Molecular analyses of human rabies virus associated with encephalitis in two children in Gabon.

Rabies is a zoonotic neurological life-threatening neglected tropical disease present worldwide, and Gabon is listed as an endemic country. However, despite strong clinical suspicion in humans and molecular confirmation of rabies virus (RABV) infections in dogs for several decades, no molecularly confirmed human case in Gabon has ever been reported. In this study, we describe two cases of human rabies and provide the first molecular diagnostic report on suspected human rabies cases in Gabon. Our results showed that the RABVs isolated from the patients are closely related to other RABV strains belonging to the African 1A subclade in the Cosmopolitan lineage isolated more than 20 years ago from Gabonese dog brains, suggesting that only this species circulates in the country. Because both patients had a history of dog bites a few weeks before symptom onset and the main causative agent of human rabies worldwide is dog-associated RABV, we conclude that dogs are likely to be the source of human infection in this study.

[HELLP syndrome: nine cases treated at Josephine-Bongo Maternity Hospital]. / Le HELLP syndrome : à propos de neuf cas traités à la maternité Joséphine-Bongo.

INTRODUCTION: the aim of this study was to evaluate the management of HELLP syndrome at Josephine-Bongo Maternity Hospital. STUDY POPULATION AND METHODS: the retrospective study included all women admitted to the intensive care unit of our hospital from 1 January 2004 through 30 December 2007 with HELLP syndrome. The characteristics studied included: age, parity, number of previous pregnancies, antenatal monitoring, term at onset, clinical and laboratory signs, treatment, complications, perinatal and neonatal mortality and duration of intensive care unit admission. RESULTS: nine patients, mainly primiparas with an average age of 29.7 ±â€Š6.5 years were admitted to intensive care. HELLP syndrome was diagnosed at a mean term of 33 ±â€Š2.7 weeks. The clinical signs noted included the following: jaundice (100%), headaches (100%) and epigastric pain (67%). The laboratory analysis showed: a mean haemoglobin level of 8.7 ±â€Š1.2 g/dL, an average platelet level of 70,900 ±â€Š27,052.9/mm(3), and mean transaminase levels of 120 ±â€Š60 UI/L for aspartate aminotransferase (AST) and 99 ±â€Š41.1 UI/L for alanine aminotransferase (ALT). Hypertension was treated by continuous intravenous administration of nicardipine. The fetal pulmonary development was ensured with betamethasone. Delivery was by caesarean for four women (44%) and vaginal for the other five (56%). One maternal death was noted, related to a rupture of a subcapsular haematoma of liver. CONCLUSION: in view of the extent of perinatal morbidity and mortality associated with HELLP syndrome, abdominal ultrasonography to detect any subcapsular haematoma of liver should be performed to determine the need for immediate delivery. It would be appropriate to provide the Josephine-Bongo Maternity Hospital with a neonatal intensive care unit of high quality.

[Current aspects of extra-uterine pregnancy in Libreville (Gabon): an account of 153 cases]. / Aspects actuels de la grossesse extra-utérine à Libreville (Gabon): à propos de 153 cas.

The impact of extra-uterine pregnancy is still increasing in the world. At the same time, its treatment is being improved in developed countries. The purpose of this study is to assess the current aspects of extra-uterine pregnancy in Libreville (Gabon) and to suggest actions which may improve its vital prognosis in the African context. The present study is only prospective and focuses on 153 extra-uterine cases of pregnancy recorded from February 1, 1997 to July 31, 2000. The average frequency was 2.32%. This frequency has been steadily increasing and went from 2% in 1997 to 2.32 % in 2000. The average age of the patients was 29. Extra-uterine pregnancy was diagnosed until the patients were 17. It concerned all parities. The average age was 8 weeks of pregnancy. Three para-clinical investigations allowed the confirmation of the diagnosis: ultrasound scan, coelioscopy, beta GCH plasma dosage. Laparotomy was the main therapeutic solution. No maternal death was recorded. The education of women capable of procreating on the necessity of early consultations, the supplying of hospitals with means which allow para-clinical investigations and the motivation of medical staff seem to be the main solutions to decrease the mortality rate due to extra-uterine pregnancy in Africa.