Annales de la Societe belge de medecine tropicale最新文献

The epidemiology of hepatitis C (HCV), especially on the African continent, is not well known. In this study, we investigated the presence of antibodies to HCV in 685 out-patients, seen in several health care centers or hospitals in different regions in Burundi from January to February 1991. Serological tests of the second generation were used. The global prevalence varied from 3.2% to 14.1% according to the center. Urban seroprevalence tended to be higher than rural prevalence. Also, with increasing age, a higher prevalence was observed. Anti-HCV antibodies were absent in patients younger than 21, while specific antibodies were detected in 23.1% of patients older than 50. Although the prevalence in men (10.4%) was higher than in women (7.4%), this difference was not statistically significant. Taking into account the selection of subjects participating in this evaluation, the results can not be extrapolated to the general population. No association between HCV and human immunodeficiency virus (HIV) was seen in this study. In contrast to previously described results from studies using reagents of the first generation, no cross-reactions were observed with anti-malarial antibodies.

The classical clinical picture of amoebic infection of the liver consists of fever, right upper quadrant pain and hepatomegaly. In recent years, the widespread availability of ultrasound and serology made an early diagnosis possible, which could result in less prominent clinical pictures. Thirty six cases of liver amoebiasis diagnosed in Antwerp between 1985 and 1992, were reviewed. Three patients acquired their infection in Belgium. For the other patients, the average delay between arrival in Belgium and the first symptoms was 5.64 months. The classical triad of clinical signs (fever, right upper quadrant pain and hepatomegaly), was observed in only 13.9% of the patients, whereas it was much more frequent in earlier studies (68-75%). The right lobe was the most frequently affected (94%). The colour of the liquid, obtained by puncture, was brown in 61% of patients in whom it was reported. Amoebic cysts were found in the stools of only one patient. Amoebic serology was initially negative in only one patient, but became positive on second testing. Chest X-rays were abnormal in 34% of the patients. All patients who develop unexplained fever during the year after a stay in tropical countries should undergo an abdominal ultrasound examination and serological testing for Entamoeba histolytica.

Pyogenic infections are common in tropical countries and draining pus is one of the most frequent surgical operations all over the developing world. While superficial abscesses are easily detectable by clinical means the diagnosis of deeper abscesses in muscles, joints, parenchymatous organs and body cavities is frequently difficult or even impossible. In those situations B-mode ultrasound represents a valuable diagnostic tool. Furthermore, diagnosis may be confirmed or defined by ultrasound guided needle aspiration and ultrasound-guided drainage. Those measures may save surgical interventions and cost. Based on our experience with more than 3820 ultrasound examinations in 2746 patients of Northern Zaire sonographic characteristics of pyogenic abscesses are defined. Clinical examples of pyogenic affections with the corresponding ultrasound morphology are presented.

Maternal mortality remains one of the major problems in public health today especially in developing countries where maternal mortality is estimated to be between 500 and 1000 deaths for 100,000 live births. In 1987, the safe motherhood initiative was launched with the objective of reducing maternal mortality by 50% within ten years. One of the methods introduced to reduce the high incidence of maternal and neonatal mortality in developing countries, is the partogram, a visual means used in evaluating a normal delivery. It acts as an early warning system, allowing for the early detection of abnormal evolution in labour as well for the mother as for the foetus. This instrument was introduced in all the maternity wards in Niger in 1990 by the Ministry of Public Health. A study was conducted in one of the maternities of the capital to ascertain the effectiveness of this new instrument to both the mother during labor and the newborn child. 1299 women in labor, primi-and multiparous, participated in the study. Two groups were formed: one consisted of women that delivered prior to the introduction of the partogram, the second group was comprised of women who delivered after its introduction. The results of this study have shown that the introduction of the partogram: reduces the amount of time that a women is in labor, improves the follow-up care the pregnant woman receives, results in a more timely decision made by the health official, and consequently, a prompt referral to a specialised center. The authors estimate that, if used correctly, the introduction of this instrument can have along with other appropriate measures, a considerable impact in the reduction of maternal and neonatal mortality.

Trypanosoma brucei gambiense sleeping sickness transmitted by tsetse flies (Glossina spp.) is lethal if not treated adequately. The endemicity was generally well under control in the sixties. However, since the seventies the disease is returning in most of its old foci, with alarming endemic levels in several areas. Mathematical modelling provides a rational basis for finding the optimal strategies to control these recrudescences. We present a deterministic model of the basic transmission of trypanosomiasis between human and vector hosts in natural situations. The parameters were quantified on the basis of available evidence from the literature. The model predicts a stable equilibrium state with very high prevalences: approximately 95% of humans and 27% of flies being infected. The model further shows that the build-up of an epidemic is initially very slow, and it takes several months before the equilibrium state is reached. Consequently communities have enough time to avoid catastrophic situations by migrating to safer areas. If is therefore unlikely that such high equilibrium situations will occur in practice. The expression of the basic reproductive rate R0, the number of new infections during the lifetime of an infected subject with high values of R0 implies that efforts to diminish transmission to levels where the disease cannot maintain itself in the population, have to be substantial. The necessary reduction of fly numbers in order to enable eradication, has been calculated. In almost all situations a reduction of at least 90% is necessary, which is in accordance with the field experiences of vector control programmes. The present model can be considered as a starting point in the further development of a complete simulation model, which could be applied in supporting decision making in trypanosomiasis control.

Active case detection in health centres and epidemiological surveys made it possible to determine the extent of onchocerciasis endemic regions in Burundi. The largest endemic region, in the north-west of the country, covers almost totally the province of Cibitoke and partially the adjoining province of Bubanza. The population at risk is 330,000. The endemic region in the south-west of Burundi covers more than one third of the province of Bururi and has 230,000 people at risk. The smallest endemic region is in the province of Rutana (south-east), where 52,000 people live.

To describe the clinical manifestations of dengue haemorrhagic fever (DHF) all children with a clinical diagnosis of DHF admitted to the paediatric ward of the Dr. Hassan Sadikin General Hospital (Bandung, Indonesia) between April 1st 1991 and September 30th 1993 were enrolled in a prospective study. Of the 306 children with a clinical diagnosis of DHF on admission in only 128 (41.8%) the diagnosis of DHF was confirmed by HI test. Of the confirmed cases, 24 (19%) developed shock and 1 (0.7%) died. Of the 174 cases with a negative HI test, 33 (19%) developed shock and 4 (2%) died. Four of the children died of shock before an hemagglutination inhibitor (HI) test was performed. The overall case mortality rate was 2.9%. The symptoms and signs of the 128 children with serologically confirmed DHF included fever or a history of fever (100%), petechiae (29.7%), epistaxis (39.1%), other forms of bleeding (5.5%), a positive Tourniquet test (78.1%), hepatomegaly (46.9%), epigastric pain (61.7%), vomiting (55.5%), thrombocytopenia < 100,000/mm3 (3.2% on admission and 15.3% during hospitalisation). Four (3%) children developed encephalopathy and 1 child an acute liver failure. In order to decrease the mortality associated with DHF early diagnosis and adequate case management are essential.

An epidemiological survey of malaria was carried out from September 1992 to November 1994 in three villages located in the Senegal river delta, two villages growing rice in irrigated fields and one practicing traditional rain water agriculture. Entomological observations showed that Anopheles pharoensis is the main anopheline species caught in the area with a high population density in the rice growing villages. The population density of species of the An. gambiae complex, represented by An. gambiae s.s., An. arabiensis and An. melas is low. Agressivity rates and anthropophlic indexes of An. pharoensis females are high but their parity rates are low. The malaria transmission is weak and was not perceptible in the area as shown by the negative results obtained with the ELISA tests and the examination of salivary glands. Parasitological indexes, malaria morbidity and incidence rates are low and are in agreement with the entomological data. In the Senegal river delta, irrigation has, on the whole, increased the An. pharoensis density but both malaria transmission and incidence rates did not rise.