BackgroundMalaria remains one of the deadliest diseases in the tropic. Its severe form represents a major public health concern in sub-Saharan Africa. The study aimed to describe and analyze clinical features and outcomes of severe malaria in children from Libreville.MethodsMedical records (March 2018- to December 2019) from the emergency ward of the “Mother and Child University Hospital” were analyzed. Children hospitalized for malaria who met one or more criteria of the severe form rating according to the WHO guideline were included in the study.ResultsOne hundred thirty-four children (134) children were included in the study. All children were anemic with 44% of children showing severe anemia. Thirty-three percent (33%) of admitted children were comatose or agonizing. The most frequent form of severe malaria was cerebral malaria with 101 cases (75.4%). The death rate was 18.6% (25/134). Twenty-one (21) children (84% of the deceased) died within the first 48 hours of hospitalization. In the subgroup of the deceased children, hepatomegaly was significantly more frequent (88%) than in the subgroup of those who survived (2.8%) (χ2 = 97.38; p<0.0001); Leukocytosis was more pronounced in the subgroup of the children under one year p<0.0001). Deep acidotic breathing was more frequent in cerebral malaria (χ2 = 5.4; p = 0.02).ConclusionsData revealed a high malaria-associated fatality rate. Cerebral malaria was the most frequent severe form of malaria. The relatively high frequency of comatose and/or agonizing children on admission raises the question of parents’ awareness and poor initial assessment of children’s clinical state.

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Pathogen sensing and recognition through pattern recognition receptors, and subsequent production of pro-inflammatory cytokines, is the cornerstone of the innate immune system. Despite the fact that HIV-exposed uninfected (HEU) infants are prone to serious bacterial infections, no study has focused on the functionality of their bacteria recognition system. This is the first study to investigate baseline levels of three critically important immune response molecules in this population: complement component (C)-3, toll-like receptor (TLR)-4, and C-reactive protein (CRP). We enrolled 16 HEU and 6 HIV-unexposed (HU) infants. TLR4 function was investigated by stimulating whole blood with increasing concentrations of TLR4-agonist ultrapure lipopolysaccharides. TLR4/TLR4-agonist dose response were assessed by measuring IL-6 secretion. Complement C3 and CRP were measured by photo spectrometry. Data showed no significant differences in baseline concentration of CRP between HEU and HU infants. Complement C3 was significantly higher in HEU infants than HU infants. TLR4 anergy was observed in 7 of 12 HEU infants, whereas the rest of HEU infants (n = 4) and the control HU infants tested (n = 3) showed responsive TLR4. None of the HEU infants investigated in this study had severe infections in the year after their birth. In conclusion, TLR4 anergy can occur in HEU infants without necessarily translating to increased vulnerability to infectious diseases.

Background: Stunting and undernutrition mark the nutritional status of the sickle cell patient, but some surveys show trends to overweight in some countries. The primary objective of this study was to compare the growth of children with sickle cell, with non-sickle cell children in Gabon. Methods: It was a prospective case-control study, conducted from April to June 2016 in Libreville and Lambarene in Gabon. Cases were homozygous (SS) sickle cell children aged from 0 to 15 years; controls were normal hemoglobin-AA documented, matched by sex and age. We compared their weight, height, arm and head circumferences measured according to conventional techniques. Results: We compared 118 cases to 118 controls, mean age was 85 ± 7.2 months, and the sex ratio was 1.07. Before 59 months, there was no significant difference in the comparison of the averages of the anthropometric indices except for the z-score of the brachial perimeter for age which was smaller in the cases (-0.85 versus-0.19, P = 0.04). The risk of stunting in cases was greater (odds ratio (OR) = 6.9, 95% confidence interval (CI): 5.4-8.3), the growth retardation increased with age, correlated factors with growth retardation were male gender (relative risk (RR) = 2.04, 95% CI: 1.2-2.7), a mother with no remunerative activity (r = 0.11, P < 0.03), a number of transfusions > 3 (r = 0.2, P = 0.003), and mean hematocrit of 9.6-15.9% (r = 0.4, P < 0.004). There were no obese subjects in cases. Conclusions: Growth retardation of children suffering from sickle cell in Gabon appears and increases with age. Male gender, low socioeconomic conditions and signs of severity or non-controlled disease are correlated with this retardation.

Objective Herd immunity is achieved when in a population, immune individuals are in a sufficiently large proportion. Neutralizing antibodies specific to SARS-CoV-2 that are produced following infection or vaccination are critical for controlling the spread of COVID-19. The objective of the present work was to investigate the rate of SARS-CoV-2 natural immunization in Gabonese. Results One thousand, four hundred and ninety two people were enrolled. The overall prevalence of anti-SARS-CoV-2 antibodies was 36.2%. Moreover, 76.4% of people who developed a humoral response to SARS-CoV-2 produced both anti-SARS-CoV-2 N-protein antibodies and anti-SARS-CoV-2 S-protein antibodies, which correspond to 27.7% of the total population. In infants (0–9 month), children (1–17 years) and adults, the prevalence of anti-SARS-CoV-2 antibodies was relatively the same, between 33 and 37% (any antibody types) and between 25 and 28.6% (neutralizing antibodies). In this African context, one-third (1/3) of the screened population was exposed to SARS-CoV-2 and three-quarter (3/4) of those exposed individuals developed neutralizing antibodies against SARS-CoV-2. This data suggest that herd immunity is not yet to be achieved in Gabon.