[African histoplamosis. A report of three pediatric cases]

Histoplasmosis duboisii (Histoplasma capsulatum var duboisii) is uncommon disease especially in children. It is observed in Africa where the incidence is unknown. The authors report a series of three pediatric cases. The report concerned 2 girls and one boy who were 3, 9 and 4 year-old, respectively. Symptoms evolved for more than two months in each case. At admission, we found fever and poor general condition. Observed lesions were lymphnodes localisation disseminated (cases 1 and 2), subcutaneous (cold abscess) and cutaneous simulating molluscum contagiosum (case 2), osteoarticular (cases 2 and 3), abdominal including peritoneal and hepatosplenic (case 1). In all cases, a mild leukocytosis was found and an accelerated erythrocyte sedimentation rate (ESR) greater than 70mm. The HIV serology was negative. The treatment consisted of itraconazole in 2 cases and ketoconazole in one case. The evolution was insidious, leading to the discharge against medical advice. The death occurred at home in all cases.

CONCLUSION

Histoplasmosis duboisii can realize two main clinical presentations (localized or disseminated), affecting the skin, lymph nodes, bones, sometimes the intra-abdominal organs. HIV serology is not always positive in disseminated forms. The evolution is unpredictable and capricious under antifungal treatment. The disease should be well explained to prevent a possible discharge against medical advice, often pejorative.

[Pulmonary tuberculosis in infants in Brazzaville, Congo. A review of 117 cases]

Little information is available on pulmonary tuberculosis in infants in sub-Saharan Africa. This retrospective study was conducted in infants ranging in age from 1 to 23 months admitted to the Paediatric Departments of the University Hospital Centre in Brazzaville, Congo for pulmonary tuberculosis between January 1, 1999 and July 1, 2004. Tuberculosis was diagnosed on the basis of epidemiological, clinical, radiological, and follow-up data. All children over 12 months old underwent HIV testing. In case of positive test results, children between the ages of 12 and 18 months were retested after the age of 18 months. Of a total of 803 children admitted for tuberculosis during the study period, 117 (14.6%) were under the age of 24 months (53% males). Mean age was 17.5 months. The BCG test was mentioned in 75.2% of cases. Determination of the contagion in 50.4% of cases indicated that transmission was intrafamilial in 69.3% of cases. The mean delay for hospitalization was 2.6 months (range, 21 days to 16 months). Eighty-one patients (69.2%) presented severe malnutrition. Intrathoracic forms accounted for most cases with bronchopneumopathy (72.6%) and mediastinal adenopathy (40.2%). The incidence of bronchopneumonopathy and isolated forms was significantly higher in children over one year old than in children under one year old: 78.3% versus 21.7 % (p<0.01) and 62.8% versus 37.2% (p<0.001) respectively. A total of 35 children (43.8%) over the age of 12 months presented HIV infection. In comparison with HIV-negative children, HIV-positive children were more likely to present malnutrition and presented a statistically higher incidence of mediastinal adenopathy and multifocal forms. All associated extrathoracic lesions (21.4% of cases) occurred in HIV-positive children. Outcome was favourable in all HIV-negative children while 7 HIV-positive children (20%) died during treatment. Pulmonary tuberculosis in infants in Brazzaville is characterized by frequent association with HIV infection and prognosis is more severe in case of HIV co-infection.

[Early diagnosis of leukaemia in the trisomic child. Congolese experience based on two cases]

We are reporting here two cases of acute leukemia in Congolese children with Down syndrome. They were aged 27 and 30 months. The two cases were revealed by anemia, hyperthermia with enlargement of the liver and the spleen. Clinical course was unfavorable. Therefore, the early diagnosis of leukemia remains very important in patient with Down syndrome presenting hyperthermia with hepatosplenomegaly.

[Severe malaria associated with acute renal insufficiency: apropos of a case]

Renal insufficiency as a complication of severe malaria is a rare pathology. A case was observed in young girl aged 10.5 years following Plasmodium malaria fever. Clinical features included severe anemia, oligo-anuria, and creatinemia of 80 mg/l. The haemoglobin electrophoresis was standard. Under furosemide, the resumption of diuresis was effective nine days later. Renal functions of the child affected by severe Plasmodium malarial fever must always be checked.

[Kawasaki syndrome: apropos of 2 cases observed in Brazzaville]

The authors report for first time in Congo two cases of Kawasaki syndrome. One case from a five years boy carried out a typical form of an adeno-mucocutaneous syndrome; the other from a six month little girl was an incomplete form. In both cases, the immediate development has been excellent. The scarceness of this syndrome among the blacks and the diagnostic difficulties have been the background of the interest of this work.

[Early isosexual precocious pseudopuberty revealing a juvenile granulosa cell tumor in a 3-year-old Congolese girl]

We describe a juvenile granulosa cell tumor expressed by an early pseudopuberty occurring in a 3-year-old black child. Clinically, an endocrine syndrome was associated with a pelvic mass and ascites. Hyperoestrogenia and serum alphafetoprotein level were biologically detected. Histological examination showed typical microscopic features of a granulosa cell tumor. The patient is well four years after surgery. Growth and mental development are normal.