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At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Delay between first HIV-related symptoms and diagnosis of HIV infection in patients attending the internal medicine department of the Fondation Jeanne Ebori (FJE), Libreville, Gabon.

BACKGROUND: HIV-infected patients (pts) in Africa are often diagnosed at very advanced stages of disease. They seek relief using traditional medicine or religious beliefs. General practitioners (GPs) are often consulted first. Once the HIV diagnosis has been made, concomitant use of alternative and allopathic medicine is also frequent. OBJECTIVE: To describe the delay between presentation of HIV-related symptoms and diagnosis, the first physician consulted, and the use of traditional medicine or religion as an alternative or complement to allopathic medicine in HIV-infected patients. METHOD: Patients followed for HIV infection at Fondation Jeanne Ebori were retrospectively interviewed to trace their therapeutic itinerary. RESULTS: 150 pts were interviewed. There were 63% females, mean age was 39 years, median CD4 count was 242 cells/microL (102-394), CDC stage A/B/C was 32%/40%/28%, and 57% had very low income. Religious affiliations were Catholic (52%), Protestant (21%), Muslim (3%), "progressive" Church (16%), and none (7%). The median time elapsed between their first symptoms and HIV diagnosis was 124 (20-292) days. The first person consulted was a traditional healer (5%), GP (61%), or private clinics (23%). Traditional healers were consulted for initiation rites in 23%, cure of disease in 90%, or sorcery in 20%. Once allopathic medicine was started, concomitant alternative therapy occurred in 25 (17%) for traditional medicine and 4 (3%) for faith healing. Resort to traditional healer (odds ratio [OR] 2.6, p = .02) and to faith healing (OR 3.1, p = .048) were risk factors for diagnosis delay. CONCLUSION: Many factors related to patients, the health system, and culture or society are detrimental to an early diagnosis of HIV infection in Gabon. Increasing awareness of the risk of HIV infection throughout the general population and hope and trust in western medicine in patients and non-HIV-specialist physicians, as well as suppression of social stigma, could shorten the delay before diagnosis. Better communication between allopathic physicians and traditional or faith healers could also improve the care of HIV-infected patients.

Adolescent↗
PubMed2006

Submicroscopic Plasmodium falciparum infections before and after sulfadoxine-pyrimethamine and artesunate association treatment in Dienga, Southeastern Gabon.

BACKGROUND: It has been shown that Plasmodium falciparum submicroscopic infections (SMI) can contribute to malaria-associated anemia as well as to cerebral malaria. Polymerase chain reaction (PCR) assays are usually used as an alternative to microscopy in detecting subpatently infected individuals. OBJECTIVES: The main objective of this study was to investigate the occurrence of SMI before and after a suppressive antimalarial treatment in the population of the village of Dienga in Gabon. METHODS: Nested PCR was used to detect SMI and to determine genotypes. RESULTS: The prevalence rates of SMI were 13.67% (38/278) at day 0 and 8.99% (25/278) at day 14 after sulfadoxine-pyrimethamine-artesunate treatment. Genotype analysis of two polymorphic regions of the merozoite surface protein (MSP)-1 block 2, MSP-2 and a dimorphic region of the erythrocyte binding antigen (EBA-175) revealed that as many as 88% (22/25) of SMI detected after treatment were completely new alleles, indicating either previously sequestered parasites or newly acquired infections. CONCLUSION: These results demonstrate the usefulness of sulfadoxine-pyrimethamine-artesunate association treatment in the population of Dienga and confirmed early parasite genotype change after a suppressive antimalarial treatment in endemic areas.

Adolescent↗
PubMed2006

[Difficulties of the patients to undergo their ARV treatment at the Libreville outpatient health center, Gabon].

The therapeutic observance is a real issue of chronic diseases. This issue is twice as much important in the case of aids treatment by antiretrovirals as a good observance is essential to avoid emergence of resistances and to improve patients' health. A research was conducted in Libreville, the capital of Gabon, at the ambulatory treatment center of HIV patients. The interviews of one hundred patients of the center, under treatment for more than two months, concerned their problems related to specific drugs intake and have helped to point out some reasons of non observance. The first reason refers to side effects inducing many difficulties in regular drugs intakes, a complete information is requested by the patients. Another main reason of non observance or bad observance is linked to material and financial problems or to treatment's reduced accessibility The research points out the importance of supplementary treatment costs (transportation, sick leave, food). At last, major observations were made on schedule management, drugs intake management, needs for more information and help for prevention, everyday life and diet.

Adult↗
PubMedDate not supplied

Isolation and phylogenetic characterization of Ebola viruses causing different outbreaks in Gabon.

Three outbreaks of Ebola hemorrhagic fever have recently occurred in Gabon. Virus has been isolated from clinical materials from all three outbreaks, and nucleotide sequence analysis of the glycoprotein gene of the isolates and virus present in clinical samples has been carried out. These data indicate that each of the three outbreaks should be considered an independent emergence of a different Ebola virus of the Zaire subtype. As in earlier Ebola virus outbreaks, no genetic variability was detected between virus samples taken during an individual outbreak.

Animals↗
PubMed2005

Wild animal mortality monitoring and human Ebola outbreaks, Gabon and Republic of Congo, 2001-2003.

All human Ebola virus outbreaks during 2001-2003 in the forest zone between Gabon and Republic of Congo resulted from handling infected wild animal carcasses. After the first outbreak, we created an Animal Mortality Monitoring Network in collaboration with the Gabonese and Congolese Ministries of Forestry and Environment and wildlife organizations (Wildlife Conservation Society and Programme de Conservation et Utilisation Rationnelle des Ecosystemes Forestiers en Afrique Centrale) to predict and possibly prevent human Ebola outbreaks. Since August 2001, 98 wild animal carcasses have been recovered by the network, including 65 great apes. Analysis of 21 carcasses found that 10 gorillas, 3 chimpanzees, and 1 duiker tested positive for Ebola virus. Wild animal outbreaks began before each of the 5 human Ebola outbreaks. Twice we alerted the health authorities to an imminent risk for human outbreaks, weeks before they occurred.

Animals↗
PubMed2005

Bartonella quintana and Rickettsia felis in Gabon.

We detected Rickettsia felis DNA in Ctenocephalides felis and Bartonella quintana DNA in 3 Pulex irritans fleas taken from a pet Cercopithecus cephus monkey in Gabon, sub-Saharan Africa. This is the first report of B. quintana in the human flea.

Animals↗
PubMed1988

Natural antibodies against three distinct and defined antigens of Plasmodium falciparum in residents of a mesoendemic area in Gabon.

The magnitude of the antibody response to three distinct and defined antigens of Plasmodium falciparum was assessed in 144 inhabitants of the Kassa district (Haut Ogooué Province, Gabon), a region where malaria is mesoendemic. Antibodies against a polypeptide consisting of 40 (Asn-Ala-Asn-Pro) repeats of P. falciparum circumsporozoite protein [(NANP)40] were detected by ELISA. Antibodies against the fusion peptide 31.1, which consists of the N-terminal portion of the 190-200 kDa glycoprotein, were also detected by ELISA. Antibodies against ring-infected erythrocyte surface antigens (RESA), mainly the P. falciparum 155 kDa antigen (Pf 155), were detected by IFA on glutaraldehyde-fixed P. falciparum infected red blood cells (IRBC). In addition, a standard IFA employing air-dried P. falciparum IRBC was used to detect antibodies against intraerythrocytic asexual forms. Parasitemia and spleen enlargement were also recorded. The frequency of sera positive for specific antibodies increased with age for all the antigens tested. Plateau antibody levels were reached at different ages for the different antigens. Individual antibody responses varied in titer to the different antigens. Subjects with parasite-negative thick smears showed higher titers of anti-31.1 as well as an increased frequency of anti-RESA antibodies compared to subjects having positive smears. No differences in the titer and in the prevalence of anti-(NANP)40 antibodies were found between these groups. The results suggest that the antibody response against asexual blood stage antigens, especially anti-RESA and anti-31.1, may play a role in controlling parasitemia.

Adolescent↗
PubMed1994

Comparison of micronized halofantrine with chloroquine-antibiotic combinations for treating Plasmodium falciparum malaria in adults from Gabon.

Multidrug resistance of Plasmodium falciparum is spreading throughout Africa. In Lambarene, Gabon where chloroquine-resistant malaria is prevalent, a randomized comparative trial with three regimens for treating P. falciparum malaria in adults was performed. One hundred two patients evaluated received either a new micronized formulation of halofantrine (8 mg/kg every 6 hr in three doses) (group H) or chloroquine (25 mg/kg for a 48-hr period) plus clindamycin (5 mg/kg every 12 hr in six doses) (group CC1), or chloroquine (as above) plus doxycycline (2 mg/kg every 12 hr in six doses) (group CD). All treatment regimens were well-tolerated. In group H, 100% of the patients were cured, and in group CC1, 97% of the patients were cured by day 28 of follow-up. In group CD, a significantly lower cure rate of 75% (P < 0.01) and a slower parasite clearance was observed, but only low grade (RI) resistance occurred.

Administration, Oral↗
PubMed1997

Lack of malaria parasite transmission between apes and humans in Gabon.

The International Center for Medical Research (CIRMF) is located in an area highly endemic for malaria in southeastern Gabon, where humans and apes (gorillas and chimpanzees) are living in the same geographic area. The presence of the CIRMF primate center housing apes (59 chimpanzees and nine gorillas in 1994) within the city of Franceville provided an opportunity to investigate the capability of cross-transmission of malaria species from humans to apes. The main vector of human malaria, Anopheles gambiae, was found in the primate center and in a nearby populated area of Franceville. Despite high malaria transmission in humans of both Plasmodium falciparum and P. malariae (mean of 43% cumulative prevalence in schoolchildren), none of the apes were found infected with plasmodia during a six-month investigation. However, low antibody levels against sporozoite and blood stages of both P. falciparum and P. malariae were detected in a few chimpanzees and gorillas. These results demonstrate that only rarely would apes be bitten in the field by mosquitoes infected with human malaria parasites. In the case of infection proven by serology, we did not find any evidence that blood-stage malaria parasites were able to the gametocyte stage. The absence of any established malaria transmission cycle within the primate colony of CIRMF indicates that apes cannot be considered as animal reservoirs for human malaria parasites in this environment.

Adolescent↗
PubMed1997

Day-to-day variation of egg output and schistosome circulating antigens in urine of Schistosoma haematobium-infected school children from Gabon and follow-up after chemotherapy.

A group of 31 school children from Gabon infected with Schistosoma haematobium was examined before praziquantel therapy and followed on days 3, 9, 14, 21, 24, 28, 31 and 35 after therapy. The day-to-day variation of schistosome circulating antigens, urinary egg output, and the reagent strip index (RSI, a pathologic marker) was studied in six consecutive pretreatment urine samples collected under standardized conditions. The geometric mean pretreatment for egg output ranged between 97 and 223 eggs per 10 ml of urine; for urine circulating anodic antigen (CAA) levels this was 44-154 pg/ml and for circulating cathodic antigen (CCA) levels this was 180-601 pg/ml. On the day of treatment, 97% of the children had viable eggs in their urine, 87% had a positive RSI; positive CAA levels were detected in 61% of the children and positive CCA levels in 77%. A significant correlation was consistently found between RSI and egg counts. Five weeks after chemotherapy egg output, levels of CAA and CCA and the severity of pathologic findings in the lower renal tract, as indicated by the RSI, had decreased significantly in all cases. Our results indicate that egg output in urine is an accurate method for diagnosis of S. haematobium, and additionally show less day-to-day variation than detection by ELISA of schistosome circulating antigens in urine.

Adolescent↗
PubMed1998

Plasma levels of artesunate and dihydroartemisinin in children with Plasmodium falciparum malaria in Gabon after administration of 50-milligram artesunate suppositories.

A thermostable suppository of artesunate (artesunic acid) has been developed. In Gabon, 12 children with Plasmodium falciparum malaria received two administrations of this suppository in a 4-hr interval. Parasitemia and fever were then measured and the plasma levels of artesunate and its active metabolite, dihydroartemisinin, were determined by means of a reversed phase high-pressure liquid chromatography method using reductive electrochemical detection. Substantial parasite clearance (97-100%) was noted 24 hr after the beginning of the treatment and body temperature had returned to normal. Absorption, metabolism, and elimination of artesunate were rapid. Mean values of maximum plasma levels (Cmax) and maximum concentration peak times (tmax) were evaluated. The Cmax of dihydroartemisinin (0.18 +/- 0.10 microg/ml [mean +/- SE]) was higher than the Cmax of artesunate (0.09 +/- 0.04 microg/ml) and the tmax of dihydroartemisinin (1.13 +/- 0.58 hr) was higher than the tmax of artesunate (0.58 +/- 0.19 hr). Plasma levels 30 min after the second suppository administration were not consistently higher than those found 30 min after the first administration.

Absorption↗
PubMedDate not supplied

Prevalence and genetic variants of hepatitis GB-C/HG and TT viruses in Gabon, equatorial Africa.

The distribution of Hepatitis GB-C/HG (GB-C/HG) and TT viruses (TTV) infections was investigated in selected populations from Gabon using Polymerase Chain Reaction (PCR) and Enzyme Linked Immunosorbent Assay (ELISA) for anti-Envelop 2 (anti-E2) GBV-C/HGV antibodies. Among pregnant women, 29 of 229 (12.6%) were Hepatitis GB virus-C and Hepatitis G virus (GBV-C/HGV) RNA positive (+) and 32 of 81 (39.5%) anti-E2 + versus 8 of 39 (20.5%) TTV DNA +. Among sickle cell anemia patients, 9.7% (3/31) were GBV-C/HGV RNA + versus 22.5% (7/31) TTV DNA +. For tuberculosis patients, the figures were 11.5% (4/35) and 0%. A study of hepatocellular carcinoma cases (n = 27) versus controls (n = 66) did not show significant differences for GBV-C/HGV RNA (10.7% versus 12.1%) and TTV DNA (44.4% versus 30.3%). According to phylogenetic analysis, the 15 GBV-C/HGV strains investigated clustered in group 1, the most common in sub-Saharan Africa whereas TTV sequences (n = 4) mostly clustered in genotypes G1 and one close to genotype G3. In the Gabonese populations investigated, GBV-C/HGV and TTV infections were highly endemic. These data are consistent with the low pathogenicity of these agents.

Adult↗
PubMed1999

Malaria transmission in a region of savanna-forest mosaic, Haut-Ogooué, Gabon.

During the 2 years 1993 to 1995, an entomological survey was carried out in the savanna-forest area of Franceville, Gabon, investigating malaria transmission in one suburban district of Franceville (Akou) and in one rural village (Benguia). The biting rates of the Anopheles vectors were 10 times higher in the rural zone compared to the suburban zone. Anopheles funestus Giles was the predominant species in both zones followed by Anopheles gambiae s.l. Giles. The densities of Anopheles nili Theobald and Anopheles moucheti Evans were very low. In the suburban zone, transmission was maintained throughout the year by An. funestus and An. gambiae s.l., whereas in rural zones the secondary vectors An. nili and An. moucheti were also involved in transmission. Humans in a suburban setting received one infective bite per person every 4 days, whereas in the rural area the infective biting rate was 4 times higher. Considering each vector, the observed entomological inoculation rates (EIRs) were one infective bite per person every 6 and 17 days for An. funestus and An. gambiae s.l., respectively, at Akou. At Benguia, the EIRs were one infective bite per person every 2, 3, 6, and 19 days for the 4 An. funestus, An. gambiae s.l., An. nili, and An. moucheti, respectively. The predominance of An. funestus over An. gambiae s.l. and its high EIR make it the most important malaria vector in this region of Haut-Ogooué.

Aedes↗
PubMed1999

[In vitro sensitivity of Plasmodium falciparum isolates from Gabon to chloroquine and cycloguanil].

The in vitro susceptibility of 91 Plasmodium falciparum isolates obtained from malaria-infected children living near Libreville (Gabon) was evaluated against chloroquine and cycloguanil (biologically active metabolite of proguanil), using an isotopic micro-drug susceptibility test. In vitro resistance to chloroquine and cycloguanil was observed in 83% (35/42) and in 38% (30/78) of the patients, respectively. Our data showed that 41% (16/39) of Gabonese field isolates were resistant both to chloroquine and cycloguanil. These findings are of great importance because they might indicate imminent chloroquine-proguanil failure, and there are not many affordable antimalarial drugs to replace chloroquine-proguanil combination.

Adolescent↗
PubMed1999

[Salmonellosis in HIV infection in a hospital setting in Gabon].

A case-control study was carried out in Libreville, Gabon, to determine the incidence of salmonella infection in HIV patients and identify any special clinical, therapeutic, or prognostic features. The records of 3000 patients hospitalized in the Infectious Disease Department of the Jeanne Ebori Foundation between January 1990 and December 1994 were studied. The incidence of salmonella infection, serotype, clinical presentation, prognostic factors and therapeutic modalities were compared in 2759 HIV-positive patients and 441 HIV-negative patients. Salmonella infection was noted in a total of 208 patients (58 HIV-positive and 150 HIV-negative). The incidence of salmonella infection was 13 p. 100 (non-typhoid in 76 p. 100 of cases) in HIV-positive patients versus 5.4 p. 100 in HIV-negative patients. The predominant serotypes in HIV-positive patients were Salmonella typhimurium and Salmonella enteritidis which accounted 41 p. 100 and 26 p. 100 of the isolated strains. The only significantly difference in clinical presentation was a higher incidence of bacteremia (84 p. 100) and focal lesions (11.4 p. 100) in HIV-positive patients with low-grade salmonella infection. The duration of treatment was three weeks with cotrimoxazole and 10 days with fluoroquinolones and cephalosporines. The outcome in HIV-positive patients was recurrence-free cure in 40 p. 100, multiple relapses in 12 p. 100, and death in 24 p. 100. The remaining patients were lost from follow-up. This study demonstrates the gravity of low-grade salmonella infection in African HIV-positive patients. Early diagnosis is necessary to allow chemotherapy which can be effective despite immunodeficiency.

Adolescent↗
PubMed1999

[Oral receptivity of Aedes aegypti formosus from Franceville (Gabon, central Africa) for type 2 dengue virus].

Dengue is widely distributed in the tropics but epidemic activity was rarely reported in Africa before the 1980's. In the past 15 years, increased epidemic dengue fever has been reported both in East and West Africa, raising concern about the ability of local populations of Aedes aegypti to transmit dengue viruses. Ae. aegypti is present in two forms in Africa: Ae. aegypti aegypti and Ae. aegypti formosus. This latter form, much darker, was not originally a local species but is now colonizing artificial breeding sites within cities. We have been able to demonstrate the oral susceptibility for dengue type 2 virus of Ae. aegypti formosus collected in Franceville, Gabon (Central Africa). However, these mosquitoes sampled exhibited lower infection rates than those of a control colony of Ae. aegypti aegypti originating from French Polynesia.

Aedes↗
PubMed2000

[Early anterolateral surgery for tuberculosis of the lower cervical spine with neurological complications in adult. Our experience in Gabon].

OBJECTIVE: To report our therapeutic experience with tuberculosis of the lower cervical spine with neurological complications in 9 adults in Gabon. PATIENTS AND METHODS: A retrospective study of these 9 adults treated for progressive Pott's tetraplegia or paraplegia from 1982 to 1998 was conducted. The medical treatment consisted of the early administration in the first 3 patients of rifampin, isoniazid and ethambutol for 18 months; and, in the remaining 6 patients, of rifampin, isoniazid, ethambutol and pyrazinamide for 6 months. This medical treatment was systematically started 3 weeks before surgery in 7 patients, once the disease had been diagnosed radiologically. Two patients with an acute onset of paraplegia underwent surgery on an emergency basis. The standard anterior approach was used: debridement was done in 3 cases, to establish the diagnosis; 6 patients underwent radical surgery for severe neurological deficit and spinal instability. Average follow-up time was 40.6 months. RESULTS: Three patients were found to be functionally and neurologically normal at follow-up examinations. Eight of the nine patients recovered sufficiently to walk unaided. One patient was able to get about on crutches. After 3-4 months, a satisfactory consolidation was already observed, with reduction of kyphosis in 4 cases. All patients were considered medically cured by the Antituberculous Center. CONCLUSION: Early radical surgery, as primary procedure, in conjunction with a six-month chemotherapeutic regimen (four drugs) seems to be adequate for the management of tuberculosis of the lower cervical spine with neurological complications and spinal instability, in our setting.

Adult↗