[Cryptococcal meningitis in children: description of 3 cases]. / Cryptococcose neuroméningée de l'enfant : à propos de 3 cas.

Cryptococcal meningitis is much less common in children than adults. The purpose of this report is to describe 3 cases of cryptococcal meningitis observed in children admitted to the Neurology Department of the Fann University Hospital Center in Dakar, Senegal between July 2003 and November 2008. There were 2 girls whose ages were 8 and 15 years and one 9-year-old boy. All 3 patients presented acute or chronic meningoencephalitis. Diagnosis was based on direct microscopic examination of India ink preparations of cerebrospinal fluid (CSF) showing Cryptococcus neoformans at direct exam. Two patients were immunocompromised including one presenting severe protein-caloric malnutrition and one infected by HIV-1. The third patient was immunocompetent. All 3 patients were treated by intravenous Fluconazole. The immunocompetent boy died after 1 month of hospitalization due to cardiovascular and respiratory insufficiency. Both girls survived with severe neurosensory sequels. Cryptococcal meningitis that is relatively frequent in adulthood may be underestimated in children and should be tested for in any children presenting meningoencephalitis of undetermined cause.

[Pédiatric haemophilus influenzae b meningitis in Dakar]. / Méningite pédiatrique à haemophilus influenzae b à Dakar.

OBJECTIVE: This study had for aim to determine the etiology of Haemophilus b pediatric meningitis. DESIGN: A retrospective study of 216 biologically confirmed cases was carried out during 6 years (January 1995- December 2000) on children 0 to 15 years of age, hospitalized at the Albert Royer Children Hospital Center. RESULTS: Haemophilus influenzae b is the first cause of pediatric meningitis (19.7%) followed by Nesseria meningitidis (14.5%), and Streptococcus pneumoniae (13.6%). The Haemophilus influenzae b meningitis cases are distributed all year round with a peak between January and March, that is to say, during the dry and cool season. They affect children at an average age of 11.7 months, with a sex ratio of 1.1 for boys. Almost all of the patients live in the low-socio-economic areas of the Dakar suburbs (92.8%). More than 90% of the H. influenzae b isolates are sensitive to ceftriaxone (96%) chloramphenicol (93%), and to ampicillin (91%). Clinical evolution is marked by death (17.8%) and recovery with psychological, sensory, and motor sequels (19.9%). CONCLUSION: This report should help to include the combined vaccine Antihaemophilus influenzae b in the Senegalese Broad Vaccination Program. The final aim is the reduction of morbidity and mortality of infections due to Haemophilus influenzae b.

[Child asthma in Senegal: epidemiological and clinical features in hospitals]. / Asthme de l'enfant au Senegal: aspects epidemiologiques et cliniques en milieu hospitalier.

This report is a retrospective study carried out from records of diseased of asthma, fallowed up in a paediatric national center of reference during the period from 1st of November 1987 to 31 st of august 1993. The goal was to describe the epidemiological and clinical factors linked to that affection in order to better contribute to improve its managment. For all the diseaseds of this report we notice and analysed the socio economical data, the promoting factors the occurring mode of the disease, the main clinical manifestations of the affection and their consequences. The morbid association and the data of the paraclinical exploration particularly the functional breathing exploration. Thus we noticed that the consultation in a specialized center occurs relatively late because of bad orientation of the deseaseds. In effect the mean age of diseaseds at the first consultation is 7.5 years while the disease begins in average at 3.5 years. By elsewhere we notice that 15% of these diseaseds live in an aggressive mesologic medium. With an atopy in 78.4% of the cases, loaded personal case history in 96.6% of the cases and that the releasing factors are not known for most of them (81.9%). Asthma in our diseaseds is not very frequent (77%) in general with a moderate intensity of crises (69%). However disturbances of physical activity are noted among 23% of the sample which corresponds nearly to the number of subjects with severe respiratory obstruction (25%). We quoted that there is an relation ship between the frequency of the cases the intensity of the crisis and the disturbances of physical activities of the diseaseds (x2:25.9, df = 2, p= 0,000002). Tacking count of all these factors may serve to set up a asthma prevention and treatment project in Senegal based on populations education and care providers training.