[Parasitemia in Plasmodium falciparum malarial attacks in children]. / Parasitémie au cours des accès palustres à Plasmodium falciparum chez l'enfant.

In order to evaluate the predictive value of parasitaemia, this parameter was measured on admission in 69 Gabonese children aged from 3 to 13 years hospitalized for Plasmodium falciparum malarial attacks. Fourteen of these children had cerebral malaria, 5 had isolated convulsions and 50 had uncomplicated attacks. The parasitaemia values measured were compared with those found in asymptomatic children of the same age range carrying trophozoites. There were no significant differences in mean parasitaemia count between the 3 types of malarial attack, and only the asymptomatic carriers had significantly lower counts. However, the wide scattering of individual values within each group indicated that simple measurement of parasitaemia is not discriminative enough to predict the course of malarial attacks in children living in endemic regions. In particular, malarial attacks with very low or very high parasitaemia value are possible, but similar values are found in asymptomatic carriers.

[Malaria and hemoglobin S: interactions in African children]. / Paludisme et hémoglobine S: interactions chez l'enfant africain.

Among 300 cases of Plasmodium falciparum malaria attacks explored in Gabon, the proportion of homozygous (SS) or heterozygous (AS) sickle-cell patients was 6.2 percent in 206 ordinary attacks and 3.2 percent in 94 cerebral malaria attacks, and 23.2 percent in the general population. On the other hand, asymptomatic carriage, as detected in 98 children by thin blood films in school screening, was as frequent in the SS or AS infantile population as in the general population. These data show that haemoglobin S protects effectively, although not entirely, against severe attacks of P. falciparum malaria. The incidence of anaemia and vaso-obstructive crisis in malaria-infested sickle-cell patients suggests that subclinical carriage of haematozoa may worsen the course of sickle-cell disease, and this must be taken into account when planning treatment.

[Decreased intraepithelial lymphocytes in the intestinal mucosa in children with malnutrition and parasitic infections]. / Baisse des lymphocytes intraépithéliaux dans la muqueuse intestinale de l'enfant malnutri et parasité.

In Gabon, 15 children aged 13 to 36 months admitted for malnutrition with chronic diarrhea underwent a small bowel biopsy for detection of parasites in the duodenal contents and histologic evaluation of the intestinal mucosa. In every case, intraepithelial lymphocyte counts (IELC) were under the lower limit of normal for children and adults, regardless of whether or not parasites were found. Partial villous atrophy was a consistent finding. Proportion of lymphocytes among intraepithelial cells was 7.4% in the 6 children with no parasitic infection, 7.9% in the children with giardiasis, and 8.1% in the children with strongyloidiasis. Appropriate treatment of the parasitic infections was quickly followed by resolution of the diarrhea in the nine patients with demonstrable intestinal parasites. These data should be compared with the well documented lymphocyte function anomalies associated with protein-calory malnutrition. The fall in IELC and lack of response to local anigenic stimulations are features of malnutrition.

Influence of intestinal parasitism on lactose absorption in well-nourished African children.

Hydrogen breath tests were performed in Gabon (Central Africa) after a loading dose of lactose in 67 well-nourished African children (50 with intestinal parasites and 17 unparasitized) and in 18 unparasitized young adults. All had normal nutritional status, and none had diarrhea or digestive symptoms. Parasites that were found included Ascaris lumbricoides in 76% of the parasitized children, Trichuris trichiura in 58%, Giardia in 24%, Entamoeba histolytica in 20%, Schistosoma intercalatum in 16%, and Necator Americanus in 14%. A similar proportion of parasitized (64%) or unparasitized (62.8%) subjects were lactose malabsorbers. Giardia infection was associated with a higher, but not significantly different, proportion of lactose intolerance (10 of 12, 83.3%). The presence of infection with A. lumbricoides or T. trichiura did not increase the percentage of lactose malabsorption. These data indicate that a decrease of lactase activity in well-nourished African children is not related to the presence or the importance of Ascaris or other intestinal parasites if the nutritional status is normal.

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.

[Intestinal parasites and lactose malabsorption]. / Parasites intestinaux et malabsorption du lactose.

Breath-test was performed for diagnosis of lactose malabsorption in 50 Gabonese children of normal nutritional status, aged 5 to 15 years, with parasites in stools, but without diarrhoea or digestive symptoms. Control group was unparasitized and consisted of 17 children and 18 young adults living in the same area. Parasites discovered by stool examination were Ascaris lumbricoides in 76% of parasitized children, Trichuris trichiura in 58%, Giardia in 24%, Entamoeba histolytica in 20%, Schistosoma intercalatum in 16% and Necator Americanus in 14%. Children were given a 10 g lactose load and adults 20 g. Lactose malabsorption was discovered in 64% of parasitized patients and in 63% of unparasitized. Ten of 12 (83.3%) of Giardia infected children had a lactose malabsorption (no significant difference). These data show that decrease of lactase activity in African children is not related to the presence or to the importance of intestinal parasitism, except for Giardia infestation, if nutritional status is normal.

[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.

[Interaction of cholestyramine and chloroquine]. / Interaction entre cholestyramine et chloroquine.

The plasma levels of chloroquine after an oral intake of 10 mg/kg were measured in 5 children, with or without simultaneous intake of cholestyramine. Plasma chloroquine levels measured 6 hours after intake were significantly lower in case of simultaneous administration of cholestyramine, in spite of important individual changes. These data suggest a decrease in chloroquine bioavailability in the presence of cholestyramine. However, the methodology used does not allow to assert it.

[Rigid tube bronchoscopy in tuberculous children. Apropos of 24 cases]. / La bronchoscopie avec tube rigide chez l'enfant tuberculeux. A propos de vingt-quatre observations.

We report the preliminary results of a study in children with tuberculosis. Rigid tube bronchoscopy provided diagnostic information in 79% of cases and allowed a few therapeutic procedures including aspiration of secretions and removal of inflammatory granulomas. We found that the most common lesion is bronchial compression. Rigid tube bronchoscopy is acceptably comfortable under general anesthesia and provides valuable results.

[Use of a fermented powdered milk in malnourished or lactose intolerant children]. / Utilisation d'un lait fermenté en poudre chez l'enfant malnutri ou intolérant au lactose.

Lactase deficient subjects, who form the bulk of the world population, absorb yogurt lactose because the bacteria used for fermentation produce beta-galactosidase. From a milk fermented by these bacteria and dried by a temperature-controlled process a power could be obtained which possess residual lactase activity but, unlike yogurt, does not need storage at low temperature. The lactose of this fermented powdered milk is perfectly absorbed, as proved by hydrogen respiratory tests performed in 35 lactose intolerant African subjects living in isolated villages. In 25 malnourished children under 3 years of age, this milk allowed renutrition without inducing diarrhoea--a result which could not have been obtained with ordinary milk in two-thirds of the cases. This type of food is potentially valuable to feed the large population of the third world.

[Hepatotoxicity of the combination of isoniazid-rifampicin in African children. Role of malnutrition and HB virus]. / Hépatotoxicité de l'association isoniazide-rifampicine chez l'enfant africain. Influence de la malnutrition et du virus HB.

Forty-seven Gabonese children with tuberculosis either limited to the lung or associated with other localizations were treated with isoniazid-rifampin (INH + RIF). They had liver tests done during the first 6 months of treatment. In 30 patients (63.8%) there was an increase in aminotransferase levels [over 100 UI/l in 14 (29.2%)]. The main factors increasing the risk of hepatic toxicity was a high dosage of INH and overall malnutrition. In fact, the weights of patients presenting with signs of hepatic toxicity were significantly lower than those in children who had no alterations of liver function. 68% of the severely malnourished (marasmus of kwashiorkor) presented with high ALAT or ASAT levels during treatment. The eventual role of the chronic HBV carrier state is discussed as 2 children presented with a chronic form of hepatitis at the time the treatment was initiated.

Milk lactose malabsorption in Gabon measured by the breath hydrogen test.

It is usual to consider that the greatest part of the black African population is lactose intolerant. Also, milk lactose malabsorption was studied by a breath hydrogen technique in 87 Gabonese children and 20 Gabonese adults (central Africa). The prevalence of malabsorption was 64.2% in rural schoolchildren, 65% in the urban hospitalized, and 60% in adults. Twelve children and six adults had clinical symptoms after a lactose load. All subjects were Bantus, with no tradition of consuming dairy products. These data must be considered in programs of nutritional support in Africa.

[Breast-feeding and intestinal parasites]. / Allaitement maternel et parasites intestinaux.

The extent of intestinal parasitic infection was determined using 4 methods of fecal examination in 400 Gabonese infants aged 0.5 to 24 months (86 exclusively and 151 partially breast-fed and 163 artificially fed) and in 170 of their mothers in an African urban community. Parasitic prevalence was the same in the stools of the mothers from the 3 infant groups, providing evidence for the same level of exposure to parasites in all infants. Exclusively and partially breast-fed infants excreted parasites in numbers significantly lower than artificially fed infants of the same ages, during the first and the second years of life. This antiparasitic activity of human milk concerned mostly Giardia and ascaris, was not exclusively due to a decreased exposure to parasites in breast-fed infants and did not seem exclusively antibody-mediated; the role of lipids is possible.

[Intestinal parasitic colonization and protein-caloric malnutrition]. / Colonisation parasitaire intestinale et malnutrition protéino-calorique.

Intestinal parasitic infection was determined by fecal examination for parasites with several complementary methods in 380 young Gabonese infants aged 6 to 24 months (190 with normal weights and 190 with malnutrition, matched for age). Trichuris trichiura, Ascaris lombricoides, Giardia intestinalis, Entamoeba histolytica and Strongyloides stercoralis were the most prevalent parasites, without any difference between well-fed infants and patients with malnutrition. The higher prevalence of Strongyloides stercoralis in protein energy malnutrition might be related to a methodologic problem. However, more than 20% of diarrheas in infants with severe malnutrition were dramatically improved by specific treatment of S. stercoralis or Giardia with thiabendazole or metronidazole.

[Interaction between Salmonella and Schistosoma intercalatum]. / Interactions salmonelles-bilharziose à Schistosoma intercalatum.

Close interactions between salmonellae and Schistosoma intercalatum were demonstrated by a study of 118 children conducted at Libreville, Gabon. Bilharziasis, confirmed by rectal biopsy, was present in 76% of children hospitalized for typhoid-like salmonella septicaemia, as against 38% of controls of the same age living in the same district (P less than 0.001). Although the clinical symptoms were typical of typhoid fever, with stupor, myocarditis or leucopenia depending on the cases, the germs responsible in 26 out of 42 cases were salmonella species regarded as minor. Finally, the salmonella infection was clinically prolonged by bilharziasis in 1 out of 3 patients. It would therefore appear that salmonella adheres to the wall of S. intercalatum as to that of other schistosoma species, and that both infections must be treated concomitantly.

[Indications characteristic for different antiparasitic treatments in endemic zones]. / Indications particulières de certains traitements antiparasitaires en zones d'endémie.

In endemic regions, certain anti-parasitic therapies are automatically prescribed when confronted with apparently benign childhood disorders. The diagnostic differentiation between a simple febrile seizure provoked by Plasmodium falciparum is often impossible, requiring the initial use of intravenous quinine. Helminth or Giardia infestations often aggravate the chronic diarrhea of malnutrition, or are revealed with corticosteroid therapy, necessitating the initiation of an appropriate treatment. In addition, the frequent association of typhoid and schistosomiasis, requires therapy for both in order to prevent relapses.

[Etiology of acute infantile gastroenteritis in Gabon]. / Etiologies des gastroentérites aiguës infantiles au Gabon.

Rotaviruses are the main etiology of acute diarrhoeas in gabonese children (11 to 30% according to age). Salmonellae (11.4%), Shigellae (7.1%) and E. histolytica (7.1%), isolated or associated with enterobacteria, E. coli (3%), Giardia and Strongyloides stercoralis (1.4%), Yersinia enterocolitica (1%) and Balantidium coli (0.5%) were also found, without cholera.