[Preliminary results of an herpetology investigation in sugar cane plantation in Democratic Republic of Congo]. / Résultats préliminaires d'une enquête herpétologique en plantation de cannes à sucre en République Démocratique du Congo.

Out of the 3,000 species of snakes described in the world, 163 are currently known from D.R. of Congo. We performed a systematic survey in sugar-cane plantations of the Sugar Company of Kwilu-Ngongo (Bas-Congo), located at 160 km South-West from Kinshasa and exploiting nearly 10,000 ha. The plantation is divided into 3 sectors in the middle of which we deposited barrels filled of formaldehyde. All the employees of the Sugar Company of Kwilu-Ngongo were requested to collect encountered snakes and put them in the nearest barrel. Between August 9th and September 21st, 2004, we collected 36 snakes in two different sites, revealing the presence of 3 families and 12 species. The most abundant species in Causus maculatus (47% in the first site--Point 8--and 29% in the second site--Point 13). The most poisonous and dangerous species were captured only in the first site--point 8, and were Dendroaspis jamesoni and Naja melanoleuca, both young.

[Epidemiology of snakebites in sugar cane plantations of Kwilu Ngongo in Democratic Republic of Congo]. / Epidémiologie des morsures de serpent dans les plantations de cannes à sucre de Kwilu Ngongo en République Démocratique du Congo.

An epidemiological study was undertaken in a sugar cane plantation of the Sugar Company of Kwilu Ngongo in the Democratic Republic of Congo (DRC) to evaluate the incidence of the snakebites, to report the epidemiological and clinical indicators and the therapeutic practices. The plantations extend by 41 km covering about 10,000 hectares in arboreal savannahs. The method associated i) a retrospective survey carried out from the registers of two health centres located in the heart of the plantations, then in the files of the central hospital of the sugar company and in a public health centre, and ii) an household survey using a questionnaire administered to 579 concessions and households over six years. The calculated incidence is estimated at 80 bites per annum for 100,000 inhabitants. More than half of the bites involved men working in industrial sugar cane plantations or in the fields and occurred during the rain season. Setting fire in sugar cane plantations during harvest had an influence both on the snake behaviour and men's activities. Because of the lack of antivenom, the treatment of snakebites remained symptomatic. The average duration of hospitalizations was 4 days, the criterion of monitoring being based on the disappearance of the oedema localized at the foot sometimes extending to the leg.

Predictors of stroke - associated mortality in Africans.

BACKGROUND: The objective of the study was to examine the association of the stroke-related mortality with gender, age, ethnicity, social class, blood pressure, fibrinogen, selected clinical data and meteorologic parameters in hospitalized Africans. METHODS: A series of 1032 consecutively hospitalized incident cases of acute stroke between 1987 and 1991 was studied. Univariate and multivariate analyses were used to estimate the risk (odds ratio=OR) of stroke mortality for meteorologic parameters on the month before the accident onset and selected sociodemophysiological variables on the day of admission. RESULTS: The variables significantly associated with stroke mortality in multivariate analysis were male sex (OR= 2.3 [1.3 - 4.1]), low social class (OR= 2.0 [1.2 - 4.0]), migrant tribes (OR= 1.7 [1.5 - 1.8]), ischemic stroke (OR= 1.4 [1.2 - 1.6]), heart rate >=100 bpm (OR= 1.1 [1.0 - 1.2]), age > or =60 years (OR= 1.03 [1.01 - 1.06]), systolic blood pressure> 160 mmHg (OR= 1. 02 [1.01 - 1.03]), and fibrinogen > or =400 mg/dl (OR= 1.01 [1.002 - 1. 02]). However, diastolic blood pressure > 90 mmHg and global radiation< 340 Cal/cm(2)/day were significantly (p< 0.05) and inversely associated with stroke mortality. CONCLUSION: Our results indicate that male sex, older age, low social class, migration, ischemic stroke and higher baseline levels of heart rate, systolic blood pressure and fibrinogen are significant predictors of stroke mortality, but lower global radiation and higher diastolic blood pressure are inversely linked.

Hematocrit and stroke in black Africans under tropical climate and meteorological influence.

OBJECTIVES: To assess the relationship between hematocrit and risk of fatal and non-fatal stroke in conjunction with meteorological variations. DESIGN: Prospective study of a series of Africans living in Kinshasa, Congo, followed up for 5 years. SUBJECTS: A total of 1,032 unselected patients consecutively admitted to hospitals for acute stroke. Main outcome measures. Fatal and non-fatal ischemic or hemorrhagic strokes. The association of hematocrit with stroke morbidity and mortality and meteorological variables were evaluated by simple or multiple linear regression and logistic regression. RESULTS: Patients were aged 53.7 +/- 12.1 years. Hematocrit was mostly correlated with mean ambient air temperature (r = 0.124; p < 0.001) and atmospheric pressure at 6 a.m GMT (r = 0.157; p < 0.001). Patients with hematocrit > 40% presented the highest levels of systolic blood pressure, fibrinogen, body temperature, resting heart rate, duration of coma and incidence of all stroke types and ischemic stroke (p < 0.001). Hematocrit > 40% was associated with stroke mortality (Odds ratio, 6.2, 4.5-8.6; p < 0.001). The risk of stroke mortality was multiplied by 21, 18.3 and 4.2 in conditions of a mean ambient air temperature > 28 degrees C, atmospheric pressure 975-977 mm Hg and body temperature > 37 degrees C respectively. CONCLUSIONS: Our study suggests that higher hematocrit is associated with an increased risk of stroke morbidity and mortality, particularly ischemic stroke at noon. This risk is probably mediated by increased susceptibility of African older hypertensive subjects to meteorological variations.

Le profil biologique de la fievre typhoide a Kinshasa

Les auteurs etudient quelques aspects biologiques de la fievre typhoide a Kinshasa chez 208 patients. Anemie (40;6 pour cent); leucopenie (22;8 pour cent); hyperleucocytose (21;3 pour cent); uremie elevee (60 pour cent); creatinemie augmentee (6 pour cent); transaminases perturbees (56;9 pour cent) pour les SGOT; 52;5 pour cent pour les SGPT: telles sont les caracteristiques essentielles des examens hematobiochimiques. Les coprocultures sont positives dans 38;1 pour cent des cas et les homocultures le sont dans 77;9 des cas. Salmonella typhi (S. typhi) est rarement isole dans les urines (2 pour cent); Salmonella paratyphi B (S.para typhi B) n'a ete isole qu'une fois

Prevalence du neuropaludisme chez l'adulte zairois en milieu hospitalier

Dans le present travail; les auteurs ont etudie 4.214 dossiers de malades admis en Soins Intensifs de Medecine Interne des Cliniques Universitaires de Kinshasa entre le 1er janvier 1984 et le 31 decembre 1993. Leur analyse a montre que 48 patients (soit 1;14 pour cent) ont ete hospitalises pour neuropaludisme. Les adolescents ainsi que les adultes jeunes ont ete les groupes les plus touches. Un traitement precoce et adequat a la quinine a permis une evolution tres favorable dans la plupart des cas (62;5 pour cent)

Etiologie de la fievre au cours du SIDA : a propos de 64 cas

La presente etude recherche les causes frequentes de la fievre associee a l'infection a VIH dans une zone tropicale. Prospective; elle porte sur 64 patients dont 23 hommes et 41 femmes hospitalises pour une fievre isolee ou associee a d'autres symptomes. Le bilan clinique et paraclinique retient: le paludisme (40 pour cent); la tuberculose pulmonaire (37;5 pour cent); la cryptococcose neuro-meningee et la toxoplasmose cerebrale (12;5 pour cent chacune); la fievre typhoide (7;8 pour cent); le sarcomede kaposi (6;2 pour cent); l'infection urinaire a Escherichia coli (4;7 pour cent); la trypanosomiase humaine africaine et les salmonelloses mineures (1;6 pour cent chacune). La courbe de la fievre au cours de l'infection a VIH n'a aucune allure pathognomonique

Oral manifestations of AIDS in a heterosexual population in a Zaire hospital.

Oral lesions associated with HIV infection as classified by the WHO Collaborative Centre for Oral manifestation of HIV were studied in 83 heterosexual AIDS patients in Kinshasa, Zaire. One or more lesions were fungal (94%), bacterial (33%) and viral (23%). Neoplasm was found in 12% of cases while lesions of unknown etiology in 14%. As location of those lesions, the palate, lips, tongue and the buccal mucosae mostly predominate as sites. The findings from this study were clinically similar to those reported in AIDS in other areas.

PIP: From January 1988-September 1989, dental practitioners performed a comprehensive oral examination on 83 HIV positive patients at the Department of Infectious Diseases, University Clinic of Internal Medicine in Kinshasa, Zaire for a study on prevalence and clinical aspects of oral lesions associated with HIV infection. Women comprised 55.5% of these AIDS patients. They all had oral lesions: 94% fungal, 33% bacterial, 23% viral, 14% unknown origin, and 12% neoplasms. The majority of these oral lesions developed in 31-40 year olds. Further, the 21-30 year olds were more likely to have bacterial infections, especially aggressive periodontitis. Fungal infections occurred most often on the lips, palate, and tongue, while viral infections occurred mainly on the tongue. Kaposi's sarcoma only afflicted the palate. Pseudomembranous candidiasis was the leading fungal infection (32% of all oral lesions) then atrophic (22.8%) and hyperplastic (6%) types. 17% and 16% of all lesions included these bacterial infections: aggressive periodontitis and necrotizing gingivitis respectively. the leading viral infection was hairy leukoplakia (14%) followed by leukoplakia (8%), and herpetic stomatitis (4%). The unknown lesions included ulcers (12%) and a swollen salivary gland )2%). 12% of the examined AIDS patients, mostly 31-50 year olds, had oral Kaposi's sarcoma. They also had it on other parts of the body. Since HIV prevalence in Zaire ranges between 3-8%, all dentists should be cognizant of oral manifestations of HIV which may indeed be the 1st clinical indications of HIV. They should refer any patients with such lesions to a health facility with AIDS specialists for diagnosis and care.

[Ophthalmologic manifestations of AIDS in an African milieu. Report of 45 cases]. / Manifestations ophtalmologiques du SIDA en milieu africain. A propos de 45 cas.

Acquired Immune Deficiency Syndrome (AIDS) is a pathological entity whose agent is a virus called HIV (Human Immunodeficiency Virus). The principal immunological deficit is the insufficience of immunity in mediation cell. Actually AIDS can be considered as the "bubonic plague" of the 20th century. Eye lesions caused by AIDS could present in 54 to 94% of patients of AIDS (3,19). Eye symptoms can be classified into four main categories or groups: retinal vascular lesions, eye opportunist infections, neoplasms of the eye surface and the orbit and finally neuro-ophthalmological anomalies. This study was realised at the university clinic of Mont Amba in Kinshasa, Zaire. A total of 45 cases were studied of which 42 cases with full blown AIDS (1 Congolese, 3 Ruandese, 1 Zambian and 37 Zaireans) and the other three were HIV positive (all were Zaireans). Among the 45 cases, 20 were studied retrospectively with a counting down of 5 years, and 25 others comprised of a prospective group of study or research. The patients were seen either in an ophthalmology Department/Service, or in a medical Service/Centre or in both. The criteria of diagnosis of AIDS were almost the same: skin anergy, infections and/or neoplasm opportunists, the lymphopenia T4, the report T4/T8 low or inversed and the HIV serology positive. A complete opthalmological test was undertaken, the indirect ophthalmoscopy and the retina fluorography were not done. A sex ratio is 1,64 (28 men for 17 women). The 45 patients were sexually active heterosexuals. None of them used drug intravenously. No accidental case of blood transfusion was revealed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pericarditis and acquired immunodeficiency syndrome]. / Péricardite et syndrome d'immunodéficience acquise.

In order to evaluate the frequency and clinical features of pericarditis caused by the HIV virus, 17 patients (mean age 28 years) presenting with pericarditis were investigated at the University Clinics of Mont-Amba (Zaïre), between January, 1985 and December, 1986. The clinical diagnosis of AIDS had been made on the basis of the WHO criteria. An ELISA test, a tuberculin test and a T4-lymphocyte count were performed in all patients. Cardiovascular explorations were limited to electrocardiography, radiography of the chest, echocardiography and pericardial needle aspiration. HIV pericarditis accounted for 50 p. 100 of all cases of pericarditis. It was either dry or effusive with little fluid, and its clinical signs at the early stage of AIDS were retrosternal pain and pericardial friction rub. A search for anti-HIV antibodies may be negative at that stage. Diagnostic errors can be avoided if the tuberculin test is negative and if an ELISA test is performed repeatedly at 3 weeks' intervals. Pericarditis should be counted among the minor signs of AIDS.

PIP: Cardiac manifestations have not attracted the attention of AIDS researchers as much as pulmonary, digestive tract, and nervous system effects. Recent autopsies on AIDS patients, however, have revealed cardiac lesions of several types, including pericarditis. To evaluate the frequency and clinical aspects of pericarditis due to HIV infection, 17 subjects with AIDS-associated pericarditis were studied at the University Clinics in Mont-Amba, Kinshasa, Zaire, between January 1985-December 1986. Subjects ranged in age from 20-50 years and averaged 28 years. 11 women were prostitutes and 6 men reported having at least 5 sexual partners. The clinical diagnosis of AIDS was based on World Health Organization criteria. An ELISA test, a tuberculin test, and a T-4 lymphocyte count were prepared for each patient. All 17 had an electrocardiogram, a radiography of the chest, and echocardiography, and 12 had pericardial needle aspiration. HIV pericarditis accounted for 50% of cases of pericarditis in the service. It was either dry or effusive with little fluid. Its clinical signs at the early stages of AIDS were retrosternal pain and pericardial friction rub. A search for anti-HIV antibodies may be negative at the early stages, but diagnostic errors can be avoided if the tuberculin test is negative a if an ELISA test is repeated at 3 week intervals. Pericarditis can be considered 1 of the minor signs of AIDS.

Isolation of human immune deficiency virus from African AIDS patients and from persons without AIDS or IgG antibody to human immune deficiency virus.

We previously reported a high incidence of acquired immune deficiency syndrome (AIDS) in Kinshasa, Zaire, as well as a high frequency of antibody to human immunodeficiency virus (HIV), which includes HTLV-III and LAV viruses, in persons without AIDS. In this report we assessed the frequency of HIV virus infection in persons with and without clinical AIDS and the association of virus isolation to presence of antibody. We isolated HIV from 27 (77%) of 35 patients with AIDS, and 5 of 9 patients with AIDS-related complex (ARC). Virus was also isolated from plasma and cerebrospinal fluid of patients in the study. The presence of antibody was a reliable marker for virus infection in African patients with AIDS. HIV was isolated from 5 of 27 control patients without AIDS, 3 of whom had normal T helper to T suppressor ratios and normal numbers of T helper cells. Two of these patients had no detectable antibody to HIV by ELISA or Western blot methods. In a population, such as the general heterosexual population of Kinshasa, with frequent infection by HIV and with few clearly definable risk groups, screening for antibodies to HIV may not be sufficient to identify some virus infected persons.

PIP: This study represented the 1st attempt to isolate human immunodeficiency virus (HIV) from African acquired immunodeficiency syndrome (AIDS) patients and controls. HIV was isolated from 27 (77%) of 35 Zairians with AIDS and from 5 (55%) of 9 patients with AIDS-related complex (ARC). In addition, 5 (19%) of 27 controls admitted to Zaire's Mama Yemo Hospital for causes unrelated to AIDS were found to be positive for antibodies to HIV. Next, an effort was made to isolate the virus from 42 AIDS or ARC patients on whom data were already available on the results of an enzyme-linked immunosorbent assay (ELISA). HIV was isolated from 30 (81%) of 37 patients with positive ELISA tests and from none of the 5 patients with a negative assay. Among controls, antibodies were found in a higher proportion of patients with abnormal helper: suppressor ratios or a low absolute T helper cell count. On the other hand, these abnormalities were not found in 3 of the 5 control patients from whom HIV was isolated, including 2 without HIV antibody. This suggests that neither of these criterion are good indicators of virus infection. The isolation of HIV infection from 5 hospital controls with no clinical signs of infection suggests that either the rate of asymptomatic HIV virus infection is high in Zaire or that common tropical diseases such as malaria or tuberculosis may be associated with HIV infection. The frequency of HIV isolation from AIDS and ARC patients in this study is higher than that in earlier reports from non-Africans, but is comparable to current statistics from the US.

Fever origins in the tropics.

The causes of fever were attempted to identify in a prospective study on 300 adult in- and outpatients with fever at Kinshasa Teaching Hospital, Zaire. Infection was by far the primary cause of fever (87%). Tuberculosis occurred in 15% of the inpatients. Malaria was the most frequent febrile disease: one fever in two was malaria. Connective tissue diseases and neoplasms were rare.

Concentrations of gentamicin in bronchial secretions after intramuscular and endotracheal administration.

A crossover study was performed in five adult tracheotomized patients without respiratory tract disease to investigate the tracheobronchial kinetics of intramuscularly and endotracheally administered gentamicin in the absence of infection. Although intramuscular injection of 2 mg/kg of gentamicin yielded adequate levels in the serum, the concentrations in the bronchial secretions of noninfected patients were not adequate to inhibit strains of Pseudomonas aeruginosa isolated from other patients with clinical infections. Conversely, endotracheally administered gentamicin resulted in high and sustained concentrations in the bronchial secretions that were many times superior to the minimum bactericidal concentration of gentamicin against Pseudomonas aeruginosa. Gentamicin administered by aerosols resulted in concentrations within the bronchial secretions and sputum that were adequate to kill more than 90 per cent of the strains of Pseudomonas aeruginosa isolated in this hosopital. These studies suggest that endotracheally administered gentamicin might prove to be an adequate adjunct for the treatment of severe Pseudomonas infection of the tracheobronchial tract, particularly in the absence of foreight bodies and abnormalities of structure or function.

Comparison of amikacin and gentamicin.

The sensitivity to gentamicin (G) and to amikacin (A) of 25 strains of Escherichia coli (EC), 25 Klebsiella sp. (K), 25 Proteus and Providence sp. (PP), and 25 Ps. aeruginosa (PA) were tested in vitro by the disc method, by the inocula-replicating method, and by a tube dilution technique using 10-5 microorganisms/ml. Bactericidal concentrations active on 50% and 90% of the strains were 1.5 and 4.5 mug/ml for EC, 3 and mug/ml for K, 1.5 and 3 mug/ml for PP, and 3 and 3 mug/ml for PA. Resistance to killing by 12 mug/ml of G was found for 16 strains (1 EC, 9 K, 4 PP, and 2 PA) but only 5 strains were also resistant to 12 mug/ml of A. Conversely, 4 strains (1 EC, 1 PP, and 2 PA) were resistant to 12 mug/ml of A but were killed by 6 mug/ml of G or even less. G (1.5 MG/KG) AND A (5 mg/kg) were administered to 5 bolunteers in a crossover fashion. The mean bactericidal activity of the sera obtained at 1 hr after the injection of G and A was, respectively, 1/4 and 1/4 for ED, 1/4 and 1/8 for K, 1/2 and 1/2 for PP, and 1/2 and 1/2 for PA. Sera obtained in A-treated patients killed at a dilution of 1/8, 8 strains of ED, 17 K, 1 PP, and O PA; at that dilution sera from G-treated patients killed 5 ED, 9 K, O P, and O PA. The main advantage of A over G might be the absence of cross-resistance between A and G for particular pathogens.