Archives de l'Institut Pasteur de Madagascar最新文献

In order to document the evolution of the chemoresistance of Plasmodium falciparum to chloroquine in Madagascar, a study was carried out in Sainte-Marie island located at 6 km on the eastern border of the country. Symptomatic malaria patients who satisfied criteria for resistance testing, were recruited by a process of passive case detection at two clinics. These patients were enrolled in a sensitivity 14-day in vivo test for uncomplicated P. falciparum malaria attacks. All subjects received a supervised therapeutic regimen of chloroquine (25 mg base/kg over 3 days). Parasitemia and symptoms were monitored for 14 days. 62 (93.9%) out of the 66 enrolled patients completed the 14-day follow-up. A total of 50 of 62 patients (80.6%) presented an adequate clinical response. Early and late treatment failures were observed in 3 (4.8%) and 9 (14.5%) patients respectively. Failure therapeutic treatments treated with sulfadoxine-pyrimethamine were successful. Chloroquine remains effective in the treatment of malaria due to P. falciparum and therefore its choice as a first line drug remains justified. Likewise, guidelines for the use of sulfadoxine-pyrimethamine as second line drug are adequate. In vitro, 4 resistances out of 27 successful tests to chloroquine (14.8%) and 1 resistance out of 25 successful tests to mefloquine (4%) were recorded. No resistance to quinine nor to amodiaquine were noticed. Alternative antimalarial drugs such as quinine, amodiaquine or mefloquine can be used in patients for whom the treatment with chloroquine is not possible. Nevertheless, the level of therapeutic failures to chloroquine detected in this study highlights the need and importance of drug sensitivity test for the development of a rational national antimalarial drug policy.

The resistance of Xenopsylla cheopis from urban area to pyrethroids, to DDT, and their susceptibility to carbamate are known. We have evaluated the susceptibility of X. cheopis collected from three rural localities: Ambodisiarivo (district of Antananarivo Avaradrano), Mandoto (district of Betafo), Analaroa (district of Anjozorobe) in the province of Antananarivo and in Besoa (district of Ambalavao) in the province of Fianarantsoa. The standard WHO protocol was used and four insecticides were tested: deltamethrin 0.025%, cyfluthrin 0.15% (pyrethroids), DDT 4% (organochlorine), propoxur 1% and bendiocarb 0.1% (carbamate). X. cheopis has been shown resistance to DDT 4%, to deltamethrin 0.025% but was susceptible in the rural area around Antananarivo City. They were tolerant to deltamethrin 0.025% and cyfluthrin 0.15% but susceptible to propoxur 0.1% and bendiocarbe 1% in the districts of Betafo and Anjozorobe. In Besoa, X. cheopis was resistant to DDT 4%, tolerant to deltamethrin 0.025% and cyfluthrin 0.15% but susceptible to propoxur 0.1% and bendiocarbe 1%. These results indicate that DDT and pyrethroids can not be recommended any more for the vector control in the rural area around the capital. The use of pyrethroids in the other districts of the central highland must be joined with a X. cheopis susceptibility control. In case of resistance to pyrethroids, carbamates would be proposed to control plague vector in the rural area. The high level of resistance to DDT and pyrethroid in the rural area around the capital confirms the importance of studying the flea population in different area of Madagascar and the possibility of the gene resistance propagation.

Neonatal infections represented the second cause of morbidity at the neonatalogy service of the Maternity Hospital of Befelatanana, and they were the first cause of the perinatal mortality (81%). This prospective study was carried out from May 1997 and December 1998 and had concerned neonatal infections suspicions among newborns. Its purpose was to identify problems with regard to the management of those newborns and to assess the impact of the prevention. Over 14,009 births, 1,877 neonates had infections recorded during the first week of life. Were noticed as main pathogen germs isolated: Escherichia coli, groups B, A, G, D Streptococci and Staphylococcus aureus. The authors conclude that screening and early treatment of materno-fetal infections constitute with asepsis, prevention basis of neonatal infections.

C-Reactive Protein (CRP) measurement is used to orientate the diagnosis of an inflammation especially in childhood febrish diseases. A retrospective study was carried out at the pediatric service of the General hospital of Befelatanana in Antananarivo for 48 months (1997-1998). The population of this study was continued of 361 patients taken from 714 febrish children. 384 CRP were performed. The initial CRP measurement allowed to differentiate 152 presumed bacterial infections: 49 respiratory tract infections, 62 in neurological pathology, 10 in digestive pathology, 19 in otorhinolaryngology pathology, 12 in urinary pathology, and 153 presumed viral infections: 86 respiratory tract infections, 29 in neurological pathology, 12 in digestive pathology, 26 in otorhinolaryngology pathology. There was a right correlation of CRP values and leukocyte levels in presumed bacterial infections. Specificity and sensibility of the test applied in different child febrish diseases were satisfactory. CRP measurement is easy and rapid to perform. It is useful and seems to be the appropriate method to diagnose childhood febrish diseases in countries where facilities are insufficient and financial possibilities limited.

Cervix neoplasms are the most frequent of female neoplasms in Madagascar. The authors reported a prospective study carried out at the Hospital Center of the University of Mahajanga for ten months (January-October 1993). 500 patients were investigated. 465 results of cervix and vaginal smears were considered. The Bethesda group classification was used to interpret lesions. 333 specific pathological lesions were listed. Bacterial infections and trichomoniasis were their principal causes. 4 cases were presumed as human papillomavirus condylomata. 39 SIL low-grade and 24 SIL high-grade were detected. 5 cervix neoplasms were diagnosed. Only few patients had consultation to perform cervix and vaginal smears because these exams are expensive. It may be an explication to the chronicity of lesions, a favourising factor of cancer. The role of viruses, especially human papillomavirus, in the development of cervix neoplasms is mentioned. The authors conclude that the low number of cervix neoplasms they founded is misleading. Cervix neoplasms are the first female cancers in Madagascar. A systematic surveillance of all female genitalia diseases must be programed. While its settling, cervix neoplasms control must be centred on Information--Education--Communication.

A retrospective study on tubercular primary infection in children was carried-out for 18 months (January 1994--June 1995) at the Child Hospital of Tsaralalana in Antananarivo-City. 27 cases were reported. The sex-ratio was of 1,01/1. The most clinical forms were pulmonary tuberculosis. An associated factor was malnutrition. Contact has been traced back to close family. Short course treatment regimen was the standard applied.

The purpose of this retrospective study carried out by 1997 in two paediatric units of Antananarivo: paediatric unit of the General hospital of Befelatanana (Marfan) and paediatric unit of the Hospital Center of Soavinandriana (CI), was to evaluate direct service costs for an hospitalization of a child affected by lower acute airway diseases. In the first unit, there is partial charge, in the second, there is full charge. Direct services were continued by complementary tests, therapy and meals. The length of the hospitalization changes according to the cause and the severity of diseases. Average direct service costs were of 19 and 38 US$ respectively. Maximum direct service costs were of 77 and 154 US$ respectively. Amounts of direct service costs were crippled especially by inappropriate use of antibiotics.

Congenital afibrinogenemia is a rare autosomal recessive disease caused by markedly reduced or absent synthesis of fibrinogen. Consanguinity is common in affected family. Clinical manifestations range to minimal or moderate bleeding to catastrophic haemorrhage. Bleedings are often post-traumatic, sometimes spontaneous. Diagnosis is established by laboratory tests presenting trace or absence of fibrinogen. Substitutive treatment with fibrinogen concentrates or fresh frozen plasma is used. The authors reported the case of a 41-year-old male with congenital afibrinogenemia with fatal spontaneous cerebral haemorrhage. Diagnosis was made upon history, bleeding history, clinical examination, blood coagulation tests and radiography. Cerebral haemorrhage must be suspected in any patient presenting blood coagulation disorders with bleeding history. Drug therapy must be installed immediately and continued before obtention of specific radiology images which are often late in relation to clinical signs.

Preterm deliveries (PT) produce new-borns whose prognosis is generally very dark. Prematurity is the first cause of neonatal death. A retrospective study was carried out at the Maternity Hospital of Befelatanana, Antananarivo in order to specify causes and difficulties of PT and to draw up strategy for their better management so that premature infants have chance to survive. The survey concerned 1394 patients: all pregnancies whose gestational age are between 22 and 36 weeks and those who delivery viable infants discharged home whose weights are between 500 and 2,500 grams. PT occur frequently among teenagers and more than 35-year old women. Risk factors and determinative causes of PT are mothers' toxic habits, gyneco-obstetrical history as PT, abortion, cicatricial uterus, urogenital infections. 12 maternal deaths were noted. Infant perinatal mortality rate was of 47.3 per cent. The authors conclude that difficulties were in labor and both antepartum and intrapartum periods. Preventive measures must surpass curative therapy. They will be based on the improvement of standard of living, the reinforcement of planning family and a strict pregnancy surveillance.