[Severe liver cytolysis could be a marker of the severity of hemorrhagic dengue: report of two cases]. / La sévérité de la cytolyse hépatique pourrait être un marqueur de gravité de la dengue hémorragique : à propos de deux cas.

We report two cases of severe dengue fever in persons returned from stays in endemic areas during the summer outbreak of 2010. Both presented a hemorrhagic syndrome associated with primary hemostasis disorders, neutropenia, and severe hepatic cytolysis without any hepatocellular insufficiency. Three days after hospitalization, the first patient's AST and ALT levels rose to 80 and 12 times the upper reference values respectively, and the second patient's to 12 and 7 times those values. The second also presented signs of hemodynamic shock. Our observations suggest that the combination of severe hepatic cytolysis and hemostatic disorders may be a predictive marker of the severity of dengue fever. The pathophysiologic mechanisms explaining this severity remain unknown.

Epileptiform seizures revealing neurocysticercosis: report of two clinical cases in Libreville, Gabon.

Neurocysticercosis (NCC) is the most common helminth infection of the central nervous system. It is caused by the larval form of the tapeworm Taenia solium and is increasingly recognized as a major cause of neurologic disease worldwide. Epilepsy is the usual mode of revelation. Neuroimaging, including computed tomography and magnetic resonance imaging, combined with serodiagnostic techniques have led to this increased recognition. We report on two cases (one co-infected with the HIV) of NCC diagnosed in 2006 and 2008 at the Omar Bongo Ondimba Army Teaching Hospital. New-onset epilepsy revealed the two cases. Medical treatment with albendazole, anti-epileptic drugs and corticosteroids led to full recovery. NCC should be considered in tropical countries as a leading cause of epilepsy. Moreover, NCC should be included in the differential diagnosis of neurologic infections in HIV patients in endemic populations.

[Clinical and laboratory findings in HIV-infected patients at the Jeanne Ebori Foundation in Libreville, Gabon (2002-2005)]. / Bilan clinico-biologique des patients infectés par le VIH à la Fondation Jeanne Ebori de Libreville (2002-2005).

The purpose of this study was to evaluate management of HIV-infected/AIDS patients within the framework of the ACCESS program at Center N 3 over a 4-year period. This retrospective single-center study included HIV-positive patients treated at the Jeanne Ebori Foundation in Libreville, Gabon between January 2002 and December 2005. The active file included 749 patients, i.e., 436 undergoing antiretroviral therapy and 313 with intention to treat. The population consisted mainly of city dwellers. Mean patient age was 38.8 years with a female predominance (sex ratio, 0.8). The highest incidence of infection was observed in the 20- to 30-year age group. Socioeconomic position was low in 63.2 % of patients. Clinical suspicion (67%) was the main reason for testing. In order of frequency, symptoms defined according to the WHO criteria were classified as stage B (33.5 %) and stage C (27.1%). Opportunistic infections were observed in 95% of cases: fungal: 57%, bacterial: 30.7%, and viral: 7.3%. Tritherapy, i.e., 2INTI + 1INNTI (72.9%) and 2INTI+1 IP (17.1%), was used in most cases. Treatment led to clinical improvement with a gradual, steady, and sustained increase in CD4 lymphocyte count. Adverse events were noted including gastrointestinal reactions (16%), neurological manifestations (12%), and general symptoms (12%). Concurrent disturbances in lipid levels and liver function were noted. Overall outcome was positive with a decrease in mortality from 39.2% (M0-M6) to 2.7% (M30-M36). The findings of this study show that improvement in socioeconomic conditions and availability of adequate diagnostic and therapeutic resources at management centers to obtain long-term control of HIV infection are still current issues.

Bilan clinico-biologique des patients infectes par le VIH a la fondation Jeanne Ebori de Libreville (2002-2005)

Notre etude a consiste a faire le bilan d'activites du centre no3 de prise en charge des patients infectes par l'infection a VIH/SIDA; dans le cadre du programme ACCESS. Il s'est agit d'une analyse retrospective; unicentrique; de patients VIH positifs realisee sur 4 ans de janvier 2002 a decembre 2005 a la Fondation Jeanne Ebori. La file active etait composee de 749 patients : 436 sous traitement antiretroviral et 313 en intention d'etre traiter. La population etait en majorite urbaine. L'age moyen des patients etait de 38;8 ans avec une predominance feminine (sex-ratio de 0;8). La tranche d'age la plus infectee etait celle dont l'age variait entre 20 et 50 ans. Le niveau socio-economique etait faible chez 63;2des malades. La suspicion clinique (67) etait le principal motif du test ; la symptomatologie etait selon la classification de l'OMS; par ordre de frequence : stade B (33;5) et stade C (27;1). La pathologie infectieuse opportuniste represente 95des cas (mycosique : 57; bacterienne : 30;7; virale :7;3). Les tritherapies incluant 2INTI + 1INNTI (72;9); 2INTI+1 IP (17;1) etaient les plus prescrites. L'efficacite du traitement antiretroviral s'etait traduite dans l'ensemble par une amelioration des parametres cliniques; une ascension reguliere; progressive et durable du taux de lymphocytes CD4. La survenue des effets indesirables a type de troubles digestifs (16); troubles neurologiques (12); signes generaux (12) etait notee. La perturbation des bilans lipidique et hepatique etait observee au cours du meme temps. Le bilan etait globalement positif avec une chute du taux de deces allant de 39;2(M0-M6) a 2;7(M30-M36). Ce travail montre que l'amelioration des conditions socio-economiques; l'approvisionnement equitable des centres de prise en charge en moyens diagnostiques et therapeutiques pour obtenir a long terme le controle de l'infection par le VIH; demeurent d'actualite

[Opportunistic diseases in HIV-infected patients at the Jeanne Ebori Foundation in Libreville, Gabon]. / Les maladies opportunistes de l'infection par le VIH a l'hôpital Fondation Jeanne Ebori de Libreville, Gabon.

The purpose of this study was to determine the frequencies of opportunistic diseases among AIDS patients at the Jeanne Ebori Foundation (JEF) in Libreville, Gabon. A total 6313 file of patients treated in the internal medicine unit between 1994 and 1998 were analyzed. Findings showed that the main diseases related to AIDS classified according to seroprevalence were as follows: purigo (100%), cerebral toxoplasmosis (100%), oral candidiaisis (88%), bacteremia (87.8%), shingles (84.6%), minor salmonelosis (72%), and tuberclosis. The main diagnoses unrelated to AIDS at the JEF according to seroprevalene were typhoid (9.4%), common pneumonia (28%), bacterial meningitis (26.3%, hepatitis B (20.0%), and malaria (14%). In addition to these diseases there were nine cases of Kaposi's sarcoma, four cases of isosporosis, two cases of cryptococcosis, two cases of herpes Varicella, one case of cryptosporidiosis, and one case of isosporosis. The incidence of opportunistic disease was high in our study and must be taken in drug procurement.

Les maladies opportunistes de l'infection par le VIH a l'hopital Fondation Jeanne Ebori de Libreville; Gabon

Dans le but de recenser en terme de frequence les differentes maladies opportunistes diagnostiquees au cours du sida a la FJE; 6313 dossiers des patients du service de medecine interne ont ete analyses de 1994 a 1998. Les resultats ont montre que parmi les principales maladies opportunistes classant pour le sida en terme de seroprevalence etaient les suivantes : le pruri go (100); les toxoplasmoses cerebrales (100); les candidoses orales (88); les bacteriemies (87;8); le zona (84;6); les salmonelloses mineures (72); les tuberculoses (53). Les principaux diagnostics non classant du sida a la FJE en terme de seroprevalence ont ete les typhoides (29;4); les pneumonies banales (28); les meningites bacteriennes (26;3); les hepatites B (20); les paludismes (14). A ces pathologies; il faut ajouter neuf cas de kaposi; quatre isosporoses; deux cryptococcoses; un herpes; une varicelle; une cryptosporidiose; une anguillulose. La frequence des maladies opportunistes est elevee dans notre etude et doit etre pris en compte dans l'approvisionnement en medicaments

[Isolated case of haemorrhagic fever observed in Gabon during the 2002 outbreak of Ebola but distant from epidemic zones]. / Cas isolé de fièvre hémorragique survenu au gabon en 2002 pendant l'epidémie d'ebola mais distant des régions epidémiques.

During the last outbreak of Ebola virus haemorrhagic fever that occurred concurrently in Gabon and Congo, several primary foci were identified in the Ogooue Ivindo province (Northeast Gabon), where previous outbreaks had occurred. A 48-year-old woman living in Franceville located 580 Km from the epicentre presented fever with haemorrhagic signs. She was evacuated to Libreville where Ebola infection was suspected. Diagnosis was confirmed at the Centre International de Recherches Médicales of Franceville on the basis of detection of specific antibodies. Symptoms had already subsided by the time diagnosis was documented. An epidemiological investigation was undertaken to identify the source of contamination and detect secondary cases. No human or nonhuman primate source of contamination could be formally identified. Direct contact with the virus reservoir could not be ruled out. No secondary cases were detected. The favourable outcome, absence of secondary, and failure to identify a source of contamination suggest that epidemiologically undefined cases may go unnoticed during and outside of outbreaks.

[Causes of adult acute bacterial diarrhea in an internal medicine department in Libreville, Gabon]. / Etiologies des diarrhées aiguës bactériennes de l'adulte dans un service de médecine interne à Libreville, Gabon.

This retrospective study of patients treated between 1992 and 1996 was undertaken as a preliminary step to identifying the main bacterial causes of diarrheal disease in Libreville, Gabon. A total 371 files showing positive stool cultures were analyzed. From an epidemiological standpoint, data showed that the high risk population was young people of both sexes. The incidence of diarrhea was correlated with climatic conditions with an endemic-epidemic pattern characterized by peak activity during the rainy season. In the vast majority of cases, the underlying etiology was gastroenteritis due to invasive organisms. The most commonly identified agents were salmonellae (46.6%) and Shigellae (44.2%). Treatment should focus on rehydration. Fluoro-quinolones were the most commonly indicated drugs for antimicrobial treatment but cotrimoxazole was often useful. In general, the prognosis of bacterial diarrhea is favorable provided that it is treated early and concurrent conditions are taken into account.

[Spectrum of opportunistic infections in subjects infected with HIV at Libreville, Gabon]. / Panorama des affections opportunistes au cours de l'infection par le VIH à Libreville, Gabon.

This retrospective study (1992-1996) was carried out in the Internal Medicine Department of the Jeanne Ebori Foundation at Libreville. We analyzed 351 files with the aim of counting the numbers of cases of various opportunistic infections and estimating the frequencies of these infections. The prevalence of seropositivity for HIV was 27.7% in the hospital population. Young adults from modest socioeconomic backgrounds were found to consult at stage IV of the infection. Oropharyngeal candidiasis (37%), zona (18.5%), salmonellosis (18.2%) and tuberculosis (14.5%) were the most frequently diagnosed opportunistic infections. Intestinal parasitoses, cryptococcosis, radiculomeningitis, cerebral toxoplasmosis and visceral fungal infections were diagnosed less frequently. The prevalence of Kaposi's sarcoma was 6.3%. Most of the opportunistic infections encountered were treatable but the mortality rate was high (11.7%) due to late diagnosis, the lack of availability of drugs and the poor economic conditions of the population.

[Typhoid and paratyphoid fever in adults in the Internal Medicine Department at Libreville (Gabon)]. / Fièvres typhoïdes de l'adulte dans un service de médicine interne à Libreville (Gabon).

We carried out a retrospective study of 150 files of patients suffering from typhoid or paratyphoid fever, confirmed bacteriologically, between January 1992 and December 1996 at Libreville. Young adults were the most frequently affected. These infections were associated with unstable living conditions and lack of cleanliness. Neurological (17%), digestive (12%) and cardiovascular (3%) complications were the principal factors aggravating the disease. The following serotypes were identified: Salmonella typhi (47%), S. paratyphi B (25%), S. paratyphi C (20%) and S. paratyphi A (8%). Salmonellosis was associated with schistosomiasis (13%), nematodiasis (2.3%), sickle-cell anemia (7%) and HIV infection (8%). The mortality rate was 3.3%. Fluoroquinolones are the molecules of choice for treating typhoid and paratyphoid fevers.

[Pulmonary amebiasis and tuberculosis association. Two case reports in Libreville, Gabon]. / Association amibiase-tuberculose pulmonaire. A propos de deux cas à Libreville, Gabon.

Amoebiasis and tuberculosis are common in Gabon. International travel, cultural exchanges, changing immigration and climate of tropical provide an ideal environment for these pathogenic organisms. However, the unexpected survival of these two pathologies in the same patient is exceptional.

[Bacterial meningitis in the adult. Study of 85 cases observed in the infectious disease unit of the Fondation Jeanne Ebori (F.J.E.), Libreville, Gabon]. / Les méningites bactériennes de l'adulte. Etude de 85 cas observés dans l'unité des maladies infectieuses de la Fondation Jeanne Ebori (F. J. E.), Libreville, Gabon.

We conducted a retrospective review to specify the frequency, identify the aetiological factors of bacterial meningitis in adults (BMA) and to evaluate the therapeutic protocol used. This study was conducted on 85 (BMA) cases of hospitalised patients between January 1991 and December 1995 (5 years) on our service. The BMA represented 3% of all admissions for infectious diseases at the Foundation Jeanne Ebori in Libreville. It occurred in an endemosporadic fashion. All patients were Black Africans with an average age of 33 years (range: 16-60 years). Males predominated by a ratio of 2.4. Tha patients were seen late in the evolution of the disease, as shown by the folloxing clinical signs: neuropsychic problems (100%), 25 patients (29%) were in a profound coma, 5 (6%) had a hemiplegia, 2 (2%) an hypoacousie and 1 (1%) seizure. Aetiological factors were found in 17 cases (20%) to be in the ORL sphere (sinusitis: n = 8, ear infection: n = 4), pneumopathies (n = 4) and one case of breach dure-mere. The predominant germ was pneumocoque, isolated in 55 cases (65%), 15 cases had a LCR clear (18%). Bacteria gram negative (6%) were identified in the immunocompromised HIV. Third generation cephems had an efficiency higher than beta lactamines: 83% against 73%. The mortality was 18%; 3% of the remaining patients had neurological deafness. The seriousness of the results of this survey calls for the urgent implementation of a surveillance programme.