Archives de l'Institut Pasteur de Madagascar最新文献

In Madagascar, tuberculosis remains an important cause of morbidity and letality with a Risk of Annual Tubercular Infection about 1% in 1996 in spite of a vaccination rate of 82.6% and tubercular drugs free of charge. In 1995, the National Tubercular Control Program detected 7,000 cases of pulmonary tuberculosis and expected more than 12,000 cases per year. This study was carried out in order to review the management and the treatment of the child tuberculosis in Madagascar. This retrospective study was conducted in four pediatric units of the General hospital of Befelatanana (A and B), Ambohimiandra Hospital and Regional Hospital Centre of Toliara for a twenty four months period from January 1997 to December 1998. All the less than 15-year-old children medical files were consulted. 214 cases were suspected of tuberculosis. 133 of them were treated upon clinical presumption basis and/or radiological exams (33 bacteriological and/or histopathological exams were only realized). 56% of the cases were vaccinated by BCG vaccine. Respiratory diseases with fever motive 46% of hospitalization. The majority of these children are living in poor conditions and 38% of them had malnutrition. Were found as clinical manifestations: 47% of pulmonary tuberculosis (among them 20% were smear-positive pulmonary tuberculosis), 12% had ganglionar tuberculosis, 10% peritoneal tuberculosis, 8% a tubercular meningitis, 5% a Pott-disease and 2% a miliary-disease. Mortality increases with suffocation. 18% of cases died, especially infants and in tubercular meningitis. The authors conclude that management and treatment of tuberculosis need an early diagnosis. But the diagnosis is difficult in front of non specific clinical manifestations in children and due to lack of means and national agreement which settle up diagnosis and therapy. A scoring system based upon clinical signs in agreement with complementary medical tests is desirable.

Generally preterm ruptures of membranes (PRM) are harmless, but they become serious if the labor doesn't occur in the following 24 hours. Then, they might generate neonatal infections which provoke heavy fetal and maternal mortality. A retrospective study was carried out in 1998 at the Maternity Hospital of Befelatanana, Antananarivo in order to sum up knowledges on epidemiology and fetal prognosis of this disease, and to draw up measures to aim to reduce causes of PRM. 4232 cases of PRM were registered for the study period. The average age of parturient women was of 27 years old. PRM occur frequently among primiparas and high level multiparas. Risk factors and determinative causes are gyneco-obstetrical history as abortion, preterm delivery, cicatricial uterus, urogenital infections; uterine malformation; placenta praevia; hydramnios; dystocic labor presentation; uterine distension due to either multiple pregnancy or disproportion of fetus and birth canal; irregular and poor prenatal visits quality; low standard of living. Numerous premature infants of PRM outcomes had infections: 1,619 out of 4315 new-borns. Infant perinatal mortality rate was of 11.7 per cent. Maternal complications were infections, uterine rupture, hemorrhages. 5 deaths were noted. The reduction of PRM rate might be obtained by improvement of standard of living and hygiene, correct cares during pregnancy and intergenesic periods.

62 rhinopharingeal samples from malagasy children, aged of 6 days to 14 years old, hospitalized because of acute respiratory infections, with doubtful viral etiology case, during June to August 1992, at the "Hôpital des Enfants" in Antananarivo, were examined by two methods: inoculation by embryonned eggs and inoculation by MDCK cells. 24.1% of the samples were positive. The repartition of the cases by age and by sex were studied. The children aged of 1 to 12 months were the most affected with 65.7% of all cases (male: 60%, female: 40%). One subtype was detected: A(H3N2).

Idiopathic thrombocytopenic purpura (ITP), haematologic disease affecting the only blood platelets, is an acquired disease. It appears as cutaneous and mucosal bleedings preceded by a feverish syndrome. Cerebral haemorrhage is possible but very rare. If the disease occurs frequently in Europe and in the United States of America, there is a lack of data in Africa and in Madagascar. In order to fill this gap, the authors carried out retrospective and prospective studies in two paediatric units of Antananarivo for 32 months. They reported 4 cases of PTI of which clinical signs were moderate. As therapy, corticosteroids were used and were efficiency. It is desirable to settle a program allowing to survey sick children.

Ravages caused by cholera among children are well known. The disease invaded Madagascar in 1999 May. This retrospective study reported the first childhood cholera cases. The survey was carried out at the Befelatanana Hospital during the period of cholera outbreak from April 23th to July 31st. The purpose of the study was to specify clinical, epidemiological and bacteriological characteristics of the disease. 5 out of 178 suspected cholera cases were less than 15 years old. 2 young girls out these 5 children, inhabitants of Antananarivo-City were hospitalized for acute diarrhoea with serious dehydratation. Their disease was confirmed by bacteriology. Vibrio cholera O1 strain, serovar Ogawa was identified. Epidemiological investigation allowed to identify the contamination modal in the file no 1. The authors conclude that cholera is an important problem of public health in developing country like Madagascar. Disease control needs environmental sanitation and good individual hygiene practices.

Version by internal manipulations (VIM) cause high fetal and maternal morbidity and mortality rates. A retrospective study was carried out in 1998 at at the Maternity Hospital of Befelatanana, Antananarivo in order to assess VIM frequency, to specify their indications and technical difficulties by performing them. 177 VIM were registered for the period study: 85 on singleton pregnancies, 91 on the second twin and 1 on the third infant of a triplet pregnancy. VIM annual incidence was of 2.1 per cent. The average age of parturient women was 27 years old. Risk factors and determinative causes are gyneco-obstetrical history as abortion, preterm delivery, urogenital infections; high blood pressure; poor prenatal visits; poor cares during labor; untimely and inappropriate drug prescriptions; low standard of living. Maternal complications were hemorrhages of the afterbirth (73.0 per cent), uterine rupture (8.0 per cent), cervix tearing (5.0 per cent). 19 maternal deaths were noted. Infant perinatal mortality was of 68.0 per cent. The authors conclude that VIM is the only alternative to cesarotomy provided it is properly performed by a competent and experienced practitioner. VIM must be kept for the second twin in unengaged transverse lie.

Multiple pregnancies (MP) outcomes are often complicated. They deliver premature infants and provoke high blood pressure. A retrospective study was carried out in 1998 at the Maternity Hospital of Befelatanana, Antananarivo in order to assess MP frequency and to specify the most important favourising factors and difficulties during labor and the quality of the labor management. All pregnancies with a MP were included in this survey. 143 MP were registered: 142 twin pregnancies and 1 triplet pregnancy. 2.0 per cent of cases were recurrent MP. The average age of pregnancies was 26 years old. Among these 143 MP, 48.0 per cent were primiparas. Poor quality of prenatal visits is frequently encountered. As antecedents there are abortion, hormonal contraceptive taking, preterm delivery, gravidic toxemia, cicatricial uterus, ectopic pregnancy. 6.3 per cent of the first twin had breech presentation, 2.0 per cent transversal labor presentation. As events during labor 40.0 per cent dynamic dystocia, 26.0 per cent acute fetal suffering, 27.0 per cent hyperthermia, 23.0 per cent high blood pressure, some of them as eclampsia or pre-eclampsia were noted. 60.0 per cent of the first twin delivery were easy. Whatever his labor presentation, version by internal manipulations following by breech extraction was performed on the second twin (67.0 per cent of cases). 18.2 per cent of parturient women had cesaretomy. 11 maternal deaths were noted. Infant perinatal mortality rate was of 35.7 per cent. Infant morbidity and mortality are essentially due to infections. The authors conclude that complications prevention will be obtained by improvement of standard of living of all female able to procreate. It needs also correct cares at prenatal visits and during labor. Health education must be focalized on strict and correct surveillance of pregnancies and intergenesic periods by the reinforcement of planning family.

The authors reported a case of Cat--Scratch Disease (CSD) in a 14-year-old boy; it was an unusual CSD by its mediastinal mass location. Histopathological lesions which appeared as pseudo-tubercular folliculi mislead us. Disease was finally diagnosed by biological exams: a strongly positive Hanger-Rose reaction and serological assays used for the diagnosis of psittacosis, ornithosis, lymphagranuloma venereum and trachoma. CSD is a common cause of chronic lymphadenopathy in children. In the majority of patients, CSD is a mild illness. Some unusual forms as Parinaud's oculoglandular syndrome, neurological lesions, osteomyelitis and exceptionaly mediastinal lymphadenopathy have been reported. 2 cases of the latest ones were already described.

The purpose of this study is to assess the frequency of spontaneous and induced abortions at the Hospital Maternity of Befelatanana, in Antananarivo--City by 1997. The study was also carried out to identify causes and risk factors of abortions in order to draw up a control program. 958 abortion cases were counted. The patient average age was 28 old years. 289 cases (30.3%) of these abortions had complications, 1 out of 25 patients died. Some of causes of abortion have been specified: prior patient health, cultural, social and economic factors. Existence of abortions is a failure report of the Reproductive Heath Program. Abortion control must be based on sanitary education in which family planning is very important, on correct management of abortion cases and their complications. But all that is not possible if there are not improvements of the standard of living.