Neurocysticercosis: a major aetiological factor of late-onset epilepsy in Madagascar.

To assess the impact of cysticercosis on public health in Madagascar, we compared patients > 15 years with late-onset epilepsy to non-epileptic controls in a matched case-control study. The association between epilepsy and cysticercosis was studied by enzyme-linked immunoelectrotransfer blot (EITB) assay for antibodies specific to Taenia solium. The EITB assay was performed on 104 pairs of sera specimens and on 95 pairs of cerebrospinal fluid (CSF) specimens. Depending on whether we consider the results obtained from sera or from CSF, we obtain for the population attributable risk percent of cysticercosis in late-onset epilepsy two slightly different estimates: 22.3% and 17.6%. Therefore cysticercosis is a major aetiological factor of late-onset epilepsy in Madagascar. In the control group, the frequency of positive results, especially in CSF specimens (7.4%), confirms the existence of asymptomatic cases of neurocysticercosis.

Serial transmission of spongiocytic hepatitis to woodchucks (possible association with a specific delta strain).

BACKGROUND/AIMS: Outbreaks of severe hepatitis have been reported from Africa and South America. Description of the cases has shown the histological hallmark to be the presence of ballooning hepatocytes with fat drops surrounding the nucleus (spongiocytes or morula cells). METHODS: Experimental reproduction of this syndrome for the verification of a possible role of a specific HDV strain was performed by the inoculation of serum and liver extracts from African patients (Bangui-Central African Republic), who died with this syndrome, into American woodchuck carriers of WHV (WC 231,144), the results of which were then compared with animals inoculated with a reference wild HDV strain (WC 300,173,154), and those which received material from a European fulminant HDV case (WC 88,93). RESULTS: Following the initial inoculation, the animals receiving African inocula had a delayed anti-HDV seroconversion, high mortality and showed the presence of spongiocytes, while the other animals had a classical evolution of HDV superinfection in woodchucks. Furthermore, the African inocula caused less inhibition of WHV replication, as well as a predominant cytoplasmic expression of HDAg, in contrast to the animals which received the other inocula. The second passage experiments gave similar results. CONCLUSIONS: We conclude that this peculiar form of HDV fulminant hepatitis can be experimentally reproduced and might be specifically related to a more pathogenic strain.

[Extra-pulmonary tuberculosis in Antananarivo. Principal localizations and biological diagnosis]. / Les tuberculoses extra-pulmonaires á Antananarivo. Principales localisations et diagnostic biologique.

We describe the state of extrapulmonary tuberculosis in the capital of Antananarivo, a city of high endemicity for tuberculosis but very low endemicity for HIV infection. The Laboratory of Mycobacteria in the Institut Pasteur of Madagascar had examined from August 94 to April 95, 543 pathological samples issued from 295 patients clinically suspected of extrapulmonary tuberculosis (64% male and 36% female). The diagnosis of tuberculosis was confirmed for 47.7% of the patients (141/295), using either the culture technique or the histopathological method: 93% of them had an unique localization whereas 7% had a double localization. The most frequent form encountered was the pleural localization (77.8%), followed by the lymphadenopathic form (8,4%) and the abdominal form (6.9%). The confirmation rate on biopsies was 67% by histopathological method compared to 55% by the culture. On the fluid samples, the confirmation rate was 20.9% using the culture. The agreement between histology and culture was 70.3%. Of the 138 strains identified, 135 were M. tuberculosis, 1 M. bovis and 2 environmental mycobacteria.

[Pericardial tuberculosis in Madagascar. 23 cases]. / Les péricardites tuberculeuses á Madagascar. A propos de 29 cas.

A 56 months retrospective study, from October 1990 to May 1995, at the Centre Hospitalier de Soavinandriana in Antananarivo pointed out 29 tuberculous pericarditis among the 97 pericardial effusions discovered by the echocardiography of 5600 patients. The sex-ratio was 0,81 and the mean age 38,6 years old (+/- 14,3). Hospitalization was justified by dyspnea (18 cases), thoracic pain (18 cases), lower limbs edema (6 cases) and ascitis (3 cases). Moreover, electrocardiography showed microvoltage in 18 cases and thoracic radiography showed one heart enlargement. Even if for 15 cases a pleural effusion was associated, only 2 patients had a pulmonary image suggestive of tuberculosis. Tuberculous pericarditis has been proved by the following examinations: pericardium puncture (21 cases), pericardium and pleural biopsy (respectively 11 and 13 cases), ganglionic biopsy and search of alcohol-acid-fast bacilli in sputum: 1 case. Histologic proof has been obtained 8 times out of 9 pericardial biopsies and 6 times out of 7 pleural biopsies. Bacteriological proof has been obtained 11 times by pathological samples cultivation: twice from fresh caseous material taken from the pericardium, once from 13 pleural fluids, 5 times from 6 pericardial biopsies, 3 times from 3 pleural biopsies. The patients have been put under antituberculous treatment associated with prednisone. 20 patients have been declared cured at the end of the treatment, 5 were dead and 4 were lost out of sight. Tuberculous pericarditis has become rare in developed countries but it is still challenging in Madagascar. In spite of the antituberculous treatment associated with corticoids, prognosis is severe (evolution towards pericardial constriction death.

Discovery of a novel point mutation changing the HDAg expression of a hepatitis delta virus isolate from Central African Republic.

None of the mutations so far discovered in several hepatitis delta virus (HDV) isolates appears to determine important changes in HDV specific protein (HDAg) expression, except for a putative mutation at nucleotide 1012 converting an amber stop codon (TAG) to a codon for tryptophan (TGG). Here we present the characterization of an HDV obtained from the liver of a woodchuck inoculated with sera from fulminant HDV patients in Central African Republic (CAR). By restriction enzyme analysis and sequencing of HDAg-coding region cDNA clones, we found that this HDV isolate bears a novel mutation (T to A) at nucleotide 1013 which converts the amber stop codon (TAG) to a codon for lysine (AAG). Comparison of these nucleotide sequences with those available from American, Japanese, Taiwanese, French, Italian and Nauru isolates showed a variability of 1.7 to 21.5% and 1.9 to 28.7% at the nucleic acid and amino acid levels, respectively. The HDAg-encoding sequence of the CAR isolate is closely related to that of the Italian HDV isolate. The in vitro expression of this HDV isolate resulted in a unique HDAg species (28K) which was identical with that characterized in vivo.

Fulminant hepatitis with microvesicular steatosis (a histologic comparison of cases occurring in Brazil--Labrea hepatitis--and in central Africa--Bangui hepatitis).

A similar histopathologic picture of fatal hepatitis associated with widespread acute fatty changes in hepatocytes and single-cell necrosis was seen in epidemic cases occurring in two distinct equatorial areas having high prevalences of HBV and HDV infections. The cases were previously considered to be two different entities; Labrea hepatitis in Brazil, and Bangui hepatitis in the Central African Republic. However, the histopathologic findings suggest that they are pathogenetically and etiologically related to HBV and HDV infections, probably modified by some as yet unknown factor(s) present in equatorial forest zones.

[Idiopathic chylopericardium. Apropos of a new case. Review of the literature]. / Le chylopéricarde idiopathique. A propos d'un nouveau cas--revue de la littérature.

The authors report a new case of primary chylopericardium in an asymptomatic 26 year old male. In view of the negativity of the complementary etiological investigations a surgical subxiphoid window was performed and this confirmed the diagnosis. After failure of isolated evacuatory drainage, the patient was cured by pericardectomy. The anatomo-clinical, biochemical and diagnostic features of this condition are described based on a review of the other cases of primary chylopericardium reported in the literature. Surgical pericardectomy seems to be the only effective long term treatment.

[malnutrition and human immunodeficiency virus (HIV) in Bagui (Central Africa). Study and 2-year follow-up of a cohort of 175 malnourished children and 101 mothers]. / Malnutrition et virus de l'immunodéficience humaine (VIH) à Bangui (Centrafrique). Etude et suivi d'une cohorte de 175 enfants dénutris et de 101 mères pendant 2 ans.

In Bangui (Central African Republic) a survey started in 1986 for 2 years. 175 undernourished children and the mothers were surveyed. In this target group, a high seroprevalence to HIV was determined (12 p.c. of the undernourished children and 25 p.c. for the mothers.) It was also possible to put into light the predictive signs of HIV1 infection in the undernourished people, to follow them up clinically and to determine the sociocultural profile of the undernourished child's mother. In fact, unmarried woman, incidentally prostitute. This is a group at risk that has to be privileged within the control of HIV infection.

[The treatment of imported Plasmodium falciparum malaria with halofantrine. Apropos of 59 case reports (corrected and republished article orginally printed in Med Trop (Mars) 1990 Jan-Mar;50(1):113-7)]. / Traitement du paludisme d'importation à Plasmodium falciparum par l'Halofantrine. A propos de 59 observations.

59 cases of Plasmodium falciparum malaria fever occurring in non-immune Caucasian subjects having got a correct chemoprophylaxis by chloroquine were treated by halofantrine (HALFAN). They were given 1500 mg divided in 3 doses of 500 mg every 6 hours from D1 to D8. All them were back from a malarial highly endemic zone with chloroquine resistance. Analysis of the main biological and clinical efficiency parameters displayed very satisfactory results: disappearances of fever (mean 22 H) and parasitemia (mean 36 H) are short. After two months of monitoring, no malaria recrudescence was noted. With an efficacy of 10 p.c. associated to a noticeable clinical and biological tolerance Halofantrine is a first-class treatment of chloroquine resistant malaria fever.

[Pseudotumoral naso-sinusal aspergillosis stabilized by itraconazole]. / Aspergillose pseudotumorale naso-sinusienne stabilisée par l'itraconazole.

A 25 year-old non-immunocompromised African man showed a sino-orbital aspergillosis involving mostly the sphenoïd sinus, presenting as a growing tumour. Histopathologic study of the specimen biopsy revealed granulomata with intracellular septum branching hyphae. The electrosyneresis demonstrated serum antibodies to Aspergillus flavus. Initial treatment consisted of only surgical debridement in association of standard antifungal therapy (miconazole). After 14 months, a recurrence of the aspergillosis was stopped by the administration of itraconazole, an oral triazole antifungal. This treatment was performed during a period of 12 months and marked clinical improvement was observed. No adverse effects were noted. Itraconazole may be useful in therapy for extra-pulmonary aspergillosis when standard therapy has failed.

[Clinical aspects of human immunodeficiency virus (HIV) infection in Central Africa: 6 years' experience at a hospital in an endemic area]. / Aspects cliniques de l'infection par le virus de l'immunodéficience humaine (VIH) en Centrafrique: expérience hospitalière de 6 ans en zone d'endémie.

In Bangui (Central African Republic), where seroprevalence of HIV is 11% in the adult population, AIDS presents some clinical aspects different from the ones known in the west; the clinical experience reported in this paper is based on 504 cases infested by HIV group 4; diagnosis is very often made thanks to the clinical score recommended by World Health Organization (predictive value of 66%). Predominant manifestations (14%) are: asthenia (100%), emaciation (100%), fever (88%), diarrhea (42%), pulmonary attacks (37%), adenopathies, cutaneous manifestations (35%), neurological manifestations (14%). Some affections call for HIV infection with a significant predictive value: herpes zoster (96%), Kaposi's symptom (68%), mouth candidiasis (71%), pulmonary tuberculosis (56%: as far as some others are concerned, HIV has to be suspected: infant denutrition, acute infections, neurological disorders. Development is severe: 45% of the patients examined died in the 4 months coming after diagnosis. Epidemiology speaking, they are young patients (mean age 27.4 years), neither addicted nor "doped", heterosexual with multiple partners, with female prostitution occasionally; sex ratio is 0.95. Recognized transmission by transfusion is the exception (2/504). The transmission due to vaccination or injection is rare and difficult to evaluate. Only radical alteration of sexual behaviour will modify HIV dissemination.

[Zona in human immunodeficiency virus (HIV-1) infection in Bangui (Central Africa)]. / Le Zona au cours de l'infection par le virus de l'immunodéficience humaine (VIH1) à Bangui (Centrafrique).

In Bangui (Central African Republic) where HIV1 prevalence was 7.8% in 1987, 61 cases of herpes zoster have been studied: 17 "during" AIDS and 44 "isolated" cases. During AIDS, herpes zoster has no prognosis value. When it seems to be "isolated", herpes zoster is closely linked to HIV1: 42 seropositives out of 44 (predictive value of 95%) and it announces the outbreak of AIDS in the 2 years to come.

Clinical and histopathological aspects of Kaposi's sarcoma in Africa: relationship with HIV serology.

From 1983 to 1987, 45 Kaposi's sarcomas (KS) were diagnosed at the University Hospital in Bangui; 37 cases were easily classified as either endemic or AIDS-related KS on clinical grounds and HIV serology. Moreover, probably due to the stage at which patients consulted and lesions were sampled, noticeable histopathological differences were observed between the two clinical presentations. But for 8/45 which we classified as "borderline KS", strong discrepancies occurred between clinical aspects, patient evolution, HIV serology and histopathology. In two cases, HIV-positive patients had typical endemic non-evolutive KS and have survived 15 and 36 months.

PIP: 45 cases of Kaposi's sarcoma diagnosed in Bangui, Central African Republic since 1983 were compared with respect to clinical features, evolution, HIV seroprevalence, immune status and histopathology. 37 cases were categorized as typical endemic KS or atypical aggressive KS, but 8 were found to be "borderline KS" with mixed characteristics. Endemic KS presents as a simple hemangioma with granulations in clusters of capillaries, both in the epidermis and dermis. Later 3 types of tissue damage may be seen: 1) nodular mixed fibroblasts, spindle cells, lymphocytes and histiocytes with vascular slits; 2) fibrocystoma-like; 3) angiosarcoma-like. AIDS-related KS showed scattered spindle cells, vascular slits resembling capillaries, considerable infiltration by plasma cells, lymphocytes and inflammatory cells, PAS-positive eosinophilic tumor cells, and ferric pigmented macrophages. Typical endemic KS lesions are multifocal and limited to the lower extremities. Aggressive AIDS-related KS lesions were infiltrative, edematous or indurated, sometimes located buccally or conjunctively. All 45 patients could be classified as endemic or aggressive KS clinically. None of the patients with clearly endemic KS had antibodies to HIV. The 8 borderline cases had a wide variation in findings. The mean survival times for 6 endemic KS patients was 30 months or more; that of the AIDS-related KS patients was 3.5 months.

[Tuberculosis in infection with the human immunodeficiency virus (HIV) in Bangui (Central African Republic)]. / La tuberculose au cours de l'infection par le virus de l'immunodéficience humaine (VIH) à Bangui (République centrafricaine).

Tuberculosis in Central African Republic is an endemic disease. Its prevalence is 3.87 p. 1.000. The relationship between tuberculosis and HIV infection has been observed on 39 out of 72 cases in the National Hospital of Bangui from September 1986 to June 1987. Tuberculosis is often acute and a severe disease with cervical adenopathies. 13 out of 39 patients died. In spite of cutaneous anergy, some cases (7/39) recovered with antituberculosis therapy.

[Rift Valley Fever and phleboviroses in the Central African Republic]. / La fièvre de la Vallée du Rift et les phléboviroses en République centrafricaine.

During 1984 and 1985, six Rift Valley Fever virus strains (RVF) were isolated in Central African Republic, among them five from human samples. Three strains were isolated in 1985 at the end of the rainy season, from sera of patients dead with severe jaundice with haemorrhagic syndrome, what could evoke a little outbreak. At this occasion, these RVF strains and the other strains of phleboviruses previously isolated in CAR, were antigenically compared by Immuno-fluorescent assay (IFA) and Complement Fixation Test (CF), using mice immuno ascitic fluids prepared against each strain. A lot of cross reactions were noted between the different strains, but all the RVF strains seem to have the same antigenic outline.