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Two epidemiological surveys of cryptosporidiosis in urban and suburban areas of Libreville, Gabon, Equatorial Africa, were conducted in children. On 450 fecal samples on the first study, Cryptosporidium sp. has been seen about 3.11%. For the second survey, on 296 children, aged between 0 and 2 years, with acute diarrhoea, the rate of infestation was 24%. The maxima was observed for infants aged between 6-18 months, in case of malnutrition and during wet seasons.

In a study carried out in Gabon, antibodies against the treponema were looked for in the cerebrospinal fluid (CSF) in 13 children with active congenital syphilis (presence of specific IgM antibodies) and in 7 children with positive serologic reactions reflecting transplacental passage of maternal antibodies. Serologic reactions used included the VDRL test, the TPHA test, and the FTA-ABS IgG and IgM tests. Among the 13 children with syphilis, 7 had a positive FTA-ABS IgG test in the CSF without correlation with severity of clinical features, CSF protein levels or CSF cytologic findings. The TPHA test was positive in only four children and the VDRL test was always negative. Passage of antibodies into the CSF is possible (1 case in this study after treatment of the mother), but TPHA is helpful in developing countries of research of neurosyphilis.

Total IgG and tetanus antibodies were evaluated in 2 series of mother-child pairs: 50 in Paris and 134 in Africa. All pregnancies had been normal and birth weights greater than 3 kg. Cord blood mothers tetanus antibodies ratios were 1.5 in Paris and 0.98 in Libreville (p less than 0.01) respectively. Some African children were not protected, either due to the lack of response of their mothers to immunization (2.2%) or to an insufficient antibodies transplacental transport (2.9%), or to the lack of immunization of mothers (5.9%). On the contrary, all European children were protected, in spite of low maternal antibody levels. Likewise, in Paris cord blood IgG level was 12.24 g/l vs 9.42 in mothers (cord blood/mother ratio: 1.34) and in Africa 18.4 g/l in cord blood and 22.3 g/l in mothers (cord blood/mother ratio: 0.88; p less than 0.01). The correlations between maternal IgG levels and placental transfer rates indicate that the transplacental active transfer is limited by common high IgG levels in Africa, thus contributing to a decrease in protection of neonates, especially against tetanus in which humoral responses predominate.

In a study carried out in Gabon, antibodies against the treponema were looked for in the cerebrospinal fluid (CSF) in 13 children with active congenital syphilis (presence of specific IgM antibodies) and in 7 children with positive serologic reactions reflecting transplacental passage of maternal antibodies. Serologic reactions used included the VDRL test, the TPHA test, and the FTA-ABS IgG and IgM tests. Among the 13 children with syphilis, 7 had a positive FTA-ABS IgG test in the CSF; positivity of this test was not correlated with severity of clinical features, CSF protein levels or CSF cytologic findings. The TPHA test was positive in only four children and the VDRL test was consistently negative. These findings are similar to those reported in another group of patients with meningeal involvement proven by the demonstration of IgM in the CSF using recent techniques. Passage of antibodies into the CSF is possible (1 case in this study) but for safety patients with specific IgG in the CSF should be given penicillin in a dosage that provides treponema-killing levels in situ (100,000 U/kg/d). Use of this dosage is recommended whenever sensitive techniques for CSF analysis are not available.

The plasma levels of chloroquine after an oral intake of 10 mg/kg were measured in 5 children, with or without simultaneous intake of cholestyramine. Plasma chloroquine levels measured 6 hours after intake were significantly lower in case of simultaneous administration of cholestyramine, in spite of important individual changes. These data suggest a decrease in chloroquine bioavailability in the presence of cholestyramine. However, the methodology used does not allow to assert it.

Lactase deficient subjects, who form the bulk of the world population, absorb yogurt lactose because the bacteria used for fermentation produce beta-galactosidase. From a milk fermented by these bacteria and dried by a temperature-controlled process a power could be obtained which possess residual lactase activity but, unlike yogurt, does not need storage at low temperature. The lactose of this fermented powdered milk is perfectly absorbed, as proved by hydrogen respiratory tests performed in 35 lactose intolerant African subjects living in isolated villages. In 25 malnourished children under 3 years of age, this milk allowed renutrition without inducing diarrhoea--a result which could not have been obtained with ordinary milk in two-thirds of the cases. This type of food is potentially valuable to feed the large population of the third world.

We report the preliminary results of a study in children with tuberculosis. Rigid tube bronchoscopy provided diagnostic information in 79% of cases and allowed a few therapeutic procedures including aspiration of secretions and removal of inflammatory granulomas. We found that the most common lesion is bronchial compression. Rigid tube bronchoscopy is acceptably comfortable under general anesthesia and provides valuable results.

Data on titres of specific antibodies against measles virus and information given by families and physicians were analysed in 133 vaccinated and 117 unvaccinated children. Only 2 of the 133 vaccinated children reported a history of measles, while 131 had detectable levels of antibodies. Measles antibodies were detected in 102 (87.2 %) of the unvaccinated children, but a history of measles diagnosed clinically by a physician was reported in only 42 of them. These findings suggest that subclinical cases of measles are possible and contribute to the high circulation of the measles virus in the child population in France.

Severe malnutritions are characterised by low IGF-I and high GH plasma levels. The reasons why high levels of GH do not stimulate IGF-I synthesis are not clear. With the aim of improving our knowledge of this problem, we assayed plasma basal GH (by RIA), GH-BP(by HPLC gel filtration), IGF-I (by RIA) and IGFBP-3 (by RIA) in 20 children (age range: 1-2.2 yrs.). Of these, 6 were affected by kwashiorkor, 8 by marasmus and 6 were controls of the same ethnic group and age, hospitalised for minimal pathologies. At the same time the same parameters were evaluated in 5 acromegalic adults for comparison. All blood samples were taken after informed consent in occasion of routine samples. High basal GH levels were observed in kwashiorkor (14.6 ±5.3 ng/ml)(M±SD), marasmus (13. 5 ±2.5 ng/ml) and acromegalic patients (52.7 ±32.4 ng/ml); as expected in kwashiorkor and marasmus low levels of IGF-I (62.8 ±14.8 and 47.2 ±12.6 ng/ml respectively) and IGFBP-3 (1.37 ±0.8 and 0.81 ±0.6 mg/l respectively) were also found. In normal controls IGF-I was significantly higher (165.2 ±34.8 ng/ml, p

Lymphoblast transformation tests were carried out in the presence of alpha-lactalbumin and beta-lactoglobulin. In patients with cow's milk protein intestinal intolerance in seventeen of forty-five (37.8%) the lymphoblast transformation tests were positive. Sensitization in the first month of life seemed to favour lymphoblast transformation. In control children in only four of forty-three (9.5%) the lymphoblast transformation tests were positive, the difference from intolerant patients being significant 0.01 less than P less than 0.001. Lymphoblast transformation tests were negative in the seven children with active coeliac disease. Although a negative test does not exclude cow's milk protein intolerance, lymphoblast transformation tests can be considered a useful aid in diagnosis because of its specificity.

494 placentae coming from two different geographical parts of Gabon were studied. They were grouped into control, premature, small-for-dates and stillborn. The urban population gives rise to most mothers of about 26 years of age, who deliver normally at 38 weeks of babies weighing 3,300 g and 50 cm long, with placentae weighing 550 g, as well as premature babies and those in which there is white cell infiltration of the membranes, signs of toxaemia and normal placentae. On the eastern plateaux of Gabon there are more mothers around the age of 23, who deliver normally at 37 weeks of pregnancy of babies weighing 3,100 g and 48 cm long, with placentae weighing 450 g, with small-for-dates babies and inflammation of the placenta. Malaria is the cause of many premature deliveries and of small-for-dates and stillborn, especially in the plateaux.

The extent of intestinal parasitic infection was determined using 4 methods of fecal examination in 400 Gabonese infants aged 0.5 to 24 months (86 exclusively and 151 partially breast-fed and 163 artificially fed) and in 170 of their mothers in an African urban community. Parasitic prevalence was the same in the stools of the mothers from the 3 infant groups, providing evidence for the same level of exposure to parasites in all infants. Exclusively and partially breast-fed infants excreted parasites in numbers significantly lower than artificially fed infants of the same ages, during the first and the second years of life. This antiparasitic activity of human milk concerned mostly Giardia and ascaris, was not exclusively due to a decreased exposure to parasites in breast-fed infants and did not seem exclusively antibody-mediated; the role of lipids is possible.

Forty-seven Gabonese children with tuberculosis either limited to the lung or associated with other localizations were treated with isoniazid-rifampin (INH + RIF). They had liver tests done during the first 6 months of treatment. In 30 patients (63.8%) there was an increase in aminotransferase levels [over 100 UI/l in 14 (29.2%)]. The main factors increasing the risk of hepatic toxicity was a high dosage of INH and overall malnutrition. In fact, the weights of patients presenting with signs of hepatic toxicity were significantly lower than those in children who had no alterations of liver function. 68% of the severely malnourished (marasmus of kwashiorkor) presented with high ALAT or ASAT levels during treatment. The eventual role of the chronic HBV carrier state is discussed as 2 children presented with a chronic form of hepatitis at the time the treatment was initiated.

14 cases of hypopituitarism associated with mid-line defects are reported: 7 with septo-optic dysplasia, 5 with agenesis of corpus callosum and septum pellucidum without optical lesion (2 with cleft palate), 1 with familial pituitary aplasia and 1 with mediofrontal cutaneous aplasia. The most striking features in these patients are: precocious signs of pituitary deficiency, mainly hypoglycemia; micropenis and cryptorchidism in males; decrease of growth velocity 2 months to 6 years after birth. Neuroradiological investigations, evaluation of somatotropic and corticotropic secretions with glucagon test, and evaluation of thyrotropin and prolactin secretion with thyroliberin test, offer in the youngest patients the best way to precocious diagnosis and treatment.

76 diarrheic infants (from 15 days to 2 years) had a stool examination for rotavirus (ELISA method) and a stool culture and were classified according to breast feeding or not. This study was performed in a semi-urban region (Haut-Ogooué, Gabon). The preliminary results suggest a protection by breast feeding against rotavirus and enteropathogenic bacteria, rapid elimination of diarrheic agents may be facilitated by human milk.

Parasitic infections are endemic in children in Africa, making eradication an impossibility. Therapy is directed towards the individual manifesting an imbalance in the host-parasite relationship. Sanitation education is often disappointing, and until effective vaccines are developed, drug therapy remains the only worthwhile intervention. In order for a drug to be used on a mass campaign basis, financial considerations and side effects are of primary importance. Mefloquine has been shown to be a useful second line drug for chloroquine resistant strains of malaria in our Parasitology department. Benzimidazoles in a single dose are useful for intestinal nematode infections. New drugs are now available for schistosomiasis, filariasis, and protozoan infections.

Endocrine evaluation with LH-RH (0.1 mg/m2) and chorionic gonadotrophin (HCG 3 X 1,500 I.U.) in 154 cryptorchid boys aged 1 month to 15 years showed a decrease of LH pituitary secretion and Leydig-cells response to HCG in prepubertal and early pubertal patients. These deficiencies were positively correlated. Partial and at least transient descent of cryptorchid testis or testes has been obtained in 87 of 265 patients treated with HCG (3 to 9 X 1,500 I.U.). Plasma testosterone after HCG 3 X 1,500 I.U. was less increased in patients whose cryptorchid testis or testes descended after 9 X 1,500 I.U. than in those whose testes remained undescended. These data suggest that a partial, early and transient deficiency of pituitary LH secretion may be responsible for testicular maldescent in part of cryptorchid boys.

The identification of different infectious agents found in infantile diarrheas was undertaken in 237 children hospitalized in pediatric institutions in Libreville. In neonates between 0 and 18 months of age, the most common pathogen was Rotavirus (20.6%), followed by Shigella (10.8%), E. coli (9.24%), Salmonella (3.46%), E. histolytica (0.8%) and Y. enterocolitica (0.4%). The highest percentage of diarrheas caused by rotaviruses was found among children between 6 and 11 months of age. The frequency of Salmonella among children 2 to 4 years of age is almost the same at that in children under 2 years of age (3.44%). Isolation of Shigella in this group reaches 12.06%. The protective effect of breast milk and the carriage state among adults are discussed.

Close interactions between salmonellae and Schistosoma intercalatum were demonstrated by a study of 118 children conducted at Libreville, Gabon. Bilharziasis, confirmed by rectal biopsy, was present in 76% of children hospitalized for typhoid-like salmonella septicaemia, as against 38% of controls of the same age living in the same district (P less than 0.001). Although the clinical symptoms were typical of typhoid fever, with stupor, myocarditis or leucopenia depending on the cases, the germs responsible in 26 out of 42 cases were salmonella species regarded as minor. Finally, the salmonella infection was clinically prolonged by bilharziasis in 1 out of 3 patients. It would therefore appear that salmonella adheres to the wall of S. intercalatum as to that of other schistosoma species, and that both infections must be treated concomitantly.

Four children aged between 7 and 19 months with severe bronchopneumonia due to adenovirus type 7, proved by virology and/or serology developed severe hyponatraemia. One of them is reported in detail: it was possible to estimate plasma ADH levels and thereby prove the existence of reversible hypersecretion of the hormone. Whilst the syndrome of hyponatraemia with inappropriate secretion of ADH has not yet been reported in association with severe pneumonia in the child, it is known in adults. The limits of the syndrome and its physiopathology are discussed. It may be due either to vagal stimulation as a result of a fall in left aressure, or to central involvement. Therapeutic implications of the problem are emphasized.

Sensitization to penicillin was determined in vitro in twenty subjects, 30 days after cutaneous side-effects due to ampicillin. The study inclued the detection of anti-penicillin IgE, IgM, a lymphoblastic transformation test and a leucocyte migration test. No difference could be demonstrated between the sensitization 30 days after an ampicillin reaction and the sensitization 30 days after a penicillin reaction.

Measurements of thyroxin (T4), thyroxin-binding globulin (TBG) and TSH were carried out in 34 full-term newborns, 21 prematures and 11 neonates with respiratory distress (6 with hyaline membrane disease) at 5 days of age. In cases with neonatal respiratory distress and to a lesser extent in prematures, low T4 due to a decrease of TBG was found, TSH being identical in all groups. The positive correlation between TBG and transferrin suggests a disturbance in hepatic synthesis. The authors conclude that, in cases with neonatal respiratory distress, low T4 does not mean hypothyroidism and does not require a treatment, provided TSH remains within normal limits.