Archives de l'Institut Pasteur de Madagascar最新文献

The definition of severe malaria is no longer limited to cerebral malaria, but it is as well extended to other clinical forms of the disease. The authors reported the epidemiological and clinical survey and evaluative aspects of severe malaria in Antananarivo. This retrospective study included 48 children less than 15 years old, hospitalized at the paediatric unit Debré of the Centre Hospitalier Universitaire de Befelatanana (Antananarivo) for severe malaria as defined by world Health Organization (WHO) criteria. The hospitalization frequency was 0.87%. Higher frequency was noticed for the children less than 5 years old, the sex-ratio was 1.4/1. The cerebral complications as seen in many African countries were the most frequent clinical form. The death rate was 14.58% and the proportional mortality was 1.07%, 2.1% of the patients had sequel. The improvement of severe malaria prognosis was not only on better equipment in intensive care wards, but also on improved and early diagnosis and management.

Cervical and mediastinal cystic lymphangioma are rare and benign tumours. They looked like a lateral and cervical mass. Medical imaging allows to suspect the diagnosis but histology only may to assert it. The best therapy is surgery. Sclerosis by chemical drugs is only an alternative if surgery is not possible. A recovery is completely obtained if the whole tumour is removed.

Diagnosis of an acute obstructive dyspnea is very difficult because there are many possible causes. The authors reported the case of a 3.5-year-old boy with an atopic status who presented iterative asthma attacks which evolute to severity in spite of an appropriate therapy. Then suffocation occurred with a serious infectious context. The cause of the disease was diagnosed by respiratory tract endoscopic exam which allowed to detect a laryngeal papillomatis. The surgical extraction of this tumour cured the patient. Physiopathology of acute obstructive dyspnea in child was discussed. Upper airway obstructions are separated from lower pulmonary diseases. Two syndromes are very difficult to separate among upper airway obstructions: spasmodic laryngitis and subglottal laryngitis. They are considered in fact as different outward signs of the same disease: subglottal laryngitis is the infectious evolutive form of a spasmodic laryngitis in which atopic status exists. Laryngeal papillomatosis would be a favourising factor of infection. The authors conclude that respiratory tract endoscopic exam is very important to diagnose childhood acute obstructive dyspnea.

A seroepidemiological survey was carried out in July 1999 to assess the prevalence of cysticercosis in general population in the Mahajanga City (West of Madagascar). Blood specimens were collected from a randomised sample including 626 individuals more than 2 years old. ELISA and confirmative immunoblot techniques (EITB) were used to measure Cysticercus cellulosae antibodies. The overall prevalence by ELISA test was 19% (15.8-22.7% CI95%). Among positive cases, 87% were also positive by EITB. Cysticercosis is considered as major health problem in Madagascar. A national control programme implementation is imperative.

In this article, the authors summarize studies on hepatitis B virus infection in Madagascar. Estimated prevalence rate for acute or chronic HBs antigen infection is 23% among general population which classify the country in high endemicity area. Vertical and horizontal transmissions for the childhood are high with an estimated prevalence rate for HBs antigen infection of 10 to 35% among children under less than 5-year-old according to areas. This situation indicates that an expanded program of immunization against hepatitis B virus is warranted.

The authors describe one case of acute flaccid paralytic of lower limbs in a 10-year-old boy with Echovirus 7 isolated in the stool and a high titer of homologous antibodies (> or = 1,024). At the final stage of poliomyelitis program eradication, paralysis associated with non polio enterovirus may replace cases of paralytic poliomyelitis. In the present study, the authors highlight the needs to confirm virologically all suspect cases of acute flaccid paralytic. Aetiological function of the virus isolated and interpretation of the diagnostic methods are discussed.

Acute pelvic pains of pregnancy (APPP) generate a lot of social and professional problems to pregnancy. A retrospective study was carried out in 1996 at the Maternity Hospital of Befelatanana, Antananarivo in order to specify epidemiological feature of APPP suffering pregnancy and to search favourising factors and determinative causes of this disease so that a strategy will be drawn up to reduce its frequency and to organize correct cares. 1,612 APPP were registered for the study period, i.e. an annual incidence of 15.5 per cent. Non periodic APPP were the most frequent clinical forms (99.6 per cent). The average age of pregnancy was 26 years old. Risk factors and determinative causes are infections, hormonal diseases, nulliparity and primiparity, low standard of living. APPP had been associated to hemorrhages (37.4 per cent), circulatory shock (14.5 per cent), and hyperthermia (63.5 per cent). 83 deaths were noted. Deaths are provoked by abortion infectious complications, hemorrhages, hepato-nephric lesions due to abortifacient plants. The authors conclude that prevent measures remain as the best therapy. They are based on Information-Education-Communication program drawn towards sexual education, Reproduction Health and improvement of genital infections cares.

Cysticercosus cellulosae is usually located in muscles, subcutaneous tissues, brain and eyes. The authors reported a rare case of bronchial cysticercosis in a 20-year-old man. The only clinical signs were hemoptysis. Bronchial fibroscopy allowed to have a visual field of the cysticercus lesion. This parasitological tumor was removed by surgical resection. The diagnosis was confirmed by histological examination. A drug therapy by praziquantel completed the treatment.

As part of the National Tuberculosis Program (NTP), a quality control of the slides (search of acido-fast bacilli in the sputa) of the Treatment and Diagnosis Centers (TDC) forming the National Laboratory Network is carried out each year. In 1999, 76 TDC out of the 174 (44%) had been controlled using the method of double reading of the smears. The global concordance of the results in the 76 TDC is satisfactory (98%). Reability was 91% for the positive smears and 92% for the negative smears. A good quality of smears was observed in 53% of the centers. The TDC reliable at 100% for both positive and negative smears were 51 (67%) of which 36 (47%) had also a good quality of smears. Those later were mainly found in Toamasina, Fianarantsoa, Antananarivo and Mahajanga.

In Madagascar, as in several african countries, haematological normal values has not been established. To assess the haematological normal values in the laboratory of the Institut Pasteur de Madagascar, blood cell counts among 67 adults healthy malagasy volunteers, living in highlands of Madagascar, was performed. Blood was analysed with a Coulter STKS haematological autoanalyzer. A significant difference was noted between both sexes for the count of red blood cells, leukocytes, platelets, neutrophile polynuclears, eosinophile polynuclears, lymphocytes and for haemoglobin and haematocrit values. Our data were compared to those of different african and caucasian populations.