[Epidemiological and evolutionary profile of tuberculosis under the influence og HIV]. / Profil épidémiologique et évolutif de la tuberculose sous l'influence de l'infection par le VIH dans un centre de prise en charge ambulatoire au Gabon.

INTRODUCTION: We conducted this study to understand the impact of HIV infection on the epidemiology of tuberculosis (TB) in an outpatient care center. PATIENTS AND METHODS: This is a retrospective and comparative study between subjects infected or not infected with HIV, using TB case notification data registered from October 2017 to September 2019 in the intermediate care facility (CDT) of the University Hospital of Libreville. Comparisons were made by bivariate analysis; proportions were compared using the Chi2 or the Fisher Exact test. Variables of significant interest were included in a binary logistic regression model for multivariate analysis. RESULTS: Prevalence of HIV infection was 30.4%. Average age was 35.2 years with extremes at 15 and 83 years. In the results of the multivariate analysis, female patients were more frequently infected with HIV (p=0.002; OR=1.960, 95% CI [1.275 - 3.015]) and HIV infection was associated with a reduction in the proportion of PTB (+) (p=0.001; OR=0.483, 95% CI [0.311 - 0.752]). HIV infection was also associated with an increased proportion of new cases (P=0.007; OR=2.987, 95% CI [1.353 - 6.597]), EPT (p<0.001; OR=1.084, 95% CI [1.054 - 1.131] and an unfavorable therapeutic outcome (p=0.016; OR=2.744, 95% CI [1.208 - 6.233]). CONCLUSION: TB/HIV co-infection remains high. It continues to negatively impact outpatient management of TB.

[Behavior and attitudes towards smoking among student midwives in Libreville]. / Comportements et attitudes des élèves sages-femmes de Libreville vis-à-vis du tabagisme.

BACKGROUND: The midwife, in taking on a public health role, is one of the most important resources for the prevention of smoking and in helping smoking cessation among women of childbearing age thanks to their numerous contacts with pregnant women. With this in mind, we conducted a study among student midwives to examine their smoking behavior, their attitudes towards smoking, and their participation in prevention. METHOD: This was a descriptive cross-sectional study conducted from 15 January to 15 February 2018 using a self-administered questionnaire and included the student midwives of the University of Health Science at Libreville (Gabon). RESULTS: A total of 188 student midwives completed the questionnaires (70.7% of students of the 1st year, 15.0% of students of the 2nd year and 14.3% of students of the 3rd year). Gaps exist in the knowledge of student midwives regarding the risks of cigarette smoking in pregnancy and its role in the development of complications for the mother and foetus. Overall, 17.1% of student midwives think that smoking is responsible for the occurrence of ectopic pregnancies, 20.3% believe it is responsible for retro-placental haematoma, 17.6% for premature rupture of the membranes. The prevalence of smoking was 11.1% and was most frequent in 2nd year students (25.0%) and 3rd year students (14.8%) (P<0.023). The mean age of beginning smoking was 19.0±4.4 years. The main initiating factors were peer influence (28.6%), pleasure (19.0%) and stress (14.3%). Nicotine dependence was weak to moderate among 48.8% of smokers and absent in 52.2%. CONCLUSION: Gaps exist in the knowledge of student midwives regarding the risks of cigarette smoking to complications of pregnancy. There is need therefore to include formal training on tobacco control strategies at an early stage in the medical curriculum.

Assessment of Imatinib in the treatment of chronic myeloid leukemia in Gabon: a cohort of 17 cases.

The prognosis for chronic myeloid leukemia, the first hematologic malignancy for which successful targeted therapy has been developed, has changed markedly in the West. In developing countries, however, prognosis remains poor, mainly because of lack of access to treatment. The effort made by some nongovernmental organizations to distribute first-generation tyrosine kinase inhibitors free of charge has changed this situation in some regions, notably in sub-Saharan Africa and Gabon in particular. We report the results in a cohort of 17 patients.

[Tuberculosis of the breast: four cases report at the Armies Instruction's Hospital Omar Bongo Ondimba (HIAOBO) in Libreville (Gabon)]. / Tuberculose mammaire : à propos de quatre cas à l'hôpital d'instruction des armées Omar Bongo Ondimba (HIAOBO) de Libreville (Gabon).

Mammary tuberculosis is a rare localization of extra pulmonary tuberculosis. Its frequency increases proportionally with the HIV pandemic. We report four cases of breast tuberculosis diagnosed in the general medicine department of HIAOBO including two with positive HIV serology. It is necessary to know this extra pulmonary form/feature as the differential diagnosis with breast tumors is sometimes difficult.

Apport du Crag-Test serum dans le diagnostic de la cryptococcose neuroméningée en milieu rural. A propos de deux observations

Introduction : La cryptococcose neuro-méningée est la plus commune des affections mortelles du Système Nerveux Central chez les patients immuno-déprimés en Afrique Subsaharienne. Il s'agit alors d'une véritable urgence diagnostique et thérapeutique, d'où la mise en œuvre des tests diagnostiques rapides et efficace. Le Crag-Test serum (Antigénémie cryptococcique) pourrait alors se révéler utile sur ces terrains particuliers en milieu rural africain. Observation : Nous rapportons deux cas de cryptococcose neuro-méningée chez deux patientes âgées respectivement de 48 et 38 ans au regard du terrain d'immuno-dépression acquis, la présence de levure encapsulée à l'examen du liquide cérébro-spinal à l'encre de Chine dans un cas et la positivité du Crag-test serum dans les deux cas. La présence d'emblée de facteurs de mauvais pronostic expliquaient l'issue fatale. Conclusion : Compte tenu de la gravité potentielle de cette affection, le Crag-test serum devrait être facilement accessible et disponible pour un diagnostic rapide et une prise en charge précoce et efficace afin de limiter la morbi-mortalité

[Breast cancer in men: about 3 cases at the l'Hôpital d'instruction des armées Omar Bongo Ondimba (HIAOBO) (Gabon)]. / Cancer du sein chez l'homme: à propos de trois observations à l'Hôpital d'instruction des armées Omar Bongo Ondimba (HIAOBO) (Gabon).

We report three cases of breast cancer in men observed at Military Teaching Hospital Omar Bongo Ondimba between January 2008 and December 2009, under varying circumstances, with all unfavorable evolution.

[Epidemiology of upper gastrointestinal bleeding in Gabon]. / Profil épidémiologique des hémorragies digestives hautes au Gabon.

The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.

[Intrathoracic giant peripheral nerve sheath tumor during Von Recklinghausen disease]. / Tumeur nerveuse géante du thorax au cours de la maladie de Von Recklinghausen.

We report the case of a patient aged 23, admitted for bilateral intrathoracic tumor, including a giant right. Surgery was performed by right sternothoracotomy. After 7 days, she presented an irreversible cardiac arrest. The malignant peripheral nerve sheath tumors are rare and aggressive. Their incidence is 0.001% in the general population and 0.16% in patients with neurofibromatosis type 1. These tumors are characterized by their risk of recurrence and poor prognosis. The treatment is the surgical resection. We analyze incidence, diagnosis and prognosis of these tumors.

[Leptospirosis in Libreville (Gabon): four cases]. / La leptospirose à Libreville (Gabon) : à propos de quatre cas.

OBJECTIVE: Leptospirosis is an endemic disease in tropical countries, where it is characterized by clinical polymorphism. We report four cases of leptospirosis diagnosed at the military hospital of Libreville (Gabon). CASE REPORTS: Four men aged 16 to 31-years-old, were admitted for febrile jaundice, with impaired general condition and pain. All lived in disadvantaged neighborhoods in the capital. In each case, the laboratory workups found hepatic cytolysis, renal failure, hyperleukocytosis, anemia, and an inflammatory state. Serology was negative for hepatitis B and C and for HIV, as was testing for malaria. The failure to respond to presumptive antimalarial treatment suggested leptospirosis, and the diagnosis was confirmed in every case by positive serologies with significant antibody titers. The course was quickly favorable under treatment by an appropriate antibiotic; liver and kidney function returned to normal within a few days. CONCLUSION: In tropical zones, the diagnosis of leptospirosis must be considered in all cases of febrile jaundice, especially when liver and kidney function are impaired.

[Profile of adenopathies in a tropical setting: 78 observations in Gabon]. / Profil étiologique des adénopathies en milieu tropical : soixante-dix-huit observations au Gabon.

OBJECTIVE: To determine the main causes of lymphadenopathies and their clinical characteristics in Gabon. MATERIAL AND METHOD: This retrospective study analyzed the records of patients hospitalized in the medical department at the Military Hospital of Libreville (Gabon) from January 2010 through December 2011 who presented one or more lymphadenopathies. RESULTS: The study included 78 patients (45 men, 33 women), with a mean age of 42.2 ± 15.9 years. Lymphadenopathies were superficial in 67.9% of cases, abdominal in 42% of cases and mediastinal in 24% of cases. Both deep and superficial locations were noted in 26% (20 cases). Weight loss (63%), fever (56%), asthenia (54%), hepatomegaly (26%), and splenomegaly (20%) were the clinical signs most frequently associated with lymphadenopathy. The main diagnoses were tuberculosis (52%, 41 cases) and non-Hodgkin's lymphoma (11%, 9 cases). Infection with human immunodeficiency virus (HIV) was found in 47% of cases. CONCLUSION: Tuberculosis remains the most frequent cause of lymphadenopathy in our setting. HIV testing should be routinely performed in all patients with lymphadenopathy.

[Morbidity and mortality in HIV-infected patients in the Military Hospital in Libreville (Gabon)]. / Morbimortalité chez les patients infectés par le VIH à l'hôpital militaire de Libreville, Gabon.

OBJECTIVE: To study the morbidity and mortality of HIV-infected patients at the military hospital in Libreville (Gabon). MATERIALS & METHODS: A retrospective study of the clinical records of 289 HIV-positive patients hospitalized in the department of internal medicine between January 2008 and December 2010. RESULTS: The patient's median age was 40 years (range: 18-70). The principal presenting complaints were fever (82%), weight loss (76.47%) and coughing (26.64%). Median time from symptom onset to consultation was 150 days (1-365). The predominant opportunistic diseases were oropharyngeal candidiasis (71.62%), all forms of tuberculosis (26.29%) and cerebral toxoplasmosis (23.87%). The median CD4 lymphocyte count was 177/mm(3 )(1-590). In-hospital mortality was 27.68%. The factors associated with death were long time to consultation and severe immunosuppression (CD4 count <100/mm(3)). CONCLUSION: Despite increased awareness, lateness of diagnosis and thus of treatment persist, and AIDS remains one of the principal causes of morbidity and mortality in Gabon.

[Histoplasmosis: case report from Gabon]. / Histoplasmose : première observation au Gabon.

The purpose of this report is to describe the first case of infection with Histoplasma capsulatum variety duboisii in Gabon, in a patient with HIV infection.

[Multifocal pyomyositis after being hit by a truncheon in Gabon]. / Pyomyosite multifocale après coups de matraque au Gabon.

Pyomyositis is an acute primary bacterial infection of striated muscle. It affects mainly but not only immunocompromised patients, especially in tropical areas. The responsible microbe is often found to be Staphylococcus aureus. We report here the case of an immunocompetent 17-year-old with multifocal pyomyositis from which S. aureus was isolated two weeks after he was hit with a truncheon.

[Centrilobular nodules with ground-glass opacities in the lungs]. / Un lâcher de ballon curable.

We report the case of a 56 year-old Gabonese man under treatment by candesartan-hydrochlorothiazide for essential hypertension. After 2 months of treatment, he presented with pneumonia and severe respiratory failure. The chest radiography showed centrilobular nodules resembling tumor metastases, but no evidence of a primary tumor. Laboratory and imaging found no evidence of infectious or autoimmune disease. The computed tomography findings led to a diagnosis of diffuse alveolitis. The candesartan treatment was stopped and oral corticosteroid therapy (50 mg/day) initiated. The rapid favorable outcome supports the diagnosis of a drug-induced infiltrative lung disease.

[Multi-resistant tuberculosis at the hôpital d'instruction des armées de Libreville (Gabon) about 16 cases]. / Tuberculose multirésistante à l'hôpital d'instruction des armées de Libreville (Gabon) à propos de 16 cas.

According to WHO estimates, between 1 and 20% of tuberculosis cases in the world are multiresistant. In Gabon, this prevalence is estimated at 1.9%. In this forward-looking study from March 2006 to August 2010, we report 16 cases of multi-resistant tuberculosis out of 24 suspected resistant samples (persistence of the clinical and radiological signs after three months of well conducted treatment with first-line anti-tuberculous drugs). This study is realized in association with the laboratory of mycobacterium of the Percy military teaching hospital, Clamart, France.

[Clinical and radiological features of tuberculosis during HIV infection in Libreville, Gabon]. / Aspects cliniques et radiologiques de la tuberculose au cours de l'infection par le VIH à Libreville, Gabon.

OBJECTIVE: The purpose of this report is to describe the clinical and radiological features of tuberculosis during HIV infection. MATERIALS AND METHODS: This retrospective comparative study was based on review of patients treated between 2006 and 2010 in the Department of Medicine of the Military Hospital in Libreville, Gabon. A total of 156 patients with all types of tuberculosis were included, i.e., a study group of 78 tuberculosis patients co-infected with HIV and a control group of 78 seronegative tuberculosis patients. Analysis was carried out on demographic, clinical and radiological data. RESULTS. Most patients in both groups were male. Mean patient age was 37.1 +/- 10.3 in the seropositive group and 29.5 +/- 11.5 in the seronegative group. Deterioration in general health was quantitatively higher in the seropositive group. Tuberculosis was confined to the lungs in 41% of patients co-infected with HIV and 55% of seronegative patients. Chest x-rays showed more extensive cavitation in seronegative patients. Mixed pulmonary and extrapulmonary disease was observed in 20.5% of seropositive patients and 10.3% of seronegative patients. The CD4 lymphocyte rate was not statistically different between patients with pulmonary versus extrapulmonary tuberculosis. CONCLUSION. Tuberculosis during HIV infection often has an atypical or banal clinical presentation. Radiological findings may be non-distinctive or even normal. For this reason, diagnosis of tuberculosis may be difficult.

[Pneumocystis jiroveci pneumonia: first documented case in Libreville, Gabon]. / Pneumonie à pneumocystis jiroveci: premier cas documenté à Libreville (Gabon).

The purpose of this report is to describle the first documented case of pneumocystosis in Gabon. Diagnosis was confirmed based on microbiological methods in a 59-year-old immunodepressed HIV-positive man. Diagnosis was further documented by observation of Pneumocystis jiroveci cysts in the broncho-alveolar lavage (BAL) after Gomori-Grocott color reaction. The patient responded well to treatment with Cotrimoxazole, corticoids and oxygen.

Epileptiform seizures revealing neurocysticercosis: report of two clinical cases in Libreville, Gabon.

Neurocysticercosis (NCC) is the most common helminth infection of the central nervous system. It is caused by the larval form of the tapeworm Taenia solium and is increasingly recognized as a major cause of neurologic disease worldwide. Epilepsy is the usual mode of revelation. Neuroimaging, including computed tomography and magnetic resonance imaging, combined with serodiagnostic techniques have led to this increased recognition. We report on two cases (one co-infected with the HIV) of NCC diagnosed in 2006 and 2008 at the Omar Bongo Ondimba Army Teaching Hospital. New-onset epilepsy revealed the two cases. Medical treatment with albendazole, anti-epileptic drugs and corticosteroids led to full recovery. NCC should be considered in tropical countries as a leading cause of epilepsy. Moreover, NCC should be included in the differential diagnosis of neurologic infections in HIV patients in endemic populations.

[Neuromeningeal cryptococcosis and AIDS: an 11-case series from Libreville, Gabon]. / Cryptococcose neuroméningée et sida: 11 observations a Libreville, Gabon.

UNLABELLED: Neuromeningeal cryptococcosis occurs mainly in immunodepressed patients and especially AIDS patients. The purpose of this study was to determine the clinical and prognostic features of this severe brain infection. PATIENTS AND METHODS: This retrospective study was carried out on HIV-infected patients hospitalized for cryptococcal meningitis in the internal medicine unit of a military hospital in Libreville, Gabon from January 1, 2006 to November 31, 2009. RESULTS: Eleven cases of cryptococcosis were identified among a total of 290 cases of AIDS. Mean patient age was 39 years. The main clinical manifestation was headache that was either isolated or associated with other cerebral signs. In all cases, cerebrospinal fluid analysis demonstrated a clear aseptic aspect with direct examination after addition of India ink showing the presence of encapsulated yeast cells identified as cryptococcus. The patient was treated with amphotericin B and fluconazole. The mortality rate was 81.8% (9/11 cases). CONCLUSION: Since the manifestations of cryptococcosis during clinical AIDS are non-specific, systematic screening is recommended in AIDS patients. Early treatment could reduce mortality.

[A case of meningo-encephalitis due to West Nile virus in Libreville, Gabon]. / Un cas de méningoencéphalite à virus West Nile à Libreville, Gabon.

Acute forms of meningo-encephalitis due to West Nile virus are rare. The purpose of this report is to describe the first case of acute meningoencephalitis due to West Nile virus diagnosed in Gabon. The patient was a 20-year-old Gabonese man. Diagnostic was confirmed by molecular biology. The patient died 12 days after admission to the hospital. This case is discussed based on a review of the literature.