Caractéristiques cliniques de la bronchopneumopathie chronique obstructive à l'Hopital d'Instruction des Armées Omar Bongo Ondimba

Il s'agit d'une étude rétrospective menée sur cinq ans à l'hôpital d'instruction des armées Omar Bongo Ondimba au cours de laquelle nous avons obtenu les résultats suivants : une prévalence de 0,78.Une prédominance masculine (68,9%), avec un âge moyen de 66 ans chez des patients présentant des co-morbidités à type de diabète (6,6%) et d'HTA (36,34%). La majorité des patients était des sans-emploi (31,45%). Les antécédents tabagiques (principale étiologie) étaient retrouvés dans 85% des cas avec 70% de fumeurs actifs et une consommation moyenne de 24±18 paquets/année.Le motif de consultation le plus fréquent était la dyspnée (50,8%) alors que le facteur favorisant prédominant était le tabac (83,6%). Mais les infections (surtout tuberculeuse) vienaient en seconde position (9,84%). L'anomalie radiologique la plus fréquente était l'emphysème centro lobulaire (30,51%). Les patients étaient pour la plupart au stade II (57,4%). Ils avaient quasiment tous bénéficié de beta 2 mimétiques (95,08%) et de corticothérapie inhalées (91,80%).La BPCO est une maladie chronique évolutive dont la principale cause reste le tabac (surtout en Occident). Mais la pollution et les infections post tuberculeuses ne doivent pas être négligées dans les pays en voie de développement. Ceci nécessite de la part des pouvoirs publics une mobilisation des ressources humaines et financières avec intégration de la BPCO dans le programme de santé publique. Le dépistage (peak Flow dans les salles de consultation) et la prise en charge des patients doivent être assurés. Il faut élaborer un cadre législatif anti-tabac et renforcer les moyens préventifs et thérapeutiques de la lutte contre la tuberculose

[Mycoplasma pneumoniae encephalitis successfully treated by levofloxacin]. / Méningo-encéphalite aiguë à Mycoplasma pneumoniae de l'adulte traitée avec succès par lévofloxacine.

INTRODUCTION: Mycoplasma pneumonia (MP) infection may be associated with several neurological complications. Encephalitis, which affects children and rarely young adults, is the most frequent. CASE REPORT: A 23-year-old man was admitted for pneumonia with encephalitis. Mycoplasma pneumoniae infection was documented by serology, and polymerase chain reaction in the cerebrospinal fluid. Despite serious initial presentation, outcome was favourable with levofloxacin treatment. CONCLUSION: MP infection should be considered as a potential aetiology in acute encephalitis in young people and in individuals with respiratory symptoms. Antibiotic therapy (fluoroquinolones or macrolides) should be used if MP is strongly suspected or in case of severe acute meningo-encephalitis.

[Multifocal pyomyositis after being hit by a truncheon in Gabon]. / Pyomyosite multifocale après coups de matraque au Gabon.

Pyomyositis is an acute primary bacterial infection of striated muscle. It affects mainly but not only immunocompromised patients, especially in tropical areas. The responsible microbe is often found to be Staphylococcus aureus. We report here the case of an immunocompetent 17-year-old with multifocal pyomyositis from which S. aureus was isolated two weeks after he was hit with a truncheon.

[Mycoplasma pneumoniae: a cause of febrile hemolytic anemia in travelers]. / Mycoplasma pneumoniae: une cause d'hémolyse fébrile chez le voyageur.

Mycoplasma pneumoniae can cause varied hematologic manifestations that are frequently associated with lower respiratory tract infections. Acute febrile hemolysis without respiratory symptoms is quite rare. We describe the case of a 25-year-old man, admitted for acute fever with hemolysis, after returning from Djibouti. M. pneumoniae infection was proved by serological testing. A favorable outcome followed macrolide treatment.

[Multi-resistant tuberculosis at the hôpital d'instruction des armées de Libreville (Gabon) about 16 cases]. / Tuberculose multirésistante à l'hôpital d'instruction des armées de Libreville (Gabon) à propos de 16 cas.

According to WHO estimates, between 1 and 20% of tuberculosis cases in the world are multiresistant. In Gabon, this prevalence is estimated at 1.9%. In this forward-looking study from March 2006 to August 2010, we report 16 cases of multi-resistant tuberculosis out of 24 suspected resistant samples (persistence of the clinical and radiological signs after three months of well conducted treatment with first-line anti-tuberculous drugs). This study is realized in association with the laboratory of mycobacterium of the Percy military teaching hospital, Clamart, France.

[Pleuropulmonary manifestations of necrotising vasculitis]. / Manifestations pleuropulmonaires des vascularites nécrosantes.

The pleuropulmonary manifestations of necrotising vasculitis are frequent and polymorphic. If the existence of extrapulmonary signs and the presence of neutrophil polynuclear anticytoplasmic antibodies are helpful for the diagnosis of a bout of vasculitis, the existence of pleuropulmonary symptoms can also make for discussion of infections or iatrogenic effects induced by immunosuppressive treatments.

[Hematological disorders and hypereosinophilias]. / Hyperéosinophilies et affections hématologiques.

Hematological disorders are the third cause of hypereosinophilia, after allergic and parasitic diseases. Hematological disorders associated with hypereosinophilias can be classified as clonal, reactive or idiopathic, and recently the improvements of cytogenetic, molecular biology and immunology have allowed to revisit numerous cases previously diagnosed as idiopathic hypereosinophilic syndrome. Reactive eosinophilias are mainly associated with lymphoma or abnormal, often clonal T lymphoid population. Clonal eosinophilia is related either to various myeloid malignancies or to a genuine myeloproliferative disorder from the eosinophile lineage, the so-called chronic eosinophilic leukaemia. Chronic eosinophilic leukaemia can be associated with recurrent genes rearrangements involving PDGFRA, PDGFRB and FGFR1 or with clonal abnormalities not yet categorized. Idiopathic hypereosinophilic syndrome remains an exclusive diagnosis in presence of moderate or severe unexplained eosinophilia with target organ damage. The purpose of the diagnostic work-up of hypereosinophilic syndrome is to evidence either an abnormal T cell population or a clonal haematopoiesis. Imatinib mesylate dramatically improves chronic eosinophilic leukaemias associated with PDGFR abnormalities, while corticosteroids are still the main treatment for the other patients. In a near future, advances could arise from identification of new genes involved in clonal eosinophilia or in alternative therapy such as the anti-IL-5 antibodies.