Cervical spondylitis and spinal abscess due to Actinomyces meyeri

Human actinomycosis with involvement of the spine is a rare condition although it has been first described a long time ago. It is probably underrecognized since its clinical presentation is often misleading and accurate bacteriological diagnosis is challenging. We herein report a rare case of cervical actinomycosis with paravertebral abscess and spondylitis imputed to an infection by Actinomyces meyeri in a 52-year-old immunocompetent Caucasian man. A. meyeri should be considered as a potential cause for subacute or chronic spondylitis, even in immunocompetent subjects. Modern diagnostic tools such as Matrix-Assisted Laser Desorption–Ionization Time of Flight mass spectrometry and 16S rRNA sequencing are efficient for accurate microbiological identification.

Prevalence of Vitamin A Deficiency in Pregnant and Lactating Women in the Republic of Congo.

Vitamin A status in a sample of pregnant and lactating women living in several representative regions of Congo was assessed and compared between August and September 2004. This survey was conducted using a randomized two-stage cluster-sampling method with stratification on 90 clusters, each consisting of at least 15 women. Vitamin A status was determined in a total of 1,054 individuals, using the impression cytology with transfer (ICT) test, the modified relative dose response test (MRDR test) on dried blood spots (DBS), and clinical examination to detect signs of xerophthalmia. The clinical criterion defining vitamin A deficiency was the presence of active xerophthalmia (Bitot’s spots [X1B]), active corneal disease), and/ or night blindness (XN stage). The prevalence of clinical signs of stage XN and X1B xerophthalmia in the Republic of Congo was found to be 16% and 19% respectively. The prevalence of clinical signs (X1B) was greater in the rural north than in urban areas, with a gradient running from urban (5%) to rural area (33%); 27% of all the ICT tests showed that the subjects were suffering from vitamin A deficiency. The deficiency rates were significantly higher (p<0.001) in urban surroundings (Brazzaville) than in the rural northern regions. The biochemical MRDR test showed the presence of vitamin A deficiency (≥0.06) in 26% of the mothers in Brazzaville compared to 6% in the town of Kouilou; 44% of the women had retinol levels of <10 μg/dL in the rural north whereas these percentages were significantly lower in the urban areas surveyed (chi-square=62.30, p<0.001). A significant correlation was found to exist (p<0.001) between the ICT test and the MRDR test on DBS. In the population as a whole, 30% of the mothers suffering from malarial attack had abnormally low MRDR levels (≥0.06) compared to no malaria. The results of the present study confirm that vitamin A deficiency is a serious public-health issue in pregnant and lactating mothers in the Republic of Congo.

Use of pre-packaged chloroquine for the home of presumed malaria in Malagasy children

Objective: The main objective of this study was to assess the quality of home malaria management with pre-packaged chloroquine in two areas in the Moramanga district of Madagascar. The knowledge; attitude and practices of care providers in terms of home treatment options were evaluated and compared. The availability of treatment options by studying retailers and community-based service providers was also investigated. Methods: A cross-sectional investigation in two communities; in the hamlets and villages located close to carers; retailers; community-based service providers and primary health centres was carried out. Results :Carers in the two districts were equally well aware of the use of pre-packaged chloroquine. Their first response to the onset of fever was to treat children with this antimalarial drug at home. The dose administered and treatment compliance were entirely satisfactory (100) with pre-packaged chloroquine and rarely satisfactory (1.6to 4.5) with non pre-packaged chloroquine. In cases of treatment failure; the carers took patients to health centres. Chloroquine was supplied principally by private pharmacies and travelling salesmen selling unpackaged chloroquine tablets. Non pre-packaged chloroquine was the most common drug used at health centres. The frequency of positive rapid malaria tests (P=0.01) was significantly higher in children treated with non pre-packaged chloroquine (38) than in children treated with pre-packaged chloroquine (1.3). Conclusions: Home malaria management should be improved in Madagascar. Efforts should focus on communication; the training of community-based service providers; access to pre-packaged drugs and the gradual withdrawal of pre-packaged chloroquine and its replacement by pre-packaged artemisinin-based combination therapies