Clinical trial of beta-arteether versus quinine for the treatment of cerebral malaria in children in Yaounde, Cameroon.

One hundred and two children aged 0-10 years with cerebral malaria (Blantyre coma score of 2 or less) were randomly treated either with intramuscular arteether (3.2 mg/kg on Day 0, followed by 1.6 mg/kg on Days 1 to 4) or intravenous (i.v.) quinine dihydrochloride (20 mg of the salt/kg, followed by 10 mg of the salt/kg every 8 hr up to Day 6). Treatment with oral quinine sulfate (10 mg/kg every 8 hr) was substituted for i.v. quinine when the patient was able to take oral medicine. All patients were followed up in the hospital for 7 days; thereafter, they were treated as outpatients on Days 14, 21, and 28. Mortality rate, the main efficacy parameter, was 11.8% lower in the arteether treatment group than in the quinine group (15.7% versus 27.4%); however, the difference was not significant (P = 0.25). Means for fever clearance time, coma resolution time, and parasite clearance time were similar in the 2 treatment groups (42.2 +/- 34.9 hr; 34.8 +/- 18.8 hr, and 46.3 +/- 28.5 hr, respectively for arteether, versus 45.0 +/- 26.7 hr; 30.3 +/- 18.9 hr, and 40.7 +/- 18.9 hr, respectively, for quinine). At 28 days, the cure rates were 73.2% and 64.9% for the arteether and quinine treatment groups, respectively. Arteether is safe and therapeutically at least as effective as quinine for the treatment of cerebral malaria in children in Cameroon. Because of its ease of administration, arteether appears to be suited for use in the rural zones where monitoring facilities do not exist.

Prevalence of Campylobacter enteritis in children from Yaounde (Cameroon).

A cross sectional study on the prevalence of Campylobacter jejuni/coli and its possible aetiologic role in childhood diarrhoea in Yaounde was undertaken in 272 children presenting with diarrhoea and 157 age matched controls from April 1989 to October 1990. Stool cultures were performed according to standard techniques for Campylobacter jejuni/coli shigella and salmonella species. Rotavirus was detected using a latex agglutination test. Campylobacter jejuni/coli was isolated from 21 (7,7 pc) of 272 patients with diarrhoea and five of 157 (3,2 pc) controls (p > 0.05), all aged zero to four years old. Shigella and salmonella species were cultured from 2,2 pc and 1,1 pc of 272 patients respectively while rotavirus antigen was detected in 19,6 pc of 204 patients. Twenty eight pc of children with Campylobacter enteritis were exposed to chickens while 23,8 regularly drank water from streams which probably were contaminated. Our results indicate a high prevalence of campylobacter enteritis in children living in Yaounde and also suggest that a high rate of carriage of Campylobacter jejuni/coli could exist in children zero to four years without diarrhoeal illness. to four years without diarrhoeal illness.

[Neonatal septicemia and meningitis caused by gram-negative bacilli in Yaondé: clinical, bacteriological and prognostic aspects]. / Les septicémies et méningites néonatales a bacilles gram négatifs a Yaoundé: aspects cliniques, bactériologiques et pronostiques.

Based on 139 cases collected in 36 months, the authors show that neonatal sepsis and meningitis with Gram negative bacilli represent 62.33% of confirmed neonatal sepsis (223 cases out of 6,784 neonatal hospitalisations). 53.96% of cases are manifest within the first 72 hours of life. 35.25% of these infants are preemies. The principal predisposing factors are: foul-smelling leukorrhea (45.23%), prolonged rupture of membranes (26.62%) and notion of resuscitation (36.69%). The most important clinical signs are: thermal dysregulation (47.48%), tonus disturbances (35.97%) and respiratory distress (25.90%). Sepsis make up 85.61% of cases; the principal germs isolated being: Acinetobacter (21.58%), Pseudomonas (15.83%), Escherichia coli (14.39%), Enterobacter (12.95%), Klebsiella (11.51%). Of the germs isolated, 27.78% were resistant to initial treatment with the association ampicillin gentamicin. Mortality rate was 46.76%.