[Human African trypanosomiasis: report of three cases]. / Trypanosomose humaine africaine révélée par une fièvre prolongée : à propos de trois cas pédiatriques.

Prolonged fever is an important cause of morbidity in pediatric practice, especially in tropical areas. It is above all a problem of etiological diagnosis given the vast number of etiologies. In sub-Saharan Africa, practitioners more often focus on bacterial infections and malaria at the expense of other infectious diseases such as human African trypanosomiasis (HAT), most often leading to overuse of antibiotics and antimalarials. A dramatic resurgence of HAT, also called sleeping sickness, has been reported during the last few decades in large areas of Central Africa. Furthermore, with the development of air transport, cases of children infected during a trip to Africa can be exported outside endemic areas, making diagnosis even more difficult. This parasitic infection causes a protracted, often initially unrecognized, illness with episodes of fever, headache, and malaise, accompanied by progressive lymphadenopathy, before the development of a progressive meningoencephalitis. These three case reports aim to remind practitioners of clinical and biological signs suggestive of HAT diagnosis in children living in endemic areas or having stayed there during the months prior to visiting the doctor. The prognosis is largely dependent on the precocity of diagnosis and therapeutic support.

Evaluation de l'etat nutritionnel des enfants ages de 1 a 60 mois; hospitalises a Libreville

L'etat nutritionnel des enfants hospitalises n'est pas assez pris en compte en pratique courante. Le but de cette etude etait d'evaluer l'etat nutritionnel des enfants hospitalises. Il s'est agi d'une etude prospective longitudinale; menee dans trois hopitaux de Libreville; de juillet 2010 a mars 2011. Etaient inclus les enfants ages de 1 a 60 mois revolus; hospitalises; vus et mesures avant la 48eme heure d'hospitalisation. Les mesures ont ete interpretees a partir des normes OMS 2006. Les caracteristiques socio-professionnelles des parents ont ete recueillies sur fiche standardisee. Au total; 311 enfants (55 filles et 45 garcons) ont ete inclus. Le niveau d'instruction des meres etait secondaire dans 60 (n=188); le chef de famille etait dans 47 (n=147) employe non cadre; et dans 30 (n=94) sans emploi conventionnel. Les motifs d'hospitalisation etaient domines par l'acces palustre a 47 (n=147). Selon l'indice poids pour taille 5;5 des patients etaient emacies ( -2 z) et 2;9 gravement emacies ( -3z). Selon l'indice de masse corporelle; 5;5 etaient en surpoids ( +2 z) et 1;6 obeses ( +3 z). Selon l'indice taille pour age 9;9 avaient un retard de croissance ( -2z); et 0;6 un retard de croissance important ( -3z). Les caracteristiques familiales correlees a l'emaciation etaient : absence d'activite remuneratrice de la mere (r

[Sickle cell disease pain management following the World Health Organization's protocol]. / Prise en charge de la douleur drépanocytaire selon les critères de l'Organisation mondiale de la santé.

UNLABELLED: Twenty-four percent of the Gabonese population has sickle cell trait, and 1-3% has sickle cell disease. Patients' management must follow well-defined protocols that take into account the debilitating effect of severe pain episodes. OBJECTIVES: To evaluate the three-step analgesic ladder for control of pain for sickle cell disease pain crises. METHODOLOGY: This is a prospective and descriptive study based on surveys filled between February 2000 and March 2001. Surveys were restricted to sickle cell disease patients having developed pain crises before and during their stay at the hospital. The assessment of the pain was based on the DEGR and EVA scales. The treatment followed the World Health Organisation's analgesic ladder. The criteria used for estimate pain severity and sedation duration were measured before, 2 and 24 h after treatment administration began (H0, H2 and H24) to evaluate its effectiveness. RESULTS: Sixty children were included. All the social layers of the population were represented. The school level was variable. Fifty-six percent of the patients suffered their first pain crisis before they were 1 year old. Thirty-one percent had annual crises and 20% monthly crises. Pain was located in joints in 35% of the cases, and in joints and bones in 15% of the cases. Eighty-one percent of the pain crises were successfully treated in stage I. The passage to stage II occurred in the remaining cases (18.3% of the cases). CONCLUSION: The WHO's three-step analgesic ladder for control of pain is effective for the sickle cell disease pain episodes. Stage I drugs relieved the pain for 81.6% of the patients in a relatively short time (2-16 h). It was not possible to go to stage III.

Thrombocytopenia and Plasmodium falciparum malaria in children with different exposures.

We studied thrombocytopenia during acute Plasmodium falciparum malaria in 64 traveller children from Paris (France), 85 children from Dakar (Senegal) with an intermittent exposure (69 with severe attack or cerebral malaria), and 81 children from Libreville (Gabon) with a perennial exposure (43 with severe attack or cerebral malaria). Initial thrombocytopenia was present in 43-58% of children with P falciparum malaria but was not more frequent in severe outcome or cerebral malaria. Low parasitaemia may lead to the misdiagnosis of malaria and delayed treatment when there is associated thrombocytopenia

[Leptospirosis in children of Libreville: difficult diagnosis, apropos of 1 case]. / Leptospirose de l'enfant à Libreville: difficultés diagnostiques, à propos d'un cas.

Leptospirosis is a widespread zoonosis, which is diagnosed less frequently in children than might be expected from the level of exposure to hazards, especially in tropical areas. A 15 1/2-year-old Gabonese boy was admitted following five days of fever, headache, myalgia, abdominal pain, diarrhea, intestinal bleeding, jaundice and conjunctival suffusion. Laboratory data showed abnormal liver and renal function tests, and diagnosis of Plasmodium falciparum malaria was confirmed by thin blood smear. The patient did not clinically improve despite antimalarial treatment and then leptospirosis was suspected. Serologic tests were performed and leptospirosis was later confirmed. Antibiotic treatment (cefuroxim) was given. The outcome was good, liver and renal tests returned to normal in a few days. In tropical area, leptospirosis should be considered in children who are diagnosed with either an unexplained fever, a pseudo-influenza syndrome, or jaundice with hepatorenal involvement and gastrointestinal bleeding.

La place de la sequestrectomie osseuse dans les osteomyelites chroniques de l'enfant: experience de 10 ans a l'Hopital Pediatrique d'Owendo de Libreville (Gabon)

Sur une serie de 36 cas d'osteomyelites chroniques de l'enfant; 69;4 per cent etaient drepanocytaires; 30;6 per cent non drepanocytaires. Tous presentaient des sequestres osseux. A leur propos; une analyse des donnees epidemiologiques; topographiques; enfin une reflexion sur la conduite du traitement est proposee pour eviter de creer les conditions d'une pseudathrose. La radiographie standard nous est apparue suffisante pour decider du moment de la sequestrectomie; le plus tard possible

Serological tests in cerebrospinal fluid for congenital syphilis in central Africa.

Serological tests were performed in the cerebrospinal fluid (CSF) of 13 children with active congenital syphilis (presence of specific IgM FTA-ABS antibodies) and of seven seropositive children with no active syphilis (FTA-ABS IgM-negative) born to syphilitic treated mothers in Libreville, Gabon. Antibodies against treponema were measured by the Venereal Disease Research Laboratory test (VDRL), the Treponema pallidum haemagglutination assay (TPHA) and the fluorescent treponema antibody absorption tests (FTA-ABS IgG and IgM). Of the 13 children with active syphilis, seven had a positive FTA-ABS IgG in the CSF. The result of this test was not correlated with the severity of clinical features, CSF protein levels or number of CSF white blood cells. The CSF-TPHA test was positive in four out of 12 children, and the CSF-VDRL test was negative in all the children with active congenital syphilis. One of the seven newborns with mother-transmitted antibodies had a positive FTA-ABS and TPHA in the CSF. These data show that the VDRL is not sensitive enough to diagnose congenital neurosyphilis, and that FTA-ABS or, at least, TPHA are convenient, sometimes with false-positive results, when a sophisticated method of detecting specific IgM in CSF is not available.

[Meningeal attacks during the course of congenital syphilis and therapeutic consequences]. / Atteinte méningée au cours de la syphilis congénitale et conséquences thérapeutiques.

In a study carried out in Gabon, antibodies against the treponema were looked for in the cerebrospinal fluid (CSF) in 13 children with active congenital syphilis (presence of specific IgM antibodies) and in 7 children with positive serologic reactions reflecting transplacental passage of maternal antibodies. Serologic reactions used included the VDRL test, the TPHA test, and the FTA-ABS IgG and IgM tests. Among the 13 children with syphilis, 7 had a positive FTA-ABS IgG test in the CSF without correlation with severity of clinical features, CSF protein levels or CSF cytologic findings. The TPHA test was positive in only four children and the VDRL test was always negative. Passage of antibodies into the CSF is possible (1 case in this study after treatment of the mother), but TPHA is helpful in developing countries of research of neurosyphilis.

[Specific serologic reactions in the cerebrospinal fluid in congenital syphilis and therapeutic implications]. / Réactions sérologiques spécifiques dans le liquide céphalorachidien au cours de la syphilis congénitale et conséquences thérapeutiques.

In a study carried out in Gabon, antibodies against the treponema were looked for in the cerebrospinal fluid (CSF) in 13 children with active congenital syphilis (presence of specific IgM antibodies) and in 7 children with positive serologic reactions reflecting transplacental passage of maternal antibodies. Serologic reactions used included the VDRL test, the TPHA test, and the FTA-ABS IgG and IgM tests. Among the 13 children with syphilis, 7 had a positive FTA-ABS IgG test in the CSF; positivity of this test was not correlated with severity of clinical features, CSF protein levels or CSF cytologic findings. The TPHA test was positive in only four children and the VDRL test was consistently negative. These findings are similar to those reported in another group of patients with meningeal involvement proven by the demonstration of IgM in the CSF using recent techniques. Passage of antibodies into the CSF is possible (1 case in this study) but for safety patients with specific IgG in the CSF should be given penicillin in a dosage that provides treponema-killing levels in situ (100,000 U/kg/d). Use of this dosage is recommended whenever sensitive techniques for CSF analysis are not available.

[Hepatotoxicity of the combination of isoniazid-rifampicin in African children. Role of malnutrition and HB virus]. / Hépatotoxicité de l'association isoniazide-rifampicine chez l'enfant africain. Influence de la malnutrition et du virus HB.

Forty-seven Gabonese children with tuberculosis either limited to the lung or associated with other localizations were treated with isoniazid-rifampin (INH + RIF). They had liver tests done during the first 6 months of treatment. In 30 patients (63.8%) there was an increase in aminotransferase levels [over 100 UI/l in 14 (29.2%)]. The main factors increasing the risk of hepatic toxicity was a high dosage of INH and overall malnutrition. In fact, the weights of patients presenting with signs of hepatic toxicity were significantly lower than those in children who had no alterations of liver function. 68% of the severely malnourished (marasmus of kwashiorkor) presented with high ALAT or ASAT levels during treatment. The eventual role of the chronic HBV carrier state is discussed as 2 children presented with a chronic form of hepatitis at the time the treatment was initiated.