Annales de la Societe belge de medecine tropicale最新文献

The modalities of prevention and treatment of malaria in expatriates residing in Brazzaville, capital of the Congo, have been studied in March 1989, April 1990 and April 1992. These surveys of the type Behavior, Attitude, Practice have been carried out in the Ecole Française where the same questionnaire has been distributed among the primary school children to complete by their parents. Only the data pertaining to Europeans, Lebanese, and North-Americans are presented. The proportion of French expatriates is 80%. A progressive decrease is noticed in the regular taking of chemoprophylaxis: the percentage varies between 86 and 43% according ot the duration of residence in 1989, to between 57 and 16% in 1992. Chloroquine alone remains the most widely used product, especially in long term expatriates. The association chloroquine-proguanil is mentioned only by a quarter or respondents. Apparently efficient, it is especially taken by people exposed for less than 4 years. Amodiaquine, although contra-indicated for prevention purposes, is cited in 1992 by 9% of subjects taking regular chemoprophylaxis; other products are only exceptionally used. In curative treatment, which generally is presumptive, halofantrine is since 1990 the most widely used drug, especially in children. In contrast, a relative disclaimer is noted for the amino-4-quinolines, due to resistance, but also and with no justification, for the association sulfadoxine-pyrimethamine and, to a lesser degree, for quinine. The occurrence of attacks considered to be malarial and their frequency, remained stable during the period of study.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular karyotype of 45 reference populations of Neotropical leishmanias was analyzed with ethidium bromide staining and with 6 chromosome-derived probes selected from a genomic library of Leishmania (Viannia) braziliensis. Size-conserved patterns were identified and found to be specific to subgenus Viannia and to its constitutive species. An important issue for epidemiology and clinical investigations was the discrimination between L. (V.) peruviana and L. (V.) braziliensis, 2 species found very similar by other genetic techniques, but responsible for totally different clinical patterns. The suggested existence of genetically distinct demes, or karyodemes, within the group-species might also show to be of importance, as these populations might differ in virulence, host-specificity and clinical manifestations.

Thirteen African cases of rhinosporidiosis are reported from Burundi, Rwanda, Tanzania, Chad and Zaire. They include the first reported cases from Burundi and from Rwanda and the first African case, outside nose and eye, localized on the urethral orifice in a Zairian male.

In the rural city of Inongo (Bandundu region, Zaire), the prevalence of HIV-1 infection has been investigated during a survey on HTLV-I infection and associated neurological diseases, using a cluster sampling technique. Thirteen individuals were infected by HIV-1, 11 adults and 2 children, giving a crude prevalence rate in the cluster sample of 1.1%. More women were infected than men. After direct standardization on the age and sex structure given by the 1984 census, the prevalence of HIV-1 in the city may be estimated at 1.0% for the whole population and 1.6% for the population above 15 years of age. The importance is stressed of protecting rural populations, particularly women of childbearing age from the HIV epidemic, by information campaigns focused on the male migrant population, including both seasonal and travelling workers.

The (confirmed) serological data, collected since 1985 and spread in space and in time, allow to draw a geographical image--distribution, dissemination--of HIV 1 infection. These data raise some questions and hypotheses on the nature and the dynamics of the epidemiological factors involved. The geographical distribution of the infection in the global population is heterogeneous. Ever since the first surveys, the virus is widely spread at low level, in the rural as well as in the urban areas, covering a large territory, from Chad to Gabon; later it tends to focus on the large metropolitan and secondary towns. The endemicity is more pronounced in a double urban conglomerate (Kinshasa, Brazzaville) and in two regional foci, the southwest of the Congo and the south of Shaba; in the two towns the prevalence rate does not progress between 1985-86 and 1991-92. The Central African Republic has suffered an active epidemic outbreak, affecting the capital and the whole network of secondary towns. The epidemiological discontinuities noticeable across Central Africa, may represent different stages of the same process or be connected to the stake of different eco-epidemiological systems.

Sixteen cases of malaria are reported per thousand inhabitants per year in Kayanza, a province in the High Plateaux of Burundi. A case control study was conducted between October 1990 and March 1991 to better document this phenomenon. The majority of confirmed cases presented in persons who had recently sojourned in an endemic area (relative risk = 18). All except one of the other patients were carriers of plasmodium species that can cause late recurrences, which is compatible with the absence of local transmission. The presumptive diagnosis of malaria, as it is routinely made in the health centres, is not very specific (60%) and it has a positive predictive value of only 10%. This implies that an anti-malaria treatment is useless for 90% of the patients who receive it. It also means that the true malaria incidence rate in Kayanza can be estimated at less than 1 per thousand per year. We propose an alternative diagnostic strategy based on the risk differences between population sub-groups. It should permit an adequate patient management and a satisfactory surveillance of malaria in non-endemic epidemiological strata.

The obstetrical referral patients admitted to the Sanon Souro hospital in Bobo-Dioulasso (Burkina Faso) during 1991 were retrospectively reviewed. During the study period 741 women were admitted. The median distance between the referring centre and Bobo-Dioulasso was 33 km. Median age was 22 years and median parity was 3. Indications for referral were dominated by obstructed labour, haemorrhages and infections. The proportion of maternal mortality in the study was 5.4% and was not related to maternal age or parity. However, there was a linear trend of increasing mortality according to the distance between the referring centre and Bobo-Dioulasso (X2 for trend: 7.56; p = 0.006). The perinatal mortality rate of 420 p. thousand was not related to maternal age, but a parity exceeding 4 was a risk factor for the occurrence of perinatal death (relative risk: 1.4; 95% C.I.: 1.2-1.7). As for maternal mortality, there was a linear increase of perinatal mortality with the distance from the referring centre (X2: 20.8; p = 0.00001). There was no marked seasonal variation in the number of referrals nor in the mortality rates per month.

Two insect growth regulators (IGR'S) acting as juvenile hormone analogs (JHA'S), OMS 3010 (phenoxycarb) and OMS 3019 (ethoxypyridine) were selected after a screening of several compounds proposed by industry on black fly larvae of the Simulium damnosum complex (Diptera: Simuliidae) the vector of onchocerciasis in West Africa. Bioassays were designed to study two parameters: larval age and exposure time. The results showed that these compounds are more efficient on old larvae (6th and 7th instars) than young larvae (3rd, 4th and 5th instars). However, exposure time seems essential. The black fly larvae live in fast running water courses. Thus, it is difficult to insure a prolonged exposure time in natural conditions. Though being active on black fly larvae, three factors are limiting the prospects for operational use of these two compounds: high dosages, limited effectiveness on young instar larvae and exposure time.

One hundred children with clinical symptoms of tinea capitis have been examined. The samples were inoculated on Sabouraud medium and incubated at 25 degrees C. In 65 of 100 cultured samples at least one dermatophyte was isolated. In 42 cases Trichophyton violaceum and in 26 cases Microsporon langeroni was grown. The cultures of three patients resulted in the mixed growth of Trichophyton violaceum and Microsporon langeroni. Determination of the type of tinea capitis on clinical symptoms alone is difficult, especially when early lesions are concerned.