[Pulmonary tuberculosis in infants in Brazzaville, Congo. A review of 117 cases]. / Tuberculose pulmonaire du nourrisson à Brazzaville (congo). A propos de 117 cas.

Little information is available on pulmonary tuberculosis in infants in sub-Saharan Africa. This retrospective study was conducted in infants ranging in age from 1 to 23 months admitted to the Paediatric Departments of the University Hospital Centre in Brazzaville, Congo for pulmonary tuberculosis between January 1, 1999 and July 1, 2004. Tuberculosis was diagnosed on the basis of epidemiological, clinical, radiological, and follow-up data. All children over 12 months old underwent HIV testing. In case of positive test results, children between the ages of 12 and 18 months were retested after the age of 18 months. Of a total of 803 children admitted for tuberculosis during the study period, 117 (14.6%) were under the age of 24 months (53% males). Mean age was 17.5 months. The BCG test was mentioned in 75.2% of cases. Determination of the contagion in 50.4% of cases indicated that transmission was intrafamilial in 69.3% of cases. The mean delay for hospitalization was 2.6 months (range, 21 days to 16 months). Eighty-one patients (69.2%) presented severe malnutrition. Intrathoracic forms accounted for most cases with bronchopneumopathy (72.6%) and mediastinal adenopathy (40.2%). The incidence of bronchopneumonopathy and isolated forms was significantly higher in children over one year old than in children under one year old: 78.3% versus 21.7 % (p<0.01) and 62.8% versus 37.2% (p<0.001) respectively. A total of 35 children (43.8%) over the age of 12 months presented HIV infection. In comparison with HIV-negative children, HIV-positive children were more likely to present malnutrition and presented a statistically higher incidence of mediastinal adenopathy and multifocal forms. All associated extrathoracic lesions (21.4% of cases) occurred in HIV-positive children. Outcome was favourable in all HIV-negative children while 7 HIV-positive children (20%) died during treatment. Pulmonary tuberculosis in infants in Brazzaville is characterized by frequent association with HIV infection and prognosis is more severe in case of HIV co-infection.

Tuberculose pulmonaire du nourrisson a Brazzaville (Congo). A propos de 117 cas

La tuberculose pulmonaire du nourrisson est peu documentee en Afrique subsaharienne. Nous avons realise une etude retrospective chez les enfants ages de 1 a 23 mois; admis pour tuberculose pulmonaire dans les services de Pediatrie du CHU de Brazzaville entre le 1e janvier 1999 et le 1e juillet 2004. La tuberculose etait diagnostiquee sur des arguments epidemiologiques; cliniques; radiologiques et evolutifs. Tous les enfants ages de plus de 12 mois avaient beneficie d'une serologie VIH. En cas de positivite; les enfants entre 12 et 18 mois etaient testes a nouveau apres l'age de 18 mois. Parmi 803 enfants admis pour tuberculose; 117 (14;6) etaient ages de moins de 24 mois (53de garcons) ; leur age moyen etait de 17;5 mois. La notion de BCG etait relevee dans 75;2des cas. Le contage tuberculeux; note dans 50;4des cas; etait le plus souvent intrafamilial (69;3des cas). Le delai moyen de recours a l'hopital etait de 2;6 mois (extremes : 21 jours - 16mois). Une malnutrition severe etait presente chez 81 patients (69;2). Les formes intra-thoraciques etaient dominees par les broncho-pneumonies (72;6) et les adenopathies mediastinales (40;2). Au dessus de un an; la bronchopneumonie etait significativement plus frequente (78;3versus 21;7; p 0;01) et les formes isolees etaient significativement plus frequentes (62;8versus 37;2; p 0;001) que chez les enfants de moins de un an. Une infection a VIH-1 existait chez 35 enfants (43;8) de plus de 12 mois. Par rapport aux enfants seronegatifs; les enfants infectes par le VIH etaient plus souvent malnutris; et ils avaient une frequence statistiquement plus elevee d'adenopathies mediastinales et de formes multifocales. Tous les enfants seronegatifs ont gueri; tandis que 7 enfants infectes par le VIH (20) sont decedes en cours du traitement. La tuberculose pulmonaire du nourrisson a Brazzaville se caracterise par son association frequente au VIH et par la severite du pronostic en cas de co-infection par le VIH

[Pubertal development in girls with homozygote sickle cell disease. Apropos of 72 cases]. / Développement pubertaire chez la fille drépanocytaire homozygote. A propos de 72 cas.

We carried out a case-control study to investigate the sexual maturation of girls suffering from homozygous sickle cell disease: 72 cases aged 10 to 18 years were compared to 40 controls of the same age. We obtained the following results: In cases, there was a significant delay in signs of physical maturation; puffiness of the mammary glands at 14.4 years +/- 1 (as versus 12.4 years +/- 1.5 in controls); pubarche occurred at 14.2 years +/- 1. Menarche occurred on average at 15.2 years +/- 1.6 (as versus 13.4 years +/- 1.4 for controls) and the lack of the menarche between the ages of 14 and 18 years was observed in 71% of cases as versus 10% of controls. At age 16, only 1% and 3% of cases were respectively at the stage of S5 and P5 as versus 40% for the controls. Thus, 37% of girls suffering from homozygous sickle cell disease were not sexually mature, whereas all controls had reached sexual maturation by the age of 14. In cases, weight remained low, and waist line and the body shape poorly developed in comparison to controls'. The examination by scanner of the pelvis of 20 girls suffering from homozygous sickle cell girls that in 25% of the cases, the ovaries of non mature girls were relatively small.