[Intrathecal synthesis of anti-Toxoplasma gondii antibodies during cerebral toxoplasmosis associated with African AIDS]. / Synthèse intrathécale d'anticorps anti-Toxoplasma gondii au cours de la toxoplasmose cérébrale associée au sida africain.

Thirty-four HIV-1-infected in-patients of the Hôpital Central des Forces Armées Congolaises, Brazzaville, Congo, hospitalized for suspected cerebral toxoplasmosis, have been evaluated for integrity of the blood-brain barrier, intrathecal synthesis of total IgG, toxoplasmic serology in blood and cerebrospinal fluid, and for intrathecal synthesis of IgG to Toxoplasma gondii. An empiric scale to gauge the possibility of clinical cerebral toxoplasmosis was used to classify the patients (+, +2, +3). Only an intrathecal synthesis of IgG to Toxoplasma gondii was found to be associated with suspected cerebral toxoplamosis: it was found in about 80% of patients, and more frequently in patients with a higher probability of disease. In contrast, alteration of the blood-brain barrier, intrathecal synthesis of total IgG and toxoplasmic serology in blood as well as in cerebrospinal fluid were not associated with suspected cerebral toxoplamosis. Taken together, these findings confirm that intrathecal synthesis of antitoxoplasmic antibodies of IgG isotype occurs in cerebral toxoplasmosis. Demonstration of intrathecal synthesis of antitoxoplasmic IgG antibodies could be used to confirm clinical diagnosis of cerebral toxoplamosis, especially in an African context, where sophisticated laboratory facilities are often lacking.

[Impact of AIDS on the resurgence of tuberculosis and reduced availability of hospital beds in Brazzaville (Congo)]. / Impact du SIDA sur la recrudescence de la tuberculose et la réduction de la disponibilité des lits hospitaliers à Brazzaville (Congo)

Our objective was twofold: firstly to evaluate the impact of AIDS on the annual increase of tuberculosis morbidity in Brazzaville; and secondly, to show its consequences on the reduced availability of hospital beds for patients treated for diseases nonrelated to AIDS. This retrospective study included 541 tuberculosis patients who were treated from 1988 to 1992 in the Department of Medicine at the Military Central Hospital in Brazzaville. The serum of all patients was tested by ELISA and Western blots for the presence of HIV. HIV and tuberculosis coinfection were very frequent (more than 30% of all AIDS cases), particularly among young people (20-45 years old). Extrapulmonary tuberculosis cases (37%) have become almost as frequent as pulmonary tuberculosis forms (42.8%) among HIV positive patients, and the clinical picture is often atypical. Tuberculosis morbidity is increasing annually because of AIDS. The longer the tuberculosis patients with AIDS remain in the hospital, the fewer beds are available for other patients. For the public health programs against AIDS in developing countries, this is becoming an urgent problem to resolve.

[Toxoplasmosis and cytomegalovirus serology in patients infected with HIV in Congo]. / Sérologie de la toxoplasmose et du cytomégalovirus des malades infectés par le VIH au Congo.

Cerebral toxoplasmosis and cytomegalovirus (CMV) infection are very frequent in AIDS. Biological markers of toxoplasmosis and CMV were studied in blood and cerebrospinal fluid (CSF) of 121 HIV-positive and 35 HIV-negative patients in the Central Hospital of the Congolese Army in Brazzaville. In the case of clinically suspected cerebral toxoplasmosis, the simultaneous presence of specific IgG antibodies in the blood and in the CSF can be considered as having complementary diagnostic value (PPV = 63.3%, NPV = 89.9%). The symptomatology of AIDS is very polymorphous and includes various etiological factors; as a result it is very difficult to estimate the responsibility of cytomegalovirus in the absence of positive viral culture, even with the simultaneous presence of specific IgG antibodies in the blood and CSF (PPV = 75.7%, NPV = 54.6%).

Approche de l'hypertension arterielle en milieu militaire au Congo: epidemiologie; caracteristiques; prise en charge

L'hypertension arterielle (HTA); affection dominante et pathologie cardio-vasculaire en Afrique a ete etudiee en milieu militaire; au sein de l'armee dans le service de medecine de l'Hopital Central des Armees Pierre MOBENGO a Brazzaville. Nous avons retenu 131 dossiers entre 1985 et 1987. Les donnees epidemiologiques recueillies revisent en baisse les frequences generalement retrouvees dans la litterature compte tenu de la jeunesse relative de la population etudiee et d'une certaine selection lors de l'incorporation. Les aspects cliniques rejoignent ceux observes par ailleurs dans ses associations morbides et dans la frequence et dans la gravite de son retentissement cerebrovasculaire notamment. Dans l'armee; cette gravite naturelle s'accroit par son impact dans les exigences propres a l'etat miltaire; dans le cadre operationnel impliquant une prise en charge de la maladie. Un modele de prise en charge global est propose; tenant compte de plus grandes possibilites qu'au sein de la population generale; malgre des moyens limites

Enquete sur la prevalence de la carie dentaire en milieu militaire a Brazzaville

Les auteurs presentent une etude sur la prevention de la carie dentaire chez les militaires de la Zone Autonome de Brazzaville (Z.A.B.). L'etude realisee sur le terrain de juin a aout 1987 a porte sur un echantillon de 1109 militaires; representatif de l'Armee. 40;22 pour cent de cette population est atteinte par la carie dentaire avec une prevalence elevee des l'incorporation. Le calcul de la C.A.O. dent donne une valeur moyenne de 1;17. Cette prevalence de carie est faible comparativement aux autres pays d'Afrique; et en net retrait sur celles observees dans les pays industrialises. Mais l'accroissement des facteurs de carie dentaire; parallele a l'evolution du mode de vie dans notre pays; necessite des maintenant une prise de conscience et des mesures de prevention. Par ailleurs; la carie dentaire constitue; en milieu militaire; un handicap severe sur le plan operationnel par l'absenteisme iteratif et prolonge qu'elle entraine

[Retrospective study of infection by the human immunodeficiency virus in pregnant women. Future of the child and the mother]. / Etude rétrospective de l'infection par le virus de l'immunodéficience humaine chez la femme enceinte. Devenir de l'enfant et de la mère.

5.4% (108 of 2,000) women have been confirmed for HIV 1 infection in Brazzaville in 1987. 1,172 deliveries have been registered by study, 7.76% have been occurred in HIV+ women. The prevalence of miscarriages was significantly, higher in HIV+ women than in HIV- ones (p less than 0.001). The birth-weight of new-borns was not significantly different among the children born to HIV+ and HIV- mothers. There were the various probable reasons of death of children born to HIV+ mothers. More frequently the respiratory affections with persistent hyperthermia were noticed. During the follow-up, in all groups of age, the fever with failure of thrive were the most frequent signs (50%) with pneumopathy. The clinical picture was completed by diarrhoea after six months of live.

[Peripheral and bone marrow hematological modifications in infection by the human immunodeficiency virus (HIV) in central Africa. Diagnostic and prognostic significance]. / Modifications hématologiques périphériques et médullaires lors de l'infection par le virus de l'immunodéficience humaine (VIH) en Afrique Centrale. Intérêt diagnostic et pronostic.

From the 24 March 1988 to the 15 June 1989, we noticed the peripheric and medullar haematologic modifications of 46 patients infected by HIV, classified in the group IV of CDC. The haematologic modifications found are: a peripheric cytopenia with a constant anemia often serious, a leuconeutropenia, a mild or missing lymphopenia. In comparison: the bone marrow is often rich in the different lineage with more often a sharp lymphoplasmocytal reaction, sometime very characteristic on the cytological side. 2 myeloid leukemia were diagnosed by participation of the myelogram. At least, the proteinogram showed a major polyclonal hypergammaglobulinemy sometimes monoclonal.

[Hematologic parameters during human immunodeficiency virus (HIV) infection in various Congolese subpopulations]. / Etude de paramètres hématologiques au cours de l'infection par le virus de l'immunodéficience humaine (VIH) dans différentes sous-populations Congolaises.

Study of 220 haematological profiles in women, men and children was realized in National Laboratory of Public Health and in Central Army Hospital in Brazzaville. The red cells count the haemoglobin level, the leucocytes and eosinophilia leukocyte counts in each sub-group of HIV+ and HIV- patients were compared. The anemia is important in HIV+ patients (Center for Diseases Control IV). The hyperleukocytosis and lymphocytosis of child and lymphopenia of adult are confirmed. The interest of surveillance of haematological parameters is as important for HIV+ asymptomatic individuals (Center for Diseases Control II) as for those of Center for Diseases Control IV group. The study of haematological profile is the interesting factor of diagnostic and prognosis.

[Clinical and developmental aspects of acquired immunodeficiency syndrome in the Congo (the experience of the medical service of the Hôpital Central des Armées Pierre Mobengo - Brazzaville)]. / Aspects cliniques et évolutifs du syndrome d'immunodépression acquise au Congo (expérience du service de médecine de l'Hôpital Central des Armées Pierre Mobengo - Brazzaville).

During a period of 20 months, 204 cases of AIDS were diagnosed among adults in the Medicine Department of the Pierre Mobengo Armed Forces Central Hospital, Brazzaville. The authors review the clinical and evolutive aspects in admitted patients during these period of time, taking into consideration the problems of diagnosis, treatment and monitoring, according to the conditions of practice. Individuality of AIDS in Central Africa is underlined by its different features. AIDS strikes heterosexual people with multiple partners, with a sex-ratio near to 1. In a patient more often cachectic and febrile, some digestive manifestations occurred, mainly diarrheal, early, neurological, of bad prognosis. Pulmonary manifestations (above all tuberculosis superinfection) and cutaneous manifestations often characteristic, are less frequent and mainly different from the ones observed in Europe and North America. Fast evolution is underlined. These characteristics of AIDS in Central Africa, of course subordinate to the medical context, seem mainly linked to a peculiarity of the disease, in close relationship with the density of the infection, diathesis and opportunistic environment, all very different.

[Role of delta viruses in fulminating hepatitis in Central Africa]. / Le rôle du virus delta dans les hépatites fulminantes en Afrique Centrale.

The delta virus (DV) was shown to be the predominant but not exclusive aetiology in 124 cases of fulminating hepatitis (FH) in the Central African Republic. The condition occurs in an endemo-epidemic form in young adults with no apparent risk factors. The mortality is high (88 p. 100) and the clinical features well established. After a short prodromic period, the patients develop severe jaundice, hepatic encephalopathy, and, in over 1/3 of cases, severe haemorrhage. Biologically, the main changes are related to hepatic cytolysis and insufficiency. Histology shows appearances of spongiocytic (steatosic) hepatitis in 81 p. 100 of cases. HBS antigen is found in 90 p. 100 of cases and DV markers are present in 53 p. 100 of these. The HBS Ag also occurs in 60 to 90 p. 100 of the close relatives of the patients and anti-DV antibodies occur in 40 to 90 p. 100 of these subjects. To the authors' knowledge, this is the first published series to demonstrate FH associated with DV in the African continent.

[A case of histoplasmosis caused by Histoplasma duboisii and treated by ketoconazole in Bangui (C.A.R.)]. / Observation d'une histoplasmose à "Histoplasma duboisii" traitée par le kétoconazole à Bangui (R.C.A.).

The authors report on one case of histoplasmosis in a young girl aged of 12, showing about 200 ulcerous vegetative lesions distributed on her body. Several different therapies were used without success. Utilization of ketoconazole during 187 days lead to a very favourable course. But the patient, escaping from medical control, died 5 months later. Existence of an acquired immunodeficient was supposed.

[Clinical aspects of AIDS in the Central African Republic]. / Aspects cliniques du SIDA en République Centrafricaine.

AIDS is known in Central African Republic since 1983: 64 recognized cases have been registered. AIDS is of endemic aspect presenting the main following signs: lost of weight (100%), degeneration of the health status (80%), lymphadenopathy (46%), pneumopathy (44%), diarrhea (40%), candidiasis (21%), Kaposi's disease (16%), purpura (8%), pruritus (8%), Cutaneous anergy to tuberculin or to the 7 antigens (Merieux test) is constant. LAV serology was positive in 61 cases. The number of helper T. cells is less than 400/mm3, and OKT4/OKT8 ratio is less than 0.50. The concerned population is heterosexual with a sexual hyperactivity.

[Bacteriological and clinical aspects of Salmonella typhi infections in the Central African Republic. Evaluation of a 3-year study in Bangui]. / Aspects bactériologiques et cliniques des infections à Salmonella typhi en République Centrafricaine. Bilan d'une étude de 3 années à Bangui.

Authors have isolated and identified 229 strains from patients with typhoid syndrome . The bacteriology of each strain was studied. We have observed the extension of A (subtype Dakar) lysotype to Central Africa from West Africa. All the strains are resistant for G penicillin. Clinical features are quite the same as in mild countries, with a high incidence in children. The typhoid fever is frequent and precocious in CAR, where prophylaxis by vaccination is not usual.