Jean Koko

L’efficacite et la tolerance d’une administration intramusculaire biquotidienne d’artemether (1,6 ou 3,2mg/kg/j) sont evaluees chez 47 enfants âges en moyenne de 2,4 ans et ayant un acces palustre a Plasmodium falciparum simple (n = 28) ou severe (n = 19). La tolerance de ce schema est egalement notee chez cinq autres malades chez lesquels l’efficacite de l’antimalarique n’a pu etre analysee, la parasitemie etant trop faible a l’inclusion. En raison de l’administration systematique d’antipyretiques, l’efficacite du traitement est jugee sur la decroissance parasitaire et la disparition des signes de severite chez les enfants ayant un acces palustre grave. Le temps de clairance parasitaire moyen est de 47,7 ± 9,8 heures pour l’ensemble des malades. La posologie d’artemether, l’administration d’un antipalude en prealable pour le traitement de l’acces ainsi que la severite de l’acces palustre sont sans influence sur ce parametre. L’eradication parasitaire complete est observee chez tous...

Introduction: Hospital-acquired infections in neonatology are a major security problem. We aimed to analyze the evolution of nosocomial infections and their epidemiological aspects in neonatal medicine unit of Angondje Teaching Hospital. Patients and methods: Retrospective and descriptive study, we included newborns hospitalized for more than 48 h from December 2012 to December 2016. Results: We admitted 727 newborns in hospital during the study period, 521 have been included, and 134 developed a nosocomial infection, a prevalence of 25.7% of cases. In the end, 103 newborns have constituted our study population. The average age was 33.6 weeks, the sex ratio 1.96. The preterm rate was 79.6 percent. The average weight was 2088.4 g. The reason for hospitalization was prematurity in 46.3%, followed by neonatal infection in 21.1%. Tachycardia associated with hypotonia and apnea, was the main sign of discovery in respectively 56.3% and 39.8%. The average delay between appearance of the signs and hospitalization was 07 days. The average of C-reactive protein was 86.64 mg/dl. Thrombocytopenia was most observed disorder on cell blood count. Escherichia coli was the significant bacteria found the blood culture, urines analysis and culture, lumbar puncture, and umbilical venous catheter culture. Imipenem was the most used antibiotics in the management of nosocomial infection in 44.7% of cases. The mortality rate was 23.3%. Conclusion: The high rate of nosocomial infection and neonatal mortality urge the implementation of effective methods against this scourge in our neonatology unit.

RESUME Introduction. Les deces a l’hopital surviennent souvent dans les 24 heures qui suivent l’admission. Une grande partie de ces deces pourrait etre evitee si les enfants gravement malades etaient identifies des leur arrivee et traites immediatement. L’objectif de  ce travail etait d’evaluer la prise en charge des enfants recus en consultation de nuit aux urgences pediatriques du Centre Hospitalier Universitaire de Libreville (CHUL). Patients et methodes. Il s’est agi d’une etude prospective et descriptive, realisee du 1er juin au 30 septembre 2016. Elle s’est deroulee dans le service des urgences de pediatrie du CHUL. Les donnees ont ete recueillies sur une fiche de collecte de donnees standardisees qui comprenait : l’identite du patient, les donnees socio demographiques et les caracteristiques cliniques. Resultats. Deux cent deux patients ont ete inclus. Cent trente-sept enfants (67,8%) ont ete pris en charge dans les 30 premieres minutes apres leur arrivee, 20 enfants (9,9%) l...

Background: Poor information about neonatal tetanus cases are assembled in Gabon. Aim: To recall practitioner about the existing danger of neonatal tetanus despite efforts made by immunization in the country and worldwide. Observations: We write about two observations in two teaching hospitals at the same period. One treated, and the other lethal. We assess their cases with the commonly used scale in Africa: Dakar Classification. Conclusion: Despite the worldwide actions against neonatal tetanus, cases appear, and we must screen the mothers with exposure factors.

Resume Introduction L’objectif est de rechercher la presence de germes nosocomiaux multiresistants dans la flore digestive des nouveau-nes hospitalises. Methodologie Etude prospective, incluant 51 nouveau-nes ayant une coproculture de la premiere selle et des selles a j15 de vie positive a un germe nosocomial multiresistant. La colonie suspecte devait avoir une concentration > 1010 bacteries/gramme de selles. Resultats L’âge moyen etait de 35,5 ± 4,3 SA. La prematurite etait observee dans 39,21 % de cas. Le poids moyen etait de 2346,17 ± 1022,5 g. La rupture prematuree des membranes etait presente dans 45,09 % des cas. Une antibiotherapie etait administree a l’admission dans 76,90 % des cas. La premiere alimentation etait faite avec un substitut de lait maternel dans 76,50 % des cas. L’analyse des premieres selles montrait la presence de bacteries multiresistantes et de Candida albicans respectivement dans 7,84 % et 11,76 % des cas. A j15 de vie, 70,59 % avaient un portage digestif de germes multiresistants. C. albicans etait le plus frequent (25 %), suivi d’Escherichia coli (22,22 %) dont 3 producteurs de betalactamase a spectre elargi. Une translocation digestive etait observee dans 30,56 % de cas. Le deces survenait chez trois nouveau-nes, du a E. coli K1 BLSE dans un cas et dans deux cas, a C. albicans. La prematurite (p  Conclusions La maitrise des facteurs de risque d’infection nosocomiale pour une prise en charge preventive est primordiale.

La drépanocytose est une hémoglobinopathie autosomique récessive. Elle atteint jusqu'à 2% des nouveau-nés dans certains pays d'Afrique subsaharienne. Chez la plupart des patients, l'incidence des complications peut être réduite si le dépistage a lieu au moment de la naissance. Objectif: Présenter notre expérience du dépistage néonatal de la drépanocytose chez le nouveau-né au Gabon. Méthodologie: Cette enquête rétrospective a concerné les données collectées par le Centre International de Recherche Médicale de Franceville(CIRMF), du 1er mai au 31 décembre 2007. Les prélèvements sanguins ont été effectués dans deux maternités de Libreville. Résultats: Neuf-cent quarante-sept nouveau-nés ont été prélevés. Le sex-ratio était de 1. Cent quarante-trois enfants étaient hétérozygotes(15,10%) et 17 homozygotes(1,80%). Soixante-huit enfants hétérozygotes étaient de sexe féminin et 73 de sexe masculin. Huit homozygotes étaient de sexe féminin et 9 de sexe masculin. Conclusion: Ce t...

The strategies recently implemented in Gabon have been effective in improving immunization coverage. These include, in particular, the integration of the Expanded Programme on Immunization (EPI) in primary health care centers, the integration of immunization outside of EPI, immunization by peripheral health centers according to pre-set advanced strategies, and awareness and catch-up campaigns. This descriptive, cross-sectional survey was conducted from 1 October 2007 through 30 January 2008, throughout public- and private-sector health care centers in the town of Libreville. In the public sector, where health care is free, the study took place at the largest health facility in the country, the Hospital Center of Libreville (HCL), at Estuary Mélen Hospital (on the outskirts of Libreville), at Nkembo Hospital, which houses the EPI offices, and the 5 Maternal and Child Health centers (MCH) where vaccine monitoring is done. Monitoring in the private sector covered only the three largest...

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) wer...

Salmonella meningitis is a rare entity, even in tropical area where salmonellosis is common. Its prognosis is poor and the choice of adequate antibiotic therapy is difficult. The files of nine children (three boys, six girls) admitted to the pediatric unit of the Owendo Pediatric Hospital in Libreville for salmonella meningitis between January 1, 1989, and December 31, 1993 were retrospectively studied. Diagnosis was established by a positive culture of cerebrospinal fluid. Salmonella was the third cause (8.65%) of purulent meningitis observed during this period. Eight children were less than 1-year old, seven were from low socioeconomic standard families. The main clinical manifestations were fever (seven cases), pallor (six cases), diarrhea (four cases), nuchal rigidity (four cases), convulsions (three cases) and bulging fontanel (three cases). Five children (55.5%) were severely anemic (hemoglobin < 5 g/dL) but none had abnormal hemoglobin. Serotyping could not be performed in...

The changes in Plasmodium falciparum in four Gabonese children suffering from severe malaria and treated with pure artemether were observed in thin blood smears fixed and stained with Giemsa and examined by light microscopy. Peripheral blood samples were taken every 8 hr up to 72 hr from three children and every 3 hr up to 9 hr from the other child. The morphologic changes involved all development stages (trophozoites, schizonts, and gametocytes); they were first seen 3 hr after the start of treatment and all parasites were abnormal after 24 hr. After two days of treatment, all infected erythrocytes disappeared except for a few with necrotic trophozoites. The morphologic changes were similar to the ultrastructural changes previously described in vivo and in vitro in experimental models. They confirm the rapid effect of artemisinin derivatives on parasite clearance and clinical recovery, particularly in cases of cerebral malaria.

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 Hea...

During a period of six years (1/1/89-12/31/94), seven children with trypanosomiasis were admitted to the Department of Pediatrics of Owendo Pediatric Hospital-Libreville, Gabon. They were 5 boys and 2 girls, aged 4-17 years, five of them under 15 years. The main reasons of hospitalization were somnolence (4 cases), psychical disorders (5 cases), neurological disorders (4 cases), asthenia (3 cases), loss of weight (3 cases) and fever (3 cases). Increased sedimentation rate (5 cases) and hypergammaglobulinemia (6 cases) were the most important biological disturbances. Serodiagnosis (CATT, indirect immunofluorescence test) was positive in all cases. The parasite was detected in blood seven times, and four times in cerebrospinal fluid (CSF). According to CSF status, six children have been classified in second stage of the disease. Six patients were treated by melarsoprol, and one by eflornithine. Tolerance and response to treatment were good in six cases. Three children presented sequel...

Bladder stones are uncommon in children in Gabon. The authors report the case of 3 boys admitted to the Paediatric Hospital of Owendo for voiding disorders. All patients came from the South of the country, but these stones cannot be described as endemic in view of the small number of cases. The authors recall the main aetiologies, the suggestive symptoms and the simple and inexpensive complementary investigations (plain abdominal x-ray and ultrasonography) allowing the definitive diagnosis. Conventional surgical treatment gives good results, but in the case of small stones, endourological treatment can be more economical in terms of the duration of hospital stay and postoperative morbidity.

The efficacy and tolerance of artemether administered intramuscularly twice daily (1.6 or 3.2 mg/kg/day) were evaluated in 47 children (mean age 2.4 years old) suffering from mild (n = 28) or severe (n = 19) attacks of Plasmodium falciparum malaria. Tolerance was also investigated in 5 additional children for whom the efficacy could not be assessed, because the parasitaemia was too low on inclusion. Antipyretics were systematically administered and therefore efficacy of the treatment was scored according to the decrease in the density of the parasite and the remission of severe symptoms in those patients with severe attacks. Parasites were eliminated in all patients in a mean of 47.7 +/- 9.8 hours. The time to eradication was not significantly affected by the dose, prior administration of an anti-malarial agents to treat the attack or the severity of the attack. There were two cases of clinical and parasitological regression, on days 14 and 21. There were no deaths. The neurological...

A 27 month epidemiological survey of cryptosporidiosis in stools was conducted in 288 Gabonese children aged between 0 and 2 years (mean 10.2 months). By at least one of two staining techniques, acid-fast and direct immunofluorescence, the rate of infection was determined to be 24%. The rate was 28% in cases of acute diarrhea, in striking contrast with the low prevalence of 14.8% in uninjured gastroenteritus subjects (p < 0.05). The notion of asymptomatic carriers was clearly demonstrated. The maximum of 34.4% was observed for infants aged between 6 and 12 months (p < 0.02). In cases of malnutrition, this rate increased to 31.8%, whereas it was 16.8% in eutrophic children (p < 0.01). For the rainy and dry seasons, it was 31.7% and 19.4%, respectively (p < 0.02). Water is emerging as an important vehicle for the transmission and spread of Cryptosporidium sp. in tropical areas.