and died from paracetamol intoxication. A prospective study of a larger population could help to recognize factors of decision for hepatic transplantation.

[Neonatal hydrometrocolpos. A cause of immediate neonatal respiratory distress]. / Hydrométrocolpos néonatal. Une cause de détresse respiratoire immédiatement néonatale.

The authors report a case of acute fetal distress and immediate respiratory distress in a neonate presenting with large hydrometrocolpos. This diagnosis, infrequently concerned in such a situation, should be suggested in cases with abdominal tumors.