[Tropical endemic limbo-conjunctivitis (TELC) and allergic management: a preliminary study in Togolese children]. / Limbo-conjonctivite endémique des tropiques (LCET) et prise en charge allergologique : étude préliminaire chez l'enfant togolais.

PURPOSE: To study the impact of certain allergens on the manifestations of tropical endemic limbo-conjunctivitis (TELC) in Togolese children. METHODS: This is a 3-year prospective study of 36 Togolese children with acute recurrences of TELC after 1 to 5 months of remission. Skin prick tests were conducted with five perennial respiratory allergens (dust mites, paper mites, roaches, dog and cat, grass pollen) and three food allergens (egg, peanut, shrimp). The reactions were compared to a negative control (saline solution) and a positive control (histamine or codeine sulfate). Length of remissions between acute exacerbations before and after allergy testing were noted. RESULTS: Thirty-five children were polysensitive. Individual allergens were: dust mites (83.3%), followed by cockroach (72.2%), shrimp (61.1%), peanuts (55.6%), eggs (44.4%), the cat and/or dog dander (38.9%), and grass pollen (22.2%). The rate of remission prior to allergy testing was 77.8% within 2 months after treatment of an exacerbation; with allergy management, 55.5% of patients experienced remission beyond 1 year. DISCUSSION: The literature reports that TELC is caused by multiple antigens. The clear predominance of respiratory and food allergens may lead to a new pathway for managing TELC in Togolese children. CONCLUSION: Allergy testing is of great importance for patients with frequent acute exacerbations of TELC.

[Chylous ascites, a revealing sign of peritoneal tuberculosis in an 11-month-old infant]. / Ascite chyleuse révélatrice d'une tuberculose péritonéale chez un nourrisson de 11 mois.

Chylous ascites is rare in children. We report on a case of chylous ascites in an 1-month-old infant in Togo. The infant had been appropriately vaccinated, had normal growth and psychomotor development, and he was living in a rural area. He had fever that had started 3 months earlier and persisted despite various treatments with antimalarials and antibiotics. Then progressively abdominal pain with abdominal distension developed, while lactescent ascites was discovered after puncture. The patient was referred to the Lomé teaching hospital for advanced management. Intradermic reaction to tuberculin (IRD) was positive (16 mm). Chylous ascites liquid analysis revealed apparently lymphocytic pleocytosis. Culture on special milieu allowed isolation of Mycobacterium tuberculosis. The clinical course was favorable with antituberculosis treatment. Peritoneal tuberculosis should be suspected in endemic areas in the case of a persistent fever with abdominal bloating and effusion, whatever the patient's age and the nature of ascites liquid.

[Tuberculosis in the newborn: recrudescence in areas with high endemic HIV infection]. / Tuberculose du nouveau-né: résurgence en milieu de forte endémie de VIH.

Despite the rising prevalence of tuberculosis due in part to the HIV pandemic in Africa, there have been few reports describing neonatal or congenital tuberculosis and its association with maternal HIV infection has been rare. The purpose of this study was to evaluate the clinical and epidemiological features of tuberculosis in newborns from areas with high endemic rates of both tuberculosis and HIV infection. During the 2-year study period all neonates admitted to the Campus Teaching Hospital in Lomé, Togo for differential diagnosis of symptoms compatible with tuberculosis were investigated. The clinical profile of tuberculosis in the newborn was correlated with that of the mother with or without HIV infection. Perinatal tuberculosis was diagnosed in 13 of the 79 newborns investigated including 8 whose mothers were co-infected by HIV and tuberculosis. Seven cases were classified as congenital tuberculosis. The predominant clinical features were respiratory distress (10/13), fever (9/13), hepatomegaly (9/13), intra-uterine growth retardation (8/13), stagnation or loss of weight (6/13), cough (4/13) and splenomegaly (4/13). Diagnosis of maternal HIV and tuberculosis infection was never made prior to newborn admission to our department. Four newborns and two mothers died within 3 months after childbirth. This study on perinatal tuberculosis in children born to mothers with or without HIV infection demonstrates the need for early diagnostic methods, consensual therapeutic protocols, and further study in larger geographical area to specify epidemiologic features and reduce high mortality.

Tuberculose du nouveau-né: Résurgence en milieu de forte épidémie de VIH

Malgré l'augmentation de la fréquence de la tuberculose en Afrique,due en partie à la pandémie duVIH,les publications sur la tuberculose néonatale ou congénitale restent rares et peu en rapport avec l'infectionVIH de la mère. Evaluer les aspects épidémiologiques et cliniques dela tuberculose du nouveau-né dans une loca-lité de forte endémie de VIH et de tuberculose,tel a été le but assigné à cette étude. Durant deux ans,tout nou-veau-né admis au Centre hospitalier universitaire-Campus de Lomé pour des signes faisant discuter le diagnos-tic de tuberculoseabénéficié d'une ex p l o ration.Le pro filclinique de latuberculose du nouveau-né et ses rap p o rt savec celle de la mère infectée ou non par le VIH ont été déterminés. Des 79 nouveau-nés ainsi explorés,13 avaientune tuberculose néonatale. Huit d'entre eux sont nés de mère infectée par le VIH et la tuberculose. Sept étaientatteints de tuberculose congénitale. Les signes cliniques prédominants étaient :la détresse respiratoire (10/13),lafi è v re (9/13),l ' h é p at o m é galie(9/13),le re t a rd de croissanceintra - u t é rine (8/13),la stag n ation ou la perte depoids( 6 / 1 3 ) ,latoux(4/13) et lasplénomégalie (4/13). Chez aucune desmèresle diagnostic de VIH et de tuberculose n'étaitétabli avant l'admission de leurs nouveau-nés. Quatre nouveau-nés et deux mères sont décédés au cours des troismois suivant l'accouchement. Cette étude de la tuberculose du nouveau-né de mère infectée ou non par le VIHdemande des méthodes de diagnostic précoce,des protocoles thérapeutiques consensuels et d'autres études surchamp géographique étendu pour en préciser l'épidémiologie et réduire la forte létalité

[Tuberculosis in newborns in a tropical neonatology unit]. / Tuberculose du nouveau-né dans une unité de néonatologie tropicale.

UNLABELLED: We report three cases of tuberculosis observed in a neonatal unit in a country characterized with a high endemia of tuberculosis. CASE REPORTS: Case 1. A term infant presented at the age of 35 days, with cough since day 18, respiratory distress and bronchopneumonia. Her mother had unrecognised tuberculosis since pregnancy. Post mortem biopsies of the infant confirmed the diagnosis of tuberculosis and social survey found out pulmonary tuberculosis in the newborn's aunt. Case 2. A term infant presented at the age of 30 days with cough since day 13, respiratory distress, nodular pulmonary lesions and right pleural effusion. Her mother had cough and stomatitis since the eighth month of pregnancy and nodular pulmonary lesions. Tuberculosis and HIV were confirmed in the mother and the infant. Social survey found tuberculosis in the newborn's paternal uncle. Case 3. A term but hypotrophic infant presented on the first day of life, with haemorrhagic troubles and respiratory distress. Tuberculosis and HIV were confirmed in the mother and the infant. Social survey found tuberculosis in the father, in a friend of her and in her three-month-old child. CONCLUSION: Congenital or neonatal tuberculosis is an under-estimated emergent disease, with a need for early diagnostic methods and consensual therapeutic protocols to improve its management.

[Epidemiologic and etiologic features of urinary infections in children at the pediatrics service of the CHU-Campus de Lome (Togo)]. / Aspects épidémiologiques et étiologiques de l'infection urinaire de l'enfant dans le service de pédiatrie du CHU-Campus de Lomé (Togo).

From 1st January 1989 to 31th December 1997, 175 infants (108 females and 67 males) were hospitalised and treated at the pediatric service of CHU-Campus for urinary tract infection; this study follows the observation of the increasing of urinary tract infection in several centers of health in Togo; the aim of this study was to have a list the contributing factors, to understand the mechanism of such infection in order to reduce its frequency and the high percent of the mortality; the diagnosis of urinary tract infection was given by the result of the cytobacteriological exam of the urine which shows the pathological germ; others forms of the investigation, as abdominal echography were used also to look for the etiology of the urinary tract infection; but, the deficit of the of the medical imagery or the old material of the laboratories limited the searching of urinary tract infection etiology; cured infants were declared on the basis of absence of pathological germ in the result of the cytobacteriological exam control of the urine; the prevalence of the urinary tract infection was 8.29% with an incidence of 7.84% at the pediatric service of CHU-Campus; clinics symptoms were atypic and polymorphic; but the fever was the first clinical sign in the newly born and the urological signs were clear only from two to thirty months; 141 children (80.57%) were cured and 34 presented the complications with 3.43% of mortality; preventive measures on the urinary tract infection in infancy were proposed for the children parents and the practical physicians; these measures included information, education and communication (IEC) on the urinary tract infection, the symptomatology and the cytobacteriological exam of the urine.

Le prurigo au cours du SIDA en milieu hospitalier a Lome

Une etude prospective a ete menee; durant 13 mois; afin de determiner la prevalence et les caracteristiques cliniques et evolutifs du prurigo au cours du SIDA en milieu hospitalier a Lome. 40 des 120 patients atteints du SIDA (33;33 pour cent) examines au cours de cette periode souffraient de prurigo. Entre 1 et 3 mois d'evolution du SIDA; la frequence etait de 53;84 pour cent; contre 26;66 pour cent apres 1 an d'evolution. Cliniquement le purit etait feroce et constant chez tous les patients; dans 31 cas le prurigo etait generalise. L'evolution a ete indefiniment chronique dans tous les cas. Cette etude confirme que le prurigo est une affection tres prevalente au cours du SIDA en zone tropicale. Sa connaissance par tous les praticiens; devrait contribuer au depistage precose de l'infection a VIH en Afrique

[Choanal atresia: an abnormality not to be overlooked. Study of three cases in the University Hospital Center of Lome, Togo]. / Atrésie choanale: une malformation à ne pas méconnaitre. Etude de trois cas au Centre Hospitalier Universitaire de Lome, Togo.

Choanal atresia is an uncommon congenital malformation which the midwife or obstetrician must recognize at birth. In this report the authors describe three cases observed at the University Hospital Center of Lome, Togo, in which diagnosis was made late, i.e. at the ages of 7 days, 13 days and 8 months. Atresia identified by rhinoscopy was bilateral in one case and unilateral in two cases. All three cases were treated by transnasal divulsion, using a rubber catheter in 2 cases and a curette in one case, followed by calibration with a Portex catheter that was removed after two months. At 6 months after treatment, all three children presented normal nasal ventilation. Since it can be easily diagnosed and treated, choanal atresia is curable and better training is needed to ensure detection at birth.

[Choanal atresia. An unrecognized malformation. Report of 3 cases at the Lomé University Hospital Center]. / Atrésie choanale. Une malformation à ne pas méconnaître. Etude de 3 cas au Centre Hospitalier Universitaire de Lomé.

The choanal atresia is a rare congenital malformation. Its clinical diagnosis is easy and must be done at the birth by the midwife or the obstetrician. We recommend the aspiration in all hospital maternity wards. This attitude avoids the unrecognized of an unilateral choanal atresia. The authors report three cases with a successfully treatment.

Atresie choanale: une malformation a ne pas meconnaitre: etude de 3 cas au Centre Hospitalier Universitaire de Lome (Togo)

L'atresie choanale est une malformation congenitale rare. Son diagnostic clinique facile doit etre realise des la naissance par la sage-femme ou l'obstetricien. Pour cela; nous conseillons l'examen du nouveau-ne avec aspiration naso-pharyngee systematique dans toutes les maternites. Cette attitude evitera la meconnaissance de l'atresie choanale unilaterale. Le traitement repose sur la divulsion avec calibrage de la choane atresiee. Les auteurs rapportent 3 cas diagnostiques en ORL dans les delais de 7 jours a 8 mois et traites avec succes par la divulsion