[About a Case of Febrile Gastroenteritis Due to Strongyloidiasis in a Gabonese Patient Treated for Lupus]

Srongyloidiasis can sometimes be a source of diagnostic wandering in a patient with an autoimmune disease living in a tropical environment, despite systematic deworming with albendazole (400 mg/day/3 days), prior to the starting of a corticotherapy. We report an observation of a febrile gastroenteritis complicated by signs of intra and extracellular dehydration, in a 37-year-old lupus patient, including duodenal biopsies, and stool parasitology, which led to the diagnosis of strongyloidiasis effectively treated by ivermectin per os (two doses) of 200 micrograms/kg, once every 2 weeks apart), following failure of a first 5-days course of albendazole (400 mg/day).

[Behavior and attitudes towards smoking among student midwives in Libreville]

BACKGROUND

The midwife, in taking on a public health role, is one of the most important resources for the prevention of smoking and in helping smoking cessation among women of childbearing age thanks to their numerous contacts with pregnant women. With this in mind, we conducted a study among student midwives to examine their smoking behavior, their attitudes towards smoking, and their participation in prevention.

METHOD

This was a descriptive cross-sectional study conducted from 15 January to 15 February 2018 using a self-administered questionnaire and included the student midwives of the University of Health Science at Libreville (Gabon).

RESULTS

A total of 188 student midwives completed the questionnaires (70.7% of students of the 1st year, 15.0% of students of the 2nd year and 14.3% of students of the 3rd year). Gaps exist in the knowledge of student midwives regarding the risks of cigarette smoking in pregnancy and its role in the development of complications for the mother and foetus. Overall, 17.1% of student midwives think that smoking is responsible for the occurrence of ectopic pregnancies, 20.3% believe it is responsible for retro-placental haematoma, 17.6% for premature rupture of the membranes. The prevalence of smoking was 11.1% and was most frequent in 2nd year students (25.0%) and 3rd year students (14.8%) (P<0.023). The mean age of beginning smoking was 19.0±4.4 years. The main initiating factors were peer influence (28.6%), pleasure (19.0%) and stress (14.3%). Nicotine dependence was weak to moderate among 48.8% of smokers and absent in 52.2%.

CONCLUSION

Gaps exist in the knowledge of student midwives regarding the risks of cigarette smoking to complications of pregnancy. There is need therefore to include formal training on tobacco control strategies at an early stage in the medical curriculum.

Patients' Families' Perceptions of Lupus in Sub-Saharan Africa

Lupus is an autoimmune disease affecting the connective tissue. Its clinical and biological polymorphism is often misunderstood by patients and families and can lead to treatment interruption and a decision to turn to alternative medicine. We used a questionnaire to assess the degree of knowledge of this disease of family members living with lupus patients. Of the 56 lupus patients receiving regular follow-up at our hospital, 123 members of 30 of their families (53.5%) participated. Overall, among these families, 81.5% of the participants perceived the disease as predominantly non-mystical, 72.3% as hereditary, 87.9% as non-contagious, and 60.9% as curable ; 90.2% considered it compatible with pregnancy, another 90.2% with work, and 73.9% with sports activity. The principal clinical signs mentioned involved joint (22.7%), skin (13%), and finger-related (11.3%) disorders, with renal disease (9.7%), heart disease (8.1%), and general signs (8.1%) mentioned most frequently as the main complications. The best-known medications for disease control were corticosteroids (20.3%) and hydroxychloroquine (17%). Family members considered non-adherence (53.6%) the most frequent factor in disease flares. More than half were unaware of the life expectancy associated with this disease, but 30.1 % thought it was lower than that of the national population of Gabon - 70 years. Only 64 (52%) of the respondents had seen documentation about lupus, mostly through the Internet (65.6%). Lupus is not a disease that families know and understand well.

Assessment of Imatinib in the treatment of chronic myeloid leukemia in Gabon: a cohort of 17 cases

The prognosis for chronic myeloid leukemia, the first hematologic malignancy for which successful targeted therapy has been developed, has changed markedly in the West. In developing countries, however, prognosis remains poor, mainly because of lack of access to treatment. The effort made by some nongovernmental organizations to distribute first-generation tyrosine kinase inhibitors free of charge has changed this situation in some regions, notably in sub-Saharan Africa and Gabon in particular. We report the results in a cohort of 17 patients.

[Tuberculosis of the breast: four cases report at the Armies Instruction's Hospital Omar Bongo Ondimba (HIAOBO) in Libreville (Gabon)]

Mammary tuberculosis is a rare localization of extra pulmonary tuberculosis. Its frequency increases proportionally with the HIV pandemic. We report four cases of breast tuberculosis diagnosed in the general medicine department of HIAOBO including two with positive HIV serology. It is necessary to know this extra pulmonary form/feature as the differential diagnosis with breast tumors is sometimes difficult.

[Breast cancer in men: about 3 cases at the l'Hôpital d'instruction des armées Omar Bongo Ondimba (HIAOBO) (Gabon)]

We report three cases of breast cancer in men observed at Military Teaching Hospital Omar Bongo Ondimba between January 2008 and December 2009, under varying circumstances, with all unfavorable evolution.

[Intrathoracic giant peripheral nerve sheath tumor during Von Recklinghausen disease]

We report the case of a patient aged 23, admitted for bilateral intrathoracic tumor, including a giant right. Surgery was performed by right sternothoracotomy. After 7 days, she presented an irreversible cardiac arrest. The malignant peripheral nerve sheath tumors are rare and aggressive. Their incidence is 0.001% in the general population and 0.16% in patients with neurofibromatosis type 1. These tumors are characterized by their risk of recurrence and poor prognosis. The treatment is the surgical resection. We analyze incidence, diagnosis and prognosis of these tumors.

[Purple extremities in black-skinned patients: blue toe syndrome as presenting sign of antiphospholipid antibody syndrome]

Although acral ischemia can involve several underlying mechanisms, suspicion of lupus warrants testing for antiphospholipid antibodies in patients with blue toe syndrome.

[Castleman's disease: first case in Gabon]

Castleman's disease is an atypical lymphoproliferative disorder characterized by hyperplasia of lymphoid structures with vascular proliferation. It has rarely been diagnosed in black African populations. The purpose of this report is to describe the first case in Gabon. The patient was a 47-year-old black African man. Outcome was fatal.

[Association myositis and hepatocellular carcinoma: one case and review of literature]

Association inflammatory myopathies and tumors are not fortuitous but association with hepatocellular carcinoma is rarely reported in literature. We described a case of association polymyositis hepatocellular carcinoma in 37-year-old black African patient, with fatal issue.

[Kikuchi-Fujimoto disease in Gabon. Description of first 2 cases in Gabon]

Kikuchi-Fujimoto disease is a rare disorder sometimes associated with systemic lupus. It has rarely been reported in the black African population. The purpose of this report is to describe the first two cases in Gabon. In patients presenting enlarged cervical lymph nodes, it is first necessary to rule out infectious disease. Histology can allow diagnosis by demonstrating necrotizing histiocyte lymphadenitis.

[Lupus, corticosteroid treatment and opportunistic infection: 26 cases in Gabon]

Opportunistic infection is frequent in lupus patients. Susceptibility is inherent in the lymphopeniant nature of the disease and enhanced by the use of immune-suppressing agents (alone or in combination) for optimal disease control. The purpose of this retrospective series of lupus patients diagnosed based on the criteria of the American College of Rheumatology (ACR) was to assess the frequency of opportunistic infection in a high-risk epidemiological area. A total of 26 patients (24 women, 2 men) with a mean age of 28.8 years were identified. Systematic review carried infectious before the steroid and in light of the local endemicity (HBs Ag, hepatitis C serology, HIV + Rx Thorax IDR) coupled with blood cultures was non-contributory, without waking the tank or during the introduction treatment. With a mean follow-up of 3.6 years (range, 0.83 to 9.91), only one case of tuberculosis was observed with fatal outcome. Our study indicates that the prevalence of opportunistic infections in the Lupus under treatment in a high-risk area for infectious diseases was low. This finding suggests that the risk of infectious complications secondary to corticosteroid therapy in sub-Saharan zone is acceptable provided that surveillance is performed on a regular basis.

[Evaluation of the cost of managing systemic lupus erythematosus in Gabon]

The purpose of this retrospective study was to evaluate the cost of managing systemic lupus erythematosus in Gabon. Study was carried out from 01/2004 to 12/2007. All patients presenting at least 4 of the 11 diagnostic criteria of the American College of Rheumatology were included. The total cost was calculated for the first year and from the second year. A total of 25 patients (24 women, 1 man) with a mean age of 29.6 years (range: 18 and 45) were included in the study. Care was provided by the patient her/himself (n = 8), parents (n = 11), or jointly by other relatives (n = 6). The average cost of accommodation was euro 769.6. Diagnostic review and impact cost were euro 53.3 and euro 58.6 respectively. Overall the average cost of hospitalization was euro 972.7. The total cost for the first year following diagnosis was 1398.6 for patients with the cutaneous-articular form of systemic lupus erythematousus and euro 1500.7 for patients with visceral forms. From the second year on, the annual cost was euro 261 for patients with the cutaneous-articular form and euro 534.7 for patients with visceral forms. Sixteen of the 25 patients were regularly re-examined as outpatients. Nine patients were lost to follow-up including 5 during the first year, 3 during the second year, and 1 during the third year. Two deaths occurred due to chronic renal failure and septic shock. This study shows that long-term follow-up for systemic lupus erythematosus in Gabon is difficult due to patient dropout.

[Dermatomyositis and pregnancy: a case in Gabon]

The purpose of this report is to describe a case of successful pregnancy involving a 30-year-old Afican woman presenting dermatomyositis, without use of immunosuppressive treatment. The child was delivered prematurely by caesarean section at 32 weeks of gestation.

[Two cases of probable immune restoration syndrome under antiretroviral treatment in patients treated for tuberculosis in Gabon]

Tuberculosis can be reactivated under specific treatment, as immune reconstitution inflammatory syndrome (IRIS), in HIV patients under antiretroviral treatment. We report two observations of tuberculosis exacerbation with extension to other territories (lymph node and pericarditis) occurring 3 weeks and 4 months after administration of tuberculosis treatment, with a favourable development, in absence of rehabilitation or addition of complementary therapy These observations show the necessity of increased surveillance on the short, medium and long term in patients with both treatment for tuberculosis and antiretroviral treatment.

[Opportunistic diseases in HIV-infected patients at the Jeanne Ebori Foundation in Libreville, Gabon]

The purpose of this study was to determine the frequencies of opportunistic diseases among AIDS patients at the Jeanne Ebori Foundation (JEF) in Libreville, Gabon. A total 6313 file of patients treated in the internal medicine unit between 1994 and 1998 were analyzed. Findings showed that the main diseases related to AIDS classified according to seroprevalence were as follows: purigo (100%), cerebral toxoplasmosis (100%), oral candidiaisis (88%), bacteremia (87.8%), shingles (84.6%), minor salmonelosis (72%), and tuberclosis. The main diagnoses unrelated to AIDS at the JEF according to seroprevalene were typhoid (9.4%), common pneumonia (28%), bacterial meningitis (26.3%, hepatitis B (20.0%), and malaria (14%). In addition to these diseases there were nine cases of Kaposi's sarcoma, four cases of isosporosis, two cases of cryptococcosis, two cases of herpes Varicella, one case of cryptosporidiosis, and one case of isosporosis. The incidence of opportunistic disease was high in our study and must be taken in drug procurement.

[Prevalence of hepatitis B and C virus, HTLV-1 and HIV in type B lymphoproliferative syndromes in Gabon]

B lymphoproliferative disorders (B-LPD) are the most frequent types of lymphoid malignancies encountered in Gabon where HCV, HBV, HTLV-I and HIV are highly prevalent and all known for lymphotropism. Prevalences of HBs Ag, antibodies to HCV, HTLV-I and HIV were compared in 40 patients (21 men, 19 women; 17 < age < 75 years) with newly diagnosed B-LPD (low grade lymphoma = 6, intermediate grade = 21, high grade = 8: chronic lymphocytic leukaemia = 5) and 160 age and sex-matched controls. None of the B-LPD patients had got transfusion or parenteral care from the onset of symptoms to the inclusion day. In the B-LPD group, 13 patients had HBs Ag and antibodies to HCV, HIV and HTLV-1 were detected in 11, 6 and 10 subjects. In monovariate analysis, HBs Ag, antibodies to HIV or HTLV-1 were risk factors for B-LPD but antibodies to HCV were not associated with such diseases. Multivariate analysis showed only a relationship between HBs Ag and B-LPD (OR = 3.86; IC: 1.11-13.48). In such patients, reactivation of B hepatitis by treatment of B-LBD may be an important concern. If a background poor immune system could explain both susceptibility to long standing virus carriage and lymphoma development, a participating action of the HBV in lymphomagenesis could not be excluded.

[Epidemiologic and clinical aspects of child tuberculosis in Gabon. Retrospective study of 47 cases]

Forty-seven pediatric cases of tuberculosis seen over three years in a department of general pediatrics are reviewed. The main epidemiological and clinical features were studied. Yearly incidence approximated 1.42% in the department. In most instances the source of contamination was not identified. Most patients had not been immunized according to recommendations. Early immunization should be performed and followed by routine tests for vaccine-induced immunity during the first two years.

[Rigid tube bronchoscopy in tuberculous children. Apropos of 24 cases]

We report the preliminary results of a study in children with tuberculosis. Rigid tube bronchoscopy provided diagnostic information in 79% of cases and allowed a few therapeutic procedures including aspiration of secretions and removal of inflammatory granulomas. We found that the most common lesion is bronchial compression. Rigid tube bronchoscopy is acceptably comfortable under general anesthesia and provides valuable results.

[Hepatotoxicity of the combination of isoniazid-rifampicin in African children. Role of malnutrition and HB virus]

Forty-seven Gabonese children with tuberculosis either limited to the lung or associated with other localizations were treated with isoniazid-rifampin (INH + RIF). They had liver tests done during the first 6 months of treatment. In 30 patients (63.8%) there was an increase in aminotransferase levels [over 100 UI/l in 14 (29.2%)]. The main factors increasing the risk of hepatic toxicity was a high dosage of INH and overall malnutrition. In fact, the weights of patients presenting with signs of hepatic toxicity were significantly lower than those in children who had no alterations of liver function. 68% of the severely malnourished (marasmus of kwashiorkor) presented with high ALAT or ASAT levels during treatment. The eventual role of the chronic HBV carrier state is discussed as 2 children presented with a chronic form of hepatitis at the time the treatment was initiated.

[Acquired immunodeficiency syndrome (AIDS) in Gabon. Apropos of 23 cases at the internal medicine service of the hospital centers in Libreville and Franceville, 1985-1987]

In 1986 prevalence rates of anti-HIV1 antibodies in randomly selected asymptomatic gabonese population ranged from 0.2% in rural areas to, 1.8% in Libreville (the largest town). We report the first description of AIDS cases observed in the hospitals of Libreville and Franceville between 1985 and 1987. 23 patients (14 males, 9 females) met the clinical diagnosis criteria for AIDS according to the provisional WHO clinical case definition for AIDS. 21 of them were gaboneses. The mean age of patients was 32.8, only one child was observed (blood transfused sickle-cell anemia). The only risk factor that we observed three times was blood transfusion. The clinical presentation of those cases will be described. 22 were positive for anti-HIV1 antibodies by Western-Blot analysis of their sera, one was anti-HIV2 positive (a congolese man hospitalized in Franceville for severe weight loss and pulmonary tuberculosis).