[Short treatment of hepatic amebiasis by tinidazole. Apropos of 10 cases]. / Traitement court de l'amibiase hépatique par le tinidazole. A propos de 10 cas.

Ten cases of hepatic amoebiasis are notified in Bamako during 14 months among hospitalized adults. The diagnosis has aimed from clinical signs, specific antibodies seen through hemagglutination and echography. These patients are treated by tinidazole: 2 g/day in unique dose during 3-9 days. The duration of treatment depends on clinical evolution. In any cases the recovery is obtained within subsequent range from 1 to 9 months. This leading is compared with other treatments proposed in the literature. The briefness of treatment, its quick efficacy and the absence of secondary effects have helped to reduce the duration of stay in hospital and its cost. A short recovery by tinidazole is proposed as tentative treatment against hepatic amoebiasis in rural area's medicine.

[The synthesis of the epidemiology and treatment of malaria of the pregnant woman and the infant in subsaharan Africa]. / Exposé de synthèse sur l'épidémiologie et le traitement du paludisme de la femme enceinte et de l'enfant en afrique subsaharienne.

This article summarizes informations regarding epidemiology, prophylaxis and treatment of Plasmodium falciparum malaria in pregnant women and children in subsaharian Africa. The authors recommend a regular antimalarial chemoprophylaxis using chloroquine and proguanil for pregnant women and particularly for primigravidae as they constitute a group at risk and considering the consequential effects on foetus. Precautions such as bed nets to avoid bites by infected mosquitoes are important. Chloroquine is the drug of choice for treatment in areas where P. falciparum remains sensitive. When chloroquine resistance exists or in cases of severe malariae, quinine must be used.

[Lessons of the socioeconomic structure of a cohort of 50 drug addicts infected with HIV and followed up over a year]. / Enseignements d'ordre socio-économique à partir d'une cohorte de 50 toxicomanes infectés par le VIH et suivis pendant un an.

Fifty drug addicts, users of intravenous heroin and infected by HIV, with an average age of 28 years, were followed for a period of one year. The purpose was to analyze, as precisely as possible, the medical and social cost of their illness as a function of the stage of the infection to which they belonged. The costs vary significantly according to the age and sex of the patients, and are higher in those patients with stage IV (confirmed clinical AIDS) than with stage II and stage III HIV infection. Although the population of drug addicts infected by HIV is likely to stabilize, the medical and social cost of caring for HIV-infected drug addicts is very heavy, and can be estimated at about 4 to 5 billion french francs by year.

[Imported falciparum malaria in Marseilles hospitals in 1987. Apropos of 104 cases]. / Le paludisme d'importation à Plasmodium falciparum dans les hôpitaux de Marseille en 1987. A propos de 104 cas.

Patients were composed of 85 adults and 19 children; 70 were European, 23 Comorian; malaria was contracted by 9 patients in French Guyana, 60 in Africa, 23 in Comoro Islands; prophylaxis was correct for 45 patients (nearly all of the cases with chloroquine) when the first symptoms occurred. Every case of malaria appeared during the month following their return from an endemic area. Fever was often moderate or intermittent, altered by prophylaxis and previous treatments. Some patients had a clinical profile of "visceral evolutive malaria" and 3 a cerebral malaria. The most frequent biologic alteration was thrombopenia (40 times under 100,000/microliters). No relation between parasites density and clinical profile has been identified. The sensitivity of the strains for antimalarial drugs has been studied 35 times: 28 strains were chloroquine resistant, 3 have a decreased sensitivity for quinine. Most of the resistant strains came from Central Africa. Two patients died.

[Current clinical aspects and role of parasitic density in the manifestations of falciparum malaria]. / Aspects cliniques actuels et rôle de la densité parasitaire dans l'expression du paludisme à Plasmodium falciparum.

56 patients carriers of Plasmodium falciparum were observed throughout 1987: 47 males and 9 females of a mean age of 32. The following clinical aspects were observed: Falciparum malaria: 35 cases, malaria with a low parasitaemia (less than 1,000 HPM): 5 cases, tropical splenomegaly syndrome: 3 cases, isolated bi- or tricytopenia: 10 cases, cerebral malaria: 1 case, asymptomatic carriers: 2 cases. Statistically speaking, no significant correlation was observed between parasitaemia and the following clinical and biological symptoms: fever, splenomegaly, Hb level, platelet count. However, we noted a level of parasitaemia higher in the acute forms of malaria (Falciparum malaria and cerebral malaria) than in the non typical forms (chronic visceral malaria, haematological disorders). All asymptomatic carriers, who represent "malaria infection", presented a low parasitaemia (less than 1,000 HPM).

[Resistant falciparum malaria at the F. Houphouet-Boigny hospital in Marseilles in 1985-1986-1987]. / Paludisme à P. falciparum chimio-resistant à l'hopital F. Houphouet-Boigny à Marseille en 1985-1986-1987.

Chemoresistant P. falciparum malaria emerged in South Sahara Africa during 1978 and is now more than half of the imported malaria in F. Houphouet-Boigny Hospital in Marseilles (France), consequently the annual number of malaria cases has doubled as compared to the previous years. In our study of 47 chemoresistant malaria cases, collected in 1985-1986-1987, mostly contracted in French-speaking Africa, residents and travellers were both equally affected. Curative treatment was quinine IV for severe malaria (34%), sulfadoxine-pyrimethamine (46.8%), and mefloquine (51%).

[The teachings of the Center for Education and Research in Tropical Medicine and Health. Analysis and pedagogic developments]. / Les enseignements du Centre de Formation et de Recherches en Médecine et Santé Tropicales. Analyse et développements pédagogiques.

Three different types of education and teaching are offered by the Education and Research Center in Tropical Health and Medicine: To 7th and 8th year students in medicine, given morning and afternoon over a period of 13 weeks, this type of education in tropical health and medicine requests a high degree of participation from the student; it is very well structured in its objectives and program with more than 50% of directed studies and guided training. Evaluation is carried out both in and at the end of sylabuses. To male and female nurses, teaching is given morning and afternoon over a period of 5 weeks. From year to year, the increased number of participants attests the success of such a teaching. To students at the end of their University programmes, whatever they may be. This multidisciplinary education is given over a period of two years, twice a month, late in the afternoon.

[African trypanosomiasis of icterohemorrhagic form]. / Trypanosomiase africaine à forme ictéro-hémorragique.

A case report of trypanosomiasis (T. rhodesiense), observed in a French tourist is described. The clinical picture associated a cytolytic hepatic jaundice, a thrombopenia with hemorrhagic manifestations, a renal insufficiency and secondarily a neutropenia with anemia. Moderate and transitory anomalies in the cerebrospinal fluid were noted. The cure was effectuated by administration of pentamidine.

[Trichinosis in Provence. Apropos of a familial epidemic]. / La trichinose en Provence. A propos d'une épidémie familiale.

An outbreak of trichinosis following meals in a rural area of Provence is reported. The epidemiologic parameters reconstitute the contamination cycle (man-pig: fox-rat) which indicated indisputably the diagnosis, the appropriate therapy, and also evidenced a rural zoonosis of trichinosis in Provence. The clinical picture among twenty-one people included morbilliform rash in 38% of cases and an enanthema in 24% of cases, uncommon findings, with respect to their frequency, and the other usual signs. Early laboratory diagnosis was made possible by blood analysis for hypereosinophilia and immunoassay (ELISA) for antigen-specific IgE. Treatment with benzimidazoles was quite effective.

Albendazole: a new broad spectrum anthelmintic. Double-blind multicenter clinical trial.

A new anthelmintic drug, albendazole, has been tested in a multicenter double-blind placebo controlled study in 392 patients from France and West Africa in children and adults with single or mixed infections caused by roundworms, hookworms, whipworms, threadworms and tapeworms. All patients were closely observed before and after treatment for clinical side effects, hematological or clinical blood chemical changes. Fecal samples obtained before, and 7 days and 21 days after treatment were examined using a concentration technic (Ritchie), a coproculture (Harada-Mori) and an egg count (Kato). Following a single dose of 400 mg in adults, cure rates of 96% in ascaridiasis, 96% in ancylostomiasis caused by dose of 400 mg in adults, cure rates of 96% in ascaridiasis, 96% in ancylostomiasis caused by Ancylostoma duodenale, 90% in ancylostomiasis caused by Necator americanus and 76% in trichuriasis were recorded. About 48% of the patients infected by Strongyloides stercoralis were cured following administration of 400 mg per day for 3 consecutive days. The efficacy of half of the adult dose (200 mg) was much lower in children. None of the patients who received placebo were cured. The drug did not produce any significant side effects and approximately the same numbers were reported in the albendazole and the placebo groups. No variations of the hematology and clinical blood chemistry values were recorded.

[Current data on health services in the Cap-Vert region. I. Inventory of resources]. / Données actuelles sur les services de santé pour la région du Cap-Vert. I: Indicateurs de moyens.

PIP: This document provides detailed information on the health facilities and manpower of the Cap-Vert region of Senegal. The Cap-Vert region is the most developed of Senegal and contains .3% of the territory but 21% of the population. Its 1,200,000 residents have much higher incomes and literacy rates than are found in the remainder of the country. Cap-Vert is divided into 3 health areas with 18 auxiliary health posts or dispensaries and 30 municipal health posts and dispensaries, in addition to 2 Red Cross posts, 10 health services affiliated with religious groups, and 13 other posts. Each center has at least 1 nurse and 18 physicians are attached to them as a group. Their function is to provide general medical care. 59 private general medical practitioners and 39 specialists also offer services. The region contains state, municipal and private hospitals. Preventive facilities include 23 maternal-child health centers; the institute of social hygiene, which provides tuberculosis and venereal disease surveillance and ambulatory care for some ailments; a service for epidemic diseases; medical care for schools; the bureau of health education; the Pasteur Institute which provides laboratory tests, produces vaccines, and conducts research and teaching programs; and municipal health services. Drugs are provided without charge in public hospitals but not in private facilities. The density of curative and preventive services is the greatest in Senegal, but it does not compensate for the budgetary shortages and the problems created by a suboptimal standard of personnel. Availability of health care varies widely according to socioeconomic level and ability to pay. The private system covers about 400,000 persons, the semipublic system based on Catholic-run health posts covers about 450,000 persons, and the state system covers about 350,000 persons totally and another 150,000 or so who also use the private services intermittently. The share of health costs assumed by the recipients of health care in the form of fees and payments is helpful although it falls far short of the total and should perhaps be increased.^ieng

[The influence of malaria chemoprophylaxis on health of a rural community in West Africa (author's transl)]. / Influence d'une chimioprophylaxie antipaludique sur l'état de santé d'une communauté rurale en Afrique de l'ouest. Résultats préliminaires.

In the village population of Mali situated in the sudan savanna, malariometric indices and hematocrit values were performed before and after mass drug administration given every 15 days by a nurse to three-quarters of the population, with the remaining quarter receiving a placebo. In this population, endemic malaria was stable and high, essentially caused by Plasmodium falciparum. The "protected" population showed a decrease of parasite rate and spleen rate with concomitent rise in hematocrit values. Following the rainy season, when transmission of malaria is highest, the normally observed increase in malariometric indices with lowered hematocrit values were not seen during chemoprophylaxis. While splenomegaly found in rural children is related to malaria, the main etiology of anaemia observed in this age group is probably malaria but a role is played by others factors.

[Treatment of intestinal nematode infections with albendazole. Preliminary results (author's transl)]. / Traitement des nématodoses intestinales par l'albendazole. Résultats préliminaires.

A randomized double-blind study, in order to evaluate effectiveness and tolerance of albendazole, was carried out in 186 african subjects presenting intestinal nematode infections in Mali and Senegal. The drug, well tolerated, given as a single dose of 0.4 g (adolescents and adults) or 0.2 g (children) is curative in more than 90% for ascariasis. For ancylostomiasis and trichuriasis, the effectiveness is less satisfactory in children, probably due to insufficient dosage in this age group.