Place du traitement de la trypanosomiase humaine africaine en Trypanosoma brucei gambiense dans l'elaboration de la strategie de lutte

Le but de cet article est de susciter une reflexion sur l'articulation logique des differentes activites de lutte contre la trypanosomiase humaine africaine; en fonction des moyens dont on dispose pour traiter les malades. En effet; on considere trop souvent le depistage comme une finalite; propre a satisfaire les statistiques et les bilans d'activites. L'auteur presente donc le traitement tel qu'il est administre au centre national et au centre regional de la Republique Centrafricaine

[Complications observed in the treatment of trypanosomiasis in the Congo]. / Accidents observés lors du traitement de la trypanosomiase au Congo.

The authors present the results obtained in the treatment of 453 sleeping sickness (T. gambiense) patients in the People's Republic of the Congo. They give the following conclusions: The mortality rate reaches 2,75% in the group of patients treated by melarsoprol and is nil in the group treated with pentamidin. The encephalitis rate is 2,1 per 100 series of melarsoprol. The treatment of encephalopathies with adrenaline according to the protocol of SINA gives very good results and should be generalized.

[Failures in the treatment of T. gambiense trypanosomiasis in the Congo]. / Les échecs du traitement de la trypanosomiase à T. gambiense au Congo.

The authors summarize the difficulties encountered in post-therapeutic follow-up of trypanosomiasis cases in the People's Republic of Congo. Systematic controls provide evidence of recontamination and relapses. The geographical distribution of cases indicates the existence of resistance in one village in the Niari district. Among the hypotheses advanced, resistance induced by pentamidine seems to be discarded.

[Demonstration of Cryptococcus neoformans in a fatal meningeal disease in the Congo]. / Mise en évidence de Cryptococcus neoformans dans une affection méningée mortelle au Congo.

Cryptococcus neoformans, mainly widespread in Occidental Europe, America and South East of Asia, was rarely described in African pathology. In Central Africa, it was isolated several times in Zaïre. All reported cases concern young people and present no associated pathology. A first fatal case, looking like an acute meningitis, was described in 1959, in a 18 years old Congolese girl. This second case discovered in Brazzaville in a 37 years old young man was a fatal encephalitis after a primary pneumopathy.

[Symptoms of human trypanosomiasis at the first diagnostic phase in the People Republic of Congo (author's transl)]. / La trypanosomiase humaine au moment du dépistage en république Populaire du Congo: distribution des signes cliniques.

A study of clinical symptoms of trypanosomiasis has been carried out on 317 patients diagnosed actively in the field by lymphatic gland puncture and fluorescent antibody test in two foci of People's Republic of the Congo. The presence and frequency of the signs have been evaluated according to the focus, age, sex, period, the level of disturbance of C.S.F. and the results of parasitology. Thus, the authors demonstrate that: --9 p. 100 of patients show symptoms; --symptomatology of the woman is richer than that of the man; --several symptoms are closely related to age (fever, glands hypertrophy, cramps, anorexia, liver and spleen enlargement, impotence). They point out moreover: --the precocity of nervous signs which often are shown by patients without any disturbance of C.S.F.; --the lack of correlation between apparent severity of the infection and the level of disturbance of C.S.F.; --the variation of frequency of adenopathy according to kinetics of endemic and the level of immunity of the populations. Finally, the results obtained in the field are compared with those given by health care deliveries.