[Relationship between chronic liver diseases and hepatitis C in Burundi adults]. / Relations entre maladies hépatiques chroniques et virus de l'hépatite C chez des adultes burundais.

A case/control study was conducted in Bujumbura, Burundi, from 1991 to 1992 to assess the relationship between chronic liver disease and hepatitis C virus (HCV). Patients presenting chronic liver disease (n = 80) were selected based on clinical, laboratory, ultrasonographic, and/or endoscopic findings. Patients with AIDS or hepatocellular carcinoma were excluded. Controls (n = 159) matched with regard to age and sex were recruited from outpatients who had blood tests at a liver disease clinic. Patients and controls were tested for anti-HCV antibodies by ELISA and LIA. Screening for hepatitis B virus (HBs antigen, anti-HBs and anti-HBc antibodies) and human immunodeficiency virus (HIV) was achieved by ELISA with confirmation of HIV infection by LIA. The incidence of anti-HCV antibodies was significantly higher in patients (55.0%) than controls (33.3%) (p < 0.001). The incidence of HBs antigens was significantly higher in patients (28.8%) than controls (7.5%) (p < 0.0001). The incidence of anti-HIV antibodies was not significantly different in the two groups. Multifactorial analysis indicated that anti-HCV antibodies and HBs antigens were risk factors for chronic liver disease, but did not detected a significant interaction between these two risk factors. Prevention of hepatitis C and B would reduce the incidence of chronic liver disease but cost currently limits widespread use of this approach.

[Ultrasonographic data of the solid organs of the abdomen in stage IV human immunodeficiency virus infection. A prospective study of 101 cases in central Africa]. / Données de l'échographie des organes pleins de l'abdomen au stade IV de l'infection par le virus de l'immunodéficience humaine. Etude prospective de 101 cas en Afrique centrale.

A systematic abdominal study of the solid organs of the abdomen (liver, spleen, pancreas, kidneys) carried out in one hundred patients from Central Africa suffering from full blown AIDS revealed disseminated hyperechoic liver in 37 cases and hypoechoic nodules of the spleen in 10 cases. The combination with abdominal adenopathy and/or serous exudates (peritoin, pleura, pericardium) suggested disseminated tuberculosis. Twenty of the 37 patients with diffusely hyperechoic liver presented within tuberculosis which was confirmed by bacteriological data (AARB present in the sputum) in 13 cases. Of the 10 patients presenting with hypoechoic nodules of the spleen, 5 presented with confirmed tuberculosis. These 10 patients were all considered to have disseminated tuberculosis. In view of the current high incidence of extrapulmonary or disseminated tuberculosis occurring in a context of AIDS and the relative infrequency of positive tests for Mycobacterium, abdominal ultrasound must be coupled with chest X-rays in screening and prompt follow-up for TB instigated in HIV-positive adult Africans.

[Findings of bile duct ultrasonography in 100 patients with AIDS in black Africa]. / Données de l'échographie des voies biliaires chez cent patients atteints de SIDA en Afrique noire.

A systematic study of bile ducts by abdominal echotomography on 100 African patients affected by AIDS disease has showed 11 bile ducts abnormalities (7 alithiasic cholecystitis and 6 inflammatory cholangitis, associated in 2 cases). The patients studies showed several associated infections, particularly a pulmonary tuberculosis and/or extra-pulmonary. The etiology of bile ducts attack has not been formally specified: lack of Cryptosporidium at the stools parasitologic exam, but presence of several opportunistic germs, or no, in the several samples (blood, cerebrospinal fluid, stools, expectoration).

[Evaluation of the surgical treatment of duodenal ulcers. Apropos of 616 patients operated on in Bujumbura]. / Bilan du traitement chirurgical de l'ulcère duodénal. A propos de 616 patients opérés à Bujumbura.

From 1982 to 1989, 616 patients were operated for duodenal ulcers in Bujumbura. 497 were men and 119 females. The mean age was 38.4. The indication for surgery was the failure of medical treatment for 56.8%. Other complications presented 41.4% and 1.8% of the patients had recurring ulcer after previous operation. The study was divided into two periods: Period I (1982-1985) and period II (1986-1989). During Period I, we observed a rapid drop of frequency in interventions and the indication for complication constituted 58% of the total surgical interventions. In period II, the frequency of interventions increased and the indication for complications did not exceed 35.6%. Ulcerous stenosis remained the most frequent complication. The choice of surgical intervention is changing into favour of techniques like highly selective vagotomy.

[Epidemiologic aspects of gastroduodenal ulcer in Burundi. Apropos of 1,476 new cases seen in 3 years]. / Aspects épidémiologiques de l'ulcère gastroduodénal au Burundi. A propos de 1,476 cas nouveaux observés en 3 ans.

The objective of this study is to evaluate the main epidemiological characteristics of gastroduodenal ulcer in Burundi, from 3,282 high gastrointestinal endoscopies, performed over a 3-year period, permitting the diagnosis of 1,476 ulcers (45%): the duodenal ulcer is predominant, almost 93 p. cent. The sex-ratio is 2.75/1. There is a peak of maximum frequency between the ages of 20 and 29 years for duodenal ulcer. The results of this study are consistent with the series published in Africa regarding the location of the ulcer, sex and age. The frequency is high in relation with the series coming from West Africa. Two provinces in the 15 which form Burundi, share between them 50% of ulcer patients. These are the highest regions of the country (average attitude = 1,800 meters), but where the socio-cultural and dietary customs are the same as in the other provinces.

[Infectious diarrhea in African acquired immunodepression syndrome (AIDS). Apropos of 100 patients studied in Bujumbura (Burundi)]. / Diarrhées infectieuses au cours du syndrome d'immunodépression acquise africain (SIDA). A propos de 100 malades étudiés à Bujumbura (Burundi).

The authors carried out a prospective survey on 100 cases of AIDS in order to find out the different etiologies of infections diarrhoea in terms of frequency and diagnosis behaviour. 84 out of 100 patients got diarrhoea. All 100 patients had their stools examined, 78 underwent high digestive fibroscopy with irrigation and aspiration of duodenal liquid (IADL), 40 duodenal biopsies. 98 infecting agents were revealed in stool exams, 50 in IADL, 7 at the occasion of histopathological exam of duodenal biopsies. All together, stool exams and IADL gave evidence that Isospora belli and Cryptosporidium are the opportunistic infecting agents most often revealed (16.2 and 13.1 p.c., respectively). The role of yeasts in diarrhoea is not evident, but esophageal candidosis is the most frequent opportunistic digestive infection (48 p.c.). Anguillula is the only intestinal worm appearing to play a role: the role of bacteria and viruses cannot be evaluated precisely, but histopathological study revealed neither an atypical mycobacteriosis nor a virus disease (herpes, cytomegalovirus). If diagnosis appears to be still difficult in 1989 when confronted with AIDS and diarrhoea, it seems highly advisable to examine the stools, to perform high digestive fibroscopy with IADL and biopsies. On the other hand, indications for colonoscopy appear to be restricted.

[Current strategies in the campaign against Plasmodium falciparum malaria in an area resistant to 4-aminoquinolines]. / Nouvelles stratégies de lutte contre le paludisme à Plasmodium falciparum en zone de résistance aux amino-4-quinoléines.

Confronted with the extension of chemoresistance of P. falciparum and the gradual renunciation of the fight against the vectors, it is important nowadays to manage better the means of fighting in the zones where chloroquine resistance exists. If preventive treatment of chills by 4-aminoquinolines is still able to realize prevention of mortality, treatment of all confirmed chills by P. falciparum has to combine sulfadoxine-pyrimethamine with quinine or amodiaquine.

[Cryptococcosis in Burundi in 1985. Report of 30 cases]. / La cryptococcose au Burundi en 1985. A propos de 30 cas.

Over a period of 23 months, 30 cases of cryptococcosis have been studied in Bujumbura (Burundi). Through them, epidemiological and clinical aspects have been underlined, and attempts have been made to establish links between cryptococcosis and A.I.D.S., which is significantly frequent in Central Africa. Cryptococcosis strikes young adults (40% between 30 and 35 years of age). Its high frequency in Bujumbura among patients infested by A.I.D.S., suggest some thoughts. A.I.D.S. in Central Africa, and particularly in Burundi, presents some peculiarities linked to surrounding and possibilities of diagnosis: opportunistic diseases are of different frequency in temperate or tropical climates: pneumocystosis are more frequent in U.S.A. but cryptococcosis and candidosis are more frequent in Africa because their diagnosis is easier. lack of classical risk factors in African populations is known, but other risk factors have to be taken into consideration: tuberculosis, intestinal parasitosis, chronic virus B hepatitis, protein-caloric deficiency.