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Cerebral malaria in African children: socioeconomic risk factors in Brazzaville, Congo.

Current epidemiologic and clinical research on cerebral malaria is directed towards prognostic criteria and neurologic sequelae. However, the assessment of risk factors related to the environment and the socioeconomic standard of the family is of practical as well as theoretical interest. A prospective survey was carried out in March 1990 in Brazzaville, Congo by interviewing subjects in two groups: 1) 600 households representative of the Brazzaville population and 2) 84 households with a child who had been hospitalized for cerebral malaria between January 1, 1988 and June 30, 1989 (i.e., 9-27 months prior to the interview). The mothers' knowledge and attitudes with regard to the prevention and treatment of malaria in children were assessed, as was the socioeconomic standards of the households. The group in which at least one child had been hospitalized for cerebral malaria had a lower socioeconomic standard than the control group. Other differences in this group included a greater number of offspring and a higher average number of decreased children, less chemoprophylaxis, antimalarials available less often in the household, less early treatment of fever at home, and drugs bought more often at the market. There was no significant difference between the groups with regard to using the correct dosage of chloroquine, ownership of a mosquito net, or the use of insecticides or repellents.

Adult↗

Experimental transmission of Crimean-Congo hemorrhagic fever virus by west African wild ground-feeding birds to Hyalomma marginatum rufipes ticks.

Hyalomma (H.) marginatum rufipes ticks commonly infest birds and are potential vectors of Crimean-Congo hemorrhagic fever (CCHF) virus in west Africa. An experimental model for investigating the role of birds in the CCHF virus transmission cycle was developed. Following CCHF virus inoculation, antibodies were detected by enzyme-linked immunosorbent assay in one red-beaked hornbill and one glossy starling, but not in two laughing doves and six domestic chickens. None of the birds showed a detectable viremia. Hyalomma marginatum rufipes larvae were placed on three red-beaked hornbills and one glossy starling. These birds were then inoculated with CCHF virus (10(1.5) 50% mouse intracerebral lethal doses). Virus transmission to larvae or nymphs was obtained and seroconversions in birds were recorded. Virus was also detected in 90% of the individually tested nymphs, as well as in adults. The virus was then successfully transmitted by adult ticks to rabbits and the engorged females were allowed to oviposit. Progeny larvae were placed on another group of birds and one of three birds showed seroconversion. The cycle of transmission of virus between ticks and aviremic ground-feeding birds represent a potential reservoir and amplification mechanism of CCHF virus in west Africa.

Animals↗

Antibodies to hemorrhagic fever viruses in domestic livestock in Niger: Rift Valley fever and Crimean-Congo hemorrhagic fever.

A repository of domestic animal sera collected in Niger between 1984 and 1988 was assayed for antibody against two zoonotic hemorrhagic fever viruses known to be present in the West African Sahel. A total of 2,540 serum samples from 2,324 cattle, sheep, goats, and camels were tested by an IgG-specific enzyme-linked immunosorbent assay (ELISA) and the 80% plaque reduction neutralization test (PRNT80) for Rift Valley fever (RVF) virus antibody. Of the 2,540 sera tested for RVF-specific IgG antibody, 1,676 sera from cattle, sheep, and goats were examined for RVF-specific IgM antibody by ELISA. A subset of 2,263 sera were examined for evidence of Crimean-Congo hemorrhagic fever (CCHF) virus antibody by an IgG-specific ELISA. Antibody against CCHF virus was found to be most prevalent in adult cattle (422 of 732 or 57.7% positive) sampled at nine locations in the Niamey area. The highest prevalence for RVF neutralizing antibodies was found in camels from the Agadez Department with 67 (47.5%) of 141 positive. The results indicate that both CCHF and RVF viruses are circulating in Niger and are potential zoonotic health risks.

Animals↗

Polymerase chain reaction for diagnosis and identification of distinct variants of Crimean-Congo hemorrhagic fever virus in the United Arab Emirates.

Viral hemorrhagic fever has re-emerged in the United Arab Emirates (UAE) since November 1993. Genomic RNA of Crimean-Congo hemorrhagic virus (C-CHFV) was detected by a newly developed, nested reverse transcriptase polymerase chain reaction (RT-PCR) in the sera of four (25.0%) of 16 suspected cases of viral hemorrhagic fever. The RT-PCR was based on oligonucleotide primers deducted from the small RNA segment encoding the nucleoprotein of the virus. By comparison with a nucleotide sequence of a C-CHFV isolate from a Chinese sheep, a divergence of 10.0-11.8% was detected in the C-CHFV variants causing the UAE outbreak. In the four positive sera, three phylogenetically distinct C-CHFV variants were amplified and confirmed by direct sequencing of the PCR fragments. These C-CHFV sequences were obtained directly from sera of infected humans without prior propagation in cell culture. The RT-PCR allows rapid detection of genomic C-CHFV RNA in clinical specimens and study of the molecular epidemiology of this infection.

Amino Acid Sequence↗

Molecular investigation of a multisource outbreak of Crimean-Congo hemorrhagic fever in the United Arab Emirates.

During the investigation of an outbreak of Crimean-Congo hemorrhagic fever (CCHF) in the United Arab Emirates (UAE) between 1994 and 1995, blood samples from suspected CCHF cases and ticks collected from livestock were tested for CCHF virus by antigen-capture ELISA and by a reverse transcription-polymerase chain reaction. Phylogenetic analysis of partial small (S) segment nucleotide sequences from four ticks and five human samples showed that with one exception, all the human and tick viruses clustered along with samples from Pakistan and Madagascar in one distinct lineage. Within this lineage, sequences from the UAE patients were identical or closely related to those from three Hyalomma spp. ticks obtained from livestock recently imported from Somalia. Another sequence from a UAE patient was more closely related to a CCHF virus from Nigeria. These data indicate that the 1994-1995 CCHF epidemic in the UAE was a multisource outbreak possibly associated with importation of CCHF virus-infected livestock and ticks.

Animals↗

An outbreak of Crimean-Congo hemorrhagic fever in the United Arab Emirates, 1994-1995.

A multi-faceted investigation was conducted in the United Arab Emirates to characterize the epidemiologic and ecologic factors underlying an outbreak of Crimean-Congo hemorrhagic fever (CCHF) noted in November 1994 among abattoir workers. A chart review was conducted among hospitalized suspected cases of viral hemorrhagic fever with onset between January 1994 and March 1995 coupled with serologic testing of available specimens for the presence of virus antigen and IgG and IgM antibodies by ELISA. Livestock handlers and animal skin processors were interviewed and tested for the presence of IgG antibody. Sera from imported and domestic ruminants were examined for antibody for CCHF virus, and ticks collected from these animals were tested with an antigen-capture ELISA. Thirty-five suspected cases of CCHF were identified (case fatality = 62%). Livestock market employees, abattoir workers, and animal skin processors accounted for 16 (57%) of 28 cases with known occupational status. Serologic evidence of past asymptomatic infection was noted in 12 (4%) of 291 livestock and abattoir workers but in none of the controls. Nineteen (7%) of 268 animals were positive for CCHF virus antibodies by ELISA including 12 ruminants from Somalia and Iran and five indigenous camels. One Hyalomma impeltatum and two H. excavatum from Somali cattle and one H. anatolicum from a Somali goat were positive for CCHF virus antigen.

Adolescent↗

Crimean-Congo Hemorrhagic Fever Outbreak in Podor, Northern Senegal in 2022: Two Independent Emergences and Unprecedented Mortality.

Crimean-Congo hemorrhagic fever (CCHF) is a lethal zoonotic disease transmitted through tick bites and contact with infected animals or humans. As CCHF continues to expand worldwide, we report on the first severe outbreak in Senegal (Podor, Saint-Louis region) in 2022. We conducted a comprehensive outbreak investigation after a confirmed CCHF human case in Podor. This included sample collections from humans, animals, and ticks from the household and surrounding area. Human and animal samples were tested by ELISA for antibodies to CCHF virus and by reverse transcription polymerase chain reaction (RT-PCR) for CCHF virus RNA, whereas tick samples underwent CCHF RT-PCR only. Positive RT-PCR samples underwent viral genome sequencing for genetic characterization. We determined three CCHF human cases, with two deaths, as well as virus circulation in 11 ticks and in livestock, with an overall seroprevalence of 42.5%. CCHF IgG antibodies were detected in human contact cases, showing its prior prevalence in the area. Phylogenetic analyses revealed high genetic diversity within CCHF genotypes, with existence of reassortants and cocirculation of two different isolates from various origins in Mboyo and Nenette villages, where human cases were detected. The data showed a correlation between the strains identified in humans and ticks in each village, showing two independent emergences in Podor. The outbreak in Podor was probably because of the high abundance of animal hosts in this sylvopastoral area, the diversity of tick populations with the presence of the main CCHF vectors, and the increasing prevalence of CCHF virus. The surveillance in this area needs to be strengthened.

Humans↗

Nutrition status of children in Kasese district at the Uganda-Congo border.

OBJECTIVE: To establish the magnitude and risk factors for malnutrition in Kasese district at the Uganda-Congo border. DESIGN: Cross sectional nutrition survey. METHODS: Thirty clusters were selected. The height, weight, and mid upper arm circumference of at least 31 children per cluster were measured. Data on food frequency, prevalence of cough, fever and diarrhoea was also collected. RESULTS: Half of the 932 children (49.8%) were stunted, and 21.9% were severely stunted. While 17.4% of the children were under weight, 1.29% were wasted and 3.7% had MUAC <12.5 cm. Risk factors for stunting included not consuming milk, fathers' low formal education, having no immunisation card, and not breast feeding among 12-23 months old. Risk factors for underweight included fathers' and mothers' low education level, consumption of legumes, and fever or diarrhoea two weeks before the survey. For wasting the risk factors were consumption of vegetables, legumes or starchy foods. Those not consuming high-energy or animal foods including milk were likely to be severely wasted as were those not breast feeding in the 12-23 months age group. Fever or a diarrhoea episode two weeks preceding the survey and living in a female-headed household, were also risk factors for severe wasting. CONCLUSION: Attention to education, poverty alleviation, appropriate feeding practices, prevention and treatment of infections might assist in combating malnutrition in this district.

Acute Disease↗

Congenital malformations in the North-Eastern Democratic Republic of Congo during Civil War.

OBJECTIVE: To report on changes in the incidence of congenital malformations in a context of an ongoing civil conflict. DESIGN: Retrospective study. SETTING: Centre Médical Evangélique (CME) of Nyankunde, a 250 bed referral hospital, in the North Eastern Democratic Republic of Congo (DRC) during the period 1993 to 2001. SUBJECTS: A total of 8824 babies were delivered alive at our maternity; and 36 of them (0.41%) were born with a clinically diagnosed congenital malformations. RESULTS: The breakdown of the observed malformations was as follow: clubbed foot nine, congenital hydrocephalus eight, spina bifida six, cleft lip four, encephalocele two, syndactyly two, imperforated anus two, Anencephaly one, lymphangioma one, bladder exstrophy one. There was a significant increase in the annual incidence of congenital malformations (p<0.001). CONCLUSION: Ongoing civil conflicts or wars ultimately have a negative impact on the incidence of congenital malformations. This is an indirect and multifactorial consequence. We conclude that ongoing civil conflict is a contributing factor to the increasing incidence of congenital malformations seen in the North-Eastern DRC.

Congenital Abnormalities↗

[Contribution to studies on the modern health care system in the Republic of Congo: geographical approach].

We carried out a geographic analysis of the modern health care system in the rural areas of Kouilou and Niari (Republic of Congo). Spatial differences in physical (e.g. vegetation, relief) and human (social and demographic profiles) factors must be characterized because they have an effect on the organization and spatial distribution of the health care system. The location of health care structures depended on the structure of the local environment. The health care system seemed primarily to be a component of the economic development determining population distribution in the forest area. In the savannah, it was part of the local administrative framework, the key factor determining the structure of the local space. Health care services were most used in areas with average to large population densities, in which there were the largest number of health care structures. Areas with "marginal" population densities and health care center distributions had the lowest rates of health care use. Health care zones can be defined by considering geographical characteristics and the characteristics of the health care system. This makes health planning (e.g. opening of health centers, improvement of health centers) much easier to undertake.

Congo↗

Thysanotaenia congolensis n. sp. (Cestoda: Anoplocephalidae) in the lesser savanna cane rat, Thryonomys gregorianus from Democratic Republic of Congo, Africa.

Ten (100%) lesser savanna cane rats, Thryonomys gregorianus, collected from the Lake Kivv area of the Democratic Republic of Congo, Africa were found to be infected with an undescribed anoplocephalid tapeworm, Thysanotaenia congolensis n. sp. Like other species of Thysanotaenia, T. congolensis n. sp. has the ovary and vitellarium centrally located, and the egg capsules and testes are intervascular. The new species differs from the 2 existing species, Thysanotaenia lemuris in lemurs and Thysanotaenia cubensis in humans, in being smaller (34-50 mm long) and in having a smaller scolex (260-410 microns in diameter), a shorter cirrus sac (115 microns long), and smaller eggs (40 microns in diameter). Anastomoses of the excretory system and formation of egg capsules in the new species are also described.

Animals↗

[Prevalence of anti-Chlamydia pneumoniae antibodies in preadolescent children in Congo].

Chlamydia pneumoniae (CPn) is recognised as a common cause of both upper and lower respiratory tract infections. Seroepidemiological studies seem to indicate a world-wide distribution of this organism. In order to evaluate the prevalence of antibodies to CPn in a healthy pediatric population, we measured anti-C. pneumoniae antibodies in a group of 253 infants without respiratory tract infections, aged from 1 to 12 years. Sera were obtained from children seen at immunization clinics and schools in Lubumbashi (Congo). Antibodies to CPn were evaluated using micro-immunofluorescence assay. IgG antibody to CPn in a titre 16 was considered as positive. The antibody prevalence was found to be 25.7%. This prevalence was 6.2% in children aged from 1 to 6 years, and 37.8% in children aged from 7 to 12 years. It was less than 10% under five years, increasing to 50% at 12 years. The progressive increasing of seropositivity related to age suggests that reinfections may be frequent. This study shows an important spread of this bacteria in the preadolescent population of an African country.

Antibodies, Bacterial↗

[Monthly variations in the level of infestation and the potential for transmission of Biomphalaria pfeifferi in 2 aquatic systems in Lwiro, Democratic Republic of Congo].

This study of variations in the rate of infestation by Biomphalaria pfeifferi and risk of schistosomiasis transmission was carried out to determine optimal timing for control measures. The study was conducted in two aquatic ecosystems, i.e. creek and fish pond, in the Lwiro region located in the eastern part (sud-Kivu) of the Democratic Republic of Congo. Biomphalaria pfeifferi infestation rates were high in the creek from November to January and consistently low in the fish pond. The risk of schistosomiasis transmission to man was highest in the creek especially during the months of January, February, May, and September. The risk of transmission was always less than 16% in the fish pond. Based on these findings, the optimal timing for control measures is the dry season for creeks and the rainy season for fish ponds.

Animals↗

Alzheimer amyloid abeta1-42 channels: effects of solvent, pH, and Congo Red.

Substantial genetic and biochemical evidence implicates amyloid peptides (Abeta) in the etiology of Alzheimer's Disease (AD). Recent evidence indicates that Abeta1-42 is the predominant species in the hallmark senile amyloid plaque of AD. Furthermore, Abeta1-42 forms aggregates inside lysosomes of cultured neurons leading to lysosomal disruption and cell death. We report here that Abeta1-42 forms slightly cation selective, voltage-independent ion channels with multiple conductance levels at neurotoxic concentrations in planar bilayer membranes. The channels show substantial irregularity of activity, and the size of conductances and the length of open lifetimes depend on solvent history. Formation of channels requires anionic lipids, is enhanced in acidic solutions, and is inhibited by Congo Red. These properties suggest that the channels are formed by aggregates of Abeta1-42. In addition, the channels are reversibly blocked by zinc in a voltage-independent manner. The properties of these channels would likely render them neurotoxic to relevant neurons in vivo. These results are consistent with the channel hypothesis of Abeta neurotoxicity.

Amyloid beta-Peptides↗

[Experimental transmission of Crimean-Congo hemorrhagic fever virus by Rhipicephalus evertsi evertsi (Acarina:Ixodidae)].

We have conducted experiments to assess the ability of Rhipicephalus evertsi evertsi tick to transmit the Crimean-Congo haemorrhagic fever (CCHF) and determine their reproductive cycle. The Rh. e. evertsi was infected by intracoelomic (transparietal and intra-anal) inoculation during the imaginal stases and by oral feeding on an infected viremic goat during imaginal and nymphal stases. The infection rate, transovarial and trans-stasial CCHF virus transmission were monitored for virus reisolation after suckling mice inoculation and the virus identified by ELISA and IFA for antigen detection. After intracoelomic inoculation, unfed adults had viral titers ranging from 0.67 to 2.9 log DL50/0.02 ml and had transmitted the virus to their vertebrate hosts by blood feeding. After 8 to 10 days of blood feeding duration, infection rates were respectively 36% and 100% for male and female ticks. In two instances out of seven transovarial transmission was observed and the virus reisolated from larvae of first generation. However, the virus was not detected after nymphal metamorphosis. After blood feeding on viremic goats, 71% of the nymphae were infected. After metamorphoses 22% of the males and 42% of the females had a low virus titer. Rh. e. evertsi appears to have a limited efficacy in transmitting and replicating the CCHF virus but must be not neglected as a potential vector during an epizootic manifestation.

Animals↗

[Malacologic-schistosomal study of the refugee camps on the Plain of Ruzizi in the Democratic Republic of the Congo].

Bilharziasis due to Schistosoma mansoni is widespread in the eastern part of the People's Republic of the Congo, particularly in the Ruzizi plain area. The intermediate host is the fresh-water snail Biomphalaria pfeifferi whose ecology is now well documented. Bilharziasis due to Schistosoma haematobium and Schistosoma intercalatum have not yet been observed but the potential for this development is high given the presence of the intermediate hosts, i.e. Bulinus truncatus, Bulinus globosus, and Bulinus forskalii, and the migration of populations in the area. Malacological and cercariometric studies were undertaken in 3 refugee camps in 1995. Findings showed that Biomphalaria pfeifferi was present in all water systems tested but that levels varied from 21 p. 100 to 70 p. 100 from one camp to another. The rate of infestation by Biomphalaria pfeifferi varied from 37 to 20 p. 100 depending on the sampling site. Given the prevalence of Schistosoma mansoni in the population, extension of bilharziasis is likely in the Ruzizi plain area and its surroundings. Potential intermediary hosts for Schistosoma haematobium and Schistosoma intercalatum were of lower relative prevalence and were found in specific biotopes. The authors propose methods of controlling water snails and preventing infection of people and water systems.

Animals↗

[Democratic Republic of the Congo: between civil war and the Marburg virus. International Committee of Technical and Scientific Coordination of the Durba Epidemic].

Because the epidemiology of viral hemorrhagic fever is unclear, each outbreak is a spectacular event that focuses the attention of the international scientific community. When an epidemic of Marburg virus disease occurred in the Durba region located in the northeastern part of the People's Republic of the Congo, 23 scientists were sent from 12 different countries. Sixty of the 73 people infected died. The first case was observed in December 1998 and the last in May 1999. Because of political unrest in the country, the outbreak was not reported immediately and most data was collected by observers retrospectively. However Marburg virus infection was confirmed in 5 of 16 patients in whom testing was performed and person-to-person transmission was demonstrated. Thus the Durba outbreak was the first epidemic of Marburg virus disease not involving laboratory contamination. Initial epidemiologic findings suggest that the first cases involved miners who were probably infected by contact with an animal reservoir such as bats. Further studies to determine seroprevalence in the general population and virologic testing on animals captured in the zone should provide answers to these questions.

Adolescent↗

[An epidemiological study of consultations of children under 5 years of age in Brazzaville (Congo)].

In most of the large cities in developing countries, geographic accessibility to health care is not a major problem. Thus, indifference to public services and a preference for home treatment, recourse to traditional medicine or to the private sector may be related to problems in the quality of services. A cross-sectional epidemiological study of hospital visits by under-5 children was carried out in health centres and hospital out-patient services in Brazzaville (Congo). Sampling in these health facilities was done using a systematic random sample with a proportion of 25%, during 4 periods chosen according to seasonal factors. An exhaustive investigation of the entire public sector serving children was done in the study. At the same time, the same data were gathered in a sample of private facilities (doctors' and nurses' offices, traditional healers, religious healing centres), chosen as a function of their permanence and the numbers of their clientele. This article analyses services offered during 2215 visits by children, who were under 1 year of age in more than 50% of cases. In the public sector, 75% of visits were to first-line health centres. Public services show marked dysfunctions: the complexity of internal referrals, clinical examinations which are inadequate in relation to symptoms, and poor communication (explanations as to cause of illness in less than 2% of cases, and on treatments in less than 50% of cases). Communication seems well developed among private physicians and traditional healers, the latter engaging in both preventive and curative activities. Communication during well-child visits and consultations at health centres is especially disappointing, in light of the very young age of the parents (1/4 are high-school or college students). There is a two-fold risk in this situation: flight towards non-conventional medicine on the one hand, and access to private medicine based on socio-economic status on the other. It thus appears necessary to standardise procedures and acts in first line public health services and to promote training of personnel in communication skills with families (training using social science perspectives and participative pedagogical techniques).

Age Factors↗