[Genital bacterial carriage during the last trimester of pregnancy and early-onset neonatal sepsis]. / Portage génital bactérien au dernier trimestre de la grossesse et infection néonatale précoce.

UNLABELLED: Bacterial infections remain a major cause of morbidity and mortality in newborn infants. OBJECTIVE: To determine the bacterial ecology and pathological status of the genital organs during the last trimester of pregnancy and the germs of the following early-onset neonatal sepsis, in order to evaluate the risk of materno-foetal infections and to find out a drug prophylaxis. METHOD: Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and of possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states. An exploration was carried out in every newborn suspected of infection. RESULTS: Genital samples were collected from 306 pregnant women. Among them, 118 were at 29-32 weeks of gestation, 104 at 33-36, and 84 at 37-40. The most frequent germs were C. albicans (33,5%), Enterbacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) and polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or endocervicitis (10.4%), asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified. These pregnancies led to 334 live births with 27 cases of early-onset neonatal sepsis to which endocervicitis (25%) and vaginosis (19,7%) were most often linked. CONCLUSION: Genital samples at the last trimester of pregnancy could evaluate the risk of maternofoetal infections and allow to adapt a drug prophylaxis of Enterobacteriaceae, the most frequent germ of neonatal infections, as it has been done for Streptococcus agalactiae. But larger studies are required to evaluate the risk of maternofoetal infections and to state the drug prophylaxis.

[Tuberculosis in the newborn: recrudescence in areas with high endemic HIV infection]. / Tuberculose du nouveau-né: résurgence en milieu de forte endémie de VIH.

Despite the rising prevalence of tuberculosis due in part to the HIV pandemic in Africa, there have been few reports describing neonatal or congenital tuberculosis and its association with maternal HIV infection has been rare. The purpose of this study was to evaluate the clinical and epidemiological features of tuberculosis in newborns from areas with high endemic rates of both tuberculosis and HIV infection. During the 2-year study period all neonates admitted to the Campus Teaching Hospital in Lomé, Togo for differential diagnosis of symptoms compatible with tuberculosis were investigated. The clinical profile of tuberculosis in the newborn was correlated with that of the mother with or without HIV infection. Perinatal tuberculosis was diagnosed in 13 of the 79 newborns investigated including 8 whose mothers were co-infected by HIV and tuberculosis. Seven cases were classified as congenital tuberculosis. The predominant clinical features were respiratory distress (10/13), fever (9/13), hepatomegaly (9/13), intra-uterine growth retardation (8/13), stagnation or loss of weight (6/13), cough (4/13) and splenomegaly (4/13). Diagnosis of maternal HIV and tuberculosis infection was never made prior to newborn admission to our department. Four newborns and two mothers died within 3 months after childbirth. This study on perinatal tuberculosis in children born to mothers with or without HIV infection demonstrates the need for early diagnostic methods, consensual therapeutic protocols, and further study in larger geographical area to specify epidemiologic features and reduce high mortality.

[Neonatal septicaemia: bacteriological aspects and outcome in the university hospital center of Lome]. / Septicémie néonatale: aspects bactériologiques et évolutifs au centre hospitalier universitaire de Lomé, Togo.

UNLABELLED: Despite the progress in neonatal intensive care and antibiotics, the neonatal septicaemia remains very frequent and lethal in tropical areas. OBJECTIVE: To study the bacteriology and outcome of the neonatal septicaemia through an analysis of 50 confirmed cases. METHODS: Every child aged of less than 29 days, suspected of infection and with at least one positive blood culture has been included. His perinatal antecedents, clinical features, bacteriological findings, treatments and clinical outcome have been collected. The patients have been divided into 3 groups in regard to the postnatal age at the first positive blood culture: before 48 hours, between 3 and 7 days and after 7 days of life. RESULTS: The neonatal septicaemia occurred in 50% of the cases before 48 hours, 24% from the 2nd to the 7th day and 26% from the 8th to the 28th day of life. Enterobacteriaceae (54%) with E. coli predominant (30%) and S. aureus (28%) were the most frequent germs and particularly during the first week of life: 20/27 and 11/14 respectively. The resistance to the association of ampicillin or amoxicillin and gentamicin was 70% for Enterobacteriaceae and 71% for Staphylococci. The lethality was 36% with an excess of lethality for S. aureus (43%). CONCLUSION: The high rates of frequency and lethality of the neonatal septicaemia in tropical areas require a perinatal care improvement to reduce its morbidity and mortality.

Tuberculose du nouveau-né: Résurgence en milieu de forte épidémie de VIH

Malgré l'augmentation de la fréquence de la tuberculose en Afrique,due en partie à la pandémie duVIH,les publications sur la tuberculose néonatale ou congénitale restent rares et peu en rapport avec l'infectionVIH de la mère. Evaluer les aspects épidémiologiques et cliniques dela tuberculose du nouveau-né dans une loca-lité de forte endémie de VIH et de tuberculose,tel a été le but assigné à cette étude. Durant deux ans,tout nou-veau-né admis au Centre hospitalier universitaire-Campus de Lomé pour des signes faisant discuter le diagnos-tic de tuberculoseabénéficié d'une ex p l o ration.Le pro filclinique de latuberculose du nouveau-né et ses rap p o rt savec celle de la mère infectée ou non par le VIH ont été déterminés. Des 79 nouveau-nés ainsi explorés,13 avaientune tuberculose néonatale. Huit d'entre eux sont nés de mère infectée par le VIH et la tuberculose. Sept étaientatteints de tuberculose congénitale. Les signes cliniques prédominants étaient :la détresse respiratoire (10/13),lafi è v re (9/13),l ' h é p at o m é galie(9/13),le re t a rd de croissanceintra - u t é rine (8/13),la stag n ation ou la perte depoids( 6 / 1 3 ) ,latoux(4/13) et lasplénomégalie (4/13). Chez aucune desmèresle diagnostic de VIH et de tuberculose n'étaitétabli avant l'admission de leurs nouveau-nés. Quatre nouveau-nés et deux mères sont décédés au cours des troismois suivant l'accouchement. Cette étude de la tuberculose du nouveau-né de mère infectée ou non par le VIHdemande des méthodes de diagnostic précoce,des protocoles thérapeutiques consensuels et d'autres études surchamp géographique étendu pour en préciser l'épidémiologie et réduire la forte létalité

[Bacterial flora in the genital tract the last trimester of pregnancy]. / Flores bactériennes génitales au dernier trimestre de la grossesse.

UNLABELLED: Very widespread in our clinical setting, early-onset sepsis is due to organisms that commonly colonize or infect the maternal genital tract; identifying such organisms would help improve prevention and treatment. OBJECTIVE: To determine the bacterial ecology and the pathological status of the genital organs during the last trimester of pregnancy, in order to evaluate the risk of materno-fetal infections and to improve the present prophylactic measures based on monitoring bacterial carriage during the first trimester. METHOD: Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy, in patients with no signs of sepsis and not taking antibiotics. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, Clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states. RESULTS: Genital samples were collected from 306 pregnant women. Among them 118 were at 29-32 weeks of gestation, 104 at 33-36 and 84 at 37-40. The most frequent germs were C. albicans (33.3%), Enterobacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) or polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or cervicitis (10.4%) and asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified. CONCLUSION: This is the first report of genital bacterial carriage in African women during the last trimester of pregnancy. Larger studies are required to evaluate the risk of maternofetal infections and to improve current prophylaxis measures.

[Post-hemolytic renal failure in children with glucose-6-phosphate dehydrogenase deficiency at the University Hospital Center in Lome]. / Insuffisance rénale post-hémolytique chez l'enfant déficient en glucose-6-phosphate déshydrogénase au Centre Hospitalier Universitaire de Lomé.

The purpose of the study was to identify predisposing factors for acute hemolysis and post-hemolytic renal failure in children with glucose-6-phosphate dehydrogenase deficiency (G6PD). Any child presenting hemoglobinuria during the study period was prospectively evaluated. Evaluation included detection of the presence of hemolytic agents, laboratory tests to measure hemolysis, G6PD activity, infection and renal failure, and assessment of outcome and management of hemolysis and renal failure. G6PD deficiency was documented in 32.1% of the 230 children admitted with hemoglobinuria. Anuric renal failure occurred during the hemolysis episode in 35.1% of patients with G6PD deficiency (21 boys and 5 girls between 30 months to 13 years old). Acute hemolysis associated with infection occurred before any treatment in 53.8% of cases and after beginning treatment in 46.1%. In 84.6% of cases, occurrence of acute hemolysis involved association of drugs considered as nonhemolytic either with themselves or with other drugs. Anuric renal failure occurred after beginning treatment in all cases and was most severe in patients with of multiple-germ infection (30.7%) and drug association (84.6%). Renal failure was reversible in 80.7% and fatal in 19.2%. Multiple-germ infection and drug association appeared as the main predisposing factors for post hemolytic anuric renal failure in patients with G6PD deficiency. The high frequency of these factors in tropical areas suggests implication of local endemic infections.

[Tuberculosis in newborns in a tropical neonatology unit]. / Tuberculose du nouveau-né dans une unité de néonatologie tropicale.

UNLABELLED: We report three cases of tuberculosis observed in a neonatal unit in a country characterized with a high endemia of tuberculosis. CASE REPORTS: Case 1. A term infant presented at the age of 35 days, with cough since day 18, respiratory distress and bronchopneumonia. Her mother had unrecognised tuberculosis since pregnancy. Post mortem biopsies of the infant confirmed the diagnosis of tuberculosis and social survey found out pulmonary tuberculosis in the newborn's aunt. Case 2. A term infant presented at the age of 30 days with cough since day 13, respiratory distress, nodular pulmonary lesions and right pleural effusion. Her mother had cough and stomatitis since the eighth month of pregnancy and nodular pulmonary lesions. Tuberculosis and HIV were confirmed in the mother and the infant. Social survey found tuberculosis in the newborn's paternal uncle. Case 3. A term but hypotrophic infant presented on the first day of life, with haemorrhagic troubles and respiratory distress. Tuberculosis and HIV were confirmed in the mother and the infant. Social survey found tuberculosis in the father, in a friend of her and in her three-month-old child. CONCLUSION: Congenital or neonatal tuberculosis is an under-estimated emergent disease, with a need for early diagnostic methods and consensual therapeutic protocols to improve its management.

[Risk factors associated with prematurity at the University Hospital of Lome, Togo]. / Facteurs de risque associés à la prématurité au CHU de Lomé, Togo.

OBJECTIVE: To determine the premature birth rate and the risk factors of preterm delivery linked to local conditions of life. METHOD: It is a prospective study including all births before 37 amenorrhoea weeks. All social, medical and behavioural factors linked to preterm deliveries have been analysed for and compared with those of the medical literature. RESULTS: Out of 1672 alive births, we identified 186 (11.1%) cases of prematurity and 30.1% of lethality. The main risk factors of preterm delivery were history of adverse pregnancy outcome (17.2%), history of induced abortion (11.3%), maternal age under 20 (26.3%), under 20 year old primipara (38.7%), inadequate antenatal care (66.6%), low level of education (38.7%) and mother suffering of overwork (29%). Other associated factors such as premature membrane rupture, malaria, urinary infections, gravidic toxaemia, genital infections and above all "unmarried-under 20 year old-primipara with low level of education and low socio-economical status", were significantly linked to preterm delivery. CONCLUSION: The risk factors thus identified correspond with the well-known factors. But many factors significantly linked to preterm delivery were local features whose importance could be reduced through better means of perinatal care and prevention.

[Epidemiologic and etiologic features of urinary infections in children at the pediatrics service of the CHU-Campus de Lome (Togo)]. / Aspects épidémiologiques et étiologiques de l'infection urinaire de l'enfant dans le service de pédiatrie du CHU-Campus de Lomé (Togo).

From 1st January 1989 to 31th December 1997, 175 infants (108 females and 67 males) were hospitalised and treated at the pediatric service of CHU-Campus for urinary tract infection; this study follows the observation of the increasing of urinary tract infection in several centers of health in Togo; the aim of this study was to have a list the contributing factors, to understand the mechanism of such infection in order to reduce its frequency and the high percent of the mortality; the diagnosis of urinary tract infection was given by the result of the cytobacteriological exam of the urine which shows the pathological germ; others forms of the investigation, as abdominal echography were used also to look for the etiology of the urinary tract infection; but, the deficit of the of the medical imagery or the old material of the laboratories limited the searching of urinary tract infection etiology; cured infants were declared on the basis of absence of pathological germ in the result of the cytobacteriological exam control of the urine; the prevalence of the urinary tract infection was 8.29% with an incidence of 7.84% at the pediatric service of CHU-Campus; clinics symptoms were atypic and polymorphic; but the fever was the first clinical sign in the newly born and the urological signs were clear only from two to thirty months; 141 children (80.57%) were cured and 34 presented the complications with 3.43% of mortality; preventive measures on the urinary tract infection in infancy were proposed for the children parents and the practical physicians; these measures included information, education and communication (IEC) on the urinary tract infection, the symptomatology and the cytobacteriological exam of the urine.

[Congenital malarial disease due to Plasmodium falciparum in high-infection-risk newborn]. / Paludisme congénital-maladie à Plasmodium falciparum chez le nouveau-né à risque infectieux.

UNLABELLED: The aim of this work was to differentiate in an endemic area congenital malaria diseases (CMD) from congenital malaria infestations (CMI) or other maternal-fetal infections. METHODS: Four hundred and seventy-five newborn (0-7 d) suspected of infection were prospectively studied. CMD was diagnosed when clinical manifestations were associated with positive thick and thin blood films in a mother and her newborn. The diagnosis of CMI was retained when despite positive parasitemia, no clinical manifestations were observed. RESULTS: Forty newborns (1.7% of the cases of maternal malaria) were diagnosed as CMD and ninety-one (19% of live births) were considered as CMI. The main clinical manifestations were related to cerebral (100%), respiratory (95%) and hemodynamic (90%) systems. Hematologic signs were present in 95% of cases. The level of parasitemia varied from 700 to 3,000 parasites/mL in CMD and from 360 to 870 parasites/mL in CMI. Death occurred in ten cases (25%) of CMD. CONCLUSION: In this malaria-endemic area, neither clinical manifestions nor parasitemia allow one to distinguish CMD from CMI associated with bacterial materno-fetal infections. Studying placental or systemic immunity and antimalaria IgM in the newborn could be of interest to clarify this problem.

[Primary nephrotic syndrome in the black African child]. / Le syndrome néphrotique primitif de l'enfant en Afrique noire.

Idiopathic nephrotic syndrome (INS) in black African children differs from that of children in temperate areas. The main differences are the high rate of corticosteroid non-responders and the low rate of minimal change glomerulopathy in black African children, possibly related to a racial factor. The identification of a high corticosensibility in certain African regions (Togo and Ghana) can lead to the identification of an ethnic factor. Further genetic studies should be carried out in order to provide a better approach to INS in Africa.

[Factors related to pathologies in the early neonatal period at the University Hospital Center of Lome (Togo)]. / Facteurs lies aux pathologies en periode neonatale precoce au CHU-Tokoin de Lome (Togo).

PIP: Early neonatal mortality is responsible for almost 75% of overall neonatal mortality in West Africa. In a prospective study of 3174 live births, the authors examined the pathologies diagnosed in newborns aged 0-7 days admitted to the Neonatology Unit of Tokoin Hospital in Lome, explored the factors associated with these pathologies, and studied their hospital evolution. The study was conducted over a 6-month period from early February to the end of July 1996. 250 subjects were included in the study. Infection (36.4%), cerebral disturbance (19.6%), prematurity (16.4%), respiratory difficulties (7.6%), and hemorrhagic disease (4.8%) were the main pathologies observed during the early neonatal period, affecting 84.8% of all subjects. The overall death rate was 52.8%, of which 64.4% died during the first 48 hours of hospitalization. Neonatal and maternal factors associated with these pathologies are discussed. The main factors linked to these pathologies during the early neonatal period are the condition of young primiparous women, the low socioeconomic level of the mothers, poor pregnancy management, and the poor perinatal environment.^ieng

[Idiopathic thrombopenic purpura in a child in black Africa: a case report in Togo]. / Le purpura thrombopénique idiopathique de l'enfant en Afrique noire: à propos d'un cas au Togo.

UNLABELLED: Idiopathic thrombocytopenic purpurea (ITP) is an autoimmune disease that occurs frequently in Europe and the US, but has rarely been described in Africa. Case report. An 8-year-old girl was admitted for cutaneous and mucosal bleeding. She had a low platelet count (11 x 10(9)/l). ITP was suspected and the diagnosis was confirmed by bone marrow examination. Corticosteroid treatment was effective. DISCUSSION: This is the second case reported in Togo since 1982. The diagnosis of the disease is straightforward, so the lack of cases reported in central Africa suggests that the disease is rare in this region. The rarity of the disease may be due to genetic or environmental factors, or it may simply be that physicians overlook this disease when making their diagnosis. Corticosteroids are now the preferred treatment for ITP because of the risk of transmitting Creutzfeldt-Jacob's disease by intravenous administration of immunoglobulin. Splenectomy is the ultimate treatment for chronic forms. CONCLUSION: Unlike other diseases, the diagnosis and treatment of which require methods unavailable in parts of Africa, ITP treatment, as currently practiced in countries of the northern hemisphere, is within the reach of most African countries. Further studies are required to determine the true frequency of the disease in central Africa.

[Neonatal mortality in the Tantigou pediatric hospital, Dapaong (north Togo) in 1984-1985 and 1994-1995]. / Mortalité néonatale à l'hôpital d'enfants de Tantigou, Dapaong (nord-Togo) en 1984-1985 & 1994-1995.

370 deaths out of 1141 hospitalized cases of newborns aged 0-28 days were retrospectively analyzed in the Tantigou pediatric hospital of Dapaong, situated 645 km from Lome in northern Togo, in 1984-1985 and 1994-1995. A decreasing trend in neonatal mortality was noted: 42.5% and 27.6% respectively. Major causes of death were prematurity or low birth weight, sepsis, hypoxia conditions. The attendance of pregnant women at health information centres seems to be improving, but the neonatal mortality rate remaining high, the implementation of primary health care/Bamako Initiative resulting especially aiming at better prenatal care for pregnant women must be sustained.

[Foreign bodies of the esophagus: etiologic and therapeutic aspects. Experience at the CHU of Lomé (Togo)]. / Corps étrangers oesophagiens: aperçu étiologique et thérapeutique. Expérience du CHU de Lomé (Togo).

AIM: To give details of the management of esophageal foreign bodies (EFB) at our hospital. DESIGN: Retrospective case review. SETTING: ENT ward of Tokoin Teaching Hospital, Lome, Togo. PATIENTS: All 105 patients admitted to the hospital for ingestion of foreign bodies between January 1990 and December 1993. The outcome for each patient was determined by examining hospital records of demographic information, identification of the foreign body and the removal procedure used. RESULTS: EFBs accounted for 6.5% of all hospital admissions. The objects ingested included coins (59.0% of cases), particularly in 2 to 5 year-old children, fish bones (12.4%), meatballs, meat bones and dentures, particularly in adults. The foreign objects were mostly removed by esophagoscopy, but sharp objects required esophagotomy (2.9%). One patient died (0.9% of cases) due to mediastinitis caused by perforation of the esophagus by a chicken bone. CONCLUSION: Community health education programs, increasing awareness of household accidents might reduce the number of emergency hospital admissions for ingestion of foreign bodies.