[Treatment of acute malaria in children].
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Acute Disease↗
Biomedical subjects
D Richard-Lenoble
Publications and source records attributed to D Richard-Lenoble.
[Placental transfer of antibodies in Africa and protection of the newborn].
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Antibodies, Bacterial↗
[Role of cryptosporidiosis in infants in Gabon. Results of two prospective studies].
Two epidemiological surveys of cryptosporidiosis in urban and suburban areas of Libreville, Gabon, Equatorial Africa, were conducted in children. On 450 fecal samples on the first study, Cryptosporidium sp. has been seen about 3.11%. For the second survey, on 296 children, aged between 0 and 2 years, with acute diarrhoea, the rate of infestation was 24%. The maxima was observed for infants aged between 6-18 months, in case of malnutrition and during wet seasons.
Acute Disease↗
[Use of a fermented powdered milk in malnourished or lactose intolerant children].
Lactase deficient subjects, who form the bulk of the world population, absorb yogurt lactose because the bacteria used for fermentation produce beta-galactosidase. From a milk fermented by these bacteria and dried by a temperature-controlled process a power could be obtained which possess residual lactase activity but, unlike yogurt, does not need storage at low temperature. The lactose of this fermented powdered milk is perfectly absorbed, as proved by hydrogen respiratory tests performed in 35 lactose intolerant African subjects living in isolated villages. In 25 malnourished children under 3 years of age, this milk allowed renutrition without inducing diarrhoea--a result which could not have been obtained with ordinary milk in two-thirds of the cases. This type of food is potentially valuable to feed the large population of the third world.
Adolescent↗
Hendersonula toruloidea as an agent of mycotic foot infection in Gabon.
Pathogenic fungi were isolated from 149 of 210 Gabonese patients with clinical signs of tinea pedis. Hendersonula toruloidea was isolated from 51 patients (34.2%), either alone (in 25%) or in association with a dermatophyte species or Candida albicans. Clinical signs of H. toruloidea infection closely resembled those of dermatophyte infection except that hyperkeratinization of the soles was most often associated with infection by H. toruloidea. H. toruloidea mycelium could be readily distinguished from dermatophyte mycelium on direct examination of skin scrapings. All the H. toruloidea isolates closely resembled the Type 1 isolates described by Moore, both microscopically and macroscopically. The importance of establishing a mycological diagnosis of this infection and the therapeutic implications of infection with H. toruloidea are discussed. This fungus was isolated from 34% of our patients from Gabon with clinical tinea pedis.
Adolescent↗
Placental transfer of tetanus antibodies and protection of the newborn.
The aim of the study was to compare the placental transfer of tetanus toxoid antibodies (TTAB) and total IgG in Africa, where we had previously demonstrated a lack of transmission from mother to the newborn of measles antibodies. Two series of mother-child pairs, 45 in Paris and 134 in Libreville, Gabon, Central Africa, were measured after full-term pregnancies and normal deliveries. Means of ratios of cord/mother concentrations for TT AB and IgG were, respectively, 2.52 and 1.28 in Paris and 0.98 and 0.82 in Gabon. In 11 pairs from Libreville no TT AB were found in mother and cord blood, but in four other African newborns (3 per cent), the mother transmitted TT AB which were lower than protective level against tetanus. Other data (negative correlation between mother IgG and cord/mother ratio of corresponding TT AB concentrations, and better transmission of TT AB in the low range of maternal IgG) indicate that the limitation of active placental transfer of antibodies is related to the high maternal IgG level common in Africa.
Adolescent↗
Feeding lactose-intolerant children with a powdered fermented milk.
Fresh yogurt has been proposed as a milk substitute for lactase-deficient patients. We investigated the possibility that a dried, low-fat milk fermented by yogurt microorganisms would be effective. Processing of a fermented milk by spray-drying led to a powder with persistence of lactase activity (11.7 units/g) without storage at 4 degrees C and stable at room temperature (20-23 degrees C). The tolerance and absorption of 10.5 g of lactose in a volume of 150 ml was studied in 25 Gabonese lactase-deficient children aged 5-14 years in the form of a standard humanized milk formula followed 1 week later by the powdered fermented milk formula. Results of the breath hydrogen test showed that in 24 of 25 cases, lactose absorption was normal with a maximal rise of hydrogen over baseline of under 13 ppm after ingestion of the powdered fermented milk. The rise was above 20 ppm in the 25 children with the same load of lactose in the form of the standard formula and one-third had symptoms of lactose intolerance. This powdered fermented milk preparation should be considered as a valid approach in programs of nutritional support targeted to countries with a high prevalence of lactase deficiency.
Adolescent↗
[Intestinal parasites and lactose malabsorption].
Breath-test was performed for diagnosis of lactose malabsorption in 50 Gabonese children of normal nutritional status, aged 5 to 15 years, with parasites in stools, but without diarrhoea or digestive symptoms. Control group was unparasitized and consisted of 17 children and 18 young adults living in the same area. Parasites discovered by stool examination were Ascaris lumbricoides in 76% of parasitized children, Trichuris trichiura in 58%, Giardia in 24%, Entamoeba histolytica in 20%, Schistosoma intercalatum in 16% and Necator Americanus in 14%. Children were given a 10 g lactose load and adults 20 g. Lactose malabsorption was discovered in 64% of parasitized patients and in 63% of unparasitized. Ten of 12 (83.3%) of Giardia infected children had a lactose malabsorption (no significant difference). These data show that decrease of lactase activity in African children is not related to the presence or to the importance of intestinal parasitism, except for Giardia infestation, if nutritional status is normal.
Adolescent↗
[Placental transfer of tetanus antibodies and protection of newborn infants].
Total IgG and tetanus antibodies were evaluated in 2 series of mother-child pairs: 50 in Paris and 134 in Africa. All pregnancies had been normal and birth weights greater than 3 kg. Cord blood mothers tetanus antibodies ratios were 1.5 in Paris and 0.98 in Libreville (p less than 0.01) respectively. Some African children were not protected, either due to the lack of response of their mothers to immunization (2.2%) or to an insufficient antibodies transplacental transport (2.9%), or to the lack of immunization of mothers (5.9%). On the contrary, all European children were protected, in spite of low maternal antibody levels. Likewise, in Paris cord blood IgG level was 12.24 g/l vs 9.42 in mothers (cord blood/mother ratio: 1.34) and in Africa 18.4 g/l in cord blood and 22.3 g/l in mothers (cord blood/mother ratio: 0.88; p less than 0.01). The correlations between maternal IgG levels and placental transfer rates indicate that the transplacental active transfer is limited by common high IgG levels in Africa, thus contributing to a decrease in protection of neonates, especially against tetanus in which humoral responses predominate.
Adolescent↗
[Interaction of cholestyramine and chloroquine].
The plasma levels of chloroquine after an oral intake of 10 mg/kg were measured in 5 children, with or without simultaneous intake of cholestyramine. Plasma chloroquine levels measured 6 hours after intake were significantly lower in case of simultaneous administration of cholestyramine, in spite of important individual changes. These data suggest a decrease in chloroquine bioavailability in the presence of cholestyramine. However, the methodology used does not allow to assert it.
Adolescent↗
Milk lactose malabsorption in Gabon measured by the breath hydrogen test.
It is usual to consider that the greatest part of the black African population is lactose intolerant. Also, milk lactose malabsorption was studied by a breath hydrogen technique in 87 Gabonese children and 20 Gabonese adults (central Africa). The prevalence of malabsorption was 64.2% in rural schoolchildren, 65% in the urban hospitalized, and 60% in adults. Twelve children and six adults had clinical symptoms after a lactose load. All subjects were Bantus, with no tradition of consuming dairy products. These data must be considered in programs of nutritional support in Africa.
Adolescent↗
Giardiasis and breast-feeding in urban Africa.
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Africa↗
[Malaria in Gabon. Bioclinical survey of non immune Europeans during short stay and prophylactic attitude].
A group of 300 young European adults visiting Gabon for relatively short periods was surveyed monthly for malaria from a parasitological, clinical, immunological, hematological point of view. The regular increase of fevers due to malaria from 1984 to 1988 and the multiplication of cases of amino-4-quinoline resistance in the plasmodial parasites call for new prophylactic considerations for this group residing in this heavily malaria infested area.
Adult↗
[Development of chloroquine resistance in Plasmodium falciparum in Gabon between 1984 and 1987-88 (in vivo evaluation in a school environment)].
Unknown in 1980, suspected in 1983 and scarcely present in 1984-85, Plasmodium falciparum resistance to chloroquine as studied in vivo in schoolchildren in Gabon, has strongly developed in 4 years time. In 1987-88, administration of 25 mg/kg of chloroquine leaves one strain out of four with a parasitic load greater than 10/1.000 red blood cells examined by thick drop technique. The present, unfortunately provisional attitude tends to maintain chloroquine at efficient doses for as long as the resistant strains are ethically and practically controllable. The dispersion without strict control of new and for the time being very efficient drugs might rapidly give rise to a polychemoresistance which would leave us without defence.
Animals↗
[The efficacy and tolerance of ivermectin (Mectizan) prescribed for the patient with multiple filarial infections (Loa loa/Onchocerca and/or M. perstans)].
Administration of ivermectin (Mectizan) in Loa loa filariasis induces a significant decrease of microfilaria load within 3 to 15 days. The excellent tolerability of the drug in patients infested simultaneously by O. volvulus and Loa loa allows to use ivermectin in mass treatments in geographical areas where the same patients can be affected by several filariasis. There is almost no efficacy against Mansonella perstans. A second administration one month after the first one in Loa loa affected patients has not led to a complete disappearance of microfilaria; the tolerability has still been good. Efficacy on Ascaris lumbricoides appears to be excellent; further studies are necessary in the cases of trichuriasis, ancylostomiasis and strongyloidiasis.
Filariasis↗
[Fungal otitis in Libreville. Study of 83 cases].
83 cases of mycotic otitis of external ear are reported during a period of 27 months from three departments of otorhinolaryngology in Libreville (Gabon, Central Africa) Prevalence is estimated at about 25% among all infectious otitis. The main functional signs are pruritus, otorrhea, pain and hypoacousia. The physical examination shows masse of white, grey, black or creamy caseous debris, invading the external auditory meatus (EAM) which is sometimes inflammatory. Fungal species responsible of otitis are Aspergillus (54%), yeasts (45%) mainly Candida, infrequently Fusarium (1%). A niger (26%), A. flavus (17%), Candida parapilosis (18%), Candida albicans (9%) are predominant species isolated (70%) among all the 21 species of identified fungi from otomycosis in Gabon. Therapy, done by thorough washing of the ear followed by insertion into the EAM of a wick soaked in Econazole or Amphotericin B, is quickly effective.
Administration, Topical↗
[Transfer of measles immunoglobulins and antibodies from mother to child in Africa and Europe].
In a series of 50 mother-child pairs from Paris the titers of measles antibodies in cord blood were 1.4 times higher that those measured in the mother's blood, but this ratio was only 0.92 in 116 African mother-child pairs from Libreville (Gabon). Similarly, the ratio of immunoglobulin G levels in cord blood to those of the mother's blood was higher in Paris (1.34) than in Libreville (0.88). This limitation in active transfer of total of specific immunoglobulins is due to their high levels usual in African mothers, and this is not without repercussions on the immune defence mechanisms of African newborns.
Adolescent↗
Ivermectin in loiasis and concomitant O. volvulus and M. perstans infections.
Two clinical studies were carried out in Gabon, Africa to evaluate the efficacy, safety, and tolerability of ivermectin in the treatment of patients with Loa loa infection. In the first study, 35 patients received single oral doses of ivermectin, 5-200 mcg/kg body weight. Blood microfilariae levels did not decrease after a single oral 5, 10, 30, or 50 mcg/kg dose of ivermectin, but levels did decrease after doses of 100, 150, and 200 mcg/kg. The most efficacious dose was 200 mcg/kg; mean blood microfilariae levels decreased to 12% of mean pretreatment values by day 15 and remained decreased for 28 days. A second study evaluated the safety and efficacy of ivermectin in patients with multifilarial infections. All 17 patients had concomitant Loa loa and O. volvulus infection. M. perstans affected 5 of the patients. Sixteen patients also had infections due to intestinal nematodes. The patients each received single oral doses of 200 mcg/kg ivermectin. Ten days later, the mean Loa loa blood microfilariae level had decreased to 20% of the mean pretreatment level. O. volvulus dermal microfilariae densities were reduced to 2% of the pretreatment levels. A minimal increase in blood microfilaria levels was observed on day 28. In contrast, dermal microfilariae levels remained near zero for the duration of the study. Intestinal infection due to Ascaris was eradicated in all of the affected patients by day 23; efficacy against Trichuris and hookworm infections, however, was poor. All patients tolerated ivermectin well including those with multiple infections.
Adult↗