Epidemiological and clinical profile of intestinal parasitosis of children in rural areas in Central African Republic.

OBJECTIVE: To describe the epidemiological and clinical profile of intestinal parasites in children in rural Central African Republic. PATIENTS AND METHODS: We conducted a multicenter cross-sectional study in Central African Republic rural areas. Children seen as outpatients regardless of the reason for consultation were included in the study after parental consent. Each stool sample sent to the laboratory in a plastic pot was subjected to a direct co-examination with physiological water. RESULTS: A total of 102 children were included in the study, of whom 53 were boys (51.96%), the median age was 4 years (3 months; 15 years old). They had a primary level of education in 31.37% of cases, 76.47% came from Health Region 1. Drilling was the source of drinking water in 61.76% of cases and the backwater was used for bathing by 26.47% of children. Abdominal pain was observed in 55 children (53.92%). The prevalence of intestinal parasitosis was 88.23%. Of 122 identified parasites, 96 were helminths (78.69%) and 26 were protozoa (21.31%). Of the three protozoan species isolated, Entamoeba histolytica was found in 15 cases (14.70%). The most common helminthiasis was Ascaris lumbricoides (40.19%). The frequency of parasitic infection was 92% in children aged from 5 to 9 years. Mono-parasitism was observed in 52.94% versus 33.33% for poly-parasitism. CONCLUSION: Intestinal parasitosis is a public health problem in Central African Republic rural areas. Improving access to drinking water for populations could reduce the magnitude of these diseases.

[Cryptococcal neuromeningitidis in HIV-infected patients in Bangui, in the era of antiretroviral treatment]. / La cryptococcose neuroméningée au cours de l'infection à VIH à Bangui, à l'ère du traitement antirétroviral.

The cryptococcal neuromeningitis is the most common fungal meningitis infections in the course of HIV/AIDS. This is the number two of opportunist infection of the central nervous system. The authors post the outcomes of a retrospective study conducted related to 122 cases of cryptococcal neuromeningitis observed over for four years ago, in Bangui in the Central African Republic, this at time when antiretroviral treatment has been avaible, corresponding to a prevalence of 6.5%. These infections very aften occur more in female folk, and to patients whose average age is 35 years old, ranging from 18 to 69 years old. The clinical symptoms often found had been headache (98,3.%), fever (95.0%), the impairing of the overall condition of the patient (86.7%) and neck stiffness (85.9%). It makes sense to notice that comorbidity case alowgwith tuberculosis, intestinal candidiasis, bacterial pneumonia and Kaposi's diseases were found out. The screening of the cerebrospinal fluid showed a sound cell count and even low count in 12.2% of cases. Direct examination of cerebrospinal fluid with India ink helps in diagnosis of 97.5% of cases, and the culture carried out from 74 patients was in any case positive. This culture allowed the diagnosis of three patients whose examination along side with India ink has been negative. The CD4 cell count was less than 100/mm(3) in 97.7% of cases. The rate of the fatality cases has been 66.4%, it has been badly impacted by a CD4 count <50/mm(3) and the lack of antiretroviral therapy. Despite the establishment of a national antiretroviral treatment program to do influence the frequency of opportunistic infections whose cryptococcal neuromeningitis, this condition is still present although it is declining. The clinical variability of this disease requires early diagnosis to avoid delayed treatment corollary of a very high mortality as we have observed.

[Current aspects of pediatric and adult tetanus in Dakar]. / Aspects actuels du tétanos de l'enfant et de l'adulte à Dakar.

OBJECTIVE: This retrospective study was undertaken to assess epidemiological and clinical aspects as well as outcome of tetanus cases in patients over 28 days of age, so as to issue recommendations. PATIENTS AND METHODS: This study included patients admitted to the Fann teaching hospital in Dakar from 2001 to 2003. Age, sex, portal of entry, clinical signs, delay from onset to admission, stage and outcome of the tetanus were recorded. RESULTS: 410 cases of tetanus were observed. The sex-ratio was 2.41. The mean age was 20 years [range 2 months-89 years]. Sixty-two percent of the patients were between six and 30 years of age. Most of the patients were workers and craftsmen (58%) or pupils (19%). A wound was the most frequent portal of entry (73%). Tetanus was localized in four out of 406 cases. The global mortality rate was 22%; but it was higher when tetanus was stage III and in case of complications. CONCLUSION: According to these results, it seems necessary to include booster doses in the Expanded Immunization Program, and to implement better prevention strategies targeting people not taken into account in this program. In addition, health care providers should check out the immunization status of their patients and accordingly offer an update or a full course of active immunization.