• [A foci of Schistosomiasis mekongi rediscovered in Northeast Cambodia: cultural perception of the illness; description and clinical observation of 20 severe cases]

      Biays, S; Stich, A H; Odermatt, P; Long, C; Yersin, C; Men, C; Saem, C; Lormand, J D; Médecins sans Frontières, Suisse. Odermatt_Biays@hotmail.com (Wiley-Blackwell, 1999-10)
      RésuméLa découverte en 1992 d'une population présentant des signes cliniques d'hypertension portale très évoluée a permis la redécouverte d'un foyer de bilharziose 'oublié' pendant plus de vingt ans dans la province de Kracheh au nord-est du Cambodge. Des éléments de la perception culturelle de la maladie par la population et des observations cliniques sur la morbidité grave provoquée par Schistosoma mekongi sont présentés. Les entretiens avec les patients et la population des villages alentours révèlent que la bilharziose a de lourdes conséquences psychosociales: angoisse de la mort, infirmité, invalidité. Les symptômes sont bien identifiés et auraient augmenté ces vingt dernières années. Ils font l'objet de dénominations et de traitements traditionnels spécifiques. Les descriptions cliniques de 20 patients illustrent la pathologie grave observée dans l'hôpital de Sambour, au nord de la province de Kracheh. Elles montrent le pouvoir pathogène de S. mekongi aux différents âges de la vie (de 7 à 58 ans): cachexie, hépatosplénomégalie, retard de croissance et pubertaire, décompensation d'hypertension portale avec ascite et rupture de varices oesophagiennes. L'efficacité du traitement à ces stades avancés de la maladie est inconstant: le suivi des patients sur 30 mois montre que 5 d'entre eux sont décédés, 5 se sont améliorés puis ont récidivés, 3 étaient dans des états stationnaires et 5 se sont nettement améliorés, 2 ont été perdus de vus. Les observations cliniques et les entretiens montrent qu'une pathologie très sévère, aux graves conséquences individuelles et communautaires, est présente dans la province de Kracheh. Cette maladie est liée à une infection par S. mekongi mais l'aggravation des symptômes par d'éventuelles infections associées est à préciser. A un stade avancé de la maladie le pronostic vital est très réservé même après traitement. Ces observations démontrent l'importance d'une intervention globale à long-terme sur toute la population touchée, à des degrés divers, par cette maladie. SUMMARY: In 1992 a foci of Schistosomiasis mekongi was rediscovered in the province of Kracheh in Northeast Cambodia. Severe clinical signs due to portal hypertension, which were frequently observed in this population, allowed the discovery of this 'forgotten' focus. Elements of the perception of the population and clinical observations of 20 severe cases due to S. mekongi infections are presented. Interviews with patients and villagers of the area of Kracheh showed severe psychosocial impact including fear from death, infirmity and invalidity. The symptoms of schistosomiasis were well known by the population and were reported to have increased in frequency in the last two decades. They have received traditional names and specific traditional treatment. (ABSTRACT TRUNCATED)
    • Anthropometry and Clinical Features of Kashin-Beck Disease in Central Tibet.

      Mathieu, F; Begaux, F; Suetens, C; De Maertelaer, V; Hinsenkamp, M; Médecins Sans Frontières, Département Médical, Bruxelles, Belgium. (Springer, 2001)
      We compared two different populations living in central Tibet with the purpose of establishing standard values for different anthropometric parameters in a rural population. Later on, these values were used as references for a similar study on a KBD population. One group (KBD) (n=1,246) came from the endemic areas, and the other group, serving as the control population (n=815), came from non-endemic areas. Both groups included children and adults and were of the Mongoloid type; they were farmers or semi-nomads. Height, weight, segment length, joint perimeter, joint diameter, joint movement were recorded. Also more subjective information such as general feeling of tiredness, rapid fatigue at work, work limitation, joint pain, muscle weakness, muscular atrophy, dwarfism, flatfoot, and waddling gate was also collected. Those variables were compared between the two groups.
    • Antibiotic Sensitivity of Endemic Shigella in Mbarara, Uganda.

      Legros, D; Ochola, D; Lwanga, N; Guma, G; Epicentre, Kampala, Uganda. (1998-03)
      We analysed the chimio-sensitivity to antibiotics of endemic strains of Shigella isolated in Mbarara district, southwest Uganda. Twenty four strains were isolated, of which none was sensitive to cotrimoxazole and eight (33.4%, 95% CI [15.6-55.3]) to ampicillin, the two antibiotics recommended to treat dysentery during non epidemic periods in Uganda. Two isolates were resistant to nalidixic acid and none was resistant to the fluoroquinolones (Ciprofloxacin, Norfloxacin). It is concluded that the results of this survey could be used to facilitate the elaboration of a new treatment protocol to treat endemic dysentery cases in Uganda.
    • Behavioural characteristics, prevalence of Chlamydia trachomatis and antibiotic susceptibility of Neisseria gonorrhoeae in men with urethral discharge in Thyolo, Malawi.

      Zachariah, R; Harries, A D; Nkhoma, W; Arendt, V; Nchingula, D; Chantulo, A; Chimtulo, F; Kirpach, P; Médecins sans Frontières-Luxembourg, Thyolo District, Malawi. zachariah@internet.lu (Elsevier, 2008-01-25)
      A study was carried out in 2000/2001 in a rural district of Malawi among men presenting with urethral discharge, in order to (a) describe their health-seeking and sexual behaviour, (b) determine the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis, and (c) verify the antibiotic susceptibility of N. gonorrhoeae. A total of 114 patients were entered into the study; 61% reported having taken some form of medication before coming to the sexually transmitted infections clinic. The most frequent alternative source of care was traditional healers. Sixty-eight (60%) patients reported sexual encounters during the symptomatic period, the majority (84%) not using condoms. Using ligase chain reaction on urine, N. gonorrhoeae was detected in 91 (80%) and C. trachomatis in 2 (2%) urine specimens. Forty five of 47 N. gonorrhoeae isolates produced penicillinase, 89% showing multi-antimicrobial resistance. This study emphasizes the need to integrate alternative care providers and particularly traditional healers in control activities, and to encourage their role in promoting safer sexual behaviour. In patients presenting with urethral discharge in our rural setting, C. trachomatis was not found to be a major pathogen. Antimicrobial susceptibility surveillance of N. gonorrhoeae is essential in order to prevent treatment failures and control the spread of resistant strains.
    • Brain injury: Iraq's unseen burden of wounded civilians

      Guerrier, Gilles; Baron, Emmanuel; Fakri, Rasheed; Mouniaman, Isabelle; Epicentre, Paris, France; Médecins Sans Frontières, Amman, Jordan; Médecins Sans Frontières, Paris, France (Nature Publishing Group, 2011-10-27)
      The burden of war-related mental disorders is well documented among US veterans (Nature 477, 390–393; 2011), but not among civilians in Iraq. This oversight must be rectified so that adequate medical support can be provided to the Iraqi people. US combat troops will soon depart Iraq, leaving Iraqis to cope with the consequences of the 2003 invasion. Although the number of violent deaths is falling, civilians have been killed almost every day this year, most of them in coordinated bomb attacks. Roadside blasts cause long-term disabilities and societal effects among injured civilians. However, these have been largely neglected by the media and no systematic surveillance has been undertaken.
    • Ceftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study.

      Nathan, N; Borel, T; Djibo, A; Evans, D; Djibo, S; Corty, J F; Guillerm, M; Alberti, K P; Pinoges, L; Guerin, P J; et al. (Elsevier, 2008-04-14)
      BACKGROUND: In sub-Saharan Africa in the 1990s, more than 600,000 people had epidemic meningococcal meningitis, of whom 10% died. The current recommended treatment by WHO is short-course long-acting oily chloramphenicol. Continuation of the production of this drug is uncertain, so simple alternatives need to be found. We assessed whether the efficacy of single-dose treatment of ceftriaxone was non-inferior to that of oily chloramphenicol for epidemic meningococcal meningitis. METHODS: In 2003, we undertook a randomised, open-label, non-inferiority trial in nine health-care facilities in Niger. Participants with suspected disease who were older than 2 months were randomly assigned to receive either chloramphenicol or ceftriaxone. Primary outcome was treatment failure (defined as death or clinical failure) at 72 h, measured with intention-to-treat and per-protocol analyses. FINDINGS: Of 510 individuals with suspected disease, 247 received ceftriaxone, 256 received chloramphenicol, and seven were lost to follow-up. The treatment failure rate at 72 h for the intention-to-treat analysis was 9% (22 patients) for both drug groups (risk difference 0.3%, 90% CI -3.8 to 4.5). Case fatality rates and clinical failure rates were equivalent in both treatment groups (14 [6%] ceftriaxone vs 12 [5%] chloramphenicol). Results were also similar for both treatment groups in individuals with confirmed meningitis caused by Neisseria meningitidis. No adverse side-effects were reported. INTERPRETATION: Single-dose ceftriaxone provides an alternative treatment for epidemic meningococcal meningitis--its efficacy, ease of use, and low cost favour its use. National and international health partners should consider ceftriaxone as an alternative first-line treatment to chloramphenicol for epidemic meningococcal meningitis.
    • Characteristics of a cholera outbreak, patterns of Vibrio cholerae and antibiotic susceptibility testing in rural Malawi.

      Zachariah, R; Harries, A D; Arendt, V; Nchingula, D; Chimtulo, F; Courteille, O; Kirpach, P; Department of Infectious Diseases, Reference Centre, Central Hospital, Rue Barble, Luxembourg. msflblantyre@malawi.net (2002)
      The cumulative cholera attack rate in an epidemic in Malawi in 1999/2000 was 59/100,000 population, case-fatality rate 4%, and 98% of all cases presenting to health facilities required intravenous therapy. Microbiological studies showed high resistance of Vibrio cholerae to commonly recommended antibiotics, predominant Ogawa serotypes and no O139 isolates.
    • Clinical Manifestations of Kashin-Beck Disease in Nyemo Valley, Tibet.

      Mathieu, F; Begaux, F; Lan, Z Y; Suetens, C; Hinsenkamp, M; Médecins sans Frontières, Lhasa, Tibet Autonomous Region. (Springer, 1997)
      Clinical manifestations of Kashin-Beck disease have been studied in Central Tibet. Statistical analysis of physical signs allowed a definition of the clinical diagnosis and a scale for the functional severity for the disease to be drawn up. This classification is used for the assessment of patients who received palliative physical treatment. A group of 136 patients have been examined and their disabled joints classified according to pain, bony enlargement and restriction of movement. 57% were between 20 and 35 years of age. The patients mainly complained about their distal weightbearing joints. The clinical evolution of the disease is described from childhood to adult life.
    • Clinical Presentation of Louse-Borne Relapsing Fever Among Ethiopian Refugees in Northern Somalia.

      Brown, V; Larouze, B; Desve, G; Rousset, J J; Thibon, M; Fourrier, A; Schwoebel, V; Médecins Sans Frontières, Paris, France. (Published by: Maney Publishing, 1988-10)
      Louse-borne relapsing fever (LBRF) is still endemic among Ethiopian populations. In order to assess the clinical presentation of LBRF in an Ethiopian refugee camp in northern Somalia, a referral system was organized for all pyrexias of unknown origin. Among the 134 patients referred, 37 showed Borrelia in fresh and stained blood smears. Common clinical features were: high fever (above 39 degrees C in 73% of the cases), headache and general body pain (88%), liver tenderness (62%), petechia (54%), nausea and vomiting (46%), chills and rigors (30%) and epistaxis (11%). Jaundice was absent. No fatalities were observed. The clinical picture was less severe than in previous studies on LBRF. This difference might be due to the fact that the present study was community-based as opposed to the previous studies which were hospital-based.
    • Clinical, Microbiological and Antibiotic Susceptibility Patterns of Diarrhoea in Korem, Ethiopia.

      Desenclos, J C; Zergabachew, A; Desmoulins, B; Chouteau, L; Desve, G; Admassu, M; Médecins sans Frontières, Paris, France. (1988-12)
      Two hundred patients with diarrhoea in a rehabilitation camp in Ethiopia were studied in October 1985 to determine the presence of pathogens in the stool and their susceptibility to antibiotics. A total of 42 (21.1%) patients had a positive culture with enterobacteriaceae, the isolation rate was 15.6% for Escherichia coli, 3.5% for Shigella spp. and 2.01% for Salmonella spp. In-vitro antibiotic resistance was frequent among the 42 isolates: 53% of E. coli strains were found to be resistant to ampicillin, 47% to chloramphenicol, 30% to co-trimoxazole and 67% to tetracycline. Of the seven Shigella, three were resistant to chloramphenicol and four to tetracycline. Multidrug resistance (two or more antibiotics) was observed in 52.3% of the 42 isolates. The protocols used for the screening of dysenteric patients for Shigella spp. or Salmonella spp. were found to be specific but poorly sensitive. The opposite was observed for amoebiasis and giardiasis. The responsibility of widespread use of common oral antibiotics is discussed as one of the major factors of antibiotic resistance occurrence at Korem.
    • Clonal reconquest of antibiotic-susceptible Salmonella enterica serotype Typhi in Son La Province, Vietnam.

      Weill, F X; Tran, H H; Roumagnac, P; Fabre, L; Minh, N B; Stavnes, T L; Lassen, J; Bjune, G; Grimont, P A D; Guerin, P J; et al. (2007-06)
      In the last three decades, high rates of resistance to common first-line antimicrobial agents have been reported in Salmonella enterica serotype Typhi (Typhi), the causative organism of typhoid fever (TF), in many regions of the world, especially in South East Asia. Analysis of Typhi strains isolated from outbreaks and sporadic cases of TF in Son La province, northwest Vietnam, in 2002 revealed that 94.5% (85/90) of the isolates were fully susceptible to amoxicillin, chloramphenicol, cotrimoxazole, tetracycline, and nalidixic acid. There was a clear decline in the occurrence of multi-drug resistant (MDR) Typhi isolates collected in this province in 2002 (4.4%) compared with the period 1995-1999 in the same province (30.8-100%). By using molecular (IS200 profiling, PstI-ribotyping, XbaI-pulsed-field gel electrophoresis, and haplotyping) and phage-typing methods, we showed that the Typhi isolates from Son La province in 2002 were genetically related; however, they were unrelated to the previous MDR clones established in Vietnam.
    • CMV retinitis screening and treatment in a resource-poor setting: three-year experience from a primary care HIV/AIDS programme in Myanmar

      Tun, Nini; London, Nikolas; Kyaw, Moe Kyaw; Smithuis, Frank; Ford, Nathan; Margolis, Todd; Drew, W Lawrence; Lewallen, Susan; Heiden, David; Medical Action Myanmar, Yangon, Myanmar; Wills Eye Institute, Retina Service, Philadelphia, PA, USA; Médecins Sans Frontières OCA, Yangon, Myanmar; Médecins Sans Frontières, London, UK; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa; University of California San Francisco, San Francisco, CA, USA; Kilimanjaro Centre for Community Ophthalmology, Moishe, Tanzania; California Pacific Medical Center, San Francisco, CA, USA; Seva Foundation, Berkeley, CA, USA. (BioMed Central, 2011-08-15)
      Cytomegalovirus retinitis is a neglected disease in resource-poor settings, in part because of the perceived complexity of care and because ophthalmologists are rarely accessible. In this paper, we describe a pilot programme of CMV retinitis management by non-ophthalmologists. The programme consists of systematic screening of all high-risk patients (CD4 <100 cells/mm3) by AIDS clinicians using indirect ophthalmoscopy, and treatment of all patients with active retinitis by intravitreal injection of ganciclovir. Prior to this programme, CMV retinitis was not routinely examined for, or treated, in Myanmar.
    • Cryptococcal antigen screening by lay cadres using a rapid test at the point of care: A feasibility study in rural Lesotho

      Rick, F; Niyibizi, AA; Shroufi, A; Onami, K; Steele, SJ; Kuleile, M; Muleya, I; Chiller, T; Walker, T; Van Cutsem, G (Public Library of Science, 2017-09-06)
      Cryptococcal meningitis is one of the leading causes of death among people with HIV in Africa, primarily due to delayed presentation, poor availability and high cost of treatment. Routine cryptococcal antigen (CrAg) screening of patients with a CD4 count less than 100 cells/mm3, followed by pre-emptive therapy if positive, might reduce mortality in high prevalence settings. Using the cryptococcal antigen (CrAg) lateral flow assay (LFA), screening is possible at the point of care (POC). However, critical shortages of health staff may limit adoption. This study investigates the feasibility of lay counsellors conducting CrAg LFA screening in rural primary care clinics in Lesotho.
    • Dracunculiasis in South Sudan

      Fabiansen, Christian; Harboe, Zitta Barrella; Christensen, Vibeke; Médecins Sans Frontières, Copenhagan, Denmark (2010-05-01)
    • Ecological study of socio-economic indicators and prevalence of asthma in schoolchildren in urban Brazil.

      da Cunha, S S; Pujades-Rodriguez, M; Barreto, M L; Genser, B; Rodrigues, L C; Instituto de Saúde Coletiva, Universidade Federal de Bahia, Salvador, Brazil. cunhass@ufba.br (2007)
      BACKGROUND: There is evidence of higher prevalence of asthma in populations of lower socio-economic status in affluent societies, and the prevalence of asthma is also very high in some Latin American countries, where societies are characterized by a marked inequality in wealth. This study aimed to examine the relationship between estimates of asthma prevalence based on surveys conducted in children in Brazilian cities and health and socioeconomic indicators measured at the population level in the same cities. METHODS: We searched the literature in the medical databases and in the annals of scientific meeting, retrieving population-based surveys of asthma that were conducted in Brazil using the methodology defined by the International Study of Asthma and Allergies in Childhood. We performed separate analyses for the age groups 6-7 years and 13-14 years. We examined the association between asthma prevalence rates and eleven health and socio-economic indicators by visual inspection and using linear regression models weighed by the inverse of the variance of each survey. RESULTS: Six health and socioeconomic variables showed a clear pattern of association with asthma. The prevalence of asthma increased with poorer sanitation and with higher infant mortality at birth and at survey year, GINI index and external mortality. In contrast, asthma prevalence decreased with higher illiteracy rates. CONCLUSION: The prevalence of asthma in urban areas of Brazil, a middle income country, appears to be higher in cities with more marked poverty or inequality.
    • Effects of Physical Therapy on Patients with Kashin-Beck Disease in Tibet.

      Mathieu, F; Suetens, C; Begaux, F; De Maertelaer, V; Hinsenkamp, M; Médecins Sant Frontières, Département Médical, Brussels, Belgium. francoise.mathieu@msf.be (Springer, 2001)
      A clinical trial of physical therapy treatment for patients suffering from Kashin-Beck disease (KBD) has been carried out in Tibet. One-hundred and thirty-five patients with Kashin-Beck disease were allocated to either physical therapy (72 patients) or prescription of multivitamins (63 patients). The patients were followed for 4 years. This study suggested a beneficial effect of physical treatment.
    • Efficacy of artesunate-amodiaquine for treating uncomplicated falciparum malaria in sub-Saharan Africa: a multi-centre analysis.

      Zwang, Julien; Olliaro, Piero; Barennes, Hubert; Bonnet, Maryline; Brasseur, Philippe; Bukirwa, Hasifa; Cohuet, Sandra; D'Alessandro, Umberto; Djimdé, Abdulaye; Karema, Corine; et al. (2009-11)
      BACKGROUND: Artesunate and amodiaquine (AS&AQ) is at present the world's second most widely used artemisinin-based combination therapy (ACT). It was necessary to evaluate the efficacy of ACT, recently adopted by the World Health Organization (WHO) and deployed over 80 countries, in order to make an evidence-based drug policy. METHODS: An individual patient data (IPD) analysis was conducted on efficacy outcomes in 26 clinical studies in sub-Saharan Africa using the WHO protocol with similar primary and secondary endpoints. RESULTS: A total of 11,700 patients (75% under 5 years old), from 33 different sites in 16 countries were followed for 28 days. Loss to follow-up was 4.9% (575/11,700). AS&AQ was given to 5,897 patients. Of these, 82% (4,826/5,897) were included in randomized comparative trials with polymerase chain reaction (PCR) genotyping results and compared to 5,413 patients (half receiving an ACT). AS&AQ and other ACT comparators resulted in rapid clearance of fever and parasitaemia, superior to non-ACT. Using survival analysis on a modified intent-to-treat population, the Day 28 PCR-adjusted efficacy of AS&AQ was greater than 90% (the WHO cut-off) in 11/16 countries. In randomized comparative trials (n = 22), the crude efficacy of AS&AQ was 75.9% (95% CI 74.6-77.1) and the PCR-adjusted efficacy was 93.9% (95% CI 93.2-94.5). The risk (weighted by site) of failure PCR-adjusted of AS&AQ was significantly inferior to non-ACT, superior to dihydroartemisinin-piperaquine (DP, in one Ugandan site), and not different from AS+SP or AL (artemether-lumefantrine). The risk of gametocyte appearance and the carriage rate of AS&AQ was only greater in one Ugandan site compared to AL and DP, and lower compared to non-ACT (p = 0.001, for all comparisons). Anaemia recovery was not different than comparator groups, except in one site in Rwanda where the patients in the DP group had a slower recovery. CONCLUSION: AS&AQ compares well to other treatments and meets the WHO efficacy criteria for use against falciparum malaria in many, but not all, the sub-Saharan African countries where it was studied. Efficacy varies between and within countries. An IPD analysis can inform general and local treatment policies. Ongoing monitoring evaluation is required.
    • Endemic juvenile hypothyroidism in a severe endemic goitre area of Sudan.

      Moreno-Reyes, R; Boelaert, M; el Badawi, S; Eltom, M; Vanderpas, J; Cemubac Medical Team, Public Health School, Free University of Brussels, Belgique. (1993-01)
      OBJECTIVE: The aim of the study was to assess thyroid function, iodine intake and exposure to dietary goitrogens of children living in an area with a high prevalence of goitre, in the region of Darfur, Sudan. DESIGN: In a village where goitre affected approximately 85% of children, a cross-sectional survey of thyroid function was performed in children 0-7 years old. PATIENTS: Twenty neonates and 190 children, aged 1 month to 7 years, were included. MEASUREMENTS: Thyroid hormones, urinary iodide and thiocyanate excretion were measured. RESULTS: Mean +/- SD serum T4 was below the normal range at birth (82 +/- 50 nmol/l) and in the age group less than 2 years (73 +/- 46). Children older than 2 years had even lower serum T4: 37 +/- 37 (P < 0.001) at 3-4 years and 36 +/- 38 (P < 0.001) at 5-7 years. Mean serum TSH was 25.8(6.2-107.7) mU/l at birth, 8.3(2.5-27.8) in the group less than 2 years, 15.3(2.9-79.1) at 3-4 years and 16.4(2.7-98.3) at 5-7 years. The overall prevalence of hypothyroidism (TSH > 50 mU/l) was 24%. Mean urinary thiocyanate was high at birth (107 +/- 69 mumol/l), normal in the group less than 2 years and higher in children older than 2 years (126 +/- 69 mumol/l) (P < 0.001). All age groups had a low urinary iodide concentration. CONCLUSION: Hypothyroidism was very frequent in each age group. The higher frequency of hypothyroidism observed in weaned children (> 2 years) was attributed to the combined effects of iodine deficiency and goitrogens (thiocyanate and glycosylflavones) derived from millet.
    • Epidemiological and clinical aspects of human Brucella suis infection in Polynesia

      Guerrier, G; Daronat, J M; Morisse, L; Yvon, J F; Pappas, G; Epicentre, Paris, France; Agence de Santé, Mata Utu, Wallis, France; Institute of Continuing Medical Education of Ioannina, Greece; International Society of Chemotherapy Zoonoses Working Group, London, UK (Cambridge University Press, 2011-06-21)
      High brucellosis seroprevalence rates in domestic swine herds have been reported in Wallis and Futuna Islands and are associated with a significant burden of human infection by Brucella suis, a species that is rarely incriminated in human disease. Between 2003 and 2010, seven patients had a positive blood culture for B. suis biovar 1, 11 symptomatic patients had a positive Rose Bengal test (RBT) and a positive serum agglutination test (SAT) and three asymptomatic cases were found to be positive for RBT, SAT or ELISA IgM (after systematic screening of 52 family members of 15 index cases). Overall, Brucella infection was diagnosed in 21 people, corresponding to a mean annual incidence of 19 cases/100 000 inhabitants. Compared to series of patients infected with other more commonly encountered Brucella spp. such as B. melitensis and B. abortus, clinical presentation and percentage and distribution of complications were similar, apart from a marked observation of significantly increased median alanine aminotransferase levels, 20 times greater than upper normal rates, but not accompanied by any particular hepatic pathology. Wallis and Futuna, where people live in close proximity to animals and where the cultural significance of pig-raising precludes the implementation of adequate veterinary preventive measures, thus represents one of the few known B. suis foci worldwide and allows for evaluation of the peculiarities of this infection.
    • Epidemiological Support for a Multifactorial Aetiology of Kashin-Beck Disease in Tibet.

      Suetens, C; Moreno-Reyes, R; Chasseur, C; Mathieu, F; Begaux, F; Haubruge, E; Durand, M; Nève, J; Vanderpas, J; Médecins Sans Frontières, Brussels, Belgium. carl.suetens@ihe.be (Springer, 2001)
      We carried out a cross-sectional study in 12 rural villages in order to identify the risk factors for Kashin-Beck disease in Tibet. Children aged 5-15 years (n=575) were examined and their corresponding houses were visited. Samples were collected in order to study fungal contamination of stored grain and the organic matter content of drinking water. Multivariate analysis was performed using logistic regression and population attributable fractions were computed to estimate the impact of each factor. The following variables were independently associated with the disease: age, gender, low socio-economic status, indicators of a poorly diversified diet, iodine deficiency and small water container size (with higher organic matter levels in small containers). Selenium deficiency was severe in all study subjects. The degree of fungal contamination of barley grain was related to the highest percentage of cases (65%) in a sample of the study population. Higher urinary iodine levels were not associated with decreasing prevalence rates when Alternaria sp. was isolated. The data that we report supports the hypothesis that Kashin-Beck disease occurs as a consequence of oxidative damage to cartilage and bone cells when associated with decreased antioxidant defence. Another mechanism that may coexist is bone remodelling stimulated by thyroid hormones whose actions can be blocked by certain mycotoxins.