Identification of termites from Gabon using MALDI-TOF MS

Termites are one of the most common pests that damage wood and other cellulosic materials. Although Africa has more varieties of termite species than any other continent, few entomological studies have been conducted in Gabon. Identifying termites poses significant difficulties for entomologists. The aim of this study was to evaluate the reliability and confirm the significance of MALDI-TOF MS in identifying fresh termites collected in equatorial Africa. A total of 108 termites were collected from 13 termite nests during a field mission in 2021 in Lekedi and Bongoville, Gabon. Termites were morphologically identified and subjected to MALDI-TOF MS, then molecular analyses using the COI and 12S rRNA genes. Four termite species were morphologically identified in this study: Pseudacanthotermes militaris, Macrotermes muelleri, Macrotermes nobilis, and Noditermes indoensis. However, when using molecular biology, only three species were identified, namely Macrotermes bellicosus, P. militaris, and N. indoensis, because the specimens initially identified as M. muelleri and M. nobilis were found to be M. bellicosus. The MALDI-TOF MS spectral profiles of the termites were all of good quality, with intra-species reproducibility and inter-species specificity. The spectra of 98 termites were blind tested against our upgraded database, which included the spectra of ten termite specimens. All tested spectra were correctly matched to their respective species, with log score values (LSVs) ranging from 1.649 to 2.592. The mean LSV was 2.215 ± 0.203, and the median was 2.241. However, 95.91% (94/98) of our spectra had LSVs above 1.8. This study demonstrates how a proteomic approach can overcome termites' molecular and morphological identification limitations and serve as a useful taxonomic tool.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry traces the geographical source of Biomphalaria pfeifferi and Bulinus forskalii, involved in schistosomiasis transmission

BACKGROUND

Freshwater snails of the genera Bulinus spp., Biomphalaria spp., and Oncomelania spp. are the main intermediate hosts of human and animal schistosomiasis. Identification of these snails has long been based on morphological and/or genomic criteria, which have their limitations. These limitations include a lack of precision for the morphological tool and cost and time for the DNA-based approach. Recently, Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight (MALDI-TOF) mass spectrometry, a new tool used which is routinely in clinical microbiology, has emerged in the field of malacology for the identification of freshwater snails. This study aimed to evaluate the ability of MALDI-TOF MS to identify Biomphalaria pfeifferi and Bulinus forskalii snail populations according to their geographical origin.

METHODS

This study was conducted on 101 Bi. pfeifferi and 81 Bu. forskalii snails collected in three distinct geographical areas of Senegal (the North-East, South-East and central part of the country), and supplemented with wild and laboratory strains. Specimens which had previously been morphologically described were identified by MALDI-TOF MS [identification log score values (LSV) ≥ 1.7], after an initial blind test using the pre-existing database. After DNA-based identification, new reference spectra of Bi. pfeifferi (n = 10) and Bu. forskalii (n = 5) from the geographical areas were added to the MALDI-TOF spectral database. The final blind test against this updated database was performed to assess identification at the geographic source level.

RESULTS

MALDI-TOF MS correctly identified 92.1% of 101 Bi. pfeifferi snails and 98.8% of 81 Bu. forskalii snails. At the final blind test, 88% of 166 specimens were correctly identified according to both their species and sampling site, with LSVs ranging from 1.74 to 2.70. The geographical source was adequately identified in 90.1% of 91 Bi. pfeifferi and 85.3% of 75 Bu. forskalii samples.

CONCLUSIONS

Our findings demonstrate that MALDI-TOF MS can identify and differentiate snail populations according to geographical origin. It outperforms the current DNA-based approaches in discriminating laboratory from wild strains. This inexpensive high-throughput approach is likely to further revolutionise epidemiological studies in areas which are endemic for schistosomiasis.

Bartonella raoultii sp. nov., isolated from infected rodents (Mastomys erythroleucus) in Senegal

Bartonella species are involved in various human diseases, causing a range of clinical manifestations; animals are considered as the main reservoirs, transmitting diverse species of Bartonella through direct contact and haematophagous insects. Here, we characterize a new species, Bartonella raoultii sp. nov., within the genus Bartonella, using a taxonogenomic polyphasic approach. Strain 094T (= CSUR B1097T=DSM 28004T), isolated from the blood of an infected rodent (Mastomys erythroleucus) in Senegal, is an aerobic and rod-shaped bacterium. The annotated non-contiguous genome sequence is 1 952322 bp long and contains 37.2 mol% G+C content, 1686 protein-coding genes and 50 RNA genes, including seven rRNA genes.

Description of Streptococcus thalassemiae sp. nov., a Bacterium Isolated from Human Blood

Blood is a precious biological liquid that is normally sterile. Therefore, bacteria in the bloodstream are shown a priori anomaly. A blood culture is systematically performed to diagnose the cause of the bacteremia. Indeed, a patient received in our service had a thalassemia major and underwent a genoidentical transplant. Then, a blood test was performed to diagnose a four-day fever. In this context, we have isolated strain Marseille-Q2617 from the blood sample. It revealed a new bacterial strain that belongs to the genus Streptococcus. It is a Gram-positive coccus, nonmotile, and nonspore forming. The major fatty acid found is hexadecanoic acid, with 49.5%. A taxonomic method was used to characterize the strain by studying their phenotypic, phylogenetic, and genomic characteristics. In addition, sequence analysis of the 16S rRNA gene shows that the strain Marseille-Q2617 has 99.94% sequence similarity to Streptococcus mitis. Average nucleotide identity (ANI) analysis for strain Marseille-Q2617T showed the highest similarity of 92.9% with S. mitis. The DNA-DNA hybridization value obtained (50.2%) between strain Marseille-Q2607 and S. mitis, its closest related species, was below the recommended threshold (<70%). Strain Marseille-Q2617T has a genome size of 2.02 Mbp with 40.5 mol% of G + C content. Based on these results, we propose a new species of the genus Streptococcus, for which the name Streptococcus thalassemiae sp. nov., Marseille-Q2617T (=CSUR Q2617 = CECT 30109) was proposed.

Level and modalities of origin of the small saphenous vein: toward codification of the proximal approach level

PURPOSE

The proximal approach to the small saphenous vein (SSV) must be performed according to precise anatomical landmarks to respect the esthetic profile of venous insufficiency surgery. In this work, we propose the tip of the lateral malleolus and the lateral edge of the calcaneal tendon as palpable landmarks from which to easily identify the situation of this vein.

METHODS

This was a cadaveric dissection study involving 62 members of fresh and embalmed anatomical subjects. We used a horizontal line passing through the tip of the lateral malleolus and the lateral edge of the calcaneal tendon as reference marks. Once the origin of the SSV as dissected, the distances between the saphenous vein and the landmarks were measured.

RESULTS

We found that the small saphenous vein was often unique. The origin of this small saphenous vein projected, on average, to 4.40 cm from the horizontal passing through the tip of the lateral malleolus and 1.2 cm from the lateral edge of the calcaneal tendon.

CONCLUSION

These two measurements constitute the orthogonal coordinates for the situation of the small saphenous vein origin.

[Multifocal histoplasmosis due to Histoplasma capsulatum var. duboisii in a 22 year-old Senegalese patient without proven immunodepression]

The authors report a case of multifocal African histoplasmosis with polymorphic skin involvement occuring in a patient without proven immunosuppression. He was a young 22-year-old patient from eastern Senegal - but born in Ouganda - who presented with polymorphic skin lesions: ombilicated papulo-nodules, gums and ulcerative and budding lesions. He showed lymphadenopathies without clinical inflammation and with a cheesy appearance of the biopsy but without tuberculosis and also hepatosplenic and bone involvement. Mycological samples of the skin and lymph nodes biopsies revealed yeasts of Histoplasma capsulatum var. duboisii with a positive culture on Sabouraud medium. HIV serology, HTLV1et 2, the serum proteins electrophoresis were unremarkable. Treatment with amphotericin B was irregular because of its inaccessibility in the national territory and its cost. The patient died of sepsis together with the aggravation of his disease.

Equine trypanosomosis in the Central River Division of The Gambia: a study of veterinary gate-clinic consultation records

The objective of this study was to provide epidemiological information of equine trypanosomosis in the Central River Division (CRD) of The Gambia. Therefore, 2285 consultations records of equines, admitted in a gate-clinic at Sololo in CRD, were studied retrospectively. The data were recorded in the period between September 1995 and July 2002 and comprised consultations of 2113 horses and 172 donkeys. 'Trypanosome infection' was the most frequently diagnosed condition and accounted for 61% of the cases. Horses were more frequently diagnosed with trypanosome infections than donkeys (p<0.001), with an occurrence of 63% compared to 43% in donkeys. In both horses and donkeys, trypanosome infections were mainly due to Trypanosoma congolense (64%) and T. vivax (32%). There was no difference observed in the occurrence of trypanosome infections in male or female donkeys (p=0.585), but there were more female (67.8%) horses observed with trypanosome infections than male horses (60.7%; p=0.003). There was no difference observed in the occurrence of trypanosome infections in donkeys older or younger than 1 year (p=0.130), but more older horses (63.2% >1 year) were observed with trypanosome infections than young horses (54.5% <1 year; p=0.033). The number of donkeys and horses with trypanosome infections decreased during the rainy season (June-September). The majority of equines that were admitted with trypanosome infections were severely anaemic. The average packed cell volume (PCV) declined with increasing parasitaemia (p=0.006). Seventy-four percent of the farmers' predictions of trypanosome infections in their equines were confirmed by darkground-microscopy. That proved that farmers had a fairly accurate knowledge of the diseases affecting their equines. The treatments executed at the gate-clinic were generally effective. The few (0.4%) relapses of the T. vivax infections that were previously treated with diminazene aceturate in this study were not sufficient to prove drug resistance. The study showed that the analysis of consultation records at a gate-clinic can provide complementary information to conventional epidemiological studies in the same research area.

Susceptibility of West African Dwarf goats and WAD×Saanen crosses to experimental infection with Trypanosoma congolense

West African Dwarf goats (WADs) and their Saanen crosses were experimentally infected with Trypanosoma congolense. No significant differences were found between trypanosome parasitaemia and antibody response of the crossbred and WAD goats. Neither the WAD goats nor the Saanen crosses were able to control the drop in PCV following trypanosome infection. The level of anaemia caused by the trypanosome infection was similar in the two breeds during the trial. Based on these findings, no difference in tolerance or susceptibility to T. congolense could be demonstrated between the WAD goats and their Saanen crosses. Although the weight of all goats increased during the trial, the crosses gained significantly more weight than the WAD goats. The trypanosome infection reduced the growth rate of both breeds, but this reduction was not statistically significant. Crossbreeding trypanotolerant WADs with trypanosusceptible Saanen goats might, therefore, be an effective means of increasing productivity.

Crystal structure of aquabis(4-methyl-5-formyl-imidazolfuranoylhydrazone)- (trinitrato)praseodymium(III) monohydrate, Pr(H2O)(C9H10O2N4)2(NO3)3·H2O

C20H24N11O15Pr, monoclinic, P121/c1 (no. 14), a = 18.956(4) Å, b = 8.161(2) Å, c = 22.151(3) Å, β = 114.53(2)°, V = 3117.5 Å3, Z = 4, Rgt(F) = 0.025, wRref(F2) = 0.063, T = 293 K.

Crystal structure of 1-benzoyl-2-picoloyl-hydrazine nickel(II)–methylene chloride solvate (1:0.25), Ni[OC(C6H5)NHN(C5H4N)CO)]2 · 0.25CH2Cl2

C26.25H20.5Cl0.5NiN6O4, monoclinic, C12/c1 (no. 15), a = 25.707(1) Å, b = 14.768(1) Å, c = 18.312(1) Å, β = 132.30(5)°, V = 5142.1 Å3, Z = 8, Rgt(F) = 0.060, wRref(F2) = 0.176, T = 173 K.

[Central nervous system germinoma: retrospective study of six cases]

PURPOSE

Retrospective analysis of six patients with intracranial germinoma treated in INO and a literature review.

MATERIALS AND METHODS

Six patients were treated from 1993 to 1998, for histologically verified primary intracranial germinoma. Median age was 18 years (range: 14-26 years). All patients received chemo-radiotherapy (4FP + radiotherapy from 30 to 50 Gy).

RESULTS

4 tumours were in complete remission. Two patients have kept non-evolutive residual cyst. Five patients are alive with non-evolutive disease after 15-40 months of follow-up (average: 27 months). One patient was lost to follow-up, 14 months after treatment, without disease.

CONCLUSION

The treatment of intracranial germinoma is currently first line chemotherapy followed by low-dose and limited irradiation.

Primary malignant lymphoma of the ovary: an unusual presentation of a rare disease

Because the outcome of patients with primary ovarian non-Hodgkin's lymphoma (NHL) is controversial, we present the incidental finding of a primary malignant lymphoma of the ovary in a 50-year-old patient. Three and a half years following ablative surgery and adjuvant chemotherapy, the patient is alive and disease free. Ovarian lymphoma is a disease of reportedly poor prognosis. However, many previously reported cases of ovarian lymphoma actually represented ovarian involvement by a more diffuse lymphomatous process. If stringent criteria are used for case selection, true primary ovarian lymphoma is a very rare disease and usually carries a favorable prognosis.

Health and productivity of traditionally managed Djallonke sheep and West African dwarf goats under high and moderate trypanosomosis risk

Trypanosome infections, packed red cell volume levels (PCV), body weight and nematode faecal egg counts of village-based small ruminants were monitored in two areas in The Gambia with either moderate or high trypanosomosis risk for 24 and 30 months respectively. Outflows from the flock and new-born animals were recorded and data on housing and management were compiled. Reported mortality rates were higher in goats than in sheep, but for both species highest in the moderate risk area. The peak of trypanosome infections lagged the peak of tsetse densities by 1-3 months in both areas. Trypanosoma vivax was the predominant species found in the infected animals, followed by T. congolense. Trypanosome prevalence was, in general, higher in sheep than in goats but only significantly higher during Year 1 in the moderate risk area. Trypanosome infection reduced the PCV level significantly and seasonal effects indicated significantly lower PCV levels during the rains. Trypanosome infection significantly depressed weight gain in both species at periods where infection rates were highest. In both species considerably lower weight gains were observed during the rainy season. Abortion rates were higher in goats than in sheep in both study sites, and highest in the high-risk site. Trypanosome infection in ewes in the high risk area increased lamb mortality significantly but had no effect on birth weights, nor on growth rates up to 4 months. Offspring mortality up to 4 months was generally high at both sites. Trypanosome infection in the dam between 3.5 to 7 months post parturition significantly increased parturition interval in both species. Peak faecal egg output occurred at the end of the rainy season and was highest for both species in the moderate risk site. Poor grazing management was found responsible for a seasonal nutritional constraint. Based on these results, these breeds of sheep and goats can be considered as trypanotolerant since they are able to remain productive under high and moderate levels of trypanosome challenge. Nevertheless, trypanosomosis affected their health and production level as shown by reduced PCV levels, depressed weight gains, longer parturition intervals and higher lamb mortality. In addition, during the rains, helminth infections and poor management leading to nutritional constraints had also a negative impact on health and production and therefore influenced the innate resilience to trypanosomosis in those indigenous breeds. Adaptations in management may have an equal impact as certain disease control measures to improve biological and economical returns from small ruminants in tsetse infested rural areas.

[Nosocomial Klebsiella pneumoniae infections at the Fann University Hospital Center, Dakar]

Twenty one (21) strains of Klebsiella pneumoniae are isolated from patients hospitalized since 48 hours for neurological affections, and from medical staff hands. Eighteen (18) other strains isolated from other clinics were studied for comparison. The identification used API20 E system (BioMérieux), and the susceptibility to antibiotics was tested by disc diffusion test (antibiogram). Production of extended-spectrum beta-lactamase was studied by synergy test method. Arbitrarily primed Polymerase Chain Reaction (AP-PCR) was used to compare the electrophoretic profiles of the strains. Nosocomial strains are more resistant than the other: 57.14% vs 16.67% (p = 0.02) and 28.57% among them are extended-spectrum beta-lactamase positive. Amikacin (87.5%) and Ciprofloxacin (100%) are the most efficient antibiotics, when Cotrimoxazole inhibits 31.25% of the strains. The electrophoretic profiles show an important diversity of strains and suggest an external contamination.

[Sensitivity profiles of enterobacteria isolated at th Fann University Hospital Center, Dakar]

This study concerns 180 strains of Enterobacteria isolated at Fann University Teaching Hospital (Dakar, Senegal). The susceptibility to antibiotics was tested by disc diffusion test (antibiogram) and by dilution method determining the minimum inhibitory concentration (MIC). All of the species present more resistant profile to beta-lactams (> 55%); however ceftriaxon and aztreonam present the lower MIC 50 (< 0.06 microgram/ml). Fluoroquinolon inhibits more than 90% of the strains of E. Coli and Proteus. Chloramphenicol is active on Salmonella, but ceftriaxon, aztreonam and the fluoroquinolon present good alternatives. Cotrimoxazole is active only on 54% of Shigella strains.

[Methicillin-resistant Staphylococcus aureus in Dakar]

This study was carried out at the Fann University Hospital Center in Dakar, Senegal between 1994 and 1996. The purpose was to assess the prevalence of methicillin-resistant Staphylococcus aureus and to propose alternative treatments. A total of 149 stains of Staphylococcus aureus were isolated from a variety of clinical specimens. Sensitivity to various antibiotics was tested by the disc diffusion technique (anti-biogram). Resistance to methicillin was evaluated by the oxacillin disc diffusion technique on Mueller-Hinton agar containing 5% NaCl. The prevalence of methicillin resistance was 66.4%. All strains of Staphylococcus aureus were sensitive to vancomycin. Other highly effective antibiotics included fucidic acid (94%), aminoglycosides (91%), cotrimoxazol (89.6%), and norfloxacin (84.5%). Most strains (70.6%) presented a wide profile against macrolides and related groups. The LSa phenotype (resistance to lincosamines and streptogramines) was the predominant resistant phenotype. The results of this study indicate that the prevalence of methicillin-resistant Staphylococcus aureus is increasing in Senegal. Since these strains respond well to chloramphenicol and cotrimoxazole, clinicians are advised to use these drugs as an alternative first-line treatment.

[Bacterial diversity during the cholera epidemic in Dakar, Senegal (1995-1996)]

Vibrio cholerae O:1, serotype Ogawa and biotype El Tor (76.1%) was responsible of the outbreak of cholera in Dakar, Senegal (1995-1996). However, other bacteria were isolated, particularly Vibrio cholerae non O:1/non O:139, Vibrio fluvialis, Vibrio alginolyticus. Vibrio parahaemolyticus, Salmonella sp.p, Shigella sp.p (23.9%). The Vibrio cholerae O:1 strains are multiresistant to sulfonamide, cotrimoxazole and chloramphenicol. 97% were also resistant to O/129 compound. Fluoroquinolone and 3rd generation cephalosporins were the more efficient antibiotics (100%).

[Severe malaria in an African seasonal endemic area. Comparison of aspects in adults and children and prognostic value of cytokines]

OBJECTIVES

The present study was conducted in West Africa in a region where malaria exists as a seasonal endemic disease. The aim was to compare clinical and biological aspects of adult severe falciparum malaria with those found in children and to appreciate the role of cytokines a prognostic markers. Thirty-one patients fulfilling the WHO criteria of severe malaria were included.

METHODS

Fifteen children (8 boys and 7 girls; mean age: 7.9 +/- 3.7 years) were compared with an adult group of 16 patients (9 men and 7 women; mean age: 31.1 +/- 14.5 years). The number of severe criteria and most of the biological features (glycaemia, parasitaemia, haemoglobin levels, platelet count) were similar in both groups. As regards immunological findings, serum levels of IgM and IgG were significantly increased in the adult group. Serum levels of TNF alpha, IL-6 and IL-2SR were similar (255.2 +/- 375.3 versus 298.4 +/- 254.1 pg/ml for TNF alpha, 534.6 +/- 642.7 versus 609.5 +/- 1217.0 pg/ml for IL-6, 253.1 +/- 120.5 versus 297.6 +/- 142.2 pg/ml for IL-2SR). Each of these cytokines correlated with the others and were also correlated to parasitaemia. Three children and two adults died during the course of the study. At admission a significant died during the course of the study. At admission a significant difference was observed between serum levels of TNF alpha (p < 0.01), IL-6 (p < 0.001) and IL-2SR (p < 0.05) in patients who were later survivors or non-survivors.

CONCLUSION

This study confirms the prognostic significance of serum levels of TNF alpha, IL-6 and IL-2SR in severe malaria.

[Severe acute asthma in adults in black Africa]

A prospective study has been conducted in an intensive care unit of West Africa in order to determine the clinical and laboratory features of severe acute asthma in black Africans. The study concerned 55 episodes of severe acute asthma, with PaCO2 above 45 mmHg, in 42 patients (26 men and 16 women, mean age 35 +/- 3 years). A triggering factor was found in only 36 percent of the cases. None of the patients were using beta-adrenergic stimulants as maintenance therapy. The mean duration of asthmatic attacks prior to hospitalization was 49 +/- 7 hours. Three patients had cardiorespiratory arrest on admission. Mechanical ventilation was necessary on 12 occasions (initially in 4 and secondarily in 8). Four patients died. It would appear from this study that severe acute asthma in black Africans is characterized by a prolonged onset and by a frequent need for mechanical ventilation, suggesting a physiopathological mechanism different from that described in industrialized countries.

Treatment of severe tetanus by intrathecal injections of baclofen without artificial ventilation

A study was conducted to evaluate repeated intrathecal injections of baclofen, without artificial ventilation, in the treatment of severe tetanus. Ten patients, 5 men and 5 women, with a mean age of 34 +/- 7 years, were included in the study. The dose of baclofen injected was 1000 micrograms between the ages of 16 and 55 years, 800 micrograms over the age of 55 years and 500 micrograms under the age of 16 years. The efficacy was assessed on the basis of the resolution of contractures and paroxysms and the initial dose was reinjected prior to the reappearance of these symptoms. Treatment was discontinued in the case of central nervous system depression or inefficacy. The first injection was effective in 9 cases for 24-48 h. The haemodynamic safety was always good. Five patients developed central depression with coma and respiratory depression, requiring artificial ventilation in 3 cases and reversed by flumazenil in 2 cases. Five patients were treated exclusively with baclofen with 4 cures. Five patients had to be ventilated with only one cure. This study confirms earlier studies concerning the efficacy of intrathecal baclofen in tetanus. However, the frequency of episodes of respiratory depression prevents the recommendation of repeated injections when respiratory intensive care facilities are not available.

[Effects of diazepam on mortality from acute chloroquine poisoning]

A retrospective study was carried out, over a twelve-year period, of all cases of acute chloroquine poisoning where more than 2 g of chloroquine had been taken. It included 386 patients; of these, 60 who had taken drugs other than chloroquine, and 17 who had ingested less than 1 g of the drug, were excluded. The remaining 309 patients were allocated to two groups: a "control group", consisting of the patients admitted between January 1973 and April 1980 (n = 146), and a "diazepam group", made up of those admitted from May 1980 to December 1989 (n = 163). The patients in the latter group had had the same symptomatic treatment as those in the control group, and had been routinely given a 0.5 mg.kg-1 bolus of diazepam on admission followed by 0.1 mg.kg-1.day-1 for every 100 mg of chloroquine supposed to have been ingested. Both groups were divided into three subgroups, those patients with cardiorespiratory arrest, and those with, and those without, symptoms on admission. No statistically significant difference was found between either the control and diazepam groups or between subgroups, concerning the distribution of age, sex, amount of chloroquine supposed to have been ingested, delay in hospital admission and death rate. However, there was a higher death rate in the asymptomatic subgroup not treated with diazepam than in the diazepam group. Therefore, the routine use of diazepam for the treatment of acute chloroquine poisoning does not seem to be justified in symptomatic cases and in those with inaugural cardiac arrest.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cerebral malaria in non-immune subjects. Current aspects in African endemic areas]

The current clinical and therapeutic aspects of cerebral malaria in non-immune adult subjects living in endemic areas of Africa were evaluated in 10 men (mean age: 40 +/- 11.4 years). On admission, 8 patients had fever, 3 were truly comatose with a Glasgow score of 7 or more. All had negative central venous pressure and only one was in a state of hyperkinetic shock. Respiratory symptoms were present in 8 cases, and jaundice was observed in 8 cases. Three patients has a haemoglobin level lower than 8 g/100 ml, and 8 had thrombocytopenia. Blood creatinine levels above 240 mumol/l and blood bilirubin levels above 50 mumol/l were found in 6 and 8 patients respectively. Plasma creatine phosphokinase was above 500 IU/l in 7 cases, and PaO2 was below 70 mmHg in 7 cases. All patients received quinine, combined with doxycycline in 6 cases. Infectious complications occurred in 5 patients, with 2 septic shocks. Two patients developed acute pulmonary oedema. Five patients died. This study shows that cerebral malaria in non-immune subjects living in endemic areas produces multivisceral deficiency similar to that observed in imported malaria. Its prognosis can be improved by loading doses of quinine and by a better prevention of nosocomial infections.