Serological tests in cerebrospinal fluid for congenital syphilis in central Africa.

Serological tests were performed in the cerebrospinal fluid (CSF) of 13 children with active congenital syphilis (presence of specific IgM FTA-ABS antibodies) and of seven seropositive children with no active syphilis (FTA-ABS IgM-negative) born to syphilitic treated mothers in Libreville, Gabon. Antibodies against treponema were measured by the Venereal Disease Research Laboratory test (VDRL), the Treponema pallidum haemagglutination assay (TPHA) and the fluorescent treponema antibody absorption tests (FTA-ABS IgG and IgM). Of the 13 children with active syphilis, seven had a positive FTA-ABS IgG in the CSF. The result of this test was not correlated with the severity of clinical features, CSF protein levels or number of CSF white blood cells. The CSF-TPHA test was positive in four out of 12 children, and the CSF-VDRL test was negative in all the children with active congenital syphilis. One of the seven newborns with mother-transmitted antibodies had a positive FTA-ABS and TPHA in the CSF. These data show that the VDRL is not sensitive enough to diagnose congenital neurosyphilis, and that FTA-ABS or, at least, TPHA are convenient, sometimes with false-positive results, when a sophisticated method of detecting specific IgM in CSF is not available.

[Meningeal attacks during the course of congenital syphilis and therapeutic consequences]. / Atteinte méningée au cours de la syphilis congénitale et conséquences thérapeutiques.

In a study carried out in Gabon, antibodies against the treponema were looked for in the cerebrospinal fluid (CSF) in 13 children with active congenital syphilis (presence of specific IgM antibodies) and in 7 children with positive serologic reactions reflecting transplacental passage of maternal antibodies. Serologic reactions used included the VDRL test, the TPHA test, and the FTA-ABS IgG and IgM tests. Among the 13 children with syphilis, 7 had a positive FTA-ABS IgG test in the CSF without correlation with severity of clinical features, CSF protein levels or CSF cytologic findings. The TPHA test was positive in only four children and the VDRL test was always negative. Passage of antibodies into the CSF is possible (1 case in this study after treatment of the mother), but TPHA is helpful in developing countries of research of neurosyphilis.

[Specific serologic reactions in the cerebrospinal fluid in congenital syphilis and therapeutic implications]. / Réactions sérologiques spécifiques dans le liquide céphalorachidien au cours de la syphilis congénitale et conséquences thérapeutiques.

In a study carried out in Gabon, antibodies against the treponema were looked for in the cerebrospinal fluid (CSF) in 13 children with active congenital syphilis (presence of specific IgM antibodies) and in 7 children with positive serologic reactions reflecting transplacental passage of maternal antibodies. Serologic reactions used included the VDRL test, the TPHA test, and the FTA-ABS IgG and IgM tests. Among the 13 children with syphilis, 7 had a positive FTA-ABS IgG test in the CSF; positivity of this test was not correlated with severity of clinical features, CSF protein levels or CSF cytologic findings. The TPHA test was positive in only four children and the VDRL test was consistently negative. These findings are similar to those reported in another group of patients with meningeal involvement proven by the demonstration of IgM in the CSF using recent techniques. Passage of antibodies into the CSF is possible (1 case in this study) but for safety patients with specific IgG in the CSF should be given penicillin in a dosage that provides treponema-killing levels in situ (100,000 U/kg/d). Use of this dosage is recommended whenever sensitive techniques for CSF analysis are not available.

[Syphilis in pregnant women in Libreville (Gabon)]. / Syphilis chez la femme enceinte à Libreville (Gabon).

We are reporting here the data of two surveys carried out in Libreville between 1982 and 1985. The first one was done with 153 women at the maternity hospital of le centre hospitalier de Libreville, the other one involved 623 women at antenatal visit. In this last group, the rate of women being seropositive is in inverse ratio to the social status, with women from high income strata having a percentage of 1,5 to 3,4% and women from lower income strata starting at 21% up to 26% of seropositivity. Promiscuity and lack of information among youngster could explain the relatively high percentage of seropositivity among female pupils and students (10.6%). We suggest to consider this group as a risk group for syphilis and to focus all necessary information toward this group and the lower income women strata of the population. Getting back to 153 women at the maternity hospital, 31 of them (20.3%) were seropositive and the ground of their admission to the hospital was: 27 delivery of death in utero, 1 case of abortion at 3 months of pregnancy, 2 cases of miscarriage at the 5 month and one case of hypotrophic fetal development, because the mother was treated for syphilis during pregnancy. The risk of congenital syphilis is low when the mother has been treated during pregnancy, so, the high number of congenital syphilis, 12/47 pregnancies followed up to delivery are an indication of an inadequacy or a total lack of treatment during those pregnancies.

[Infantile diarrhea in Libreville (Gabon). Ecological studies]. / Diarrhées du jeune enfant à Libreville (Gabon). Recherches écologiques.

The identification of different infectious agents found in infantile diarrheas was undertaken in 237 children hospitalized in pediatric institutions in Libreville. In neonates between 0 and 18 months of age, the most common pathogen was Rotavirus (20.6%), followed by Shigella (10.8%), E. coli (9.24%), Salmonella (3.46%), E. histolytica (0.8%) and Y. enterocolitica (0.4%). The highest percentage of diarrheas caused by rotaviruses was found among children between 6 and 11 months of age. The frequency of Salmonella among children 2 to 4 years of age is almost the same at that in children under 2 years of age (3.44%). Isolation of Shigella in this group reaches 12.06%. The protective effect of breast milk and the carriage state among adults are discussed.

[Serology, sensitivity to antibiotics and lysotypes of several strains of Salmonella isolated in children hospitalized at the Hospital Center of Libreville]. / Sérologie, sensibilité aux antibiotiques et lysotypie de quelques souches de Salmonella isolées chez des enfants hospitalisés au Centre Hospitalier de Libreville.

We have isolated 122 strains of Salmonellae from stools and blood cultures among children patients from Centre Hospitalier de Libreville. Isolation was carried out from July 1982 to June 1983. During that period of time, Salmonella paratyphi C was the most commonly found. We report here the isolation of a new serotype: Salmonella Libreville and the emergence of Salmonella Wien which was unknown in Libreville area. Lysotyping of S. typhi shows that three strains of A lysotype, subtype Dakar, were not indigenous. Infection by Salmonellae is still widespread among Gabonese children. Scarcity of those germs in stool could be explained by intensive antibiotherapy; on the other hand more than 50% of germs isolated from blood culture in children at Libreville area are Salmonellae. These works display the pattern of different members of the Salmonellae family found among patients of the pediatric department of the Centre Hospitalier de Libreville.