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In vitro susceptibility of African isolates of Plasmodium falciparum from Gabon to pyronaridine.

The in vitro activity of pyronaridine was evaluated against 62 isolates of Plasmodium falciparum from Libreville, Gabon using an isotopic, drug susceptibility microtest and was compared with amodiaquine, chloroquine, quinine, and halofantrine activities. The mean 50% inhibitory concentration (IC50) values of the 62 isolates from Gabon to pyronaridine was 3.0 nM (95% confidence interval [CI] = 2.1-3.9). Pyronaridine was less potent against chloroquine-resistant isolates than chloroquine-susceptible isolates but more potent than chloroquine against chloroquine-resistant parasites. The cut-off value for in vitro reduced susceptibility to pyronaridine was an IC50 > 15 nM. Two isolates (3%) showed an IC50 > 15 nM. A significant positive correlation was found between the activities of pyronaridine and chloroquine (r2 = 0.26, P < 0.001), pyronaridine and quinine (r2 = 0.36, P < 0.001), pyronaridine and amodiaquine (r2 = 0.55, P < 0.001), and pyronaridine and halofantrine (r2 = 0.50, P < 0.001). This correlation suggests in vitro cross-resistance or at least in vitro cross-susceptibility, which is not necessarily predictive of cross-resistance in vivo. The present in vitro findings require comparison with those of clinical studies.

Adolescent↗

[Endometrial carcinomas in Gabon. A study of 34 cases in 11 years: 1988-1998].

The aim of this retrospective study was to determine the importance of endometrium cancer in Gabon over an eleven-year period (1988-1998). We studied 34 cases from the register of cancers at the Faculty of Medicine in Libreville. The incidence of endometrium cancers was 5.3%. The patients came from areas with medical care facilities. They were all mature women with a mean age of 58.8 years (range: 34 to 80 years). Most of these women were menopausal (88. 24%). Uterine bleeding was the main symptom (100% of cases). Histologically, endometrium adenocarcinomas (79.41%) were the most frequently observed. The setting up of medical facilities in rural areas and efforts to provide the population with information concerning these cancers may affect the incidence and prognosis of endometrium cancer in Gabon.

Adult↗

[Position of cervix cancer detection in Gabon over a period of 19 years].

MATERIALS AND METHODS: We report the contribution of the cytology test for screening for cervix cancer in Gabon observed in a retrospective study over 19 years (1977-1995). Data from the Libreville Faculty of Medicine cytohistopathology laboratory were used. RESULTS: Over the 19-year period, 10,838 PAP smears were performed, an average of 570,42 smears per year. Sixty-eight cases of cervix cancer were diagnosed with this test: 40 invasive carcinomas (58.83%), 5 microinvasive carcinomas (7.35%), and 23 in situ carcinomas (33.82%). During the same period, 437 cervix cancers were reported in the same laboratory without prior cytology test. CONCLUSION: In Gabon, cervix cancer is usually diagnosed at an invasive stage, hence the need for systematic detection.

Carcinoma↗

[HBs Ag and antibodies to hepatitis C virus in complicated chronic liver disease in Gabon. A case control study].

BACKGROUND AND OBJECTIVE: The prevalence of HBs Ag and anti-HCV antibodies are high in the general population in Gabon. The aim of this study was to perform a case control study to determine the role of hepatitis B and C viruses in decompensated cirrhosis and hepatocellular carcinoma. METHODS: Between October 1990 and June 1998, HBs Ag and anti-HCV antibodies were investigated in 1 204 newly hospitalized patients. Sixty-seven had decompensated cirrhosis, 38 had hepatocellular carcinoma and six an association of both diseases. Prevalences were compared with those in a group of 527 sex and age matched controls from the same cohort. RESULTS: HBs Ag prevalence among cases was 35.1% (decompensated cirrhosis: 34.2%; hepatocellular carcinoma: 40.5%) and 12.5% among controls. Anti-HCV were detected in 32.4% of cases (decompensated cirrhosis: 34.2%; hepatocellular carcinoma: 28.6%) and in 20.1% of controls. Complicated chronic liver disease was linked to HBs Ag (OR=11.3; IC: 4.8-26.7; cirrhosis: OR=18; IC: 5.3-61.5; hepatocellular carcinoma: OR=8.3; IC: 2.5-27.8) in patients from 15 to 34 years old. Above 45 years, complicated chronic liver disease was linked to anti-HCV antibodies (OR=2.9; IC: 1.6-5.3; cirrhosis: OR=2.8; IC: 1.4-5.8; hepatocellular carcinoma: OR=3.2; IC: 1.1-9.5). CONCLUSION: Both Hepatitis B and C viruses are linked to complicated chronic liver disease in Gabon in an age-dependent manner.

Adolescent↗

[Pulmonary bilharziosis due to Schistosoma haematobium: pitfalls of species diagnosis. A case report from Libreville, Gabon].

The purpose of this report is to describe a case of pulmonary schistosomiasis treated at la Fondation Jeanne Ebori in Libreville, Gabon. This case is exceptional due to the rarity of the disease and the schistosomiasis agent involved. The patient was a 47-year-old woman who presented with recurrent right-sided pneumonia 6 months after initial hospitalization and nonspecific antimicrobial therapy. Her general status was altered by hyperthermia, right chest pain, and repetitive bouts of hemoptysia. Because etiological diagnosis could not be achieved and clinical condition was deteriorating, the decision was taken to perform exploratory thoracotomy. Based on operative findings, medial and lower lobectomy was performed. Histological examination demonstrated granulomatous inflammatory lesions due to bilharziosis. Infection was attributed to Schistosoma haematobium that is the most common agent in pulmonary localizations. However Ziehl coloration raised the possibility of involvement of Schistosoma intercalatum that has never been observed in the lung and of a hybrid species. Natural hybridization between S. haematobium and S. intercalatum and the presence of active transmission of the Schistosoma hybrid has been suspected in Gabon.

Animals↗

[First appearance of monkey pox in human beings in Gabon].

The authors report on the first coming out in Gabon of human monkey-pox. Four children in the same family were simultaneously attacked. In one of the two fatal cases, diagnosis of monkey-pox was confirmed by the isolation of the virus. In the three other cases, diagnosis was based on clinical and epidemiological findings. The coming out of monkey-pox in Gabon squares with sporadic coming out of this zoonosis observed in the humid tropical forests of west and Central Africa. Two fatal cases presented some symptoms of hemorrhagic fever and cutaneous symptoms did not dominate the clinical feature. As a consequence of it, monkey-pox has to be envisaged in similar cases. The attack of liver and spleen in man has not been documented up till now, as it has been for monkeys. Classical diagnosis is based on the isolation of the virus from a cutaneous lesion. In the present case, the virus was isolated from a blood sample. Epidemiological study did not reveal any interhuman transmission evidence, nor the source of infection.

Biopsy↗

[Isolated case of haemorrhagic fever observed in Gabon during the 2002 outbreak of Ebola but distant from epidemic zones].

During the last outbreak of Ebola virus haemorrhagic fever that occurred concurrently in Gabon and Congo, several primary foci were identified in the Ogooue Ivindo province (Northeast Gabon), where previous outbreaks had occurred. A 48-year-old woman living in Franceville located 580 Km from the epicentre presented fever with haemorrhagic signs. She was evacuated to Libreville where Ebola infection was suspected. Diagnosis was confirmed at the Centre International de Recherches Médicales of Franceville on the basis of detection of specific antibodies. Symptoms had already subsided by the time diagnosis was documented. An epidemiological investigation was undertaken to identify the source of contamination and detect secondary cases. No human or nonhuman primate source of contamination could be formally identified. Direct contact with the virus reservoir could not be ruled out. No secondary cases were detected. The favourable outcome, absence of secondary, and failure to identify a source of contamination suggest that epidemiologically undefined cases may go unnoticed during and outside of outbreaks.

Data Collection↗

[Onchocerciasis in the area of Lastourville, Gabon. Clinical and entomological aspects].

The African Programme for Onchocerciasis Control (APOC) has implemented a series of surveys aimed at evaluating the long-term impact of its activities. The region of Lastourville (Gabon) is one of the selected sites for this study. A total of 886 persons was examined for skin lesions, and 459 out of them participated in detailed ocular examinations. Blackflies were collected during one year and dissected. Although the focus was found to be hypoendemic (prevalence of nodules: 7.7%), the frequency of onchodermatitis was relatively high. The lesions of the anterior segment of the eye were rare, but the prevalence of optic nerve disease, and of choroido-retinal lesions reached 5.2 and 2.7%, respectively. The annual transmission potential (2,171 infective larvae per man) was high, when compared with the results recorded in the human population. This may be due to the presence of Onchocerca spp. of animal origin in the blackflies. These results indicate that in the area of Lastourville, though regarded as the main focus of onchocerciasis in Gabon, the disease is relatively mild.

Adolescent↗

Seroprevalence of retroviral infection in women with different fertility statuses in Gabon, western equatorial Africa.

Seroprevalence of retroviral infection (HIV-1, HTLV-1) in women with different fertility statuses was studied in Gabon (Western Equatorial Africa). The overall prevalence rate of HIV-1 was 1.4% and of HTLV-1, 6.8%. In the primary infertile women the age-adjusted prevalence rate of HIV-1 was significantly higher than in the fertile women (9.3% versus 0.7%) and in secondary infertile women (9.3% versus 2.1%). There was no difference in sero-prevalence of HTLV-1 among women with different fertility statuses, but a steady increase with age was seen. Concomitant infection with HTLV-1 and HIV-1 was observed in two women. In Gabon primary infertile women could be considered a risk group for HIV-1 infection.

Acquired Immunodeficiency Syndrome↗

[Vertebral tuberculosis in Gabon. Anatomo-clinical aspects, diagnostic and therapeutic problems, 107 cases from 1976 to 1986].

This retrospective study covers a period of 10.5 years (february 1976 to november 1986). It concerns 107 patients who contracted tuberculous spondylitis and originated from different provinces of Gabon. The authors report their experiences in order to emphasize the frequency of the disease, diagnostic and therapeutic problems. In Gabon, tuberculosis of the spine occupies the third position (3%), after the pulmonary form (90%) and ganglionic form (3.8%). In also represents 83.6% of the osteoarticular tuberculosis. The average age is 22 years, 55% of the patients were less than 20 years. The zone of maximum predilection, in decreasing order, is thoracic spine (36.4%), lumbar spine (33.6%), thoraco-lumbar region (10.3%). The 107 patients totalized 257 vertebral bodies destroyed (an average of 2.4 bodies per patients). On the clinical field the sick seek advice at an advance stage of the disease with gibbosity (38.3%) and neurologic deficits (21.5%). The diagnosis proof often followed the therapeutic results. There were three therapeutic modalities: medical (all patients), surgical (6 patients) and orthopedic (44 patients). The therapeutic indications improved with the available of more material and qualified staff. In children the treatment remains classic. The authors discuss the surgical indications in adults. The therapeutic results in patients treated and followed for over one year were satisfactory. Unfortunately, most patients were lost to follow-up. They suggest public health means of decreasing the frequency of the disease.

Adolescent↗

[Tumor-related epilepsy in adults in Gabon: diagnostic problems and therapeutic management].

The incidence of supratentorial brain tumors revealed by epileptic seizure is certainly underestimated in developing countries due to the lack of adequate diagnostic facilities. This report describes 10 cases of tumor-related epilepsy observed in Gabon over a 54-month period. Tumor-related seizures accounted for 5% of patients hospitalized for epilepsy in neurosurgical and neurologic units in Gabon during the study period. In two patients who refused surgery, diagnosis of the tumor was made solely on angiographic findings. Surgery was performed in 8 patients based on electroencephalographic and arteriographic findings. There were 4 astrocytomas, 3 meningiomas, and 1 glioblastoma. One patient died 8 days after the procedure due to convulsions. Another patient was lost from follow-up three months after the procedure. The remaining 6 patients are asymptomatic with follow-up periods ranging from 10 to 72 months (mean: 40.6 months). The value of early diagnosis and resection as well as post-operative use of antiepileptic drugs is emphasized.

Adult↗

Blood transfusion as a major risk factor for HTLV-I infection among hospitalized children in Gabon (Equatorial Africa).

To study the risk factors for HTLV-I infection of African infants living in a high seroprevalence area, a survey was conducted among hospitalized children and their mothers in Franceville, southern Gabon. A total of 610 children (6 months to 14 years old) from 555 families and 434 mothers participated in the study. HTLV-I seroprevalence was 7.1% in the mothers and 2.8% in the children. No increase by age was observed in the children. Significantly more children with sickle cell anemia (11 of 57, or 19.2%) were infected than others (1%) (Fisher's exact test p < 0.001). Of the 13 seropositive infants (C+) whose mothers were tested, six (43%) had a seropositive mother (M+) [p < 0.001, prevalence ratio (PR) 10.12, 95% CI 3.40-30.35, attributable risk (AR) 0.55]. Risk factors for nonmaternally acquired HTLV-I infection were previous blood transfusion (Fisher's exact test p < 0.001, PR 15.74, CI 5.20-47.60, AR 0.71) and hospital admission. In a hospitalized pediatric population in Gabon mother-to-child transmission and blood transfusion (because of sickle cell disease) were equally implicated in HTLV-I infection. Control of HTLV-I infection in children in Africa requires prevention of both vertical and transfusion-associated transmission, which may be exceedingly difficult in developing countries.

Adolescent↗

[Distribution of glycosylated hemoglobin (HbA1) in an internal medicine service in Gabon].

Measurement of glycated hemoglobin (HbA1) concentration is commonly recommended to monitor diabetes, but the relevance of this parameter in some black African populations is questionable. To assess the suitability of this test and study factors affecting HbA1 concentration, we measured HbA1 concentration in 297 consecutive patients (185 men and 112 women) hospitalized in the Internal Medicine Department of the Libreville Hospital Center in Gabon. Distribution of HbA1 was asymmetric with a median at 7.2% (IC95: 6.8-7.6%). Metabolic abnormalities associated with diabetes, renal insufficiency, hyper-bilirubinemia and hypertriglyceridemia were not preferentially correlated with a distribution of HbA1 concentration above the normal threshold of 7.5 %. Elevated concentration were observed in 81 patients presenting no abnormalities. These findings was not due ro technical problems, alcohol abuse, or aspirin intake or to congenital hematologic abnormalities that have been documented in Gabon. On the other hand, an increase in glycation secondary to latent infection which is frequent in tropical areas may partially explain these findings. Regardless of the explanation, HbA1 appears to be unsuitable for monitoring diabetes in this population group.

Adolescent↗

[Leptospirosis: a cause of pseudo-malarial fever in Gabon].

A first case of leptospirosis has been recently described in Gabon where bioclimatological characteristics could favour the transmission of that disease. Therefore, a search for antibodies to leptospirae was conducted among 55 military Frenchmen with unexplained fever during a four-month stay in Gabon. Three (5.5%) were positive with IgM levels attesting for recent contamination. A screening antigenic battery identified L. bataviae in two cases and L. sejroe in one case. The three patients were employed outside in the precedent weeks. Travelers are exposed to leptospirosis in numerous Third-World countries. Clinical and biological similarities between leptospirosis and P. falciparum malaria could induce misdiagnosis. Co-infection could also be encountered. Doxycycline, whose activity against P. falciparum is well known, is also effective against leptospirae. Therefore, this drug seems valuable for prophylactic and therapeutic actions in areas exposed to the both diseases.

Adolescent↗

[Aspects of malaria in the hospitalized child in Gabon].

To gain insight into the impact of malaria on children in terms of frequency and severity, a study was carried out in a department of the Owendo Children's Hospital in Libreville, Gabon, a fully endemic area. Diagnosis of Plasmodium falciparum malaria was confirmed by blood smears in 295 of the 1592 children admitted in 1992, i.e. 18.5% of admissions. Malaria was therefore the primary cause of hospitalization. Of 122 deaths observed during the study period 9 were due to malaria-associated complications for an overall mortality rate of 7.4% and malaria-related mortality rate of 3.1%. These rates are low in comparison with those reported by other departments in Central Africa. Convulsions were observed in 30.5% of children in the department and malaria was the underlying cause of convulsions in 62.9% of these cases. Severe anemia (< 5 g/dl) was noted in 23.7% of children overall and was associated with malaria in 54.7%. Severe malaria as defined by the criteria of the World Health Organization was observed in 33.2% of children. These findings illustrate the extent of the impact of endemic malaria on children in Gabon and emphasize the need to promote malaria control programs and improve treatment.

Age Distribution↗

The primate community of the Lopé Reserve, Gabon: diets, responses to fruit scarcity, and effects on biomass.

The diets of all diurnal primates (Gorilla g. gorilla, Pan t. troglodytes, Mandrillus sphinx, Colobus satanas, Cercocebus albigena, Cercopithecus nictitans, C. pogonias, C. cephus) in the Lópe Reserve, central Gabon, are described from qualitative and quantitative data collected over 10 years. A total of 397 foods were recorded, of which 91% were from plants. The diet of seven of the eight species were numerically dominated by fruit, the exception being Colobus satanas with a diet dominated by seeds. When proportion of feeding time was examined, fruit remained the dominant food class for six species, while Cercocebus albigena, like the black colobus, spent most time feeding on seeds. The number of foods recorded per species ranged from 46-220, but dietary breadth of the four species that have not been subjects of detailed study was certainly underestimated. Almost half of the foods (46%) were eaten by only one species, and only four (1%) were recorded for all eight species. At Lópe, fruit is scarce for 2-3 months during the annual dry season, and fruit crop failures can prolong this period of scarcity to as many as 8 months in some years. When fruit is scarce, the diets of all the species changed to include more nonfruit foods, but chimpanzees and the three species of guenons maintained a fruit dominated diet. The total biomass of the Lópe primate community is 374 kg/km2, which is low compared to other sites in tropical Africa. Within the Lópe community, biomass correlates negativity with degree of frugivory, suggesting that fruit availability may be critical, but this does not explain the low total biomass compared to other sites. Neither floristic diversity nor the composition of the primate community at Lópe can account for the biomass. While historical events such as climate-induced changes in forrest cover, disease, or impact of human activities cannot be ruled out, we conclude that the most likely explanation of low primate biomass is the occurrence of an ecological "catastrophe" in the fairly recent past from which populations have not yet recovered. We believe that the most likely scenario was climate-mediated disturbance of flowering of important fruit food species. Prolonged fruit scarcity would have caused mortalities and affected the most frugivorous species more severely.

Animals↗

Rotavirus prevalence and relationships with climatological factors in Gabon, Africa.

A one-year study of rotavirus prevalence was carried out using electron microscopy in Gabon, equatorial Africa. One hundred fifty-six nonhospitalized diarrheic children up to 10 years of age and 115 age-matched controls were investigated together with diarrheic adults and children over 10 years of age. Rotaviruses were observed only in diarrheic children under 10 years of age (10.2%). Rotaviruses were more prevalent in the dry-season months (19.2% versus 1.3%, P less than .001). Rotaviruses were the most commonly found among all the viral, bacterial, and parasitic agents we detected, with the exception of the coronaviruslike particles, which are the subject of another paper [Sitbon, 1985].

Adolescent↗

High prevalence of high-risk oncogenic human papillomaviruses harboring atypical distribution in women of childbearing age living in Libreville, Gabon.

The extent of human papillomavirus (HPV) genital shedding and type-specific diversity were evaluated in 354 consecutive women of childbearing age living in Libreville, Gabon. Detection of HPV DNA was performed by PCR using the MY09/MY11 primer set on DNA extracted from endocervical swabs. All PCR positive specimens were subjected to direct sequencing and HPV genotypes were identified on the basis of >95% sequence homology in the L1 region. Reverse line blot hybridization assay was used when a genotype could not be resolved by sequencing alone. HPV DNA was detected in 163 (46%) women, all clinically asymptomatic for HPV-related lesions. The highest prevalence of genital HPV detection (45%) was in the age group from 22 to 29 years. A total of 90 women (55%) harbored high-risk (HR) genotypes, with the most common being HPV-53 (19; 12%), HPV-58 (17; 11%), and HPV-16 (16; 10%). Low-risk genotypes were found in 36 (22%) women with HPV-54 and HPV-70 being the most frequently detected (17; 11% and 10; 6%, respectively). Finally 37 women (23%) tested positive for genotypes of unknown oncogenic risk, the most common in this category being HPV-83 (20; 12%). Multiple infections were detected in 35 (21%) women. By multivariate analysis, HPV genital shedding was significantly associated with young age (OR: 0.34; P < 0.007). The multivalent vaccine currently available against cervical carcinomas, is only active against HPV-16 and HPV-18, and will thus have a low impact in this setting.

Adolescent↗