Survenue du VIH et du VHB dans une cohorte d'enfants drepanocytaires transfuses au Complexe Pediatrique de Bangui

Objectif : Evaluer les risques d'infection par le VIH et le VHB au cours des transfusions chez l'enfant drepanocytaire a Bangui. Cadre et Methode : L'etude; prospective; s'est deroulee au Complexe Pediatrique de Bangui d'octobre 2008 au mois d'aout 2009. Elle a porte sur 98 enfants drepanocytaires ages de 18 mois a 18 ans ; apres consentement des parents. Une evaluation clinique et des tests serologiques pour la recherche du VIH et de l'antigene HBs ont ete realises avant et apres transfusion sanguine lors d'un suivi en hospitalisation et en ambulatoire. Resultats : Parmi les 98 patients recrutes dont 35 (35;7) garcons; soixante quatre (65) d'entre eux etaient ages de moins de 5 ans et la quasi-totalite (99) etait porteur d'hemoglobine SS. Le paludisme; retrouve chez 58;2 des patients; occupait le 1er rang parmi les pathologies associees. Lors des transfusions realisees; six (6) des enfants ont ete contamines par le VIH; et 14 (14;3) par le VHB. Un nombre de transfusion superieur ou egal a 3 chez un meme enfant etait significativement associe a la transmission du virus de l'hepatite B. Conclusion : Ce risque de contamination recommande le renforcement de la communaute pour des soins essentiels de base aux patients atteints de drepanocytose

Réduction de la mortalité infanto-juvénile par une meilleure prise en charge de la malnutrition et du VIH

En RCA, il est globalement ressorti des différents rapports de suivi des indicateurs des OMD que les progrès sont les plus lents en ce qui concerne l'OMD1 (Eradiquer l'extrême pauvreté et la faim), l´OMD 4 (Réduire la mortalité des enfants de moins de 5 ans), l'OMD 5 (Améliorer la santé maternelle) et l'OMD 6 (Combattre le VIH/Sida, le Paludisme et les autres maladies). A l'heure actuelle, dans la plupart des pays à ressources limitées, le cercle vicieux reliant la malnutrition au VIH/SIDA sous tendue par la pauvreté potentialise la mortalité infanto-juvénile. Mondialement, le taux de mortalité des enfants de moins de 5 ans a été réduit de 35 %, passant de 88‰ en 1990 à 57,2 ‰ en 2010 malgré l'accroissement de la population.

Prevalence of shigellosis diarrhoea in a paediatrics population: hospital based survey in Bangui, Central African Republic.

INTRODUCTION: Shigellosis is still a major public health problem in sub-Saharan countries, especially among children. METHODOLOGY: The prevalence of shigellosis in children presenting with diarrhoea in the Complexe Pédiatrique de Bangui, Central African Republic, was determined. Stools were analyzed in the bacteriology laboratory of the Institut Pasteur de Bangui, Central African Republic, where identification of Shigella species and analysis of antibiotics susceptibility were performed. RESULTS: A total of 15 strains of Shigella were isolated from 156 stools; Shigella flexneri was the only species found. Two infected children died of dehydration. Most strains were resistant to antibiotics except quinolones, which were active on all of these strains. CONCLUSIONS: The control of Shigella infections should be reinforced in Bangui, and accurate, affordable and rapid methods of diagnosis would be helpful.

Acute bacterial meningitis at the 'Complexe Pédiatrique' of Bangui, Central African Republic.

To precis the aetiologies of children meningitis and the susceptibility to antibiotics of bacteria responsible for meningitis in Bangui, we conducted a prospective study between October 2004 and September 2005, at the 'Complexe Pédiatrique de Bangui', Central African Republic (CAR). Children from 1 day to 16 years with suspected meningitis and who underwent a lumbar puncture were enrolled. Gram staining, culture on chocolate blood medium, cell count, biochemistry (protein level, glucose ratio), capsular antigen detection were performed for each cerebrospinal fluid. MICs were determined by the E-test method. Four hundred and seventeen patients were enrolled during the study period; 130 were proven acute bacterial meningitis and 37 probable bacterial meningitis. Among proven bacterial meningitis, Streptococcus pneumoniae was the most common organism responsible for meningitis (62 cases, 48%) followed by Haemophilus influenzae (46 cases, 35%) and by Neisseria meningitidis and Salmonella sp. (8 cases, 6% each). Ninety-four percent and 96% of S. pneumoniae strains tested remain susceptible to benzylpenicilline and chloramphenicol, respectively. A beta-lactamase was detected in 92% of H. influenzae strains tested. However, MICs 50% and 90% for amoxicillin were found to be 1 and 4 mg/l, respectively and 33% of these strains were resistant to chloramphenicol. The global mortality rate was 35% (59/167). This mortality rate was 47% for S. pneumoniae, 33% for H. influenzae, 62% for Salmonella sp. and 13% for N. meningitidis. The probabilistic treatment with ampicillin and chloramphenicol usually administered for children meningitis in Bangui must be reconsidered particularly in cases of H. influenzae meningitis. It is of importance to reduce the presentation delays of children with suspected meningitis in Bangui. The H. influenzae b immunization would allow a dramatic reduction of meningitis cases and deaths in Central African children.