[Acute abdominal pain in children at the Pediatric Hospital in Bangui (Central African Republic). Epidemiological, clinical, paraclinical, therapeutic and evolutive aspects]. / Les douleurs abdominales aiguës chez l'enfant au complexe pédiatrique de Bangui (Centrafrique). Aspects épidémiologiques, cliniques, paracliniques, thérapeutiques et évolutifs.

UNLABELLED: Acute abdominal pains in children in general, and in subsaharian Africa in particular, are among the most frequent causes of consultations. MATERIAL AND METHODS: The authors achieved a two-year retrospective study on acute abdominal pains in children, with the objectives of determining the frequency of acute abdominal pains, precising the epidemiological, clinical, therapeutic and evolutive aspects and different aspects of the treatment. The study concerned 312 cases. RESULTS: A predominance of the ages three to ten years was noted (67% of the cases). Most of the patients were related to low income parents. Half patients were submitted to antiparasitical treatment before arriving at the hospital and they were treated mainly by antihelminthiasis. The diagnosis were appendicitis (32.4%), typhoid perforations (9.9%), digestive forms of acute malaria (5.8%), strangulated herniae (4.8%), acute gastroenteritis (4.8%), acute pneumoniae (3.8%), urinary tract infections (3.5%), amibian liver abscess (1.9%), viral hepatitis (1.6%), Schönlein Henoch purpura (1.3%), occlusive syndrome (1.3%) and other medical causes (2.2%). In 22.8% of the cases, no cause was found. CONCLUSION: The ignorance of the seriousness signals, late recourses to hospitals structures and the limited financial means explain the high rate of mortality (8%), mainly due to appendicitis and typhoid perforations.

Etiologies of acute, persistent, and dysenteric diarrheas in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus.

A study of the etiologies of diarrhea in adults in relation to their human immunodeficiency virus (HIV) serostatus and number of CD4+ cells was carried out in the Central African Republic. In cases and controls, multi-parasitism was observed. Salmonella spp. were identified mainly during acute diarrhea, with 50% of the S. enteritidis isolated during the study being responsible for septicemia and/or urinary tract infection in immunodeficient patients. Enteroaggregative Escherichia coli (EAggEC) were the most frequently identified agent in HIV+ patients with persistent diarrhea; 42.8% of the patients with EAggEC as sole pathogens had bloody diarrhea, and these strains were negative for the presence of a virulence plasmid. Coccidia were found in those with acute and persistent diarrhea. Blood was observed in 53.3% of infections involving coccidia as the sole pathogen. Microsporidium spp. and Blastocystis hominis were found only in HIV+ patients with persistent diarrhea. Shigella spp., Campylobacter spp., and Entamoeba histolytica were found in HIV+ and HIV- dysenteric patients; bacteria resembling spirochetes that could not be cultivated were identified only in HIV+ cases with dysentery. Shiga-like toxin-producing E. coli O157:H- was isolated from two cases with hemolytic-uremic syndrome. Fungi were identified as the sole pathogen in 6.4% of the HIV+ patients with persistent diarrhea. Most of enteropathogenic bacteria identified were resistant to ampicillin and trimethoprim-sulfamethoxazole, remained susceptible to ampicillin plus clavulanic acid, and were susceptible to amikacin, gentamicin, and ciprofloxacin.

High mortality rates among patients with tuberculosis in Bangui, Central African Republic.

PIP: Survival time until death was investigated in a prospective cohort of 224 tuberculosis patients from Bangui, Central African Republic, who were randomly selected from among 1492 such patients registered in 1993 and 1994. 6 patients (2.7%) presented with extrapulmonary tuberculosis, 186 (83%) were smear-positive, and 139 (62%) were infected with HIV-1. 23 (10.3%) had multidrug-resistant tuberculosis strains. The treatment regimen (isoniazid, rifampicin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid and ethambutol for another 6 months) was successful in 46.4% of HIV-infected patients compared with 67.1% of HIV-negative patients. At the end of 8 months, 39.1% of HIV-infected patients but only 8.2% of HIV-negative patients had died. 24 months after the start of tuberculosis treatment, the cumulative death rate was 58% in HIV-seropositive patients compared with 20% in seronegative patients. Median life expectancy to death among HIV-infected tuberculosis patients was 15 months. Decreased survival was significantly associated with HIV-seropositivity, older age, failure to complete the full treatment regimen, and a low CD4 cell count. Multidrug-resistant tuberculosis was not linked to increased mortality.^ieng