[Acquired immunodeficiency syndrome in elderly persons in a tropical zone. Apropos of 175 cases in the Congo]. / Le syndrome d'immunodéficience acquise chez les personnes âgées en zone tropicale. A propos de 175 cas congolais.

The objective of this study has been to estimate the frequency of AIDS occurring in older age groups on the basis of hospital statistics and note the prognostic particularities in these groups. One hundred and seventy five (175) cases of AIDS reported to the University Hospital Center of Brazzaville occurring in persons aged 55 years and over were followed up retrospectively from 1 January 1990 to 31 December 1996. The results of this study indicate that AIDS is not rare in older age groups: 4.7% of all infected subjects registered during the period of study. The sex-ratio was 1.3/1 (99 males and 76 females). The overall mean age was 60.45. Contamination seems to be the most often of heterosexual origin. Many symptoms were found. The most frequent ones were weight loss (100% cases), fever (89.7%), diarrhoea (60.5%), neuro-psychiatric disorders (49.7%), and respiratory manifestations (50.2%). Lethal evolution was rapid, with 74% deaths at the end of the 1st year and 100% at the end of 2nd year, as a consequence of delayed diagnosis as well as the natural development of the disease. The results of this study point to the necessity of prevention strategies which include not only young, but older age groups as well.

[Esophageal tuberculosis: an unusual localization in an immunocompetent patient]. / Tuberculose oesophagienne: une localisation inhabituelle chez une patiente immunocompétente.

Oesophageal tuberculosis is a rare localisation for extrapulmonary tuberculosis. This report describes the case of a 30-year-old immunocompetent woman with dysphagia, fever and weight loss. Endoscopic examination revealed an ulcerated lesion in the third part of the oesophagus strongly suggesting oesophageal carcinoma. Histologic samples showed epithelioid cells granuloma in the submucosa. Diagnosis was later confirmed by acid-fast bacilli positive gastric aspirates and a positive Mantoux test using the tuberculin reaction. Barium swallow revealed a narrowing in the third oesophagus. A chest x-ray revealed a infiltrated lesion and a mediastinal lymph node. The patient was put on antitubercular treatment. On follow-up after 3 months, dysphagia, fever, weight loss had disappeared and the ulcerated lesion of oesophagus had improved. The subsequent course of the patient is not known, since she was lost to follow-up.

[Digestive bleeding and anti-inflammatory drugs at the teaching hospital of Brazzaville]. / Les hémorragies digestives et les médicaments anti-inflammatoires au CHU de Brazzaville.

Authors relate a retrospective survey of 140 cases of digestive haemorrhage after intake of anti-inflammatory drugs from January 1988 to December 2000. The digestive haemorrhage frequency after intake of anti-inflammatory drugs reaches 16%. This survey included 94 men and 46 women whose average age is 42.3 years, with extremes of 15 and 79 years. Among these patients, 75 took salicylic acetyl acid (SAA), 56 non-steroidal anti-inflammatory drug (NSAID) and 9 the SAA and NSAID association. More than half of patients relied on self-medication (91 cases ie. 65%). The haematemesis followed by melaena induced the most frequent bleeding (42.8% of cases), while the isolated haematemesis, the isolated melaena and the isolated rectal haemorrhage were found respectively in 35%, 15% and 7.2%. Haemorrhages occur early under SAA and seem less severe than those occurring under NSAID. Lesions responsible for the bleeding are: the duodenal ulcer (68.7%), the haemorrhagic gastritis (6.4%), the gastric ulcer (5%), the oesophagitis (4.2%), the gastric and duodenal ulcer association (3.5%), anorectal exsudative pains and haemorrhagic anal ulcerations. The duodenal ulcer predominance could be attributed to previous lesions.

[Prevalence of hepatitis B viral markers in a population of pregnant women in Brazzaville (Congo)]. / Prévalence des marqueurs du virus de l'hépatite B dans une population de femmes enceintes à Brazzaville (Congo).

The risk of perinatal transmission of hepatitis B virus is well-known; but, in Congo, where hepatitis B virus is endemic and the prevalence of hepatocellular carcinoma is high, there is no study on this mode of transmission. For three months, we screened systematically for HBsAg in 292 pregnant women who came as outpatients or to deliver in 3 health centres in Brazzaville. Positive sera for HBsAg were also tested for the other markers of HBV, except for specific DNA. The seroprevalence of HBV among these women was 6.5%. It was significantly higher among inpatients than among outpatients. The overall prevalence of HBs was 57.8%; the prevalence of the profile HBsAg + HBeAg was 2.05%. The risk of maternofoetal transmission of HBV was 2.7%. This study shows that the antenatal screening for HBV and the integration of the immunization against HBV in the expanded programme of immunization against HBV are good means to prevent the infection.

[Serological markers of hepatitis B virus in hospitalized patients (Gastroenterology and Internal Medicine Service of the University Hospital Center of Brazzaville - Congo )]. / Etude de marqueurs serologiques du virus de l'hepatite B chez des patients hospitalisés (Service de Gastro-Entérologie et de Médecine Interne du Centre Hospitalier Universitaire de Brazzaville - Congo.

The prevalence of serum markers of the hepatitis B virus was studied in 139 patients, 88 men and 51 women, at the Gastroenterology and Internal Medicine Department at the University Hospital in Brazzaville (Congo). The findings show that 125 individuals (89%), 79 men and 46 women, show signs of infection. Only 14 patients, 9 men and 5 women, show no hepatitis B virus markers. 64 individuals (46%) are carriers of Ag HBS, and among these, 23 (35.9%) are carriers of Ag HBe. Ac anti HBC was found 116 times (83.4%): 12 times by itself, and 16 times in association with Ac anti HBS. 43 individuals (30.9 %) are carriers of Ac anti HBS. Such high frequency of Ac anti HBS, whether or not accompanied by Ac anti HBC, argues in favor of the age of the infection. The study points out the high frequency of hepatitis B virus markers (89.8 %) compared with blood donors (7 to 9 %). This should incite government officials to set up some preventive procedures.

[Cost of of hospital management of cirrhoses and its complications at the University Hospital of Brazzaville]. / Le coût financier de la prise en charge hospitalière de la cirrhose et de ses complications au CHU de Brazzaville.

This retrospective pilot study was conducted in a series of 166 patients hospitalized for the first time for management of cirrhosis with or without complications over a two-year period at the University Hospital Center in Brazzaville, Congo. Complications included ascitics, hepatic encephalopathy, gastrointestinal bleeding, and hepatocellular carcinoma. Total care cost was determined by adding up expenditures for the initial examination, each day of hospitalization, adjuvant investigations, and administered medication. The mean per-patient cost was 272345 F CFA (415.79 [symbol: see text]) in cases involving ascites, 195675 F CFA (298.74 [symbol: see text]) in cases involving encephalopathy, 207935 F CFA (317.45 [symbol: see text]) in cases involving hepatocellular carcinoma, 245680 F CFA (375.08 [symbol: see text]) in cases involving gastrointestinal bleeding and 205615 F CFA (313.90 [symbol: see text]) in uncomplicated cases. These data document the high cost of hospital care for cirrhosis and related complications in Congo.

[Pneumatosis cystoides intestinalis: the first case in Congo]. / Pneumatose kystique intestinale: le premier cas congolais.

We report the first congolese case of intestinal cystic pneumatosis diagnosis at a patient of 64 years who was hospitalized for a glairo-sanguinolent diarrhea, of diffuse abdominal pains and meteorism. Diagnosis was confirmed by the coloscopy which showed polypoïdes formings to fine, translucent walls, depressibles, and for intestinal opacification which showed parietales incomplete images of the left colonist. Evolution was favorable under metronidazol and ciprofloxacin. The coloscopy of control did not find a recurrence.

[Clinical aspects of AIDS in Africa]. / Les aspects cliniques du SIDA en Afrique.

The clinical manifestations of HIV infection in Africa are similar to those observed in Europe and North America. However, some features related to ecological and diagnostic factors give the disease a certain African peculiarity. In more than 80 p. 100 of the cases AIDS is characterized by deep alteration of the subject's general condition, with chronic diarrhoea, severe asthenia, prolonged fever and massive loss of weight. This "slim disease" is only found at the terminal stage of AIDS in North America. Opportunistic infections are multiple, often associated, and their frequency differs from that found in Europe and the USA. Thus, pulmonary pneumocystosis is rare (12.5 to 21 p. 100 of the cases, as against 50 to 80 p. 100 in Europe). Isosporosis is frequent (4 to 48 p. 100 of the cases instead of 0.2 p. 100 in the USA), and this also applies to cryptosporidiosis (7 to 21 p. 100 of the cases, compared with 3.3 p. 100 in the USA). Gastrointestinal candidiasis occurs in 21 to 49 p. 100 and cryptococcosis in 10 to 30 p. 100 of the patients. Material problems make it impossible to evaluate the prevalence of certain infections, notably toxoplasma and CMV infections. The prevalence of Kaposi's sarcoma is low (15 to 20 p. 100). Dermatological manifestations occur at an early stage and are both common and varied (papular eruption, prurigo, herpes zoster, changes in the hair and skin appearance); they characterize the "African aspect" of AIDS. Tuberculosis is particularly frequent: in Africa, 30 to 40 p. 100 of tuberculous patients are HIV seropositive, as opposed to 10-25 p. 10 in Western countries.(ABSTRACT TRUNCATED AT 250 WORDS)

[Histoplasma capsulatum histoplasmosis. Apropos of a disseminated form with skin lesions in a woman from Zaire]. / Histoplasmose à Histoplasma capsulatum. A propos d'une forme disséminée avec localisation cutanée chez une Zaïroise.

A case of disseminated histoplasmosis with cutaneous lesions due to Histoplasma capsulatum is reported. The patient was a 22 years old congolese woman (Zaïre). The diagnosis was made on born narrow a few days only before she died. The cutaneous lesions were also positive for H. capsulatum.

[Opportunistic parasitic diseases and mycoses in AIDS. Their frequencies in Brazzaville (Congo)]. / Parasitoses et mycoses opportunistes au cours du SIDA. Leurs fréquences à Brazzaville (Congo).

To determine the frequency of opportunistic parasitic and mycotic diseases in adult AIDS patients in the Congo, a study was conducted at l'Hôpital Universitaire de Brazzaville in 1986 and 1987. Diagnosis of AIDS was made using the WHO clinical definition for Africa (Bangui, 1985) and HIV seropositivity Pasteur Elisa test. Oral pharyngeal candidiasis occurred in 36% of cases. Intestinal parasitic profile found in 118 patients, 2/3 of whom were associated with chronic diarrhoea showed clearly relative frequency of isosporiasis (Isospora belli): 9.3% and rarity of crystosporidiosis: 4.2%. 12 meningitic cryptococcosis cases out of 139 patients was confirmed (8.6%); for cerebral toxoplasmosis, it was by comparing the serum toxoplasmosis antibody and cerebrospinal fluid rates on 75 patients that an estimation of 20% was reached. Pneumocytis carinii pneumonia seems to be rare, lower than 10%. No case of disseminated histoplasmosis and malignant strongyloidiasis was observed.

PIP: Studies conducted with locally available means at the University Hospital in Brazzaville have provided data on opportunistic parasitic and mycotic disease in AIDS patients in the Congo. The diagnosis of AIDS was based on the World Health Organization clinical definition for Africa and on positive ELISA tests. Patients were prospectively studied in 1986-87. 12 cases of meningitic cryptococcosis were found in 139 patients studied, for a rate of almost 9% of AIDS cases. Prior to the AIDS epidemic only 2 cases were published in the Congo. 35.6% of 146 cases studied showed oral pharyngeal candidiasis on clinical examination. The frequency of esophageal and bronchopulmonary candidiasis could not be estimated with the means available. 118 AIDS patients had intestinal parasites, of whom 2/3 had chronic diarrhea. 9.3% were caused by Isospora belli and 4.2% by Cryptosporidiosis. Other intestinal flora were apparently affected by routinely administered antiparasite treatments. An estimate of 20% for cerebral toxoplasmosis was obtained by comparing serum toxoplasmosis antibody and cerebrospinal fluid rates for 75 patients. The rate of pneumocystis carinii pneumonia appears on indirect evidence to be under 10%. No cases of disseminated histoplasmosis or malignant strongyloidiasis were observed. The biggest differences between the patterns of opportunistic infection in industrialized countries and especially the US and in the Congo appear to be the lesser frequency in the Congo of pneumocystosis and the greater frequency of Isosporosis and cerebral toxoplasmosis.

[Clinical and biological consequences of human immunodeficiency virus (LAV) infection in 15 Congolese subjects]. / Conséquences cliniques et biologiques de l'infection à human immunodeficiency virus (HIV) chez 15 sujets congolais.

We report 15 cases of symptomatic HIV infection seen in Paris between June 1983 and June 1985 in Congolese patients. The first signs were diarrhea, weight loss, fever, pruritus. Disseminated lymphadenopathy was frequent. Twelve patients had AIDS, and the opportunistic infections were: isosporosis, oesophageal candidiasis, cerebral toxoplasmosis, Kaposi's sarcoma, CNS' cryptococcosis, cutaneo-mucosal.

[Escherichia coli diarrhea of children and adults at the Brazzaville General Hospital]. / Les diarrhées à colibacille de l'enfant et de l'adulte à l'Hôpital général de Brazzaville.

The high number of the strains of Escherichia coli (E. coli) isolated from faeces, demonstrated that this bacteria takes the first place in diarrhoea. These isolations had the same frequency all the year long. In infants, the enteropathogenic E. coli (E. P. E. C.) (28.57%) are still frequent contrary to developed countries. The E. coli with hemagglutination phenomenon (colonisation factors) but without toxin detected were also responsible (mortality 6%). The E. coli without toxin and not belonging to E. P. E. C. group were also frequent (71.42%). In adults, only the enteroinvasive E. coli (E. I. E. C.) (16.6%) and the E. coli with hemagglutination but without toxin detected (16.6%) were observed. This situation is due to bad hygienic conditions among the people and the tropical climate.

[Needle-biopsy of liver in the Brazzaville General Hospital. Results of 42 cases (author's transl)]. / La ponction-biopsie du foie a l'Hôpital Général de Brazzaville. Résultats à propos de quarante-deux cas.

42 needle-biopsies were realized in the two Medicine Departments of the General Hospital, Brazzaville. The authors strike the balance of those biopsies. They show the advantage off the needle-biopsy and histologic study of primary carcinoma of liver.

Aspects de la perturbation du bilan nutritionnel au cours du SIDA a Brazzaville

Deux cent malades des deux sexes; atteints de SIDA et hospitalises au CHU de Brazzaville pour diverses affections associees; sont etudies au plan de leur bilan nutritionnel evalue par des parametres anthropometriques; proteiques et lipidiques (index de masse corporelle; albumine; transferrine; retinol-binding protein; transthyretine; apolipoproteine A1; apolipoproteine B; cholesterol total; HDL-cholesterol; LDL-cholesterol; phospholipides; triglycerides). Les resultats obtenus sont compares a ceux obtenus chez soixante dix temoins seronegatifs donneurs de sang. Ces resultats montrent chez les malades atteints de SIDA; une diminution statistiquement significative de l'index de masse corporelle et des concentrations seriques de tous les parametres; a l'exception des triglyceriques et de l'apolipoproteine B

Seroprevalence de l'infection par le Virus Delta au Congo

Le virus de l'hepatite delta (VHD) peut etre responsable de lesions hepatiques aigues ou chroniques chez les patients infectes par le virus de l'hepatite B (VHB). Les auteurs pensent qu'il n'existe aucune etude de prevalence de ce virus au Congo ou le portage du VHB est tres eleve; 7 a 9 pour cent dans la population generale (12); 9;2 pour cent chez les presumes sains (11; 12); 73 a 90 pour cent chez les malades (11; 12) et ou le carcinome hepato-cellulaire occupe le premier rang des cancers dans les deux sexes (11). Afin d'evaluer la seroprevalence du VHD au Congo; ils ont cherche les marqueurs de ce virus chez 1579 sujets representatifs de la population congolaise: 316 lepreux; 302 donneurs de sang; 292 femmes enceintes; 221 patients hospitalises et 448 ruraux asymptomatiques. L'etude a ete menee de 1989 a 1992. L'Ag HBS a ete prealablement dose par radio-immunologie (Laboratoire Abott) puis les marqueurs du VHD par une technique immuno-enzymatique. Sur les 1579 serums testes; 145 etaient positifs; 22 possedaient l'AC anti VHD; soit un portage global de 15;2 pour cent; aucun serum n'a revele la presence de l'Ag D. Cette seroprevalence elevee (15;2 pour cent) confirme la place du Congo dans la zone de haute endemicite delta. Elle est en faveur d'un depistage systematique du VHD chez les porteurs d'Ag HBS et d'une politique d'immuno-prevention contre le VHB