Prevalence and genetic variants of hepatitis GB-C/HG and TT viruses in Gabon, equatorial Africa.

The distribution of Hepatitis GB-C/HG (GB-C/HG) and TT viruses (TTV) infections was investigated in selected populations from Gabon using Polymerase Chain Reaction (PCR) and Enzyme Linked Immunosorbent Assay (ELISA) for anti-Envelop 2 (anti-E2) GBV-C/HGV antibodies. Among pregnant women, 29 of 229 (12.6%) were Hepatitis GB virus-C and Hepatitis G virus (GBV-C/HGV) RNA positive (+) and 32 of 81 (39.5%) anti-E2 + versus 8 of 39 (20.5%) TTV DNA +. Among sickle cell anemia patients, 9.7% (3/31) were GBV-C/HGV RNA + versus 22.5% (7/31) TTV DNA +. For tuberculosis patients, the figures were 11.5% (4/35) and 0%. A study of hepatocellular carcinoma cases (n = 27) versus controls (n = 66) did not show significant differences for GBV-C/HGV RNA (10.7% versus 12.1%) and TTV DNA (44.4% versus 30.3%). According to phylogenetic analysis, the 15 GBV-C/HGV strains investigated clustered in group 1, the most common in sub-Saharan Africa whereas TTV sequences (n = 4) mostly clustered in genotypes G1 and one close to genotype G3. In the Gabonese populations investigated, GBV-C/HGV and TTV infections were highly endemic. These data are consistent with the low pathogenicity of these agents.

[Types of sugar diabetes encountered in internal medicine in Gabon]. / Typologie des diabètes sucrés rencontrés en medecine interne au Gabon.

In the 108 patients with diabetes (75 men and 33 women between the ages of 15 and 86 years) hospitalized in the Internal Medicine Department of the Libreville Hospital Center between January 1, 1989 and December 31, 1991, 53 were easily classified, 12 being due to alcohol-induced chronic calcific pancreatitis, two to insulin-dependent diabetes, and 39 to non-insulin-dependent diabetes. Fifty-five patients treated with insulin were not immediately classifiable including 11 who were obese and probably should not have required insulin. In the remaining 44 patients who were not overweight, the youngest often presented features comparable to those observed in patients with chronic calcific pancreatitis except with regard to calcification. Most of the older patients were women in whom diagnosis was coincidental. These findings indicate that authentic insulin-dependent diabetes is uncommon, that non-insulin-dependent diabetes are frequent, and that the endocrine pancreas is particularly susceptible to alcohol abuse.

[Mycosis fungoides in a Gabonese patient infected with HTLV-I]. / Mycosis fongoïde chez une gabonaise infectée par le HTLV-I.

Association of human T-lymphotropic virus type-1 (HTLV-1) with T-cell malignancy is well-known but its relationship with mycosis fungoides is controversial. Typical mycosis fungoides was diagnosed at tumor stage in a 58-year-old Gabonese woman also infected with HTLV-1. Infection with lymphoma of the skin is uncommon in Africa but it is probably underestimated. Association of mycosis fungoides with retrovirus infection could be coincidental since there is a high prevalence of HTLV-1 in Gabon and the only currently recognized association is T-cell leukemia/lymphoma. However recent data indicate the presence of similar retrovirus particles and a common tax gene in the monocytes of most patients presenting mycosis fungoides.

[Distribution of glycosylated hemoglobin (HbA1) in an internal medicine service in Gabon]. / Distribution de l'hémoglobine glyquée (HbA1) en médecine interne au Gabon.

Measurement of glycated hemoglobin (HbA1) concentration is commonly recommended to monitor diabetes, but the relevance of this parameter in some black African populations is questionable. To assess the suitability of this test and study factors affecting HbA1 concentration, we measured HbA1 concentration in 297 consecutive patients (185 men and 112 women) hospitalized in the Internal Medicine Department of the Libreville Hospital Center in Gabon. Distribution of HbA1 was asymmetric with a median at 7.2% (IC95: 6.8-7.6%). Metabolic abnormalities associated with diabetes, renal insufficiency, hyper-bilirubinemia and hypertriglyceridemia were not preferentially correlated with a distribution of HbA1 concentration above the normal threshold of 7.5 %. Elevated concentration were observed in 81 patients presenting no abnormalities. These findings was not due ro technical problems, alcohol abuse, or aspirin intake or to congenital hematologic abnormalities that have been documented in Gabon. On the other hand, an increase in glycation secondary to latent infection which is frequent in tropical areas may partially explain these findings. Regardless of the explanation, HbA1 appears to be unsuitable for monitoring diabetes in this population group.

Premiere description du syndrome de ZOLLINGER-ELLISON au Gabon. [Lettre]

L'observation d'une patiente de 54 ans presentant un syndrome de ZOLLINGER-ELLISON est rapportee. C'est le premier cas decrit en Afrique Centrale. Sa localisation ganglionnaire en fait un cas frequent dans la litterature. A cet effet; les aspects diagnostiques et therapeutiques sont discutes

[First clinical and serological description of leptospirosis in Gabon]. / Première description clinique et sérologique de la leptospirose au Gabon.

We report the first case of leptospirosis describe in Gabon. Several environmental factors could favour the transmission of the disease in that country.

[Evaluation of 3 tests applied in the immunological diagnosis of hepatic amebiasis in Gabon]. / Evaluation de trois tests appliqués au diagnostic immunologique de l'amibiase hépatique au Gabon.

The diagnosis of hepatic amoebiasis is not always easy. In case of suspicion of hepatic amoebiasis in an endemic area, the patient is immediately treated with a 5-nitroimidazole. Immunological diagnosis is indispensable. After a comparative study of BLA, IHA and IFA reactions, the BLA test has shown to be well adapted to the context of a country with insufficient sanitary infrastructure. The BLA test is easily performed and enables rapid detection of antibodies. The result obtained in about 5 minutes allows to adjust the therapeutic conduct.

Serological tests in cerebrospinal fluid for congenital syphilis in central Africa.

Serological tests were performed in the cerebrospinal fluid (CSF) of 13 children with active congenital syphilis (presence of specific IgM FTA-ABS antibodies) and of seven seropositive children with no active syphilis (FTA-ABS IgM-negative) born to syphilitic treated mothers in Libreville, Gabon. Antibodies against treponema were measured by the Venereal Disease Research Laboratory test (VDRL), the Treponema pallidum haemagglutination assay (TPHA) and the fluorescent treponema antibody absorption tests (FTA-ABS IgG and IgM). Of the 13 children with active syphilis, seven had a positive FTA-ABS IgG in the CSF. The result of this test was not correlated with the severity of clinical features, CSF protein levels or number of CSF white blood cells. The CSF-TPHA test was positive in four out of 12 children, and the CSF-VDRL test was negative in all the children with active congenital syphilis. One of the seven newborns with mother-transmitted antibodies had a positive FTA-ABS and TPHA in the CSF. These data show that the VDRL is not sensitive enough to diagnose congenital neurosyphilis, and that FTA-ABS or, at least, TPHA are convenient, sometimes with false-positive results, when a sophisticated method of detecting specific IgM in CSF is not available.

[Characteristics of the development of insulin need in primary diabetes of adults in Gabon]. / Particularités de l'évolution des besoins en insuline dans le diabète primitif de l'adulte au Gabon.

In a span of 18 months 48 Gabonese adults with apparent primary diabetes were studied at the University Hospital of Libreville. 23 patients were first seen at the time of the clinical onset of the disease and 25 others were treated with insulin before their first hospitalization during this period. Initial insulin therapy seemed necessary for all the subjects but equilibration was generally easy and insulin could be discontinued in most cases after several months of treatment. These subjects did not fit the criteria for the classical insulin-dependent or non-insulin-dependent forms of diabetes and they had no antecedent of malnutrition. The acute clinical presentation might have been due to failing insulin secretion secondary to hyperglycemic beta-cell toxicity. Such an evolution has already been described in some black American diabetics with a family link. So, genetic factors could be essential in atypical forms of diabetes mellitus in Africa.

[Primary non-Hodgkin malignant lymphoma of the spleen in Africa. Apropos of 2 probable cases]. / Les lymphomes malins non Hodgkiniens primitifs de la rate en Afrique. A propos de deux cas probables.

The authors report two cases of primary splenic presentation of malignant lymphoma in Gabon. This disease seems very uncommon but its frequency is perhaps underestimated in Africa. The hypothesis of a possible relation with tropical splenomegaly deserves consideration. At the beginning of the disease large cell types follow a local growing pattern but symptoms are already obvious. Therefore early diagnosis would permit curative splenectomy.

[Meningeal attacks during the course of congenital syphilis and therapeutic consequences]. / Atteinte méningée au cours de la syphilis congénitale et conséquences thérapeutiques.

In a study carried out in Gabon, antibodies against the treponema were looked for in the cerebrospinal fluid (CSF) in 13 children with active congenital syphilis (presence of specific IgM antibodies) and in 7 children with positive serologic reactions reflecting transplacental passage of maternal antibodies. Serologic reactions used included the VDRL test, the TPHA test, and the FTA-ABS IgG and IgM tests. Among the 13 children with syphilis, 7 had a positive FTA-ABS IgG test in the CSF without correlation with severity of clinical features, CSF protein levels or CSF cytologic findings. The TPHA test was positive in only four children and the VDRL test was always negative. Passage of antibodies into the CSF is possible (1 case in this study after treatment of the mother), but TPHA is helpful in developing countries of research of neurosyphilis.

[Results of a systematic search for Plasmodium in internal medicine in Gabon]. / Résultats d'une recherche systématique d'hématozoaires en médecine interne au Gabon.

Among 158 adults hospitalized at the University Hospital of Libreville who did not receive any treatment against malaria before blood screening, 20 were carriers of malaria parasites. Plasmodium falciparum was seen in 19 cases with a parasitic density lower than 1,000 trophozoits/mm3 of blood in 18 cases. The most important prevalence was observed into the group of older people. In most cases symptoms related to malaria did not occur during the hospitalization. We conclude that, in such patients, a parasitic density lower than 1,000 trophozoits/mm3 is not sufficient to assess the diagnosis of malaria and does not deserve systematic treatment.

[Specific serologic reactions in the cerebrospinal fluid in congenital syphilis and therapeutic implications]. / Réactions sérologiques spécifiques dans le liquide céphalorachidien au cours de la syphilis congénitale et conséquences thérapeutiques.

In a study carried out in Gabon, antibodies against the treponema were looked for in the cerebrospinal fluid (CSF) in 13 children with active congenital syphilis (presence of specific IgM antibodies) and in 7 children with positive serologic reactions reflecting transplacental passage of maternal antibodies. Serologic reactions used included the VDRL test, the TPHA test, and the FTA-ABS IgG and IgM tests. Among the 13 children with syphilis, 7 had a positive FTA-ABS IgG test in the CSF; positivity of this test was not correlated with severity of clinical features, CSF protein levels or CSF cytologic findings. The TPHA test was positive in only four children and the VDRL test was consistently negative. These findings are similar to those reported in another group of patients with meningeal involvement proven by the demonstration of IgM in the CSF using recent techniques. Passage of antibodies into the CSF is possible (1 case in this study) but for safety patients with specific IgG in the CSF should be given penicillin in a dosage that provides treponema-killing levels in situ (100,000 U/kg/d). Use of this dosage is recommended whenever sensitive techniques for CSF analysis are not available.

[Acquired immunodeficiency syndrome (AIDS) in Gabon. Apropos of 23 cases at the internal medicine service of the hospital centers in Libreville and Franceville, 1985-1987]. / Le syndrome d'immunodépression acquise (SIDA) au Gabon. A propos de 23 cas dans les services de médecine interne des Centres Hospitaliers de Libreville et de Franceville de 1985 à 1987.

In 1986 prevalence rates of anti-HIV1 antibodies in randomly selected asymptomatic gabonese population ranged from 0.2% in rural areas to, 1.8% in Libreville (the largest town). We report the first description of AIDS cases observed in the hospitals of Libreville and Franceville between 1985 and 1987. 23 patients (14 males, 9 females) met the clinical diagnosis criteria for AIDS according to the provisional WHO clinical case definition for AIDS. 21 of them were gaboneses. The mean age of patients was 32.8, only one child was observed (blood transfused sickle-cell anemia). The only risk factor that we observed three times was blood transfusion. The clinical presentation of those cases will be described. 22 were positive for anti-HIV1 antibodies by Western-Blot analysis of their sera, one was anti-HIV2 positive (a congolese man hospitalized in Franceville for severe weight loss and pulmonary tuberculosis).

[A rare etiology of anasarca in Africa: gastric lymphoma]. / Une étiologie rare d'anasarque en Afrique: le lymphome gastrique.

The authors report the case of a young 16 year-old woman from Gabon hospitalized because of edemas. The laboratory tests show a hypoproteinemia of 32 g/l with hypoalbuminemia of 9.4 g/l. After ruling out a renal, cardiac or hepatic etiology as well as malnutrition, the endoscopic exploration of the G.I tract, performed because of abdominal pain, enables to make the diagnosis: malignant, non-Hodgkin gastric lymphoma, confirmed by biopsies during the procedure. Edemas and hypoproteinemia were related to an exudative enteropathy secondary to ulcerations of the gastric mucosa.