[Chylous ascites, a revealing sign of peritoneal tuberculosis in an 11-month-old infant]. / Ascite chyleuse révélatrice d'une tuberculose péritonéale chez un nourrisson de 11 mois.

Chylous ascites is rare in children. We report on a case of chylous ascites in an 1-month-old infant in Togo. The infant had been appropriately vaccinated, had normal growth and psychomotor development, and he was living in a rural area. He had fever that had started 3 months earlier and persisted despite various treatments with antimalarials and antibiotics. Then progressively abdominal pain with abdominal distension developed, while lactescent ascites was discovered after puncture. The patient was referred to the Lomé teaching hospital for advanced management. Intradermic reaction to tuberculin (IRD) was positive (16 mm). Chylous ascites liquid analysis revealed apparently lymphocytic pleocytosis. Culture on special milieu allowed isolation of Mycobacterium tuberculosis. The clinical course was favorable with antituberculosis treatment. Peritoneal tuberculosis should be suspected in endemic areas in the case of a persistent fever with abdominal bloating and effusion, whatever the patient's age and the nature of ascites liquid.

[Follow-up of HIV-infected children receiving antiretroviral therapy in a rural area of Togo]. / Suivi des enfants infectés par le VIH/sida sous traitement antirétroviral en milieu rural au Togo.

OBJECTIVE: To evaluate the monitoring of HIV-infected children receiving antiretroviral therapy in rural areas of Togo and the effectiveness of the treatment. METHODS: This retrospective descriptive study, conducted at the Luis Scrosospi Center in Kouvé from 15 November, 2008, through 14 November, 2009, examined the records of children who had been receiving antiretroviral therapy for at least 6 months. RESULTS: We studied the records of 55 children. The sex ratio was 0.9, and the primary opportunistic infections were respiratory infections and malaria. At treatment initiation, their average age was 6 years and 3 months, the average CD4 T cell count 358/mm(3), and the mean weight 12.9 kg. The hemoglobin level was less than 8 g/dL in 31%. All children received a nutritional kit monthly. The antiretroviral therapy for 52 children was a combination of stavudine, lamivudine, and nevirapine. The adherence rate during the first 12 months was 80% (44/55 children). The mean weight gain was 860 g (below -3SD) at 3 months, 1,550 g (between -3SD and -2SD) at 6 months, and 1 270 g (between -2SD and -1SD) at 12 months of treatment. The severe acute malnutrition rate fell from 60% at treatment initiation to 56% at 3 months, 47% at 6 months, and 25% at 12 months. Also after 12 months, the CD4 T cell count had risen in 60% of the children. The main side effects were peripheral neuropathy (29%) and headaches (18%). Eight children died (14%) during the follow-up. CONCLUSION: Monitoring of HIV-infected children on antiretroviral therapy is possible in Togo's rural areas and should be encouraged for it will help to achieve the Millennium Development Goals.

[Tuberculosis in the newborn: recrudescence in areas with high endemic HIV infection]. / Tuberculose du nouveau-né: résurgence en milieu de forte endémie de VIH.

Despite the rising prevalence of tuberculosis due in part to the HIV pandemic in Africa, there have been few reports describing neonatal or congenital tuberculosis and its association with maternal HIV infection has been rare. The purpose of this study was to evaluate the clinical and epidemiological features of tuberculosis in newborns from areas with high endemic rates of both tuberculosis and HIV infection. During the 2-year study period all neonates admitted to the Campus Teaching Hospital in Lomé, Togo for differential diagnosis of symptoms compatible with tuberculosis were investigated. The clinical profile of tuberculosis in the newborn was correlated with that of the mother with or without HIV infection. Perinatal tuberculosis was diagnosed in 13 of the 79 newborns investigated including 8 whose mothers were co-infected by HIV and tuberculosis. Seven cases were classified as congenital tuberculosis. The predominant clinical features were respiratory distress (10/13), fever (9/13), hepatomegaly (9/13), intra-uterine growth retardation (8/13), stagnation or loss of weight (6/13), cough (4/13) and splenomegaly (4/13). Diagnosis of maternal HIV and tuberculosis infection was never made prior to newborn admission to our department. Four newborns and two mothers died within 3 months after childbirth. This study on perinatal tuberculosis in children born to mothers with or without HIV infection demonstrates the need for early diagnostic methods, consensual therapeutic protocols, and further study in larger geographical area to specify epidemiologic features and reduce high mortality.

Tuberculose du nouveau-né: Résurgence en milieu de forte épidémie de VIH

Malgré l'augmentation de la fréquence de la tuberculose en Afrique,due en partie à la pandémie duVIH,les publications sur la tuberculose néonatale ou congénitale restent rares et peu en rapport avec l'infectionVIH de la mère. Evaluer les aspects épidémiologiques et cliniques dela tuberculose du nouveau-né dans une loca-lité de forte endémie de VIH et de tuberculose,tel a été le but assigné à cette étude. Durant deux ans,tout nou-veau-né admis au Centre hospitalier universitaire-Campus de Lomé pour des signes faisant discuter le diagnos-tic de tuberculoseabénéficié d'une ex p l o ration.Le pro filclinique de latuberculose du nouveau-né et ses rap p o rt savec celle de la mère infectée ou non par le VIH ont été déterminés. Des 79 nouveau-nés ainsi explorés,13 avaientune tuberculose néonatale. Huit d'entre eux sont nés de mère infectée par le VIH et la tuberculose. Sept étaientatteints de tuberculose congénitale. Les signes cliniques prédominants étaient :la détresse respiratoire (10/13),lafi è v re (9/13),l ' h é p at o m é galie(9/13),le re t a rd de croissanceintra - u t é rine (8/13),la stag n ation ou la perte depoids( 6 / 1 3 ) ,latoux(4/13) et lasplénomégalie (4/13). Chez aucune desmèresle diagnostic de VIH et de tuberculose n'étaitétabli avant l'admission de leurs nouveau-nés. Quatre nouveau-nés et deux mères sont décédés au cours des troismois suivant l'accouchement. Cette étude de la tuberculose du nouveau-né de mère infectée ou non par le VIHdemande des méthodes de diagnostic précoce,des protocoles thérapeutiques consensuels et d'autres études surchamp géographique étendu pour en préciser l'épidémiologie et réduire la forte létalité