[Salmonellosis in HIV infection in a hospital setting in Gabon]. / Etude des salmonelloses au cours de l'infection à VIH en milieu hospitalier gabonais.

A case-control study was carried out in Libreville, Gabon, to determine the incidence of salmonella infection in HIV patients and identify any special clinical, therapeutic, or prognostic features. The records of 3000 patients hospitalized in the Infectious Disease Department of the Jeanne Ebori Foundation between January 1990 and December 1994 were studied. The incidence of salmonella infection, serotype, clinical presentation, prognostic factors and therapeutic modalities were compared in 2759 HIV-positive patients and 441 HIV-negative patients. Salmonella infection was noted in a total of 208 patients (58 HIV-positive and 150 HIV-negative). The incidence of salmonella infection was 13 p. 100 (non-typhoid in 76 p. 100 of cases) in HIV-positive patients versus 5.4 p. 100 in HIV-negative patients. The predominant serotypes in HIV-positive patients were Salmonella typhimurium and Salmonella enteritidis which accounted 41 p. 100 and 26 p. 100 of the isolated strains. The only significantly difference in clinical presentation was a higher incidence of bacteremia (84 p. 100) and focal lesions (11.4 p. 100) in HIV-positive patients with low-grade salmonella infection. The duration of treatment was three weeks with cotrimoxazole and 10 days with fluoroquinolones and cephalosporines. The outcome in HIV-positive patients was recurrence-free cure in 40 p. 100, multiple relapses in 12 p. 100, and death in 24 p. 100. The remaining patients were lost from follow-up. This study demonstrates the gravity of low-grade salmonella infection in African HIV-positive patients. Early diagnosis is necessary to allow chemotherapy which can be effective despite immunodeficiency.

[Tetanus in Libreville: hospital analysis of 30 cases]. / Tétanos à Libreville: analyse hospitalière de trente-quatre cas.

We investigated 34 cases of tetanus in patients younger than 75 years old in Libreville. We found that the incidence of tetanus was 8 cases for every million people. The disease mostly affected people younger than 50 (85%). Only two neonatal tetanus cases were reported. The death rate was 74%, despite the availability of intensive care and respiratory assistance. We stress the benefits of tetanus immunization, which must be continued, and suggest the use of intrathecal serotherapy for the cure of tetanus in Libreville.

[Suppurative intracranial infections in Africa]. / Les suppurations collectées intra-crâniennes en milieu africain.

The purpose of this study was to review recent African literature on suppurative intracranial infection and its implications for neurosurgery. In order of decreasing frequency the main lesions are brain abscess, subdural empyema, and epidural abscess. Despite progress in diagnostic imaging and availability of antibiotic therapy, these lesions still cause disturbingly high morbidity and mortality especially in sub-Saharan Africa where diagnosis is often delayed. The male-to-female ratio was 3.6:1 and 70 to 80% of patients were under the age of 20 years. Spread from the paranasal sinus or ear was the most common mechanism of infection. Hematogenous processes accounted for 22% of cases and the origin was undetermined in 11% to 26% of cases. Staphylococcus aureus and enteric gram-negative bacilli were the most common bacteria identified but cultures were reported as sterile in 30% to 50% of cases. While ultrasonography can be useful in newborns with an open fontanelle, arteriography is often the only feasible procedure for diagnosis in Black Africa. The diagnostic modality of choice is computed tomography which allows precise mapping prior to neurosurgery. Introduction of computed tomography in some African cities has led to a decrease in mortality ranging from 4.7% to 43%. The most effective treatment is a combination of appropriate antimicrobial therapy and surgical decompression of expanding lesions. The main procedures are aspiration through burr holes and craniotomy. Use of this combined strategy requires close cooperation between the neurosurgeon, infectious disease specialist, and microbiologist. Therapeutic indications are discussed within the context of Black Africa.