[Generalized tetanus with otitic portal of entry after using intra-auricular traditional remedies in a 2 old child]. / Tetanos généralisé à porte d'entrée otitique, suite à l'utilisation de topiques traditionnels intra-auriculaires chez un enfant de 2 ans.

A case of tetanus with uncommon way of contamination was found in the paediatric department of the Yopougon teaching hospital in Côte d'Ivoire. A two-year-old child, without vaccination against tetanus and suffering from a chronic otitis presented a generalized tetanus, after the use of traditional local remedies in his ear. Through this observation, the authors want to make population aware of the detrimental effects of traditional local auricular remedies and want to advise all physicians to make a serotherapy and/or a vaccination against tetanus to all children with chronic otitis in our area.

[Analysis of the diagnostic criteria used in childhood tuberculosis in a Cote d'Ivoire hospital]. / Analyse des critères diagnostiques de la tuberculose de l'enfant en milieu ivoirien hospitalier.

Based on a retrospective study the authors analyzed the diagnostic criteria used in pediatric department in Yopougon CHU (teaching hospital), from January 1996 to December 2002. Fifty children, aged of 1 month to 15 years, have been studied. The tuberculosis contact was found in 18%. The diagnosis of tuberculosis was accurate in 32% and it was based on presumptive arguments in 68%. The pulmonary examination and pulmonary radiographs seem to be good criteria for the tuberculosis diagnosis. The pulmonary examination found an abnormality in 96%, and the radiographs found a pathological picture in 85% of cases. The skin test was positive in 42%. The Ziehl-Neelsen coloration was used to look for the acid-fast bacilli and it was positive in 41%. But the two last examinations were not reliable in the case of HIV infection. The skin test which is very important for the diagnosis of tuberculosis is often negative among HIV infected children because of their anergy. On the other hand, the Ziehl-Neelsen coloration is based on the recognition of the acid-fast bacillus, which is not specific of the Mycobacterium tuberculosis. In our area the prevalence of HIV/AIDS is high, the atypical pneumonia with Mycobacterium were also frequent and may reveal a wrong positive diagnosis for the tuberculosis diagnosis, as they are also acid-fast bacillus.

[Sub-cutaneous location of Burkitt's lymphoma. Apropos of 1 case at Yopougon Central University Hospital, Abidjan (Côte d'Ivoire)]. / Localisation sous-cutanée du lymphome de Burkitt. A propos d'un cas au CHU de Yopougon, à Abidjan (Côte d'Ivoire).

Burkitt Lymphoma is the most frequent lymphoma of childhood in West Africa. The main localisations are facial and abdominal. In this study, the authors describe the case of a sub-cutaneous localisation of a Burkitt to a seven years old boy. He was admitted at the hospital because of an abdominal tumefaction. Nowadays such a case has seldom been published. After using cyclophosphamide, methotrexate and aracytine, all the tumefactions disappeared. This case was interesting because of the exceptional localisation of the lymphoma, which may induce a wrong diagnosis.

[Misunderstood neurological side effects of amodiaquine: apropos of 35 cases in children at Central University Hospital of Yopougon at Abidjan, Côte d' Ivoire]. / Effets neurologiques indésirables méconnus de l'amodiaquine: à propos de 35 cas chez l'enfant au CHU de Yopougon à Abidjan, Côte d'Ivoire.

The case reports about the neurological sides effects of amodiaquine are scare, and just a few of them concerned the children. But more and more, amodiaquine is prescribed because of the resistance of Plasmodium in front of chloroquine. And, in the endemic area of malaria, there are more and more neurological side effects with amodiaquine among the children. From a retrospective study, from January 1998 to June 2000, the authors described 35 case reports of children aged from 5 months to 15 years who presented neurological side effects after taking amodiaquine in endemic malarial area. The aim of this study is, first to inform the pediatricians in our area about these side effects, as they are not mentioned in therapeutic guides. Second, it shows that it is not exceptional in the endemic area of malaria.

[Inquiry of knowledge, attitudes and practice of accidental acute poisoning in children of Yopougon (Abidjan, Côte d'Ivoire]. / Enquête CAP sur les intoxications accidentelles aiguës de l'enfant à Yopougon (Abidjan, Côte d'Ivoire).

Child poisoning represent a public health problem in Africa and their particularities are linked to the way of life the population. We have made in the course of March 1999 an inquiry on 55 mothers at Yopougon in Abidjan. This inquiry was focused on their knowledge, attitudes and practices in relation acute poisoning children. The results of this inquiry will serve to organize a sanitary education for parents on the behaviour to have in case of an accident.

[Non-tuberculous bacterial pleuropneumopathies in children in Abidjan]. / Les pleuro-pneumopathies bactériennes non tuberculeuses de l'enfant à Abidjan.

We carried out a retrospective study to investigate epidemiological and clinical aspects of patient management in a hospital environment. We studied 90 cases of non-tuberculous bacterial pleuropneumopathies in children, observed over a 5-year period, from January 1 1991 to December 31 1995, at the Pediatric Medical Unit of Yopougon University Hospital. Diagnosis was based on the association of an infectious syndrome with respiratory and digestive disorders, and was confirmed by X ray. Bacteria were isolated from pleural pus and identified in fifty-one cases. Non-tuberculous bacterial pleuropneumopathies accounted for 5.22% of all pneumopathies in children, and the sex ratio for the patients affected was 1.9. Protein and energy malnutrition, anemia, being very young and climatic factors (harmattan and rainy seasons) were identified as major risk factors. The three main bacteria identified were Staphylococcus aureus (21 cases), Streptococcus pneumoniae (19 cases) and Haemophilus influenzae (6 cases). In this series of patients, 20% of the Staphylococcus aureus strains isolated were methicillin-resistant. Patients were generally treated with a combination of penicillin A and M and aminoside, with or without a pleural drain. The outcome was favorable in 77.8% of cases, with no severe sequelae detected by X ray. Six of the children died. Bacterial pneumopathies are still common in Sub-Saharan Africa and the patient being very young is indicative of a poor prognosis.

[Acute poisoning in pediatrics at the CHU of Yopougon, Côte d'Ivoire]. / Les intoxications aiguës en pédiatrie au CHU de Yopougon, Côte d'Ivoire.

From 1st January 1995 to 31st December 1996, 92 children from 1 month to 15 years old admitted for poisoning were studied. The purpose of this work was to describe the characteristics of child intoxication in our area; 64% were under 5 five years. Petroleum was the main poison (25/92). Certain traditional measures carried out by parents were identified as dangerous because leading to a high mortality rate. Two deaths were due to petroleum poisoning. In 96% of the cases, it was due to an inappropriate conservation of the hydrocarbure. The intoxications by amino-4-quinolines were also mainly due to bad self-medication. For these reasons, parents must be educated.

Le diabete de l'enfant et de l'adolescent a Abidjan

Dans un travail retrospectif du 10 janvier 1978 au 31 decembre 1988 (11 ans); visant a preciser les principaux caracteres du diabete chez l'enfant et l'adolescent; ages de 0 a 20 ans; au Centre Antidiabetique d'Abidjan; les auteurs ont recense 83 cas par le critere d'une glycemie a jeun superieure ou egale a 1;20 g/l (6;60 umol/l). La prevalence estimee par rapport a l'ensemble de la population diabetique est de 1;52 pour cent: 36 sujets de 0 a 15 ans (0;64 pour cent); 47 sujets de 16 a 20 ans (0;88 pour cent). Les malades se repartissent en 45 filles et 38 garcons; 64;63 pour cent des malades sont issus de milieu socio-economique bas. L'heredite en l'absence d'etude HLA semble presente dans 30 pour cent des cas. Les circonstances de decouvertes sont dominees par le syndrome polyuro-polydipsique (83;13 pour cent). Le precoma ou le coma diabetique est inaugural dans 10;84 pour cent des cas. Lors de la prise en charge; la glycemie est comprise entre 2 et 4 g/l (11;1 et 22;2 umol/l) chez 47 sujets (56;62 pour cent); l'acetonurie est relativement rare (8;43 pour cent). Au plan therapeutique et evolutif; l'insulinotherapie est la methode therapeutique dans la majorite des cas. Les resultats sont decevants dans 95 pour cent des cas en raison de la defaillance de l'auto-surveillance. Le pour centage eleve de malades perdus de vue (64;24 pour cent) montre les difficultes de surveillance et de traitement des jeunes diabetiques a Abidjan

Prise en charge therapeutique des infections respiratoires aigues (IRA) de l'enfant dans les centres de protection maternelle et infantile d'Abidjan

Dans un travail prospectif du 10/02/92 au 12/06/92 (4 mois) visant a l'analyse de la prise en charge therapeutique des IRA dans trois centres de la PMI d'Abidjan; les auteurs ont etudie les prescriptions de 189 enfants ages de 0 a 71 mois. Le modele de prise en charge de reference etait celui de l'OMS. 70 pour cent des sujets etaient ages de 0 a 23 mois. Les IRA investiguees se repartissent en 67 pour cent de formes hautes et en 33 pour cent de formes basses. Les IRA hautes etaient constituees de 88 rhinites; 25 pharyngites; 13 otites. Concernant les traitements; pour 180 ordonnances; 677 lignes de prescriprions (LP) ont ete recensees soit 3;7 LP par malade. Le nombre eleve des specialites et presentations (149) temoigne d'une non standardisation des protocoles therapeutiques. Les antibiotiques (84 pour cent des ordonnances); les antitussifs (62 pour cent des ordonnances); les antipyretiques (59 pour cent des ordonnances) etaient les classes therapeutiques les plus retrouvees. Les betalactamines; les macrolides constituent 92 pour cent des antibiotiques prescrits. Parmi les antitussifs 34 pour cent etaient purs et 66 pour cent des fludifiants. Dans les rhenites sans pneumopathie; les auteurs ont note une prescription abusive d'antibiotiques (75 pour cent) ainsi que des gouttes nasales contenant des antibacteries et/ou des vasoconstricteurs; des corticoides dans 96 pour cent des cas; le serum physiologique ne represente que 4 pour cent des gouttes nasales. Le cout moyen de l'ordonnance est de 6350 F CFA dans ces centres ou sont traites des malades de milieu socio-economique modeste. Devant ce constat; les auteurs preconisent la mise en place d'un programme de lutte contre les IRA de l'enfant pour une prise en charge standardisee et moins couteuse dans les centres de sante publique

[Suppurative meningitis in the newborn infant: experience with 107 cases in the Ivory Coast]. / Les méningites purulentes du nouveau-né: expérience à partir de 107 cas en Côte d'Ivoire.

A retrospective study of 107 neonates with meningitis showed that in 45% of cases the condition occurred during the first 48 hours after birth, probably following a materno-foetal infection. Male neonates accounted for 70% of the cases. In 15% of cases, the mothers previously had a known infectious disease and 55% of cases came from an unfavourable socio-economic environment. Over 50% of the infants had to be resuscitated at birth. The majority of organisms isolated were Gram-negative bacteria or Enterobacteriaceae; the commonest organism was Haemophilus influenzae. The most effective specific treatment (91% favourable results) was intravenous amoxycillin plus intramuscular gentamicin. It is recommended that the newborn infant of parents living in unfavourable socio-economic circumstances should receive careful follow-up during the first week after birth so that the diagnosis of bacterial meningitis can be made at the start of infection. The neonate should receive effective prophylactic antibiotic cover if resuscitated, if the mother has suffered from an infectious disease during pregnancy or if premature rupture of the membranes has occurred.