[Anti-measles vaccination and malaria].
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Biomedical subjects
Publications and source records attributed to D Gendrel.
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Close interactions between salmonellae and Schistosoma intercalatum were demonstrated by a study of 118 children conducted at Libreville, Gabon. Bilharziasis, confirmed by rectal biopsy, was present in 76% of children hospitalized for typhoid-like salmonella septicaemia, as against 38% of controls of the same age living in the same district (P less than 0.001). Although the clinical symptoms were typical of typhoid fever, with stupor, myocarditis or leucopenia depending on the cases, the germs responsible in 26 out of 42 cases were salmonella species regarded as minor. Finally, the salmonella infection was clinically prolonged by bilharziasis in 1 out of 3 patients. It would therefore appear that salmonella adheres to the wall of S. intercalatum as to that of other schistosoma species, and that both infections must be treated concomitantly.
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Intestinal parasitic infection was determined by fecal examination for parasites with several complementary methods in 380 young Gabonese infants aged 6 to 24 months (190 with normal weights and 190 with malnutrition, matched for age). Trichuris trichiura, Ascaris lombricoides, Giardia intestinalis, Entamoeba histolytica and Strongyloides stercoralis were the most prevalent parasites, without any difference between well-fed infants and patients with malnutrition. The higher prevalence of Strongyloides stercoralis in protein energy malnutrition might be related to a methodologic problem. However, more than 20% of diarrheas in infants with severe malnutrition were dramatically improved by specific treatment of S. stercoralis or Giardia with thiabendazole or metronidazole.
The identification of different infectious agents found in infantile diarrheas was undertaken in 237 children hospitalized in pediatric institutions in Libreville. In neonates between 0 and 18 months of age, the most common pathogen was Rotavirus (20.6%), followed by Shigella (10.8%), E. coli (9.24%), Salmonella (3.46%), E. histolytica (0.8%) and Y. enterocolitica (0.4%). The highest percentage of diarrheas caused by rotaviruses was found among children between 6 and 11 months of age. The frequency of Salmonella among children 2 to 4 years of age is almost the same at that in children under 2 years of age (3.44%). Isolation of Shigella in this group reaches 12.06%. The protective effect of breast milk and the carriage state among adults are discussed.
Rotaviruses are the main etiology of acute diarrhoeas in gabonese children (11 to 30% according to age). Salmonellae (11.4%), Shigellae (7.1%) and E. histolytica (7.1%), isolated or associated with enterobacteria, E. coli (3%), Giardia and Strongyloides stercoralis (1.4%), Yersinia enterocolitica (1%) and Balantidium coli (0.5%) were also found, without cholera.
Parasitic infections are endemic in children in Africa, making eradication an impossibility. Therapy is directed towards the individual manifesting an imbalance in the host-parasite relationship. Sanitation education is often disappointing, and until effective vaccines are developed, drug therapy remains the only worthwhile intervention. In order for a drug to be used on a mass campaign basis, financial considerations and side effects are of primary importance. Mefloquine has been shown to be a useful second line drug for chloroquine resistant strains of malaria in our Parasitology department. Benzimidazoles in a single dose are useful for intestinal nematode infections. New drugs are now available for schistosomiasis, filariasis, and protozoan infections.
In endemic regions, certain anti-parasitic therapies are automatically prescribed when confronted with apparently benign childhood disorders. The diagnostic differentiation between a simple febrile seizure provoked by Plasmodium falciparum is often impossible, requiring the initial use of intravenous quinine. Helminth or Giardia infestations often aggravate the chronic diarrhea of malnutrition, or are revealed with corticosteroid therapy, necessitating the initiation of an appropriate treatment. In addition, the frequent association of typhoid and schistosomiasis, requires therapy for both in order to prevent relapses.
Twenty-five African children from Libreville had concomitant typhoid or paratyphoid fever (Salmonella typhi, 4 children; Salmonella paratyphi A, 1; S. paratyphi B, 5; S. paratyphi C, 15) and Schistosoma intercalatum infection. In 19 children treated for both infections, no relapse occurred. In the six others, antibiotics alone were given and the Salmonella infection relapsed after 1 month. No relapse occurred after a second course of antibiotics together with treatment for the S. intercalatum infection. This observation suggests that S. intercalatum prolongs Salmonella infection, as do other species of schistosomes. The concomitant treatment of both infections is recommended.
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494 placentae coming from two different geographical parts of Gabon were studied. They were grouped into control, premature, small-for-dates and stillborn. The urban population gives rise to most mothers of about 26 years of age, who deliver normally at 38 weeks of babies weighing 3,300 g and 50 cm long, with placentae weighing 550 g, as well as premature babies and those in which there is white cell infiltration of the membranes, signs of toxaemia and normal placentae. On the eastern plateaux of Gabon there are more mothers around the age of 23, who deliver normally at 37 weeks of pregnancy of babies weighing 3,100 g and 48 cm long, with placentae weighing 450 g, with small-for-dates babies and inflammation of the placenta. Malaria is the cause of many premature deliveries and of small-for-dates and stillborn, especially in the plateaux.
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