Biomedical subjects
Publications and source records attributed to P Lepage.
A pure growth of Branhamella catarrhalis was obtained from a purulent bronchial exudate in a 28-month-old Rwandese girl, hospitalized for acute inspiratory dyspnoea with fever. The outcome was favourable under treatment with ampicillin, although the isolate was shown to produce a beta-lactamase in vitro.
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By a combination of chromatographic methods, we have obtained in an apparently homogeneous state the 24 kDa "major myelin proteolipid" (MMPL) and the 20 kDa "myelin proteolipid" (DM-20). Contrary to a commonly held view, the second one is not a conformationally different form of its major companion, as it differs markedly by its amino-acid composition, its electrophoretic behaviour after performic acid oxidation, and the results of tryptic digestion; however, they are obviously very closely related, as shown by the selective cleavages at the level of methionines and tryptophanes. These results are most simply interpreted by a single deletion in DM-20 of the hydrophilic fragment 100-140 of the (known) structure of the 24 kDa proteolipid. Lees' hypothesis of a deletion of fragment 197-267 cannot be retained.
To evaluate acquired immunodeficiency syndrome (AIDS) in central Africa a prospective study was done in Kigali, Rwanda, where Kaposi's sarcoma (KS) is endemic. During a 4 week period, 26 patients (17 males and 9 females) were diagnosed. 16 patients had opportunistic infections, associated with KS in only 2; 1 had multifocal KS alone; and 9 had clinical conditions consistent with prodromes of AIDS. All patients had severe T-cell defects characterised by cutaneous anergy, a striking decrease in the number of helper T cells, and a decreased OKT4:OKT8 ratio (mean 0.27). 21 of the 22 adult patients were living in urban centres and many of them were in the middle to upper income bracket. Most of the men were promiscuous heterosexuals and 43% of the females were prostitutes. No patient had a history of homosexuality, intravenous drug abuse, or transfusion in the previous 5 years. This study suggests that AIDS is present in central Africa as an entity probably unrelated to the well-known endemic African KS. An association of an urban environment, a relatively high income, and heterosexual promiscuity could be a risk factor for AIDS in Africa.
A fast-heating probe and chemical ionization have been used to obtain mass spectra of the synthetic glycerophospholipids 1,2-diacyl-sn-glycero-3-phosphocholine, 1,2-diacyl-sn-glycero-3-phosphoethanolamine, and 1-monoacyl-2-lyso-sn-glycero-3-phosphocholine. The phospholipids investigated gave quasimolecular peaks and fragment ions, with preferential cleavage of the C-O bond (beta position to the phosphorus atom) and loss of phosphoethanolamine or phosphocholine. This technique makes possible the analysis of mixtures of intact phosphatidylethanolamine, phosphatidylcholine, 2-lysophosphatidylcholine, and sphingomyelin isolated from natural sources such as egg yolk or brain. Only minor and inexpensive modifications of a standard mass spectrometer are required.
During a 21-month period, we observed an outbreak of severe systemic infections due to multiresistant Salmonella typhimurium among 66 children in the in-patient Department of Paediatrics of Kigali, Rwanda. These infections were more likely to occur in subjects who had stayed for a long time in the hospital for severe illness and/or malnutrition. The children usually presented first with mild to moderate diarrhoea and fever. Later, sever pulmonary involvement was often noted (rales: 58%; respiratory distress: 42%). Moreover, there were four cases of abscess, three arthritis and one meningitis. Of the 66 children, 48 were treated with cefotaxime. The fatality-rate among this group was 10.4%. The fatality-rate among the 18 other untreated patients was 77.9%, suggesting a high efficiency of cefotaxime against these strains of multiresistant Salm. typhimurium.
Cryptosporidium oocysts were present in 20 (10.4%) of 193 Rwandese children and in 3 (3.0%) of 100 adults with diarrhea. In four of the children and in one adult, Cryptosporidium was associated with other enteric pathogens. The higher incidence of Cryptosporidium in diarrheic children was statistically significant. The parasite was not found in 94 formed stools submitted for parasitological examination. The mean age of the Cryptosporidium-positive children was 13.3 months. In four children, Cryptosporidium was associated with severe malnutrition. All of those required rehydration, and one child died as a direct consequence of severe diarrhea. The three adult patients showed no recognizable immunodeficiency, and their diarrhea resolved spontaneously. Staining with 1% safranin was not only more simple and rapid but also more sensitive than the modified Ziehl-Neelsen technique.
The dynamic changes in skin mast cell (MC) numbers around incised wounds were studied, using experimental designs amenable to multiple analyses of variance. Sixty-four Wistar albino rats were shaved in the interscapular region, wounded or not wounded, and then killed 2 or 10 days later. During this period, the rats were exposed continually to a cold (2 degrees C) or control (20 degrees C) climate and treated daily over the shaved region with either tap water or a weak sulphuric acid (pH 3.5) solution. The MCs within five adjacent fields of the wound or the control reference and within the superficial and deep halves of the skin were counted (at x 400). The greatest decrease in MC numbers occurred within about 700 microns of the wound. Whereas the paucity of MCs within the wound region was evident at 2 days, near-normal levels were achieved by day 10. Cold exposure produced little effect, but MCs responded differently to the water and acid treatments as a function of distance and skin depth.
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Sera from 11 perinatally HIV1-infected Rwandan children with prolonged survival were tested in vitro for the presence of neutralizing antibodies against different HIV1 strains. These 11 sera from long survivor (LS) children were compared with 16 sera from Rwandan children with AIDS. Sera from HIV1-infected children exhibited the greatest neutralizing activity against HIV1MN cell-free infection. They also inhibited HIV1RII and HIV1LAI cell-free infection with lower titres. Higher neutralization titres were observed in sera from LS compared to the AIDS group, with a significant difference for HIV1MN and HIV1LAI strains. Sera from LS children also inhibited syncytium formation induced by HIV1MN-infected cells with higher titres than AIDS children. Sera from the HIV1-infected children showed reactivity to the HIV1MN V3 peptide, as well as to both the US/European and the African consensus V3 peptides. Higher reactivity was observed in sera from LS than from AIDS children, and the difference was significant toward the African consensus peptide. The LS children also had significantly higher V3MN IgG avidity than the AIDS children. These data support the notion that the humoral response to the V3 domain, associated with a broadly neutralizing activity, may be an important factor in the prolonged survival of these children. The specificity against HIV1MN also suggests that an antigenically MN-related strain may be prevalent in Rwanda, and that an MN-related principal neutralizing domain sequence could be an important determinant for candidate vaccines in this part of Africa.
BACKGROUND: Knowledge of the spectrum and relative frequencies of pediatric emergencies is an important factor in developing appropriate training curricula for pediatric residents. MATERIAL AND METHODS: To provide these data, we indexed the 11,483 consecutive patients seen in our pediatric emergency department (PED) during the year 2003. RESULTS: Age ranged from 1 week to 27 years, with a mean age of 3.9+/-4.3 years. 52.7% of the visits were by children younger than 3 years, 9.5% by adolescents, and 0,1% by young adults with chronic conditions. 55.1% of the patients arrived on day shift, 32.5% on evening shift and 12.4% on night shift. 61.8% of the patients were seen during the evening/nighttime or on the weekends. 25.2%, 22.1% and 28.6% of the patients seen on night, day and evening shifts respectively were hospitalized. The most common chief complaints were fever (22.1%), upper respiratory tract infection (13.2%) and diarrhea (10%). The most common final diagnoses were upper respiratory tract infection (26.7%), viral syndrome (13.1%) and gastroenteritis (10.7%). The majority of chief complaints and final diagnoses were related to infection (63.9%). CONCLUSION: These data may contribute to curriculum development in training of PED physicians. We especially recommend an emphasis on management of fever and infections to optimize the quality of care delivered in the pediatric emergency department.
The "Bacterial Meningitis Score" (BMS) has been designed to identify children at low (BMS = 0) or high (BMS > or = 2) risk of bacterial meningitis (M). Its calculation is simple; it is based on 5 different items: Gram stain, seizure at or before presentation, peripheral white blood cell count (WBC), cerebrospinal fluid (CSF) WBC and CSF protein concentration. As of today, it has been validated in one single study in the United States. The purpose of this study is to evaluate the BMS performance in children hospitalized for M over a 5 years period. The medical records of 277 patients diagnosed with M, aged 29 days to 15 years and hospitalized in the Department of Pediatrics of the CHR Citadelle Hospital in Liège between 1999 and 2003 were analysed. Among the 277 hospitalised cases, there were 29 bacterial (10,5%) and 248 viral (89,5%) M. For patients whose BMS < 2, we found 100% of viral M. For those with BMS > or = 2, 59,3% had a bacterial M and 40,7% had a viral M. 23% of the children with BMS < 2 were treated with antibiotics; 17% of children with BMS = 2 were not been treated on admission. The BMS is an easily applicable method that could allow reduce the unnecessary use of antibiotics.
Five questions were raised in 1986 regarding routine immunization of children infected by the HIV: do vaccines protect these children, both in terms of immunogenicity and clinical efficacy? is immunization, particularly with live attenuated vaccines associated with an increased risk of adverse events? could the stimulation by vaccine antigens precipitate the course of paediatric HIV infection and therefore be dangerous? what are the clinical and epidemiological features of vaccine preventable diseases among HIV-infected children? what is the risk of nosocomial transmission of HIV associated with immunization practices? Based on the best available information, the WHO formulated recommendations in 1987 and updated them in 1989. These recommendations are in general agreement with those proposed during the same period in the USA and in France (table 1). This paper provides an update on the scientific knowledge in this field, focusing on routine childhood immunization in the context of HIV infection, especially in developing countries. The cases of bacillus Calmette-Guérin (BCG), measles vaccine, diphtheria-tetanus-pertussis and poliomyelitis vaccines are reviewed. For each of these antigens, the experience of the authors in Kigali, the capital city of Rwanda, is used as an example. A brief overview of the issue of adult immunization in the context of HIV infection concludes this review. Paediatric HIV infection should not be considered as a limiting factor in the implementation and the progression of the EPI worldwide. Experience accumulated over the last seven years, particularly in Africa, indicates that the WHO recommendations should not be modified.