Aplasia cutis congenita associated with Goltz syndrome in a male neonate

Here we report the association of giant aplasia cutis congenita in a newborn black male with Goltz syndrome. The cutis aplasia defect is extensive and circonscript at the vertex. The cerebral structures are visible through the lesions. In addition, the patient has a low birth weight, syndactyly, adactyly, cutaneous atrophy, and areas of hyperpigmentation on the legs and hypoplastic maxillary. We think that these signs are probably due to mosaic mutations in PORCN. We reviewed 18 cases of Goltz syndrome in 18 male neonates but none has aplasia cutis congenita. Such a combination of severe aplasia cutis congenita was not reported previously in Goltz syndrome.

[Genital bacterial carriage during the last trimester of pregnancy and early-onset neonatal sepsis]

Bacterial infections remain a major cause of morbidity and mortality in newborn infants.

OBJECTIVE

To determine the bacterial ecology and pathological status of the genital organs during the last trimester of pregnancy and the germs of the following early-onset neonatal sepsis, in order to evaluate the risk of materno-foetal infections and to find out a drug prophylaxis.

METHOD

Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and of possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states. An exploration was carried out in every newborn suspected of infection.

RESULTS

Genital samples were collected from 306 pregnant women. Among them, 118 were at 29-32 weeks of gestation, 104 at 33-36, and 84 at 37-40. The most frequent germs were C. albicans (33,5%), Enterbacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) and polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or endocervicitis (10.4%), asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified. These pregnancies led to 334 live births with 27 cases of early-onset neonatal sepsis to which endocervicitis (25%) and vaginosis (19,7%) were most often linked.

CONCLUSION

Genital samples at the last trimester of pregnancy could evaluate the risk of maternofoetal infections and allow to adapt a drug prophylaxis of Enterobacteriaceae, the most frequent germ of neonatal infections, as it has been done for Streptococcus agalactiae. But larger studies are required to evaluate the risk of maternofoetal infections and to state the drug prophylaxis.

The child's noma in an hospital center in Burkina Faso : Clinical features and course

In order to study the therapeutic and developing aspect the child's noma in Burkina Faso, we have undertaken a retrospective study on a ten-years-period, with the files of 59 children hospitalized in the hospital of Bobo-Dioulasso, completed with a visit to the children's families after their leaving the hospital. The medical treatment has allowed to reach a recovery rate of 79.6% at the cost of aesthetic and functional after-effects which aren't negligible. The death rate in hospital was 13.7%. 31 children have profited from the restoring surgery of lesions. The care out of hospital has showed that the surgical results were mitigated.

Burkitt's lymphomain Burkina Faso hospital center : therapeutic and course

Summary A retrospective study of 41 cases of children sent to hospital and treated for the Burkitt's lymphoma for a period of 10 years has been carried out in the hospital of Bobo-Dioulasso in order to study the progressing and therapeutic features of the disease. The therapeutic means were the ablation surgery of voluminous tumors (19.5%) and the monochimiotherapy with cyclophosphamid (83%) according to Burkitt's procedure (64.7%) and N'gu procedure (35.3%). The mortality under chimiotherapy was 8.8%. The immediate evolution has shown 58.8% of complete remission, 26.5% of partial remission, 11.8% of resistance to the treatment.

[Comparative study of neonatal bacterial meningitis in Lomé, Bobo-Dioulasso, Casablanca and Lyon]

Bacterial meningitis in new-borns remains a serious event because of its high mortality and morbidity rates in Africa.

OBJECTIVE

To identify the clinical and bacteriological epidemiology and the outcome of neonatal bacterial meningitis in three African cities.

METHOD

We have analysed and compared three hospital studies done in humid tropical, Sahelian, and desert Africa with a European study.

RESULTS

Compared with the European study this African study is characterized by a high mean frequency of neonatal meningitis (6 cases per year against 1.4), more important risk factors linked to pregnancy and childbirth (50% against 33%), high rates of death (61 to 68% against 5%) and sequelae (25 to 40% against 30%), rarity of Streptococcus agalactiae (7 to 15% against 38%) and absence of Listeria. Enterobacteriaceae were predominant both in African (50 to 68%) and European (43%) studies. E. coli appeared as the most frequent germ in both European and African studies and Salmonella as more frequent in Sub-Saharan Africa than in occidental countries.

CONCLUSION

The epidemiological, bacteriological and evolutional aspects of the neonatal meningitis were identical in the three African cities. The African studies were different from the European only by their high incidence, the rarity of S. agalactiae and Listeria and the difficulties of bacterial diagnosis and management, all might explain the high rates of death and sequelae. An epidemiological survey and adequate antimicrobial therapy according to antibiotic susceptibility may improve the outcome.

[Neonatal septicaemia: bacteriological aspects and outcome in the university hospital center of Lome]

Despite the progress in neonatal intensive care and antibiotics, the neonatal septicaemia remains very frequent and lethal in tropical areas.

OBJECTIVE

To study the bacteriology and outcome of the neonatal septicaemia through an analysis of 50 confirmed cases.

METHODS

Every child aged of less than 29 days, suspected of infection and with at least one positive blood culture has been included. His perinatal antecedents, clinical features, bacteriological findings, treatments and clinical outcome have been collected. The patients have been divided into 3 groups in regard to the postnatal age at the first positive blood culture: before 48 hours, between 3 and 7 days and after 7 days of life.

RESULTS

The neonatal septicaemia occurred in 50% of the cases before 48 hours, 24% from the 2nd to the 7th day and 26% from the 8th to the 28th day of life. Enterobacteriaceae (54%) with E. coli predominant (30%) and S. aureus (28%) were the most frequent germs and particularly during the first week of life: 20/27 and 11/14 respectively. The resistance to the association of ampicillin or amoxicillin and gentamicin was 70% for Enterobacteriaceae and 71% for Staphylococci. The lethality was 36% with an excess of lethality for S. aureus (43%).

CONCLUSION

The high rates of frequency and lethality of the neonatal septicaemia in tropical areas require a perinatal care improvement to reduce its morbidity and mortality.

[Tuberculosis in the newborn: recrudescence in areas with high endemic HIV infection]

Despite the rising prevalence of tuberculosis due in part to the HIV pandemic in Africa, there have been few reports describing neonatal or congenital tuberculosis and its association with maternal HIV infection has been rare. The purpose of this study was to evaluate the clinical and epidemiological features of tuberculosis in newborns from areas with high endemic rates of both tuberculosis and HIV infection. During the 2-year study period all neonates admitted to the Campus Teaching Hospital in Lomé, Togo for differential diagnosis of symptoms compatible with tuberculosis were investigated. The clinical profile of tuberculosis in the newborn was correlated with that of the mother with or without HIV infection. Perinatal tuberculosis was diagnosed in 13 of the 79 newborns investigated including 8 whose mothers were co-infected by HIV and tuberculosis. Seven cases were classified as congenital tuberculosis. The predominant clinical features were respiratory distress (10/13), fever (9/13), hepatomegaly (9/13), intra-uterine growth retardation (8/13), stagnation or loss of weight (6/13), cough (4/13) and splenomegaly (4/13). Diagnosis of maternal HIV and tuberculosis infection was never made prior to newborn admission to our department. Four newborns and two mothers died within 3 months after childbirth. This study on perinatal tuberculosis in children born to mothers with or without HIV infection demonstrates the need for early diagnostic methods, consensual therapeutic protocols, and further study in larger geographical area to specify epidemiologic features and reduce high mortality.

[Post-hemolytic renal failure in children with glucose-6-phosphate dehydrogenase deficiency at the University Hospital Center in Lome]

The purpose of the study was to identify predisposing factors for acute hemolysis and post-hemolytic renal failure in children with glucose-6-phosphate dehydrogenase deficiency (G6PD). Any child presenting hemoglobinuria during the study period was prospectively evaluated. Evaluation included detection of the presence of hemolytic agents, laboratory tests to measure hemolysis, G6PD activity, infection and renal failure, and assessment of outcome and management of hemolysis and renal failure. G6PD deficiency was documented in 32.1% of the 230 children admitted with hemoglobinuria. Anuric renal failure occurred during the hemolysis episode in 35.1% of patients with G6PD deficiency (21 boys and 5 girls between 30 months to 13 years old). Acute hemolysis associated with infection occurred before any treatment in 53.8% of cases and after beginning treatment in 46.1%. In 84.6% of cases, occurrence of acute hemolysis involved association of drugs considered as nonhemolytic either with themselves or with other drugs. Anuric renal failure occurred after beginning treatment in all cases and was most severe in patients with of multiple-germ infection (30.7%) and drug association (84.6%). Renal failure was reversible in 80.7% and fatal in 19.2%. Multiple-germ infection and drug association appeared as the main predisposing factors for post hemolytic anuric renal failure in patients with G6PD deficiency. The high frequency of these factors in tropical areas suggests implication of local endemic infections.

[Bacterial flora in the genital tract the last trimester of pregnancy]

Very widespread in our clinical setting, early-onset sepsis is due to organisms that commonly colonize or infect the maternal genital tract; identifying such organisms would help improve prevention and treatment.

OBJECTIVE

To determine the bacterial ecology and the pathological status of the genital organs during the last trimester of pregnancy, in order to evaluate the risk of materno-fetal infections and to improve the present prophylactic measures based on monitoring bacterial carriage during the first trimester.

METHOD

Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy, in patients with no signs of sepsis and not taking antibiotics. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, Clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states.

RESULTS

Genital samples were collected from 306 pregnant women. Among them 118 were at 29-32 weeks of gestation, 104 at 33-36 and 84 at 37-40. The most frequent germs were C. albicans (33.3%), Enterobacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) or polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or cervicitis (10.4%) and asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified.

CONCLUSION

This is the first report of genital bacterial carriage in African women during the last trimester of pregnancy. Larger studies are required to evaluate the risk of maternofetal infections and to improve current prophylaxis measures.

[Tuberculosis in newborns in a tropical neonatology unit]

We report three cases of tuberculosis observed in a neonatal unit in a country characterized with a high endemia of tuberculosis.

CASE REPORTS

Case 1. A term infant presented at the age of 35 days, with cough since day 18, respiratory distress and bronchopneumonia. Her mother had unrecognised tuberculosis since pregnancy. Post mortem biopsies of the infant confirmed the diagnosis of tuberculosis and social survey found out pulmonary tuberculosis in the newborn's aunt. Case 2. A term infant presented at the age of 30 days with cough since day 13, respiratory distress, nodular pulmonary lesions and right pleural effusion. Her mother had cough and stomatitis since the eighth month of pregnancy and nodular pulmonary lesions. Tuberculosis and HIV were confirmed in the mother and the infant. Social survey found tuberculosis in the newborn's paternal uncle. Case 3. A term but hypotrophic infant presented on the first day of life, with haemorrhagic troubles and respiratory distress. Tuberculosis and HIV were confirmed in the mother and the infant. Social survey found tuberculosis in the father, in a friend of her and in her three-month-old child.

CONCLUSION

Congenital or neonatal tuberculosis is an under-estimated emergent disease, with a need for early diagnostic methods and consensual therapeutic protocols to improve its management.

[Risk factors associated with prematurity at the University Hospital of Lome, Togo]

OBJECTIVE

To determine the premature birth rate and the risk factors of preterm delivery linked to local conditions of life.

METHOD

It is a prospective study including all births before 37 amenorrhoea weeks. All social, medical and behavioural factors linked to preterm deliveries have been analysed for and compared with those of the medical literature.

RESULTS

Out of 1672 alive births, we identified 186 (11.1%) cases of prematurity and 30.1% of lethality. The main risk factors of preterm delivery were history of adverse pregnancy outcome (17.2%), history of induced abortion (11.3%), maternal age under 20 (26.3%), under 20 year old primipara (38.7%), inadequate antenatal care (66.6%), low level of education (38.7%) and mother suffering of overwork (29%). Other associated factors such as premature membrane rupture, malaria, urinary infections, gravidic toxaemia, genital infections and above all "unmarried-under 20 year old-primipara with low level of education and low socio-economical status", were significantly linked to preterm delivery.

CONCLUSION

The risk factors thus identified correspond with the well-known factors. But many factors significantly linked to preterm delivery were local features whose importance could be reduced through better means of perinatal care and prevention.

[Congenital malarial disease due to Plasmodium falciparum in high-infection-risk newborn]

The aim of this work was to differentiate in an endemic area congenital malaria diseases (CMD) from congenital malaria infestations (CMI) or other maternal-fetal infections.

METHODS

Four hundred and seventy-five newborn (0-7 d) suspected of infection were prospectively studied. CMD was diagnosed when clinical manifestations were associated with positive thick and thin blood films in a mother and her newborn. The diagnosis of CMI was retained when despite positive parasitemia, no clinical manifestations were observed.

RESULTS

Forty newborns (1.7% of the cases of maternal malaria) were diagnosed as CMD and ninety-one (19% of live births) were considered as CMI. The main clinical manifestations were related to cerebral (100%), respiratory (95%) and hemodynamic (90%) systems. Hematologic signs were present in 95% of cases. The level of parasitemia varied from 700 to 3,000 parasites/mL in CMD and from 360 to 870 parasites/mL in CMI. Death occurred in ten cases (25%) of CMD.

CONCLUSION

In this malaria-endemic area, neither clinical manifestions nor parasitemia allow one to distinguish CMD from CMI associated with bacterial materno-fetal infections. Studying placental or systemic immunity and antimalaria IgM in the newborn could be of interest to clarify this problem.

[Neonatal mortality in the Tantigou pediatric hospital, Dapaong (north Togo) in 1984-1985 and 1994-1995]

370 deaths out of 1141 hospitalized cases of newborns aged 0-28 days were retrospectively analyzed in the Tantigou pediatric hospital of Dapaong, situated 645 km from Lome in northern Togo, in 1984-1985 and 1994-1995. A decreasing trend in neonatal mortality was noted: 42.5% and 27.6% respectively. Major causes of death were prematurity or low birth weight, sepsis, hypoxia conditions. The attendance of pregnant women at health information centres seems to be improving, but the neonatal mortality rate remaining high, the implementation of primary health care/Bamako Initiative resulting especially aiming at better prenatal care for pregnant women must be sustained.

[The use of Doppler echocardiography in the diagnosis of congenital heart disease in the Pediatric Department of CHU-Tokoin, at Lomé (Togo)]

Currently, echography coupled with Doppler is a primary technique in the diagnosis of congenital heart disease. Since September 1993, the pediatric ward of the Tokoin teaching hospital of Lome has been equipped with this technology. During the following 23 months, there were 299 examinations with Doppler-echocardiography among the consultations of 15,082 children. Eighty-two cases of congenital heart defects were detected in 73 children, aged between 3 days and 13 years, of whom 79.4% were between 7 days and 30 months old. In all cases, either pulsed or continuous Doppler-echocardiography was performed at the request of doctors treating symptoms suggestive of cardiac disease, such as heart murmur (67%) and cyanopathy (22%). The noncyanotic cardiopathies found were ventricular septal defects (24%), patent ductus arteriosus (21%), interatrial septal defects (18%) and atrioventricular canal defects (9%). The most frequent cyanotic cardiopathy detected was Fallot's tetralogy (19.5%). Thus, early diagnosis and management of congenital heart disease is facilitated by systematic examination of newborns and sustained collaboration between pediatricians, obstetricians and cardiologists.

[Bilateral choanal atresia in the newborn. Recommended management apropos of 1 case observed in Lomé, Togo]

The bilateral choanal atresia is a neonatal emergency. Its diagnosis is easily evoked when faced with a respiratory distress and cyanosis. It is quickly confirmed by a nasal optic endoscopy or when a nasopharyngeal aspiration catheter is held up by an obstacle. Putting a pharyngeal Mayo's cannula is an urgent gesture. The treatment uses transnasal perforation of the septum followed for two months with frequent aspirations.