[Congenital syphilis still exists]. / La syphilis congénitale n'a pas disparu.

INTRODUCTION: Even today screening for congenital syphilis must be performed and confirmed by appropriate serological tests and bacteriological samples. OBSERVATION: A newborn presented with an apparently materno-fetal or viral fetal disease. It was in fact congenital syphilis. The mother exhibited no risk factors for syphilis. Systematic serological search for syphilis was negative in the mother at 11 weeks of amenorrhea. No signs of primary or secondary syphilis had been observed during pregnancy. At twenty-nine weeks of amenorrhea, the mother presented a menace of preterm delivery and no tocolysis at 31 weeks. Examination of the newborn revealed clinical signs of aterno-fetal infection, without specificorientation. Initial bacteriological and virological analyses were negative. Screening for specific Treponema pallidum M-type immunoglobulines (IgM) on the 9th day of life, confirmed the diagnosis of congenital syphilis. COMMENTS: Diagnosis of congenital syphilis must not be eliminated during early serological screening: clinical suspicion must lead to further anamnesis again and serological tests both in the newborn and the mother.

[Acute childhood gastroenteritis study at Central University Hospital of Pointe-à-Pitre/Abymes, Guadeloupe, from November 1997 to March 1998]. / Enquête sur les gastro-entérites aiguës infantiles au CHU de Pointe-à-Pitre/Abymes, Guadeloupe, de novembre 1997 à mars 1998.

To determine the role of enteric pathogens in acute childhood diarrhoea in Guadeloupe, 161 children (108 cases and 53 controls) from 0 to 2 years of age, admitted to Pointe-à-Pitre/Abymes University Hospital, were evaluated over a five-month period. A known enteric pathogen was identified in 40.8% of children. The most commonly identified aetiologic agents were Salmonella (16.7% of cases), especially Haddar serotype and Rotavirus (20.5%). This virus was isolated more often in the dry season. Adenovirus were detected in 3.6% of diarrhoeal stools and were not significatively associated with diarrhoeal disease. No Shigella, Campylobacter or parasites were found.

[Mortality of children with sickle cell disease in a pediatric department in Central Africa]. / Mortalité des enfants drépanocytaires dans un service de pédiatrie en Afrique Centrale.

BACKGROUND: Sickle cell disease is a serious public health problem in Gabon with a relatively high mortality rate. PATIENTS AND METHODS: Charts of 23 children (nine boys, 14 girls) who died of complications from sickle cell anemia in the department of pediatrics of Owendo Pediatric Hospital (Libreville, Gabon), from January 1, 1990 through December 31, 1992, were analysed retrospectively. RESULTS: Approximately two-thirds of the children (60.9%) were under 5 years of age. The great majority of patients were from low socio-economic standard families. Of 319 deaths observed during the study period, 23 were due to sickle cell disease-associated complications, for an overall mortality rate of 7.2% and a related mortality of 3.6%. Commonest causes of deaths were severe anemia (11 cases, i.e., 47.8%), which affected predominantly the younger patients between 6 months and 5 years (eight cases), infections (30.4%) and blood transfusion complications (21.7%). CONCLUSION: To decrease these mortality rates, appropriate health supervision and well-designed preventive strategies are needed.

[Aspects of malaria in the hospitalized child in Gabon]. / Aspects du paludisme de l'enfant en milieu hospitalier gabonais.

To gain insight into the impact of malaria on children in terms of frequency and severity, a study was carried out in a department of the Owendo Children's Hospital in Libreville, Gabon, a fully endemic area. Diagnosis of Plasmodium falciparum malaria was confirmed by blood smears in 295 of the 1592 children admitted in 1992, i.e. 18.5% of admissions. Malaria was therefore the primary cause of hospitalization. Of 122 deaths observed during the study period 9 were due to malaria-associated complications for an overall mortality rate of 7.4% and malaria-related mortality rate of 3.1%. These rates are low in comparison with those reported by other departments in Central Africa. Convulsions were observed in 30.5% of children in the department and malaria was the underlying cause of convulsions in 62.9% of these cases. Severe anemia (< 5 g/dl) was noted in 23.7% of children overall and was associated with malaria in 54.7%. Severe malaria as defined by the criteria of the World Health Organization was observed in 33.2% of children. These findings illustrate the extent of the impact of endemic malaria on children in Gabon and emphasize the need to promote malaria control programs and improve treatment.

[Human African trypanosomiasis in children. A pediatrics service experience in Libreville, Gabon]. / Trypanosomose humaine africaine chez l'enfant. Expérience d'un service de pédiatrie à Libreville, Gabon.

During a period of six years (1/1/89-12/31/94), seven children with trypanosomiasis were admitted to the Department of Pediatrics of Owendo Pediatric Hospital-Libreville, Gabon. They were 5 boys and 2 girls, aged 4-17 years, five of them under 15 years. The main reasons of hospitalization were somnolence (4 cases), psychical disorders (5 cases), neurological disorders (4 cases), asthenia (3 cases), loss of weight (3 cases) and fever (3 cases). Increased sedimentation rate (5 cases) and hypergammaglobulinemia (6 cases) were the most important biological disturbances. Serodiagnosis (CATT, indirect immunofluorescence test) was positive in all cases. The parasite was detected in blood seven times, and four times in cerebrospinal fluid (CSF). According to CSF status, six children have been classified in second stage of the disease. Six patients were treated by melarsoprol, and one by eflornithine. Tolerance and response to treatment were good in six cases. Three children presented sequels when leaving hospital. No patient was seen again after the study.

[Selection criteria for the establishment of reference values in tropical zones. Application to specific proteins: C-reactive protein, haptoglobin, transferrin in gabonese children]. / Critères de sélection pour l'établissement des valeurs de référence en zone tropicale. Application aux protéines spécifiques CRP, HPT, TRF chez l'enfant gabonais.

About 220 children (110 boys and 110 girls) aged 18 months to 10 years, 65.9% have been selected from anamnesis, clinical, and biological criteria to produce reference values on specific proteins dependent inflammatory, anemia and hemolysis (C-reactive protein = CRP; Transferrin = TRF and Haptoglobin: HPT). Specimens have been analysed by Nephelometric immuno-chemical method. For the two groups, A1 [18 months-5 years] and A2 [5-10 years], the reference values of the whole study population are reported: CRP (A1 3.35 +/- 3 mg/l: A2 2.40 +/- 2.30 g/l, with a significant difference at Student Fisher "t" test p < 0.03); TRF (A1 4.05 +/- 1.5 g/l; A2 4.50 +/- 1.4 g/l; NS, p > 0.05) HPT (A1 2.55 +/- 2.0 g/l: A2 1.20 +/- 1.10 g/l; S(r) p < 10(-5)). Furthermore, for TRF, HPT we must consider the sex in the results meaning because of significant difference into boys and girls.

Light microscopic changes in Plasmodium falciparum from Gabonese children treated with artemether.

The changes in Plasmodium falciparum in four Gabonese children suffering from severe malaria and treated with pure artemether were observed in thin blood smears fixed and stained with Giemsa and examined by light microscopy. Peripheral blood samples were taken every 8 hr up to 72 hr from three children and every 3 hr up to 9 hr from the other child. The morphologic changes involved all development stages (trophozoites, schizonts, and gametocytes); they were first seen 3 hr after the start of treatment and all parasites were abnormal after 24 hr. After two days of treatment, all infected erythrocytes disappeared except for a few with necrotic trophozoites. The morphologic changes were similar to the ultrastructural changes previously described in vivo and in vitro in experimental models. They confirm the rapid effect of artemisinin derivatives on parasite clearance and clinical recovery, particularly in cases of cerebral malaria.

[Salmonella meningitis in children in Libreville. Retrospective study of 9 cases]. / M eningites à salmonelles de l'enfant à Libreville. Etude rétrospective de neuf observations.

BACKGROUND: Salmonella meningitis is a rare entity, even in tropical area where salmonellosis is common. Its prognosis is poor and the choice of adequate antibiotic therapy is difficult. PATIENTS AND METHODS: The files of nine children (three boys, six girls) admitted to the pediatric unit of the Owendo Pediatric Hospital in Libreville for salmonella meningitis between January 1, 1989, and December 31, 1993 were retrospectively studied. Diagnosis was established by a positive culture of cerebrospinal fluid. RESULTS: Salmonella was the third cause (8.65%) of purulent meningitis observed during this period. Eight children were less than 1-year old, seven were from low socioeconomic standard families. The main clinical manifestations were fever (seven cases), pallor (six cases), diarrhea (four cases), nuchal rigidity (four cases), convulsions (three cases) and bulging fontanel (three cases). Five children (55.5%) were severely anemic (hemoglobin < 5 g/dL) but none had abnormal hemoglobin. Serotyping could not be performed in any case. Salmonella isolates were resistant to chloramphenicol in six cases and to ampicillin in five. Cefotaxime (200 mg/kg/24 h intravenously in three divided doses) was given to seven patients. The duration of therapy was at least 3 weeks in four patients. There were five deaths at ages ranging from 1 to 12 months, ie, a case fatality rate of 55.5%. Three patients (33.3%) recovered with neurological sequels. CONCLUSION: The prognosis of salmonella meningitis is poor, even in the case of prompt diagnosis and adequate therapy. Preventive measures only can decrease the risk of illness in children.

Growth hormone-binding proteins and insulin-like growth factor-binding proteins in protein-energy malnutrition, before and after nutritional rehabilitation.

To clarify the influence of nutrition on the GH-IGF axis in protein-energy malnutrition (PEM), we determined the serum levels of GH, GH-binding proteins (BP) (GHBPs), IGF-I, and IGFBPs in nine children with kwashiorkor and 13 with marasmus, before and after nutritional rehabilitation. In a basal condition, the GH level was significantly higher in the two malnourished groups than in controls (p < 0.01); in contrast, the second fraction of GHBP was lower and seemed to be related to the high GH and to a reduction in GH receptors. After refeeding, the GH level increased and the second fraction of GHBP decreased. The IGF-I basal level was higher in kwashiorkor than in marasmus subjects (p < 0.05), but in both groups it was significantly lower than in controls (p < 0.01); after refeeding it increased. IG-FBP-3, measured by RIA and Western blotting techniques, was in the control range in the kwashiorkor group but in the marasmic group it was significantly lower than in controls; after refeeding it decreased in kwashiorkor (p < 0.01 versus basal values) and increased in marasmus (p < 0.05 versus prerefeeding level). When sera of malnourished patients were mixed with adult control sera, incubated for 5 h at 37 degrees C, and assessed by ligand blotting, a low IGFBP-3 level in marasmus was found to be due to increased adaptive proteolysis of IGFBP-3; in contrast, in kwashiorkor the IGFBP-3 proteolytic activity was very low, probably because of inhibition by aflatoxins. These findings confirm that malnutrition affects the GH-IGF axis.

[Digestive cryptosporidiosis in young children in an urban area in Gabon]. / Cryptosporidiose digestive chez le jeune enfant en zone urbaine au Gabon.

A 27 month epidemiological survey of cryptosporidiosis in stools was conducted in 288 Gabonese children aged between 0 and 2 years (mean 10.2 months). By at least one of two staining techniques, acid-fast and direct immunofluorescence, the rate of infection was determined to be 24%. The rate was 28% in cases of acute diarrhea, in striking contrast with the low prevalence of 14.8% in uninjured gastroenteritus subjects (p < 0.05). The notion of asymptomatic carriers was clearly demonstrated. The maximum of 34.4% was observed for infants aged between 6 and 12 months (p < 0.02). In cases of malnutrition, this rate increased to 31.8%, whereas it was 16.8% in eutrophic children (p < 0.01). For the rainy and dry seasons, it was 31.7% and 19.4%, respectively (p < 0.02). Water is emerging as an important vehicle for the transmission and spread of Cryptosporidium sp. in tropical areas.

[Lipid profile during specific malaria therapy in Gabonese children]. / Profil lipidique au cours d'une thérapeutique curative spécifique du paludisme maladie chez l'enfant gabonais.

We report specific dyslipidemia in Gabonese children aged 18 months to 4 years old treated with Halfan for malaria. This is observed in addition to the hypoglycemia typically associated with malaria. C-HDL (high density lipoprotein) fell on day 0 (D0), then increased during the treatment. Triglycerides (TG), total cholesterol (TC) and non-esterified fatty acids (NEFA) rose on D0. CT continued to rise evenly throughout the treatment, whereas TG declined. The differences with respect to normal values are significantly different as assessed by the Student test. We report metabolic variation and tolerance to Halfan.

[Treatment of Plasmodium falciparum malaria attacks in children with artemether in Gabon]. / Traitement des accès palustres à Plasmodium falciparum de l'enfant par l'artéméther au Gabon.

The efficacy and tolerance of artemether administered intramuscularly twice daily (1.6 or 3.2 mg/kg/day) were evaluated in 47 children (mean age 2.4 years old) suffering from mild (n = 28) or severe (n = 19) attacks of Plasmodium falciparum malaria. Tolerance was also investigated in 5 additional children for whom the efficacy could not be assessed, because the parasitaemia was too low on inclusion. Antipyretics were systematically administered and therefore efficacy of the treatment was scored according to the decrease in the density of the parasite and the remission of severe symptoms in those patients with severe attacks. Parasites were eliminated in all patients in a mean of 47.7 +/- 9.8 hours. The time to eradication was not significantly affected by the dose, prior administration of an anti-malarial agents to treat the attack or the severity of the attack. There were two cases of clinical and parasitological regression, on days 14 and 21. There were no deaths. The neurological symptoms of severity resolved in 48 hours in most cases. Local and systemic tolerance was excellent.