[Child tuberculosis at the teaching hospital of Brazzaville from 1995 to 2003]. / La tuberculose chez l'enfant au CHU de Brazzaville de 1995 à 2003.

In the paediatric service of the teaching hospital of Brazzaville, 582 files of children hospitalized were studied from January 1995 to December 2003. To determine tuberculosis frequency among sickle cell children and estimate the clinical and paraclinical aspects, a case-control study of tubercular patients with HIV negative serology was carried out by comparing at the same time a cohort of 75 sickle cell patients versus 125 patients without sickle cell disease. The results of these studies are as follows. The main assessment is the high frequency of tuberculosis. In 1995 the tuberculosis rate reaches 8%, in 2003 it was up to 13.6%, and 20.6% in 2000 due to the serious consequences of the recurrent wars between 1993 and 1999. Another cause of that high frequency is the rate of HIV/aids patients with a frequency of 2.5% of hospitalization ranging from 1.6 to 3.2%, among them 35% of the tubercular patients were seropositive. The tuberculosis prevalence was 7.4% among sickle cell patients versus 14.2% among control patients. Infection was more often identified in control patients (51.2%) than in sickle cell patients (24%). 68% of the parents were really poor and 18.5% of the children were evicted from their home by war. The pulmonary localizations were prevailing in groups of patients with sickle cell disease as well as in group of control patients. Pleuritis was observed in 8% of the patients with sickle cell disease versus 16.8% for control patients (P = 0.02). No patient with sickle cell disease had a miliary. Anergia to tuberculin test was reported in 35.8% sickle cell patients versus 10.4% for the control patients (P = 0.001). Tuberculosis prevalence is higher among control patients than in sickle cell patients. The high proportion of clinical and paraclinical data of tuberculosis did not significantly differ from the two groups. Evolution was good for 98% of the patients, 1.4% of them died; 74% of deceased patients were affected by HIV/aids.

[Hydrocholecystis, a rare etiology of painful abdominal crisis in sickle cell disease. About two cases]. / Hydrocholécyste, cause rare de crises douloureuses abdominales chez le drépanocytaire. A propos de deux cas.

The authors report two cases of hydocholecystis causing abdominal pains in the sickle cell child. The patients were two girls aged respectively 4 and 12. Hydrocholecystis is defined by acute distension of the gallbladder The diagnosis was made by scan which allowed to follow the evolution in the two sickle cell children. After two crises, no more recurrence was noted in the first patient, on the other hand in the second child recurrences became more frequent. Some authors indicate surgery systematically while others recommend it only after several recurrences.

[Tuberculosis and HIV/AIDS co-infection in children: experience carried out in paediatric service of the teaching hospital of Brazzaville, Republic of Congo (1995-2004)]. / Tuberculose et infection dues au VIH/sida chez l'enfant: expérience du service de pédiatrie du CHU de Brazzaville, Congo (1995-2004).

Epidemiologic, clinical and paraclinical data of 126 children with tuberculosis whose HIV status was known, have been compared. Among them, 65% were HIV positive, the co-infection tuberculosis HIV/AIDS was observed in all social categories. The source of contamination was discovered for 72% of the patients. The mother was involved in 47.5% of cases. The main reasons of consultation were a long standing fever a chronic cough and a weight loss. Diarrhea was mainly observed in positive HIV patients (p = 0.00). The general condition was influenced by a weight loss which was more important in positive patients with a IMC lower than 10 in 12.8% of cases. There was no significant difference between all clinical forms. Digital hippocratism, chronic otitis and parotiditis were only observed in positive HIV patients with skin illness ten times more frequent (p = 0.00). Anergia to tuberculin tests (78.4%) and a sedimentation speed up to 100 mm at the first hour were observed in more than 60% of the positive HIV patients (p = 0.001). Evolution was favorable under treatment for 84% of positive HIV patients with an increasing weight becoming weaker after one month of treatment. All deaths happened among that population.

[Recurrent quadric paralysis in an 11-year-old girl with spinal tuberculosis]. / Tétraplégie récidivante chez une enfant de 11 ans présentant un mal de Pott cervical.

The authors report a recurring quadric paralysis in a 11-year-old girl with cervical, pulmonary and mediastinal tuberculosis. The diagnosis was belated. After the first treatment with anti tuberculosis drugs and immobilization with a surgical collar, an improvement has been obtained; but at the 8th month of this treatment, a partial paralysis of superior members and total paralysis of inferior members appeared. A treatment with streptomycin, ethambutol, rifampicin, pyrazinamide, isoniazide, and prednisone was undertaken. The spontaneous motility was observed at 37 days of treatment. However, at the 8th months of this treatment, quadric paralysis happened again after a fall down. After immobilization with a new surgical collar and prednisone, the spontaneous motility came back again 3 months later.

[Schooling of the child and teenager suffering from sickle-cell disease in 2004, Brazzaville, Congo]. / Scolarité de l'enfant et de l'adolescent drépanocytaire en 2004 a Brazzaville, Congo.

A case-control transversal study has been carried out in March 2004 in the paediatric unit of the Brazzaville teaching Hospital to assess the impact of the sickle cell disease on school-age children. School-age children and teenagers of both sex were distributed in 228 homozygote sickle cell children (group I) aged of 5 years old and 8 months old to 21 and 245 children recruited in state schools aged of 5 years old and 6 months to 19 years old. In the group I, 78 children suffering from sickle cell disease are ahead in their school achievement, 59 have a normal education and 91 meet some difficulties with no significant difference; in the group II, 122 children are ahead in their school achievement, 81 have a normal education and 42 meet difficulties (p < 0,001). The average of children having school difficulties was 2,4 +/- 1,5 years in the group I with extremes ranging from 1 to 3 years. By comparing both groups in primary school, no difference was to be found in children doing well at school and children having a normal education: 54 children of the group II are reported being ahead in their school achievement (39, 7%) and 81 children in the group II (55, 1%); normal education for 38 children of the group 1 (28%) and 58 children in the group II (39, 5%). On the other hand, 44 children are having school difficulties in the group I (32, 3%) against 8 children in the group II (5, 4%) (p < 0,001). As a matter of form we have observed that ahead schooling is to be found in 24 sickle cell children at HbF < 10% (41, 4%) and 54 sickle cell children at HbF < 10% (34, 2%) (p < 0,05); normal education in 14 children with sickle cell disease at HbF > 10% (24, 1%) and 45 children with sickle cell disease at HbF < 10% (25, 9%) and school difficulties in 20 children with sickle cell disease at HbF > 10% (34, 5%) and 71 children with sickle cell disease at HbF < 10% (39, 9%).

[Radiological profile in 92 children suffering from Pott's disease]. / Aspects radiologiques du mal de Pott chez i'enfant. A propos de 92 cas.

The aim of this cross-sectional study was to analyse the radiological profile in 92 patients with Pott's disease and to identify severity factors. Among these subjects, aged from 11 months to 15 years old (average: 7.5 years), 37% of children had neurological signs; the HIV test was positive in 11 % of cases. Localisations were mainly dorsal (61%) and thoracic (49%). They were often associated. Almost all patients had lesions on one vertebra (31.5%) or 2 vertebrae (38%). Most of lesions were spondylitis (61%), paravertebra abscess (35%) and compressing vertebra (34%). The severity of vertebra localisations was correlated with late diagnosis and presence of neurological complication, while a high sedimentation rate didn't appear to be a factor of severity. Therefore radiology remains essential in Pott's disease evaluation providing precious information for the diagnosis and prognosis of spine tuberculosis.

[Sickle-cell crisis in the child and teenager in Brazzaville, Congo. A retrospective study of 587 cases]. / Les crises vaso-occlusives drépanocytaires chez l'enfant et l'adolescent a Brazzaville, Congo. Etude rétrospective de 587 cas.

Using files related to children admitted at the Brazzaville teaching hospital (Congo) between May 1995 and May 2002, the authors have studied the part of sickle cell crisis (SCC) in the sickle cell disease, have assessed the epidemiological particularities, the relation between some clinical, biological factors as well as the severity of the disease. On the whole, 587 SCC have been observed in homozygous SS children aged 6 to 17. The distribution was as follows: painful osteo-articular crisis (58.6%), abdominal crisis (23.5%), acute chest syndrome (14%), neurological strokes (3.2%) and priapism (0.7%). The neurological strokes (75%) and the hand-foot syndrome (77.8%) were predominant in male. As regards the interaction age-localization of the crisis, the hand-foot syndrome mainly concerned children under five, long bones and rachis impairment those aged 11 to 15; abdominal and neurological crisis were observed especially before the age of 10, the acute chest syndrome after 10 (68.3%). Malaria (48.9%) and bacterial or viral infections (24.5%) proved to be the triggering factors when these are identified (188 cases). SCC occurred in 67.5% of the cases during the hot and rainy seasons. Moreover the haemoglobin F rate above 10% was correlated with a low prevalence of SCC, in particular the potentially severe crisis, revealing at the same time its protective value. These results show that SCC, by their frequency and/or their severity constitute a major handicap when the vital prognosis is not involved. Rigorous health habits, appropriate vaccination programme, adequate malarial prophylaxis, optimal transfusional strategy and especially the use of hydroxyurea, prove to be urgent preventive measures to put into practice. Their efficient implementation will provide a better quality of life to the sickle cell patient and will decrease the risks of severe crisis.

[Effects of age on causes of hospitalization in children suffering from sickle cell disease]. / Causes d'hospitalisation des enfants drépanocytaires: influence de l'age (C.H.U. de Brazzaville, Congo).

The objective of this work was to assess the frequency the nature of complications and prognosis of the disease in children suffering from sickle cell disease. This retrospective study was conducted from January 2002 to December 2003 among 251 children suffering from sickle cell disease, hospitalized at the Brazzaville Teaching Hospital, Congo. The main hospitalization causes were dominated by the vaso-occlusive crisis (26.7%), anaemic crisis (20.3%) and infections (36.6%). The vaso-occlusive crisis were observed particularly in the 5 year-old children (p < 0.05); the hand-foot syndrome concerned in particular children under 5 years old. Anaemic crisis were found almost exclusively in patients under 5 (p < 0.05). The infections in children under 5 (35.8%) were almost as frequent as in older children (37.4%). Some non infectious complications were only observed in children above 5: cholithiasis, 4 cases; heart failure, 4 cases; hip osteonecrosis, 1 case. Global mortality was 4.8% and higher in children under five (p > 0.05). In addition, the death causes were dominated by anaemic crisis. In conclusion, this study stresses on the need to implement a primary prevention as well as a secondary prevention adapted to age.

[Body composition in Negro African children suffering from sickle cell disease. A mixed cross-sectional longitudinal study in Brazzaville, Congo]. / Composition corporelle d'enfants drépanocytaires homozygotes congolais. Etude longitudinale a Braz- zaville, Congo.

This study evaluates the changes of body composition in homozygous children suffering from sickle cell disease and appreciates the interaction between some factors of severity of the disease. A mixed cross-sectional longitudinal study with control cases cohort was conducted in Brazzaville (Congo) among 91 children with sickle cell disease (45 boys and 46 girls) and 95 healthy children (48 boys and 47 girls), aged of 8-17 years old. Each group was initially divided into three subgroups of age: 8, 11, 14. These children were subsequently followed for 3 years. Each year, at the same period, body mass, percentage of body fat, lean body mass and body mass index were evaluated in the two groups and then compared. The effects of frequency of painful episodes, the number of severe anaemia crisis and haemoglobin F on different variables were also appreciated. The children with sickle cell disease had stunting, lower values of body mass (p < 0.001), percentage of fat (p < 0.01), lean body mass (p < 0.01), and body mass index (p <0.001) between 8 and 17 years of age. In addition, we observed a non linear association between body mass index and fat percentage, but this interaction was stronger in girls. Finally the yearly frequency of painful episodes, the number of severe anaemia crisis and haemoglobin F had most of the time an influence on body composition. Children with sickle cell disease had a decreased body composition influenced by the complications associated with the disease . These limitations are modulated by haemoglobin F but the body composition is affected by painful episodes and severe anaemic crisis. Therefore more care and attention are recommended for the children suffering from sickle cell disease in order to control this severe disease.

[Enuresis in children with sickle cell disease]. / L'énurésie chez l'enfant drépanocytaire.

POPULATIONS AND METHODS: In order to analyze epidemiological and clinical characteristics of enuresis in children with sickle cell disease, and identify risk and aetiological factors, 987 subjects (aged 5-20 years) took part in a cross-sectional study. These children were divided into two groups: group 1 consisted of 456 homozygous children with sickle cell disease (haemoglobin SS), while group 2 consisted of 531 normal children. These groups were paired according to age and sex. RESULTS: The prevalence of enuresis was 50.9% in group 1 and 16.4% in group 2, and was significantly higher (P < 0.05) in the girls. The frequency decreased significantly between the ages of 5-20. At age 16, frequency of enuretic children with sickle cell disease remained statistically greater (15.9% vs. 8.0%). The frequency of wet nights was higher (P < 0.05) in group 1. In addition, anaemia crisis and painful crisis were related to prevalence of enuresis. There was a significant (P < 0.01) negative correlation between haemoglobin F percentage and prevalence of enuresis. CONCLUSION: Enuresis is frequent in children with sickle cell disease and its intensity is linked to severity of disease.

[Epidemiologic and cytologic configuration of acute leukaemia at University Hospital of Brazzaville]. / Configuration épidemiologique et cytologique des leucémies aiguës au Centre Hospitalier et Universitaire de Brazzaville.

The authors report the epidemiologic and cytological aspects of 77 patients hospitalized between January 1995 and December 2002 in the clinical hematologic service in University hospital complex of Brazzaville, greatest hospital of the country. During this period, 7155 patients were hospitalized in this service as a frequency of (107%). reported to the number of inpatients admitted on a total of 52,458 patients. The hospital frequency of disease is 0.15%. There's no specific age for this affection (age median = 21-24 years) and all socio-professional categories can be affected with a prevalence of low income patients what complicates extremely the treatment Ratio Man/Woman is 0.8 showing a light female prevalence. On the level of the epidemiologic investigation (limited because of the insufficiency of the means), nothing is retained except rare acute leukaemias secondary to chronic myeloproliferative disorders as well as association with 2 cases of homozygous sickle cell anaemia. Mortality by acute leukaemia in the service is very high, due to lack of equipment. In the cytological plan, there's a light prevalence of the cases of acute lymphoblastic leukaemias of which some could profit from an immunological typing compared to the cases of myeloblastic acute leukaemias

[Ovarian torsion revealing an ovarian cavernous hemangioma in a child]. / Torsion de tumeur kystique de l'ovaire chez une adolescente, révélatrice d'un hémangiome caverneux.

The authors report one case of cavernous hemangioma of the left ovary, which was revealed by ovarian torsion. Such benign tumors of the blood vessels are rare in ovaries during childhood. This hemangioma was observed in a 13-year-old patient, who presented with abdominal and pelvic pain and vomiting. The pelvic mass was noted and sonography revealed a cystic tumor. An annexectomia was realized. Histology showed narcotized ovary cells, with an increased number of vascular channels composed of thin walled vessels, whose wall consisted of an endothelium. This aspect evoked a cavernous hemangioma of the ovary.

[Anemia and growth in Congolese adolescents with homozygous sickle cell anemia at Central University Hospital of Brazzaville]. / Anémie et croissance chez l'adolescent congolais drépanocytaire homozygote au CHU de Brazzaville.

The rate of hemoglobin of 71 homozygous sickle cell disease patients from 10 to 18 years was studied, as well as the mean cell volume for 61 of them. Their height, weight and bone age were compared. The rate of hemoglobin in steady state is 6.5 g/dl +/- 2.3 for girls against 7.9 g/dl +/- 1.5 for boys. There's no significant difference between the rate of hemoglobin on sexual maturation state for girls. But the boys from 14 to 18 years old with signs of sexual maturation had higher rate of hemoglobin than those had not (8.5 g/dl +/- 1.3 against 6.3 g/dl +/- 1.5). Eighteen per cent of patients with homozygous sickle cell disease had a MCV superior to 100 mu 3; 57% are between 80 to 100 mu 3 and 25% under 80 mu 3. Patients with higher MCV to 100 mu 3 had low weight and height than those with inferior MCV to 80 mu 3 or 80 and 100 mu 3. Their sexual maturation is delayed with very low bone age and elevated number of hospitalisation and transfusion. Their delay of maturation was very high too. The supplementation with folic acid can lead to reduction of MCV.

[Clinical profile of sickle cell homozygote patient after the age of 30 years]. / Profil clinique du sujet drépanocytaire homozygote après l'âge de 30 ans.

The authors analyse the clinical and epidemiological profile of 63 patients with major Sickle cell and regularly followed up in the department of haematology of the National University Hospital of Brazzaville (CHU) between the 1st of January 1993 and the 30th of June 1996. Acute vasculo occlusive crisis are rare, however anaemic crisis are still present. The average haemoglobin rate between crisis is 7.86 g/dl (extreme values 5.9 to 10.8 g/dl). This study shows that despite the multiple complications, often degenerative, life expectancy of the homozygous sickle cell patient can still be improved.

[AIDS at Central University Hospital of Brazzaville: experience of the "Grands Enfants" pediatric department]. / Le SIDA au CHU de Brazzaville: expérience du service de pédiatrie "Grands enfants".

The epidemiological factors, clinical aspects and short term evolution of children infected by aids were assessed over a period of five years in "Grands Enfants" paediatric service of Brazzaville CHU. The medical reports of 81 patients have been collected, their average age was 9 years old +/- 3.5. The HIV 1 was the only identified virus. 59% of children's parents were divorced, and 7% were single. The infection transmission was vertical in 70% of cases, transfusional in 28% of cases and indeterminate in 1% of cases. The symptoms were: the impairment of body status in 90% of cases, shown by a weight loss in 89% of cases; a long-term fever was observed in 56% of cases and a chronic diarrhoea was noticed in 54% of cases. The lymphadenopathies and digestive Candida were observed in 26% and 36% of cases. 6% of the patients had a psychomotor retardation. The respiratory infections and the diarrhoea were pathologies the most frequently noticed. The associated infections were essentially pulmonary tuberculosis 40% of cases, the otitis, the pneumococcal and cryptococcal meningia 2% of cases. The Burkitt lymphoma and the Kaposi sarcoma were shown in 1% of cases. The evolution was shown by a high mortality due to a dehydration in 59% of cases, a respiratory pathology in 22% of cases and anaemia in 15% of cases. This high mortality points out the problem of the treatment of patients, a problem increased by family poverty.

[Acute rheumatic fever among children in the Republic of Congo: report of 56 cases]. / Le rhumatisme articulaire aigu chez l'enfant en République du Congo à propos de 56 cas.

Authors report the results of a retrospective study (January 1993-December 1996) concerning 56 patients. The aim of this study was to describe epidemiology, diagnosis, evolution and treatment of rheumatic fever during childhood in the Teaching Hospital of Brazzaville. The frequency of the disease was 1.17%. There were 36 girls and 20 boys (p = 0.02). The mean age was 10 years and 8 months. Past of sore throat and recurrences of acute rheumatic fever have been notified respectively in 27 (48.2%) and 11 cases (19.6%). Arthritis were observed in 3 patients (5.4%), and 7 others (12.5%) didn't have any carditis. Fourty nine patients (87.5%) presented carditis, among which mitral regurgitation was the commonest cardiac lesion. Heart failure was observed in 25 patients (44.6%). The inflammatory process was treated by corticoid drugs and penicillin. Surgery realized in 22 patients consisted in valvuloplasty (5), bioprosthesis replacing (12). Beyond mitral valve replacing, 3 children profited of: tricuspid commissurotmy (1), surgery of congenital heart disease (2). Two patients profited of aortic prothesis. Six patients(10.7%) died because of: cardiac failure(3), infectious endocarditis (2), probable thrombosis of mechanic aortic valve (1). Primary and secondary prevention of this severe affection are primordial in Congo.

[Pubertal development in girls with homozygote sickle cell disease. Apropos of 72 cases]. / Développement pubertaire chez la fille drépanocytaire homozygote. A propos de 72 cas.

We carried out a case-control study to investigate the sexual maturation of girls suffering from homozygous sickle cell disease: 72 cases aged 10 to 18 years were compared to 40 controls of the same age. We obtained the following results: In cases, there was a significant delay in signs of physical maturation; puffiness of the mammary glands at 14.4 years +/- 1 (as versus 12.4 years +/- 1.5 in controls); pubarche occurred at 14.2 years +/- 1. Menarche occurred on average at 15.2 years +/- 1.6 (as versus 13.4 years +/- 1.4 for controls) and the lack of the menarche between the ages of 14 and 18 years was observed in 71% of cases as versus 10% of controls. At age 16, only 1% and 3% of cases were respectively at the stage of S5 and P5 as versus 40% for the controls. Thus, 37% of girls suffering from homozygous sickle cell disease were not sexually mature, whereas all controls had reached sexual maturation by the age of 14. In cases, weight remained low, and waist line and the body shape poorly developed in comparison to controls'. The examination by scanner of the pelvis of 20 girls suffering from homozygous sickle cell girls that in 25% of the cases, the ovaries of non mature girls were relatively small.

Etiology and outcome of acute renal failure in children in congo-brazzaville.

Acute renal failure (ARF) is a common problem in the Congo. This is a six-year retrospective study aiming at analyzing the etiology and the outcome of ARF at the Brazzaville's University Hospital from 1989 through 1994. One hundred and five cases of ARF (0.99%), including 54 boys (51.4%) and 51 girls (48.6%), out of 10,512 children admitted in the department of Pediatrics have been recorded. ARF represented 13.09% of the causes in 802 patients with renal disorder. The main etiologies of ARF included acute gastroenteritis with dehydration (25.7%), nephrotic syndrome (14.7%), sepsis (15.23%), malaria (12.38%), and acute glomerulonephritis (9.5%). Most cases were managed conservatively, while peritoneal dialysis (PD) was used in eight cases (7.62%). The outcome of ARF was recovery in 50.5 %, death in 37 % and chronic renal failure in 12.5% of cases. Preventive measures may help in reducing the high mortality rate and the need for dialysis.