Bacteriological profiles of acute suppurative otitis media in children in Brazzaville, Congo

Background: Acute suppurative otitis media (ASOM) is one of the main indications for antibiotic prescription in children. The close proximity of the middle ear to the brain and the increasing resistance of microbial organisms involved in otitis media make this pathology of great concern in children. The objective of this study is to determine the bacteriological profile of acute otitis media in Congo as a guide to the choice of antibiotics for empirical therapy. Methodology: A cross sectional study of children less than 17 years old with acute suppurative otitis media in the otorhinolaryngology service of the Brazzaville University Hospital, Congo, was conducted over a 14 month period. All subjects whose samples were sterile or contaminated (poly-microbial culture) and those who received antibiotic-corticosteroid therapy were excluded. The identification of bacteria to species level was done using conventional biochemical identification tests scheme. Antibiotic sensitivity was performed on isolates using the modified Bauer Kirby disk diffusion test on plain Mueller Hinton (MH) agar and MH agar with 5% horse blood. Results: Four bacteria families/species were identified; Staphylococcus aureus (32.7%), family Enterobacteriaceae (28.6%), Streptococcus pneumoniae (26.5%) and Pseudomonas aeruginosa (12.2%). Ps. aeruginosa was associated with greenish otorrhea while S. aureus, Enterobacteriaceae and S. pneumoniae were associated with yellowish otorrhea (p = 0.001). Conclusion: The bacterial aetiology of acute suppurative otitis media varies from country to country. In Congo, this study reports four main bacteria families/species involved in acute otitis media with high resistance to ß-lactam antibiotics but high sensitivity to macrolides and fluoroquinolones

[Psychosocial issues of mothers whose children have sickle cell disease]. / Vécu psychosocial des mères d'enfants drépanocytaires.

OBJECTIVES: To study and describe the psychological responses (depression and anxiety), the coping strategies, and the impact of sickle cell disease on the quality of life (QOL) of mothers. PATIENTS AND METHODS: A cross-sectional study of mothers with affected children was conducted at the university hospital center of Brazzaville, between February and April 2014. Hamilton and Beck scales, the Brief-COPE, and the Short Form Health Survey were used to assess anxiety, depression, coping strategies, and QOL, respectively. RESULTS: In all, 104 mothers of children with sickle cell disease were surveyed. Of the subjects, 73 (70.2%) had depression and 85 (81.7%) anxiety, while 19 (18.3%) mothers were neither anxious nor depressed. The study shows that depression occurred more often among mothers whose children presented with at least three vaso-occlusive crises (CVO) requiring hospitalization per year (OR=5.1; range=1.8-13.9), at least one blood transfusion (OR=6; range=2.3-15.5), and those whose disease had been known for at least 5 years (OR=3; range=1.2-7.2). On the contrary, maternal anxiety was influenced only by the number of transfusions and CVO requiring hospitalization. The main coping strategy was religious coping (65.4%) followed by acceptance (60%). The QOL of mothers with affected children was impaired in 56.7% of cases. Altered QOL was related to the number of hospitalized CVO per year, i.e., equal to or greater than 3 (OR=6.5; range=2.1-19.6 [P<0.01]), and the number of blood transfusions equal to or greater than 1 (OR=2.9; range=1.2-7.3 [P<0.025]). CONCLUSION: Sickle cell disease is a heavy burden for mothers caring for these children. Mental health disorders are present at the time of diagnosis and in everyday life.

Le psoriasis lingual. A propos d'une observation

Introduction : Le psoriasis est une pathologie inflammatoire chronique. Même si ses manifestations cutanées sont connues et décrites, les données sur l'implication orale restent limitées et rares. Nous rapportons dans ce travail une observation de psoriasis lingual, dans le but de rappeler une expression clinique inhabituelle de cette pathologie. Observation : Il s'agit d'un garçon de 16 ans qui présentait de façon chronique, une gêne alimentaire avec des douleurs linguales. Dans les antécédents, on retrouve des lésions cutanées, érythémateuses prurigineuses, surmontées de squames, prédominants sur les genoux, la face antérieures des jambes et le dos de la main. L'examen de la cavité buccale mettait en évidence, la présence de fissures avec multiples sillons sur la face dorsale de la langue. Le traitement associait des dermocorticoïdes, des bains de bouche, la polyvidone iodée, des tamponnades linguales et des histaminiques. Conclusion : Le psoriasis est une affection dermatologique chronique rare qui est resté longtemps ignoré. Les principales manifestations cliniques sont la langue géographique et la langue fissurée. Son traitement est aisé et le pronostic est heureusement bénin dans l'immense majorité des cas

Aplasies médullaires de l'enfant au CHU de Brazzaville

Introduction : L'Aplasie Médullaire (AM) est une insuffisance quantitative de l'hématopoïèse responsable d'une pancytopénie avec une moelle osseuse pauvre. Elle peut être constitutionnelle ou acquise (toxique, infectieuse, idiopathique). Si le traitement est bien codifié dans les pays riches avec l'amélioration du pronostic à long terme depuis plusieurs années, cette maladie demeure hautement mortelle dans les pays en voie de développement.Objectif : Etudier les caractéristiques cliniques, thérapeutiques et évolutives de l'AM chez l'enfant au CHU de Brazzaville.Matériels et méthodes : Il s'est agi d'une cohorte historique, réalisée sur la base des dossiers d'enfants hospitalisés pour une AM sur une période de 15 ans (2001- 2015). La classification de CAMITTA avait été utilisée.Résultats : 22 dossiers avaient été retenus. La moyenne d'âge était de 12,16 ans. Le sex-ratio garçon/fille était de 0,8. Les AM étaient toutes idiopathiques. Le syndrome anémique était le principal motif d'admission. Le taux moyen d'hémoglobine était de 4,3 g/dL, celui des polynucléaires neutrophiles de 0,340 Giga/l et celui des plaquettes de 13,2 Giga/l. Seize patients sur 22 (72,72%) souffraient de la forme sévère. Dans 90,90% des cas le traitement était symptomatique (concentrés érythrocytaires et plaquettaires, antibiothérapie) parfois associé à la corticothérapie ; 2 patients/22 (9,10%) ont reçu de la ciclosporine. Le taux de mortalité était de 94,73% après un suivi moyen de 9 semaines.Conclusion : L'AM de l'enfant au CHU de Brazzaville est essentiellement idiopathique et de pronostic redoutable

[Epidemiology and outcome of Congolese children who had surgery for heart defects]. / Épidémiologie et devenir des enfants congolais opérés pour cardiopathies congénitales.

AIMS: to determine the principal heart defects for which children underwent surgery and to determine the survival rate. PATIENT AND METHODS: this retrospective cohort study involves Congolese babies treated surgically from September 1989 to September 2010 in France for congenital heart defects (through "Mécénat chirurgie cardiaque" and "Chaîne de l'espoir"). It includes only 110 of the 182 recorded patients during the study period. RESULTS: The sex ratio for the 110 subjects included in the analysis was 1. Their mean age at surgery was 77.4 ± 57.6 months old (range: 8 to 204 months). The main congenital heart defects for which surgery was performed were ventricular septal defect (21.9%), tetralogy of Fallot either isolated (22.8%) or associated with patent foramen ovale (1.8%) or coronary anomalies (1.8%), atrial septal defect associated with other malformations (8.2%), pulmonary atresia with ventricular septal defect (5.5%), aortic stenosis (3.7%), atrioventricular septal defect (0.9%), and Laubry-Pezzi syndrome (0.9%). The median length of follow-up was 42.4 ± 35.6 months (range, 3-240 months). Patients' mean age at the study's end was 121.1 ± 86.3 months (range 20-372 months). The 5-year survival rate was 90% and the 20-year survival, 83.3%. CONCLUSION: Heart surgery for congenital heart defects has improved survival.