[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.

[Mortality of children with sickle cell disease in a pediatric department in Central Africa]. / Mortalité des enfants drépanocytaires dans un service de pédiatrie en Afrique Centrale.

BACKGROUND: Sickle cell disease is a serious public health problem in Gabon with a relatively high mortality rate. PATIENTS AND METHODS: Charts of 23 children (nine boys, 14 girls) who died of complications from sickle cell anemia in the department of pediatrics of Owendo Pediatric Hospital (Libreville, Gabon), from January 1, 1990 through December 31, 1992, were analysed retrospectively. RESULTS: Approximately two-thirds of the children (60.9%) were under 5 years of age. The great majority of patients were from low socio-economic standard families. Of 319 deaths observed during the study period, 23 were due to sickle cell disease-associated complications, for an overall mortality rate of 7.2% and a related mortality of 3.6%. Commonest causes of deaths were severe anemia (11 cases, i.e., 47.8%), which affected predominantly the younger patients between 6 months and 5 years (eight cases), infections (30.4%) and blood transfusion complications (21.7%). CONCLUSION: To decrease these mortality rates, appropriate health supervision and well-designed preventive strategies are needed.

[Human African trypanosomiasis in children. A pediatrics service experience in Libreville, Gabon]. / Trypanosomose humaine africaine chez l'enfant. Expérience d'un service de pédiatrie à Libreville, Gabon.

During a period of six years (1/1/89-12/31/94), seven children with trypanosomiasis were admitted to the Department of Pediatrics of Owendo Pediatric Hospital-Libreville, Gabon. They were 5 boys and 2 girls, aged 4-17 years, five of them under 15 years. The main reasons of hospitalization were somnolence (4 cases), psychical disorders (5 cases), neurological disorders (4 cases), asthenia (3 cases), loss of weight (3 cases) and fever (3 cases). Increased sedimentation rate (5 cases) and hypergammaglobulinemia (6 cases) were the most important biological disturbances. Serodiagnosis (CATT, indirect immunofluorescence test) was positive in all cases. The parasite was detected in blood seven times, and four times in cerebrospinal fluid (CSF). According to CSF status, six children have been classified in second stage of the disease. Six patients were treated by melarsoprol, and one by eflornithine. Tolerance and response to treatment were good in six cases. Three children presented sequels when leaving hospital. No patient was seen again after the study.

[Aspects of malaria in the hospitalized child in Gabon]. / Aspects du paludisme de l'enfant en milieu hospitalier gabonais.

To gain insight into the impact of malaria on children in terms of frequency and severity, a study was carried out in a department of the Owendo Children's Hospital in Libreville, Gabon, a fully endemic area. Diagnosis of Plasmodium falciparum malaria was confirmed by blood smears in 295 of the 1592 children admitted in 1992, i.e. 18.5% of admissions. Malaria was therefore the primary cause of hospitalization. Of 122 deaths observed during the study period 9 were due to malaria-associated complications for an overall mortality rate of 7.4% and malaria-related mortality rate of 3.1%. These rates are low in comparison with those reported by other departments in Central Africa. Convulsions were observed in 30.5% of children in the department and malaria was the underlying cause of convulsions in 62.9% of these cases. Severe anemia (< 5 g/dl) was noted in 23.7% of children overall and was associated with malaria in 54.7%. Severe malaria as defined by the criteria of the World Health Organization was observed in 33.2% of children. These findings illustrate the extent of the impact of endemic malaria on children in Gabon and emphasize the need to promote malaria control programs and improve treatment.

[Salmonella meningitis in children in Libreville. Retrospective study of 9 cases]. / M eningites à salmonelles de l'enfant à Libreville. Etude rétrospective de neuf observations.

BACKGROUND: Salmonella meningitis is a rare entity, even in tropical area where salmonellosis is common. Its prognosis is poor and the choice of adequate antibiotic therapy is difficult. PATIENTS AND METHODS: The files of nine children (three boys, six girls) admitted to the pediatric unit of the Owendo Pediatric Hospital in Libreville for salmonella meningitis between January 1, 1989, and December 31, 1993 were retrospectively studied. Diagnosis was established by a positive culture of cerebrospinal fluid. RESULTS: Salmonella was the third cause (8.65%) of purulent meningitis observed during this period. Eight children were less than 1-year old, seven were from low socioeconomic standard families. The main clinical manifestations were fever (seven cases), pallor (six cases), diarrhea (four cases), nuchal rigidity (four cases), convulsions (three cases) and bulging fontanel (three cases). Five children (55.5%) were severely anemic (hemoglobin < 5 g/dL) but none had abnormal hemoglobin. Serotyping could not be performed in any case. Salmonella isolates were resistant to chloramphenicol in six cases and to ampicillin in five. Cefotaxime (200 mg/kg/24 h intravenously in three divided doses) was given to seven patients. The duration of therapy was at least 3 weeks in four patients. There were five deaths at ages ranging from 1 to 12 months, ie, a case fatality rate of 55.5%. Three patients (33.3%) recovered with neurological sequels. CONCLUSION: The prognosis of salmonella meningitis is poor, even in the case of prompt diagnosis and adequate therapy. Preventive measures only can decrease the risk of illness in children.

[Bladder stones in children in Gabon. Three case reports]. / La lithiase vésicale chez l'enfant au Gabon. A propos de 3 observations.

Bladder stones are uncommon in children in Gabon. The authors report the case of 3 boys admitted to the Paediatric Hospital of Owendo for voiding disorders. All patients came from the South of the country, but these stones cannot be described as endemic in view of the small number of cases. The authors recall the main aetiologies, the suggestive symptoms and the simple and inexpensive complementary investigations (plain abdominal x-ray and ultrasonography) allowing the definitive diagnosis. Conventional surgical treatment gives good results, but in the case of small stones, endourological treatment can be more economical in terms of the duration of hospital stay and postoperative morbidity.

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

[Epidemiologic and clinical aspects of child tuberculosis in Gabon. Retrospective study of 47 cases]. / Aspects épidémiologiques et cliniques de la tuberculose de l'enfant au Gabon. Etude rétrospective de quarante-sept cas.

Forty-seven pediatric cases of tuberculosis seen over three years in a department of general pediatrics are reviewed. The main epidemiological and clinical features were studied. Yearly incidence approximated 1.42% in the department. In most instances the source of contamination was not identified. Most patients had not been immunized according to recommendations. Early immunization should be performed and followed by routine tests for vaccine-induced immunity during the first two years.

[Decreased intraepithelial lymphocytes in the intestinal mucosa in children with malnutrition and parasitic infections]. / Baisse des lymphocytes intraépithéliaux dans la muqueuse intestinale de l'enfant malnutri et parasité.

In Gabon, 15 children aged 13 to 36 months admitted for malnutrition with chronic diarrhea underwent a small bowel biopsy for detection of parasites in the duodenal contents and histologic evaluation of the intestinal mucosa. In every case, intraepithelial lymphocyte counts (IELC) were under the lower limit of normal for children and adults, regardless of whether or not parasites were found. Partial villous atrophy was a consistent finding. Proportion of lymphocytes among intraepithelial cells was 7.4% in the 6 children with no parasitic infection, 7.9% in the children with giardiasis, and 8.1% in the children with strongyloidiasis. Appropriate treatment of the parasitic infections was quickly followed by resolution of the diarrhea in the nine patients with demonstrable intestinal parasites. These data should be compared with the well documented lymphocyte function anomalies associated with protein-calory malnutrition. The fall in IELC and lack of response to local anigenic stimulations are features of malnutrition.

[Rigid tube bronchoscopy in tuberculous children. Apropos of 24 cases]. / La bronchoscopie avec tube rigide chez l'enfant tuberculeux. A propos de vingt-quatre observations.

We report the preliminary results of a study in children with tuberculosis. Rigid tube bronchoscopy provided diagnostic information in 79% of cases and allowed a few therapeutic procedures including aspiration of secretions and removal of inflammatory granulomas. We found that the most common lesion is bronchial compression. Rigid tube bronchoscopy is acceptably comfortable under general anesthesia and provides valuable results.

[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.