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Biomedical subjects

B Carme

Publications and source records attributed to B Carme.

At least 73 records · Page 4Linked to original sources
PubMed1993

Mortality and sequelae due to cerebral malaria in African children in Brazzaville, Congo.

This study was carried out on 170 children admitted to the University Hospital of Brazzaville (Congo) for cerebral malaria between January 1, 1988 and June 30, 1989. The selection criteria were 1) unarousable coma, cerebrospinal fluid without microorganisms or a marked cellular reaction, and the absence of other causes, and 2) that the children lived in Brazzaville. The case fatality rate was 15%. In 75% of the cases, death occurred within the first 48 hr. The prognosis worsened with the stage of the coma and a younger age. At discharge from the hospital, 9% of the cases presented with sequelae. The postcerebral malaria mortality was high; indeed, death occurred in six (7%) of 90 children discharged from the hospital whose parents were contacted between nine and 27 months later. Two deaths were directly related to neurologic sequelae. Among the 58 children examined under satisfactory conditions between nine and 27 months (mean 16.9 months) after discharge, 50% (3 of 6) still presented with attenuated forms of the sequelae observed immediately after the episode of cerebral malaria (cortical blindness had regressed completely, unlike ataxia and loss of balance). Disorders that may have been related to the episode of cerebral malaria were observed in 31% of these 58 cases.

Adolescent↗
PubMed1993

[Plasmodium falciparum malaria in urban zones of high endemic regions in black Africa. Potential seriousness and possible preventive measures].

By the year 2000, 40% of the population of sub-Saharan Africa (western and middle Africa) will live in urban areas. It is obvious that urbanization reduces the transmission of malaria and make treatment easier. However, excessive optimism is inappropriate in regions where malaria transmission remains intense and where it is unfortunately illusory to hope for any major or geographically extensive reduction in transmission outside urban and suburban areas. In this context, the benefit of a reduction in malarial morbidity could be compromised by the increased risk of severe forms in town-dwellers, who now have little or no immunity, when they venture into the surrounding rural zone. The prevention of malaria during trips to endemic areas has become a reality for sub-Saharan African town-dwellers. We have to conceive and propose specific protective measures. This version of the advice to travellers about malaria, intended for use in Africa, is fairly similar, in theory, to the advice we give in Europe to travellers going to tropical areas: 1) at most, chemoprophylaxis throughout the exposure period plus 2 or 4 weeks after their return; 2) in all cases, protection against anopheles (take and travel with an impregnated mosquito net) and: 3) above all, the systematic and rapid treatment of any suspected attack of malaria (take and travel with a medicine pack containing antimalarials). If it seems vain to hope to be able to apply these measures in the current socio-economic situation in sub-Saharan African, they are nonetheless justified.

Africa South of the Sahara↗
PubMed1993

[Plasmodium prevalence and parasitic burden in blood donors of Brazzaville, Congo].

To assess the frequency of malaria-infected blood donations in Brazzaville (Congo) thick films from all blood donors (n = 12,375, minimum per month: 857, maximum per month: 1,295; sex ratio: 9.6) at the Brazzaville University Hospital were examined quantitatively for Plasmodium (screening threshold: 20/microliters of blood) over one year (1989). The overall prevalence rate for all species of Plasmodium was 8.5%. It varied according with age but not with sex. P. falciparum predominated (92%), followed by P. malariae (7%) and P. ovale (3%). For P. falciparum: 1--the prevalence rate was 7.8% but varied over the year from 4.8% in August (6.2% for the dry season on the whole) to 11.5% in March (9.6% for the rainy season); 2--the parasitic load, also variable according to the season, was over 600/microliters in 24% of the cases (i.e. 1.9% of all donations) and over 6,000/microliters in 15 cases (i.e. 1.6% of the cases). In conclusion the proportion of blood donations infected with P. falciparum (with a parasitic load > or = 20/microliters) varied in Brazzaville from 6% in the dry season to 10% in the rainy season.

Adolescent↗
PubMed1993

Prevalence of depigmentation of the shins: a simple and cheap way to screen for severe endemic onchocerciasis in Africa.

The prevalence of skin depigmentation in the pretibial region is closely correlated in the adult Congolese population with conventional indices (microfilarial index, mean microfilarial density, cyst index) for the evaluation of endemic onchocerciasis. Individuals over 15 years of age in endemic villages who had a microfilarial index of 80-90%, had a cystic index of 60-70% and a pretibial depigmentation index about 20% (30-40% for individuals aged > 50 years). Thus, in Africa, this new evaluation index offers a simple, noninvasive, quick and cheap way to identify areas where the level of endemic onchocerciasis is probably high and which are likely to benefit from an anti-onchocerciasis campaign.

Adult↗
PubMed1993

[Antimalarial measures in expatriates in the Congo. Trends 1989-1992].

The modalities of prevention and treatment of malaria in expatriates residing in Brazzaville, capital of the Congo, have been studied in March 1989, April 1990 and April 1992. These surveys of the type Behavior, Attitude, Practice have been carried out in the Ecole Française where the same questionnaire has been distributed among the primary school children to complete by their parents. Only the data pertaining to Europeans, Lebanese, and North-Americans are presented. The proportion of French expatriates is 80%. A progressive decrease is noticed in the regular taking of chemoprophylaxis: the percentage varies between 86 and 43% according ot the duration of residence in 1989, to between 57 and 16% in 1992. Chloroquine alone remains the most widely used product, especially in long term expatriates. The association chloroquine-proguanil is mentioned only by a quarter or respondents. Apparently efficient, it is especially taken by people exposed for less than 4 years. Amodiaquine, although contra-indicated for prevention purposes, is cited in 1992 by 9% of subjects taking regular chemoprophylaxis; other products are only exceptionally used. In curative treatment, which generally is presumptive, halofantrine is since 1990 the most widely used drug, especially in children. In contrast, a relative disclaimer is noted for the amino-4-quinolines, due to resistance, but also and with no justification, for the association sulfadoxine-pyrimethamine and, to a lesser degree, for quinine. The occurrence of attacks considered to be malarial and their frequency, remained stable during the period of study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Current practices for the prevention and treatment of malaria in children and in pregnant women in the Brazzaville Region (Congo).

Current practices for the prevention and treatment of malaria in children and in pregnant women in the Brazzaville Region (Congo) were studied in 1989 and 1990. Information was obtained by interviewing a total of 1152 subjects. Overall, chemoprophylaxis was used less than was the systematic treatment of fever. Fever was treated before seeking medical advice in over 50% of the cases. Two-thirds of those interviewed reported that they slept under mosquito nets. Families with lower socio-economic standards were less likely to use chemoprophylaxis, to have antimalarials in the home, and to own mosquito nets; and they were more likely to prefer injections and to purchase drugs in the local markets.

Antimalarials↗
PubMed1992

Disseminated African histoplasmosis in a Congolese patient with AIDS.

We report the first Congolese case of African histoplasmosis in a patient with AIDS which represents the third case to be described in the literature. This contrasts with the now frequent occurrence of Histoplasma capsulatum histoplasmosis in HIV-infected subjects in North America; the difference is likely to be due to differences in exposure to the fungus rather than to differences in behaviour of the fungus or in the epidemiology of HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Child morbidity and mortality due to cerebral malaria in Brazzaville, Congo. A retrospective and prospective hospital-based study 1983-1989.

This study was conducted in all four hospitals of Brazzaville, the capital of the Congo in order to assess the trend in malaria morbidity, the frequency of cerebral malaria and the related mortality between 1983 and 1989 in Brazzaville children. For the period 1983 to 1987 the study was retrospective, based on records. For the period 1988 and 1989 a prospective study was carried out in the two main hospitals in which a system for reporting cases of cerebral malaria was set up. This was completed by a retrospective analysis of data similar to that carried for the previous years. The population of Brazzaville children aged between 0 and 14 years and the distribution by district were estimated from the 1984 official census taking the annual demographic growth to be 5%. The results show a marked increase in hospitalizations for malaria, noticeable since 1985, and which now account for about 50% of the overall non-surgical hospitalizations. The number of cases of cerebral malaria and related deaths have probably increased. However, these severe forms of malaria were relatively rare. Indeed, in 1988 and 1989, for the 0-4, 5-9 and 10-14 year age groups, the annual incidence rates of cerebral malaria were estimated at respectively 240, 61 and 13 per 100,000 and the related mortality rates at respectively 58, 5 and 1 per 100,000. No obvious relationship was found between the intensity of malaria transmission, which varied considerably according to the district, and the level of mortality from cerebral malaria.

Adolescent↗
PubMed1992

Infant and child mortality and malaria in the Congo. The trend in the suburbs of Brazzaville between 1981 and 1988.

This survey was carried out on a cohort of children born between 1st January 1981 and 30th June 1987 in the maternity department of the hospital in Linzolo, a village situated 25 km south-west of Brazzaville, the capital of the Congo. The mothers of the children resided in the suburbs of Brazzaville at the time of delivery. In this region, the rate of transmission of Plasmodium falciparum malaria is high without marked seasonable variations. The mothers and children were traced in the second quarter of 1989 in order to assess the rates and, where possible, the causes of mortality. Information on 75% of the recorded births (2424 children) was obtained directly by interviewing the mothers in the home. Between 1981 and 1988, the infant mortality rate varied overall between 33 and 52 per thousand, and in the 1-2 year age group, between 7 and 25 per thousand (1981 to 1987). The number of deaths attributable to malaria was relatively low although resistance to amino-4-quinolone is well established since 1985. During this period, no particular trend was observed in the mortality at 0-2 years, or at 0-5 years.

Child, Preschool↗
PubMed1991

[Prevention and treatment of malaria in expatriates living in Black Africa. Influence of chemoresistance. Investigations conducted in Brazzaville (Congo)].

The therapeutic, preventive and curative, habits concerning malaria of expatriates living in Brazzaville, Congo, were investigated on two occasions. In March 1989 and April 1990, a questionnaire was handed out to the pupils of the French school to be filled in by their parents. Three quarters of the expatriates are Europeans, and 85 percent of these are French. In this country where the chemoresistance of Plasmodium falciparum has been established since 1985, chemoprophylaxis was regularly performed by expatriates during their first years of residence to diminish later on; in 1989 it was still practised by more than 50 percent of adults who had been living in the tropics for more than 10 years, but in 1990 this proportion had fallen to 35 percent. Chemoprophylaxis is provided by chloroquine in 3 out of 4 persons and by amodiaquine in 1 out of 5. Mefloquine and the chloroquine-proguanil combination are still rarely prescribed as preventive treatments. About 50 percent of the expatriates have had at least on attack of malaria in the previous 2 years, with or without chemoprophylaxis and irrespective of the measures taken to avoid mosquito bites. Mosquito nets, never sprayed with insecticides, are little used, but air-conditioning at night is favoured by 80 percent of the population studied. Curative treatment was distinctly altered between 1989 and 1990, with a rapidly increasing use of mefloquine or halofantrine after confirmation of the diagnosis or as presumptive therapy.

Adolescent↗