[Bullous toxidermatosis and HIV infection in hospital environment in Lome (Togo)]. / Toxidermies bulleuses et infection à VIH en milieu hospitalier à Lomé (Togo).

A transversal study allowed to analyse the different features of severe bullous toxicodermatosis, and its relations with HIV infection. Since March 1992 to December 1995, 15 patients were hospitalized in Lome Teaching Hospital for severe bullous toxicodermatosis: 16 cases of Lyell's syndrome, 8 cases of Stevens-Johnson's syndrome and 1 case of ectodermosis. The principal drug which induced these diseases were mostly dominated by the sulfanilamide (n = 7). Nine (9) of these subjects were infected by the HIV (four of whose patients had Lyell's syndrome). Its noted five cases of death, all in the patients with HIV infection.

[Pediatric AIDS at the University Hospital Center-Tokoin (Lomé): the role of protein-calorie malnutrition and a formulation trial of a clinical diagnostic score]. / Sida pédiatrique au CHU-Tokoin (Lomé): place de la malnutrition protéino-énergétique et essai d'élaboration d'un score de diagnostic clinique.

Two cross-sectional studies were carried out in the pediatric ward of the Tokoin Teaching Hospital, Lome. One study determined the prevalence of HIV infection in the 49 malnourished patients treated in the ward in February to March and between August and December 1994. The other was carried out between July 1994 and January 1995 and included 57 other hospitalized children fulfilling at least one of the WHO's pediatric AIDS criteria. The aim was to draw up a screening system for pediatric AIDS based on clinical scores that would be more sensitive than and as specific as the WHO criteria. We tested these criteria and the other signs used in the suggested scoring system using the reference test, HIVchek. The seroprevalence of HIV was 28.6% in malnourished children and transmission was probably exclusively from mother to child. It was difficult to distinguish pediatric AIDS from protein energy malnutrition on clinical grounds, although some of the associated morbidities, including anemia, adenopathy and splenomegaly, were highly suggestive of pediatric AIDS. The second study showed that: 1) the sensitivity of the WHO criteria was low; 2) the best positive predictive values were obtained in cases of polyadenopathy and confirmed HIV infection of the mother. Both these criteria were relatively infrequent; 3) there were 6 criteria significantly associated with HIV infection, each being given a point score according to its Yule coefficient: chronic cough (4 points), chronic diarrhea (3 points), chronic fever (2 points), oropharyngeal candidiasis (2 points) and marasmus (1 point). A score of 4 points was the threshold for suspicion of pediatric AIDS. Our scoring system was more sensitive than the WHO criteria and had similar specificity and positive predictive value. We stress the importance of preventive measures against HIV infection, particularly for women of child-bearing age and suggest a new score test and appropriate clinical definitions for infants and older children.

SIDA de l'enfant dans le service de pédiatrie du CHU-Tokoin, Lomé (Togo): aspects cliniques et épidémiologiques

51 enfants souffrant de SIDA; hospitalises entre janvier 1991 et septembre 1992 dans le service de pediatrie du CHU-Tokoin (Lome); ont fait l'objet d'une analyse retrospective epidemiologique et clinique. Le sex-ratio a ete de 0;8 et l'age moyen de 25;64 mois (extremes: 2 mois et 15 ans). L'infection a HIV 1 s'est averee predominante (100 pour cent des cas). Sept enfants avaient un double profil serologique HIV1-HIV2. Diarrhee trainante; candidose oropharyngee; adenopathies; malnutrition proteino-energetique de type marasme et infections respiratoires (a germes banals et tuberculose pulmonaire) ont ete les dominantes pathologiques observees

Le diabete de l'enfant

Le diabete sucre de l'enfant est une maladie liee a un trouble de l'assimilation des glucides ou hydrates de carbone par l'organisme. On le differencie du diabete insipide du a un deficit en hormone antidiuretique qui se traduit par des urines abondantes et une soif intense mais la glycemie est normale et le sucre est absent des urines; diabete renal evoque quand il y a la presence du sucre dans les urines et une glycemie normale. Le diabete sucre apparait quand il y a une carence en insuline (cas du diabete insulino dependant) ou quand l'insuline est inefficace (cas du diabete non insulino dependant). Le diabete insulino dependant est le diabete du sujet jeune ou diabete maigre ou diabete de type 1 caracterise par une carence complete en insuline et necessitant une insulinotherapie quotidienne et a vie. Le diabete sucre est du a une predisposition genetique c'est-a-dire que l'enfant a un systeme HLA particulier avec les DR3DR4 situes sur le chromosome 6. Au cours de la vie de cet enfant; la moindre infection virale; le moindre choc psychologique; le moindre stress provoquent la destruction des cellules beta; des ilots de Langerhans du pancreas; qui secretent l'insuline. Quand 90 pour cent des cellules sont detruites; les signes cliniques apparaissent