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PubMed2001

Declining chloroquine resistance of Plasmodium falciparum in Lambaréné, Gabon from 1992 to 1998.

Plasmodium falciparum malaria continues to threaten human populations in the tropics and travellers in endemic areas. Drug resistance of the parasite is a major problem in treating this devastating disease. In a prospective trial we investigated the in vitro sensitivity of Plasmodium falciparum to chloroquine, quinine and mefloquine in the Albert Schweitzer Hospital in Lambaréné, Gabon every second year from 1992 to 1998. We used the standard WHO in vitro sensitivity assay. Parasite sensitivity to quinine and mefloquine remained stable over the years. However, parasite resistance to chloroquine decreased highly significantly with the change in local malaria treatment policy. In 1992, 100% of parasite isolates showed resistance to chloroquine, whereas in 1998 only 45% were found resistant.

Animals↗
PubMedDate not supplied

Semiautomated and simultaneous analysis of the interleukin-10 gene microsatellites IL-10G and IL-10R by fluorescence-based polymerase chain reaction reveals significant differences in allele distributions between Caucasians (Germany) and Africans (Gabon).

Interleukin-10 (IL-10) is an important immunoregulatory cytokine influencing many aspects of the adaptive and inflammatory immune response. Two dinucleotide repeats have been identified in the 5'-UTR of IL-10 and shown to be useful genetic markers in several diseases. A simple, two-colour fluorescence assay was developed for determination of microsatellite fragment length by an automatic sequencer. Using this method polymorphisms at the IL-10G and IL-10R loci of the 5' flanking region of the IL-10 gene can be identified simultaneously. A unified standard nomenclature was applied to the known IL-10G and IL-10R microsatellites. The multiplex PCR approach was used to compare the allele frequencies in two independent donor groups from Germany (Caucasian), comprising 112 and 106 cases, respectively, and one group from Gabon (African) including 91 donors. Significant differences in the allele distribution were found. Both Caucasian populations tested showed no significant differences in their allele and genotype distribution. Whereas in Africans, allele IL-10G25 is rare at 3% compared to 21% in Caucasian, alleles IL-10G22 and G23 are more prevalent in Africans than in Caucasians (22% versus 10% and 26% versus 7%, respectively). Within the IL-10R locus, the allele R13 was observed at 88% in the African group compared to 69% in Caucasians. These data may help immunogenetic studies in diseases, where IL-10 is thought to be deregulated.

Alleles↗
PubMed2001

[Causes of adult acute bacterial diarrhea in an internal medicine department in Libreville, Gabon].

This retrospective study of patients treated between 1992 and 1996 was undertaken as a preliminary step to identifying the main bacterial causes of diarrheal disease in Libreville, Gabon. A total 371 files showing positive stool cultures were analyzed. From an epidemiological standpoint, data showed that the high risk population was young people of both sexes. The incidence of diarrhea was correlated with climatic conditions with an endemic-epidemic pattern characterized by peak activity during the rainy season. In the vast majority of cases, the underlying etiology was gastroenteritis due to invasive organisms. The most commonly identified agents were salmonellae (46.6%) and Shigellae (44.2%). Treatment should focus on rehydration. Fluoro-quinolones were the most commonly indicated drugs for antimicrobial treatment but cotrimoxazole was often useful. In general, the prognosis of bacterial diarrhea is favorable provided that it is treated early and concurrent conditions are taken into account.

Acute Disease↗
PubMed2001

[Evaluation of efficacy and tolerance of amodiaquine versus chloroquine in the treatment of uncomplicated malaria outbreak in children of Gabon].

We conducted a prospective study from September 1997 to January 1998 in Libreville (Gabon). Fifty-three (53) children with uncomplicated P. falciparum malaria were included and divided into two groups. The first group (27 patients) was treated with amodiaquine and the second (26 patients) with chloroquine. The efficacy and tolerance of amodiaquine 30 mg/kg base over 3 days (10 mg/kg daily) and chloroquine 25 mg/kg base over 3 days (10 mg/kg day 0, 10 mg/kg day 1, 5 mg/kg day 3) were estimated at days 7 and 14. Clinical examination and parasitaemia were assessed on days 0, 1, 2, 3, 7, 14. Haematological and biochemical parameters were determined on days 0 and 7. Amodiaquine was shown to be more effective than chloroquine in clinical response and ridding patients of parasites: adequate clinical response was significantly higher with amodiaquine than chloroquine [100% (27/27) versus 45% (9/20), p < 0.0005]. Rates for early treatment failure (ETF) and late treatment failure (LTF) were respectively 35% and 12% with chloroquine. The parasitological success rate was significantly higher with amodiaquine than chloroquine on days 7 [93% (25/27) versus 62% (13/21), p < 0.008] and 14 [100% (13/13) versus 44% (4/9), p < 0.01]. The RI resistance type was 7% in the amodiaquine group. The rate of in vivo chloroquino-resistance was 53%, essentially of RII and RIII type. Overall, the two drugs were well tolerated.

Adolescent↗
PubMed1994

[The urbanization phenomenon in Sub-Saharan countries: the case of Gabon].

"This paper aims at outlining the impact of urbanisation on the process of development of the Gabon, a country where the last general census of the population (July 1993) showed that close [to two-thirds] of the Gabonese are city-dwellers. Therefore, the problems resulting from this situation must be identified, and appropriate policies and programs must be established...." (SUMMARY IN ENG AND SPA)

Africa↗
PubMed2002

[Analysis of snake bite envenomations in Gabon].

In tropical zones, snakebites are considered serious. Exotic snakes are characterised by the poisonousness of their venom and its abundance. Death is rapid in some cases and in others the sequelae are serious. Worldwide, there are more than 5 million victims per year, with 50,000 deaths registered and 400,000 amputations. The frequency and severity of snakebites in Gabon remain unknown. It is estimated that there is an average of one snakebite every 4 days, thus some 91 snakebites per year. Through a study carried out at the Libreville Hospital, we evaluated the frequency, severity, and fatality of this circumstantial pathology. A retrospective study conducted on 157 patients admitted for snakebite at the Intensive Care Unit of the Libreville Hospital was carried out between 1998 and 2001. 1.32% of all admissions were for snakebites. Signs of venom poisoning were observed in 27 patients (17%), versus 130 cases without envenomation. The majority of cases were in adults (78%) and children affected (22%) were aged mainly 6-14 years. The snakebite season usually coincided with the rainy season. During this period, 19 cases were registered. Snakebites occurred during the daytime (93%), in the fields in 20 cases (75%) or in the home courtyard (25%). The victims lived in town in 25 cases (93%). Antivenom was used in all envenomation cases, and the result was favourable in 23 cases (18%) but unfavourable in 4 (15%).

Adolescent↗
PubMedDate not supplied

[Current aspects of extra-uterine pregnancy in Libreville (Gabon): an account of 153 cases].

The impact of extra-uterine pregnancy is still increasing in the world. At the same time, its treatment is being improved in developed countries. The purpose of this study is to assess the current aspects of extra-uterine pregnancy in Libreville (Gabon) and to suggest actions which may improve its vital prognosis in the African context. The present study is only prospective and focuses on 153 extra-uterine cases of pregnancy recorded from February 1, 1997 to July 31, 2000. The average frequency was 2.32%. This frequency has been steadily increasing and went from 2% in 1997 to 2.32 % in 2000. The average age of the patients was 29. Extra-uterine pregnancy was diagnosed until the patients were 17. It concerned all parities. The average age was 8 weeks of pregnancy. Three para-clinical investigations allowed the confirmation of the diagnosis: ultrasound scan, coelioscopy, beta GCH plasma dosage. Laparotomy was the main therapeutic solution. No maternal death was recorded. The education of women capable of procreating on the necessity of early consultations, the supplying of hospitals with means which allow para-clinical investigations and the motivation of medical staff seem to be the main solutions to decrease the mortality rate due to extra-uterine pregnancy in Africa.

Adolescent↗
PubMed2003

Normal riboflavin status in malaria patients in Gabon.

Previous publications reported commonly the occurrence of riboflavin deficiency and a positive correlation between riboflavin status and parasitemia in patients with Plasmodium falciparum malaria. In these studies, riboflavin status was determined by erythrocyte glutathione reductase activation coefficients (EGRACs). Inherited low erythrocyte glutathione reductase activity is highly prevalent in malarial regions, however. To rule out falsely diagnosed riboflavin deficiency in affected patients, we conducted an investigation using a high-performance liquid chromatography method (HPLC) instead of the EGRAC method. In 29 infants (age range, 1-5 years), 22 schoolchildren (age range, 6-12 years), and 33 adolescents and adults (age range, 13-74 years) from Lambaréné, Gabon, with acute P. falciparum malaria, plasma concentrations of riboflavin, flavin mononucleotide (FMN), and flavin adenine dinucleotide (FAD) were measured by HPLC. Results were correlated with parasite densities. Profiles of plasma concentrations of all 3 flavin compounds were within the normal range in all patients. Concentrations of free riboflavin were not different between the 3 age groups. In adolescents and adults, FMN and FAD concentrations were higher than in infants (P = 0.002 and P = 0.001) and schoolchildren (P = 0.003 and P = 0.002). Comparing children with hyperparasitemic and uncomplicated malaria, no difference in the concentrations of either flavin compound was found. Neither the concentrations of free riboflavin nor the concentrations of one of the flavin nucleotides correlated with parasitemia within subgroups of age or of children with uncomplicated and hyperparasitemic malaria. Our data indicate that nutritional riboflavin deficiency might have been overestimated in previous malaria studies and do not support a relationship between flavin concentrations and parasitemia in P. falciparum malaria.

Adolescent↗
PubMed1992

[Seroepidemiological study of toxoplasmosis in Libreville, Gabon].

A sero-epidemiological survey of toxoplasmosis has been carried out in 1178 subjects residing in urban and suburban areas of Libreville, Gabon. Two techniques were used: Pastorex toxo of the Institut Pasteur and ISAGA of bioMérieux. The acquisition of antibodies occurs at an early age, from the age of six months on. After the age of 15 years, the age of procreation, the prevalence is 68%. Between the ages of 15 and 19 years, 19% have IgM. The risk for toxoplasmosis acquired during pregnancy is not to be neglected. It decreases between the ages of 20 and 30 years. The most probable source of contamination is the reservoir from the soil. No difference between the sexes was observed.

Adult↗
PubMed2003

Frequency and virulence properties of diarrheagenic Escherichia coli in children with diarrhea in Gabon.

To investigate the presence of diarrheagenic Escherichia coli in Lambaréné, Gabon, 150 children with diarrhea were screened for enteroaggregative E. coli (EAEC), enterotoxigenic E. coli (ETEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroinvasive E. coli (EIEC) using polymerase chain reaction and an HEp-2 cell culture techniques. Isolates of EAEC were detected in 57 children, two thirds of them between six months and two years of age, and isolates of ETEC were detected in seven patients. Isolates of EPEC, EHEC, and EIEC were not present in this population. Among the EAEC, the pCVD432 plasmid, a heat stable (ST)-like (ST-like) enterotoxin (EAST), and a plasmid-encoded heat-labile toxin (PET) were detected in 19, 34, and 42 cases, respectively. Detection of pCVD432, EAST, and PET were significantly associated with EAEC identified by the HEp-2 cell assay. Although detected only in 16 patients, the presence of the fimbriae AAF I (aagA) and AAF II (aafA) were more likely to occur in EAEC than in non-EAEC (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 0.5-38.6, and OR = 2.3, 95% CI = 1.0-5.3, respectively). The EAEC isolates exhibited decreased susceptibility for ampicillin, tetracycline, and trimethoprim.

Anti-Infective Agents↗
PubMed1992

[Stability of P. Falciparum resistance to chloroquine between 1987 and 1989 in Mounana, Gabon].

Between 1987 and 1989 the trend in the chloroquine resistance of Plasmodium falciparum in the mining town of Mounana in south-eastern Gabon was studied in vivo and in vitro in 58 and 158 subjects, respectively, aged from 1 to 15 years. The tests used were a simplified variant of the standard WHO 7-day test for the in vivo study and the isotopic semi-microtest of chemosensitivity for the in vitro study. The health situation in 1989 showed no change from the 1987 situation, but an increase in febrile symptoms suggestive of malaria was observed in 1989. This observation may be linked to a decrease in the distribution of chloroquine since 1987, accompanied by the use of other antimalarials following the appearance of chloroquine-resistant strains. While the parasitological efficacy in vivo remained the same in 1989, there was a decrease in the proportion of strains resistant to chloroquine in vitro compared to 1987; likewise, the therapeutic efficacy as estimated from temperature readings was better in 1989 than in 1987: the modification of the prophylactic strategy since 1986 and the drop in chloroquine consumption since 1987 could be responsible for a stabilization of chloroquine resistance at Mounana. The authors consider it appropriate in this region to continue treating malaria in children with chloroquine (in a dosage of 25 mg/kg) and to use a second-line treatment in the event of the recurrence of malaria symptoms within the next two weeks.

Adolescent↗
PubMed2003

[Prevalence of hepatitis B and C virus, HTLV-1 and HIV in type B lymphoproliferative syndromes in Gabon].

B lymphoproliferative disorders (B-LPD) are the most frequent types of lymphoid malignancies encountered in Gabon where HCV, HBV, HTLV-I and HIV are highly prevalent and all known for lymphotropism. Prevalences of HBs Ag, antibodies to HCV, HTLV-I and HIV were compared in 40 patients (21 men, 19 women; 17 < age < 75 years) with newly diagnosed B-LPD (low grade lymphoma = 6, intermediate grade = 21, high grade = 8: chronic lymphocytic leukaemia = 5) and 160 age and sex-matched controls. None of the B-LPD patients had got transfusion or parenteral care from the onset of symptoms to the inclusion day. In the B-LPD group, 13 patients had HBs Ag and antibodies to HCV, HIV and HTLV-1 were detected in 11, 6 and 10 subjects. In monovariate analysis, HBs Ag, antibodies to HIV or HTLV-1 were risk factors for B-LPD but antibodies to HCV were not associated with such diseases. Multivariate analysis showed only a relationship between HBs Ag and B-LPD (OR = 3.86; IC: 1.11-13.48). In such patients, reactivation of B hepatitis by treatment of B-LBD may be an important concern. If a background poor immune system could explain both susceptibility to long standing virus carriage and lymphoma development, a participating action of the HBV in lymphomagenesis could not be excluded.

Adolescent↗
PubMedDate not supplied

[Epidemiology of pain in Gabon].

The authors report on a prospective survey which took place from January 1999 to December 2000 - the epidemiology of pain in Gabon - to determine its distribution in the population. Ninety-eight women and eighty-four men aged 17 to 80 years old (mean age: 50) who consulted at the pain clinic were included in the study, a majority of the patients being aged between 21 and 60 years. Lower back pains and gonalgias secondary to osteo-arthritis or arthritis were more common in the North of the country, where the patients represented 57.7% of the sample, these two previous localisations along with cephalagias accounting for 52.7% of the motives for the visits. Thoracic and abdominal pains common in both men and women in the South were psychological. Patients working in the tertiary sector represented 45.3% of the patients, those of the secondary sector 24.4%, and those of the primary 20.3%. The non-steroidal anti-inflammatory analgesics (NSAI) associated with WHO grade 1 and 2 analgesics were effective in 50% of cases, some of whom also needed steroidal articular infiltration. Psychological pains were soothed by amitriptyline. A specific training of doctors and paramedics in pain treatment is necessary to improve care and assistance in this area.

Adolescent↗
PubMed2004

[Epidemics of Ebola haemorrhagic fever in Gabon (1994-2002). Epidemiologic aspects and considerations on control measures].

Based on the description of the four Ebola haemorrhagic fever epidemics (EHF) occurred in Gabon between 1994 and 2002, the authors are considering the cultural and psycho-sociological aspects accounting for the difficulty to implement control measures. On the whole, the result of these raging epidemics came up to 207 cases and 150 dead (lethality: 72%). Analysing precisely the aspects of the third epidemic and pointing up the possible factors explaining its spreading far beyond its epicentre, the authors bring about the limits of measures not always understood by local populations. The discussion will deal with the possibilities of a better surveillance, a quick management of intervention means including a regional permanent pre-alert and taking into account the issue raised by the possible Ebola virus endemic.

Disease Outbreaks↗
PubMed2005

[HIV seroprevalence among tuberculosis patients in Nkembo Hospital, Libreville, Gabon. Short note].

There are nearly 31,000 HIV infected patients in Gabon. In Libreville, the capital, the prevalence is estimated at 7.7%. About 2627 tuberculosis patients, all types included, have been notified in 2001 to the World Health Organization of which 43% of smear positive new cases. The co-infection HIV-TB worsens the overall prognosis of our patients. The objective of our study is to determine the HIV seroprevalence among our tuberculosis patients. It is a cross-sectional study conducted between June 25th and August 31th 2001. All patients are new or relapse tuberculosis cases. There is no difference between the types of tuberculosis. The diagnosis was clinical, radiological and based on smear AFB sputum (according to the Ziehl Neelsen method). The patients agreed orally for HIV testing. We made two tests: a rapid one followed by Elisa if positive. 358 patients were examined among them 141 women and 217 men. The M/F sex ratio was 1.53 and the average age 32 years. Proportion of new patients reached 61%. Ninety seven per cent of patients suffered from a pulmonary tuberculosis, 58% smear positive and 26% were HIV-1 positive. According to this status, no statistical difference was notified towards sex, types of disease or patients and the smear sputum results.

Adult↗
PubMed2005

Effectiveness of quinine monotherapy for the treatment of Plasmodium falciparum infection in pregnant women in Lambaréné, Gabon.

Pregnant women participating in a longitudinal immuno-epidemiologic survey in Lambaréné, Gabon, and presenting with Plasmodium falciparum parasitemia at monthly blood smear examinations were offered treatment with oral 7-day quinine monotherapy according to national health guidelines. A total of 50 pregnant women were offered 7-day oral quinine sulfate 10 mg/kg thrice daily. Clinical examinations and laboratory tests were performed on Days 28 and 56 to assess the effectiveness of this standard regimen. By Day 28, the effectiveness of the 7-day quinine regimen was 60% (95% confidence interval: 46-72%). We conclude that a 7-day course of quinine has a poor effectiveness and that alternative treatment regimens for malaria in pregnant women should be assessed.

Adult↗
PubMed2006

Association of haptoglobin levels with age, parasite density, and haptoglobin genotype in a malaria-endemic area of Gabon.

Haptoglobin (Hp) levels were investigated in relation to host genotype in a malaria-endemic area in Gabon. A cross-sectional study of 1-12-year-old children was conducted in the rainy season, a period of high malaria transmission, to examine this relationship. Variables that influenced Hp levels were Hp genotype, location, and age interacting with parasite density. At low parasite densities, there was a negative correlation between Hp levels and age. At higher densities, there was a positive correlation with age. This suggests that in the presence of greater parasite-induced hemolysis, older children are capable of increased production of Hp. Sickle cell trait and ABO blood group was not associated with Hp levels in this population.

Aging↗
PubMed2006

[Opportunistic diseases in HIV-infected patients at the Jeanne Ebori Foundation in Libreville, Gabon].

The purpose of this study was to determine the frequencies of opportunistic diseases among AIDS patients at the Jeanne Ebori Foundation (JEF) in Libreville, Gabon. A total 6313 file of patients treated in the internal medicine unit between 1994 and 1998 were analyzed. Findings showed that the main diseases related to AIDS classified according to seroprevalence were as follows: purigo (100%), cerebral toxoplasmosis (100%), oral candidiaisis (88%), bacteremia (87.8%), shingles (84.6%), minor salmonelosis (72%), and tuberclosis. The main diagnoses unrelated to AIDS at the JEF according to seroprevalene were typhoid (9.4%), common pneumonia (28%), bacterial meningitis (26.3%, hepatitis B (20.0%), and malaria (14%). In addition to these diseases there were nine cases of Kaposi's sarcoma, four cases of isosporosis, two cases of cryptococcosis, two cases of herpes Varicella, one case of cryptosporidiosis, and one case of isosporosis. The incidence of opportunistic disease was high in our study and must be taken in drug procurement.

AIDS-Related Opportunistic Infections↗