[Entomophthoramycosis: a case report of a Congolese child with rapid regression using ketoconazole]. / Basidiobolomycose: une observation chez un enfant congolais avec régression rapide sous kétoconazole.

We report the second Congolese case of subcutaneous entomophthoramycasis, a rare tropical disease expressed as cellulitis. Despite characteristic clinical features, the diagnosis for this twelve-year old child was confirmed four years after the beginning of the disease. Dramatic clinical improvement was observed within the first month of treatment with ketoconazole.

Cerebral malaria in African children: socioeconomic risk factors in Brazzaville, Congo.

Current epidemiologic and clinical research on cerebral malaria is directed towards prognostic criteria and neurologic sequelae. However, the assessment of risk factors related to the environment and the socioeconomic standard of the family is of practical as well as theoretical interest. A prospective survey was carried out in March 1990 in Brazzaville, Congo by interviewing subjects in two groups: 1) 600 households representative of the Brazzaville population and 2) 84 households with a child who had been hospitalized for cerebral malaria between January 1, 1988 and June 30, 1989 (i.e., 9-27 months prior to the interview). The mothers' knowledge and attitudes with regard to the prevention and treatment of malaria in children were assessed, as was the socioeconomic standards of the households. The group in which at least one child had been hospitalized for cerebral malaria had a lower socioeconomic standard than the control group. Other differences in this group included a greater number of offspring and a higher average number of decreased children, less chemoprophylaxis, antimalarials available less often in the household, less early treatment of fever at home, and drugs bought more often at the market. There was no significant difference between the groups with regard to using the correct dosage of chloroquine, ownership of a mosquito net, or the use of insecticides or repellents.

PIP: The aim was to compare a cerebral malaria group (B) with a control group (A) representative of the entire population of Brazzaville. Group A was composed of mothers with at least 1 child younger than 10 years old living in the urban district of Brazzaville. 30 clusters of 20 households totalling 600 were selected from the 1984 population census. Group B was composed of Brazzaville children who had been admitted to the University Hospital for cerebral malaria between January 1, 1988, and June 30, 1989. Of the 170 children for whom precise hospital records were available 145 were discharged from the hospital. In the 1st quarter of 1990 a family-based survey was carried out on 84 households to study postcerebral malaria mortality analyzing: 1) the preventive and therapeutic measures taken by mothers, and 2) the socioeconomic standards of the families in 68 and 84 households, respectively. The socioeconomic standard of group B was lower than that of group A. Those with less than a primary school education constituted: 502 (84%) in 600 controls vs. 61 (73%) in 84 cases (p = 0.02 odds ratio [OR] = 1.9). For 461 controls (77%) vs. 47 cases (56%), mothers had a good comprehension of French (p = 0.0007, OR = 2.3). The other differences were that Group B had a greater number of children, a higher average number of deceased children, less use of chemoprophylaxis, antimalarials available less often in the household, less early treatment of fever at home, and the purchase of drugs more often at the market. However, significant differences were not found with respect to owning a mosquito net or the use of insecticides and repellents.

Mortality and sequelae due to cerebral malaria in African children in Brazzaville, Congo.

This study was carried out on 170 children admitted to the University Hospital of Brazzaville (Congo) for cerebral malaria between January 1, 1988 and June 30, 1989. The selection criteria were 1) unarousable coma, cerebrospinal fluid without microorganisms or a marked cellular reaction, and the absence of other causes, and 2) that the children lived in Brazzaville. The case fatality rate was 15%. In 75% of the cases, death occurred within the first 48 hr. The prognosis worsened with the stage of the coma and a younger age. At discharge from the hospital, 9% of the cases presented with sequelae. The postcerebral malaria mortality was high; indeed, death occurred in six (7%) of 90 children discharged from the hospital whose parents were contacted between nine and 27 months later. Two deaths were directly related to neurologic sequelae. Among the 58 children examined under satisfactory conditions between nine and 27 months (mean 16.9 months) after discharge, 50% (3 of 6) still presented with attenuated forms of the sequelae observed immediately after the episode of cerebral malaria (cortical blindness had regressed completely, unlike ataxia and loss of balance). Disorders that may have been related to the episode of cerebral malaria were observed in 31% of these 58 cases.

[Efficacy of quinine in children hospitalized for malaria attacks in Brazzaville (Congo) in 1989]. / Efficacite de la quinine au cours des accès palustres de l'enfant hospitalisé à Brazzaville (Congo) en 1989.

The efficacy of quinine prescribed to children from Brazzaville hospitalized for acute malaria (temperature over 38 degrees C, P. falciparum parasitaemia over 10,000/mm3, no other obvious disease; the reason for hospitalisation often being digestive or neurological disorders) was assessed. Quinine was administered by perfusion: 25 mg/kg/day for at least 3 days. Associated treatment (sulfadoxine-pyrimethamine combination in 80% of the cases) was given at day 3. Blood was taken at day 0, and before discharge (usually between days 3 and 5). Thick Blood Smears (TBS) were examined for a volume of blood corresponding to 300 leucocytes. Antimalarials had been taken in 60% of the cases (chloroquine in 67% of the cases, quinine in 10%). Antimalarials were not assayed in the sera. In 68 cases of non pernicious malaria, no obvious cases of resistance were observed. TBF were negative in 49 out of 52 cases at day 3, and 11 out of 12 at day 4 and in five out of five cases at day 5. In 96 cases of pernicious malaria, only one case was suspected of being resistant, with a weakly positive TBS at day 7. 13 children died but all in the first three days without suspicion of resistance. Apyrexia was observed before day 4 in 89% of the cases; only one case of fever at day 7. TBS were negative before day 4 in 97% of the cases. So, at the dosage of 25 mg/kg, quinine was found to be very effective in the Congo in 1989 against both pernicious and non pernicious malaria.

[Malaria attack: a difficult diagnosis in a region of high Plasmodium falciparum endemicity]. / L'accès palustre: un diagnostic difficile en région de forte endémicité a Plasmodium falciparum.

The diagnosis of malaria attack in regions for highly endemic P. falciparum is difficult. It is more so since the wide use of antimalarials by the infected populations and the spread of drug resistance. A positive test is not evidence for a malarial attack since in certain schools, in both rural regions and in some districts of big towns, over 3/4 of the children attending school are carriers of Plasmodium. On the other hand, true attacks, even severe forms, can occur without evidence of parasitaemia. The parasitic load is thus an important factor but the following must be taken into consideration: age, level of immunity, the extent of transmission and whether if is continuous or not, self medication and the initial systematic treatments, the possibility of drug resistance, ... The difficulties are illustrated by data collected in the Congo.

[Acute rheumatic fever in New Caledonia. Clinical and epidemiological aspects]. / Le rhumatisme articulaire aigu en Nouvelle-Calédonie. Aspects cliniques et épidémiologiques.

Rheumatic fever is frequently encountered in tropical countries. Its distribution, incidence and consequences, notably on the heart, were studied in Nouvelle-Calédonie (South Pacific) on the basis of 76 patients with acute attack. The data were compared with those obtained in controls of the same age, sex and ethnic origin. Many patients developed carditis (often disabling), and relapses were frequent. The epidemiological data confirmed that rheumatic fever preferentially affects young subjects of both sexes and is more common among Melanesians and Polynesians, probably because of their lower socio-economic status.

[Epidemiologic study of acute infantile gastroenteritis in New Caledonia]. / Etude épidémiologique des gastro-entérites infantiles aiguës en Nouvelle-Calédonie.

In a test area (suburbs of Nouméa), a survey on acute infantile gastro-enteritis showed an annual incidence of 2.2% and a hospitalization rate of 27.5%. The 0 to 23 months age group was the most exposed. The factors of severity were: a low age, a high frequency of liquid stool, vomits, fever and associated acute respiratory infection. The etiologic diagnosis was possible in 76% of cases: 49.5% enteropathogens (22% bacteria, 27.5% viruses), 26.5% non-intestinal infections. The asymptomatic carriers were 11.5% for bacteria and 27.4% for viruses. In regard to epidemiology, the housing hygiene, the potable water supply and the presence of suitable water closet were over 90%. On the contrary, the individual hygiene was neglected, especially the hand washing. The pathogens are transmitted by the dirty hands of asymptomatic carriers. Mass media campaigns and health education of parents and children are the recommended prophylactic measures.

[Epidemic of gastroenteritis in Noumea (New Caledonia) caused by an enterotoxinogenic strain of Escherichia coli (0l26:B16) believed to be enteropathogenic]. / Epidémie de gastroentérites à Nouméa (Nouvelle-Calédonie) due à une souche de "Escherichia coli" entérotoxinogène 0126:B16 réputée etre entéropathogène.

A strain of enteropathogenic Escherichia coli 0126:B16 has been isolated in fifteen children and one adult during a severe outbreak. One infant is dead. The strain produced heat-stable enterotoxin, attach to rabbit enterocytes but did not have colonization factor antigen CFA/I or CFA/II. Its hemagglutination type was the same that the E. coli H10407, CFA/I+. It presented a resistance at eight antibiotics and, with the loss of enterotoxigenicity, there was a loss of resistance at ampicillin and of the capacity to attach to enterocytes.

[Eosinophilic meningitis (author's transl)]. / La méningite éosinophiles.

Eosinophilic meningitis, also named human nervous angiostrongyliasis, results from the infestation of the Nervous System by larvae of Angyostrongylus Cantonensis realizing there a parasitic deadlock. The Authors studied 54 patients whose main complaints were severe and lasting headache, and paresthesias. A meningitic syndrome is not always encountered and a facial paralysis of the lower motor neuron type has been noted in a few patients. Study of the Cerebrospinal fluid shows pleiocytosis with a variable percentage of eosinophiles. Complete recovery is usual after a couple of weeks and the prognosis can be given as excellent despite of the fact that no specific therapy is known at the present time.