The clinical manifestations observed in 102 malaria patients (parasitaemia of over 8,000 Plasmodium falciparum/mm3) hospitalized in 1989 in Brazzaville (Congo) were analyzed after ruling out the cases of pernicious malaria. The clinical picture was fever, stomach upset with headache and musculo-articular pain as in classical cases. In children these manifestations were frequently associated with convulsions. Diarrhoea was not uncommon in young children. Vomiting was frequent in both children and adults. Splenomegaly and hepatomegaly were closely related to age. In these subjects, chemoprophylaxis was rare in children, practically non-existent in those aged over 5 years. However, presumptive treatment and self medication was usual regardless of age.
This study was conducted in all four hospitals of Brazzaville, the capital of the Congo in order to assess the trend in malaria morbidity, the frequency of cerebral malaria and the related mortality between 1983 and 1989 in Brazzaville children. For the period 1983 to 1987 the study was retrospective, based on records. For the period 1988 and 1989 a prospective study was carried out in the two main hospitals in which a system for reporting cases of cerebral malaria was set up. This was completed by a retrospective analysis of data similar to that carried for the previous years. The population of Brazzaville children aged between 0 and 14 years and the distribution by district were estimated from the 1984 official census taking the annual demographic growth to be 5%. The results show a marked increase in hospitalizations for malaria, noticeable since 1985, and which now account for about 50% of the overall non-surgical hospitalizations. The number of cases of cerebral malaria and related deaths have probably increased. However, these severe forms of malaria were relatively rare. Indeed, in 1988 and 1989, for the 0-4, 5-9 and 10-14 year age groups, the annual incidence rates of cerebral malaria were estimated at respectively 240, 61 and 13 per 100,000 and the related mortality rates at respectively 58, 5 and 1 per 100,000. No obvious relationship was found between the intensity of malaria transmission, which varied considerably according to the district, and the level of mortality from cerebral malaria.
Six new cases are described for African histoplasmosis, Histoplasma capsulatum var. duboisii, from Congo. The first was an HIV sero-negative child who has been monitored for the last three years. While under treatment with ketoconazole, amphotericin B, and finally itraconazole, the development of the infection was accompanied by purulent lesions, mainly cutaneous, but also superficial and deep lymphadenopathies. As a last option, itraconazole gave very satisfactory results both during the acute phase and during long-term treatment. However, eight months after treatment had ceased, there was a relapse and the long-term treatment had to be restarted. The other cases concerned HIV sero-positive patients with disseminated infections that had all been mistaken for tuberculosis. After diagnosis of the infection in two cases, the following two years of treatment could not prevent death. A fourth case, diagnosed in December 1994, is currently undergoing treatment. The fifth subject was lost after diagnosis during follow-up, but inquires made after the discovery of the patient's death strongly indicated acquired immunodeficiency as the cause. The last of these six cases, determined as HIV sero-negative, showed large bony lesions of the spinal column associated with a sore on the thorax. Thus, in a short period of time, three or four cases of African histoplasmosis occurred which were associated with HIV infection. Only seven identical observations have previously been reported in the literature. Therefore, we believe that this mycosis should now be included in the criteria for the diagnosis and definition of AIDS in the tropics.In Congo, the parasitology-mycology laboratory in Brazzaville diagnosed six new cases of African histoplasmosis (Histoplasma capsulatum var. duboisii) in a 3-year period. Three cases had AIDS. Another case was strongly suspected of being HIV seropositive. The first case was a 4-year-old child from Brazzaville who had been monitored for more than 3 years. Health providers treated him first with ketoconazole, then amphotericin B, and finally itraconazole. The child's African histoplasmosis was characterized by purulent lesions, particularly cutaneous, but also superficial and deep lymphadenopathies. Itraconazole adequately treated the child's condition both during the acute phase and during long-term treatment. Eight months after the end of itraconazole treatment, the child suffered a relapse, resulting in re-administration of longterm treatment. The remaining African histoplasmosis cases had disseminated infections, which were initially suspected to be tuberculosis. After diagnosis, two cases died despite two years of treatment. The fourth case was diagnosed in December 1994 and is still receiving treatment. After diagnosis, the fifth case was lost to follow-up. Health providers later learned that AIDS was probably responsible for the patient's death. The sixth case did not have HIV infection. The 32-year-old man, a nurse in the central army hospital in Brazzaville, had large bony lesions of the spinal column associated with a sore on the thorax. The literature shows only seven other African histoplasmosis cases infected with HIV. These HIV-infected African histoplasmosis cases along with the seven cases in the literature suggest that African histoplasmosis should be included in the criteria for the diagnosis and definition of AIDS in tropical countries.
This study of birth weights of full term neonates completes the preliminary investigations undertaken in Brazzaville in 1985. Mean birth weight was 3,090 +/- 492 g, with higher values in males than in females. Birth weight increased with maternal age up to 30 years, with parity up to 5, and with maternal weight/stature ratio. Nutritional factors seemed to have a major influence on the birth weight of full term babies.
The aim of this cross-sectional study was to analyse the radiological profile in 92 patients with Pott's disease and to identify severity factors. Among these subjects, aged from 11 months to 15 years old (average: 7.5 years), 37% of children had neurological signs; the HIV test was positive in 11 % of cases. Localisations were mainly dorsal (61%) and thoracic (49%). They were often associated. Almost all patients had lesions on one vertebra (31.5%) or 2 vertebrae (38%). Most of lesions were spondylitis (61%), paravertebra abscess (35%) and compressing vertebra (34%). The severity of vertebra localisations was correlated with late diagnosis and presence of neurological complication, while a high sedimentation rate didn't appear to be a factor of severity. Therefore radiology remains essential in Pott's disease evaluation providing precious information for the diagnosis and prognosis of spine tuberculosis.
