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Haemoglobin N in West Africa
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MHDICIN~ AND HYGIENE, VOL. 74, No. 5, 1980. CIJRRES~CJNDJD.JCE
686
illness. Transactions
of the Royal Society Tropical Medicine and Hygiene, 73, 630-633.
of
Meegan, J. M. (1979). The Rift Valley fever epizootic in Egypt 1977-1978. 1. Description of the epizootic and virological studies. Transactions of the Royal Society of Tropical Hygiene, 73, 618-623.
Medicine
and
Meegan, J. M., Hoogstraal, H. & Moussa, M. I. (1979). An epizootic of Rift Valley fever in Egypt in 1977. Veterinary Record 105, 124-125. Weiss, K. E. (1957). Rift Valley fever: A review. Bulletin of Epizootic Diseases of Africa, 5,431-458.
Accepted
for
publication
9th November, 1979.
Neel, J. V., Robinson, A. R., Zuelzer, W. W., Livingstone. F. B. & Sutton. H. E. (1961). The frequ&cy of elevations in- the A,‘ and fetal hemoglobin fractions in the natives of Liberia and adjacent regions, with data on haptoglobin and transferrin tvnes. American ‘fournal of Human Genetics, 13,262-278.
Journal
Haemoglobin
N in West Africa agree with FACER& BROWN (1979) in their
%+-We recent article on abnormal haemoglobins among Gambian children that HbN is uncommon in West Africa. However, it is by no means unknown there. HbN has been reuorted earlier from GuineaBissau (TRINCAO et al., 1960) and Liberia and environs (NEEL et al., 1961; WILLCOX, 1975) and during a recent survey in northern Liberia we found several “fast” haemoglobins with the mobility of HbN. The earlier data together with our present findings are summarized in Table I.* Electrophoretic mobility alone is not final proof of identity but our samples seem to behave as the “Liberian I” of ROBINSON et al. (1956). This variant was investigated by AGAR & LEHMANN (1958) and renamed HbN. They found it to be similar to the two “fast” haemoglobins from Nigeria and Ghana mentioned by Facer & Brown. Thus HbN appears to be widely scattered in West Africa. In Liberia, with one exception, all individuals with HbN trait hitherto discovered come from tribes speaking a Mande tongue (Mano, Kpelle, Lorma, etc.). Further, in our study we found the haemoglobin electrophoretic pattern A + S in 117 samples (3 *Q’$) and A + C in 12 (0.4%) suggesting that in this lmguistic group HbN is at about the same prevalence as HbC. This is to be investigated further. We are, etc., MICHAEL WILLCOX JOHAN BROHULT ELIAS BENGTSSON Yekepa Research and Training Unit of the Liberian Institute for Biomedical Research, Lamco Yekepa, Liberia, West Africa. References
Agar, J. A. M. & Lehmann, H. (1958). Observations on some “fast” haemoglobins: K, J, N, and “Bar&‘. British Medical Journal, i, 929-931. Facer, C. A. & Brown, J. (1979). Incidence of abnormal haemoglobin traits among Gambian children. Transactions of the Royal Society of Tropical Medicine and Hygiene, 73, 309-311. *See p. 694.
”
I
Robinson, A. R., Zuelzer, W. W., Neel, J. V., Livinastone, F. B. and Miller. M. T. (1956’1.Two “fast”hemoglobin components in Liberian blood samples. Blood, 11, 902-906. Trinclo, C., De Almeida France, L. T. and Noguiera, A. R. (1960). Abnormal haemoglobins in Portuguese Guinea.. Nature, 185, 326-327. Willcox, M. C. (1975). Thalassaemia in northern Liberia. A survey in the Mount Nimba area.
Accepted
of
for
Medical Genetics, 12, 55-63.
publication 28th December, 1979
Gram-negative
septicaemia complicating puerpural tetanus
%+--The need to consider the possibility of additional pelvic infection in the management of post-partum tetanus is illustrated by two cases. Case 1
A 25-year-old Hausa patient presented with tetanus five days after delivery at home. In addition to the tetanus she had poorly localized abdominal tenderness and a vaginal discharge. Treatment with intrathecal and intramuscular tetanus anti-serum, Chlorpromazine, Diazepam and benzyl penicillin was started on admission. A remittant fever persisted, and blood cultures taken at admission yielded Proteus, although no pathogen was isolated from high vaginal swabs. Gentamicin was given in addition to the penicillin and she recovered. Case
2
A 29-year-old Hausa patient delivered in her compound and ten days later presented with clear evidence of tetanus and also a tender bulky uterus and a vaginal discharge. The initial treatment was the same as in Case 1, but on the third day her condition deteriorated with hypotension and oliguria. The diagnosis lay between septicaemic shock and an autonomic complication of tetanus. The Gram-negative spectrum of her antibiotic treatment was broadened and she received steroids in high dosage. The Limulus lysate assay showed endotoxaemia and later E. coli was isolated from blood cultures. The renal failure required peritoneal dialysis which was continued until the 12th day. She developed bronchopneumonia in the third week and subsequently died after a pulmonary embolus. These patients had evidence of Gram-negative septicaemia arising from puerpural pelvic infection and complicating the course of tetanus. Precise figures relating the incidence of additional pelvic infection in puerpural tetanus are not available, and
686
illness. Transactions
of the Royal Society Tropical Medicine and Hygiene, 73, 630-633.
of
Meegan, J. M. (1979). The Rift Valley fever epizootic in Egypt 1977-1978. 1. Description of the epizootic and virological studies. Transactions of the Royal Society of Tropical Hygiene, 73, 618-623.
Medicine
and
Meegan, J. M., Hoogstraal, H. & Moussa, M. I. (1979). An epizootic of Rift Valley fever in Egypt in 1977. Veterinary Record 105, 124-125. Weiss, K. E. (1957). Rift Valley fever: A review. Bulletin of Epizootic Diseases of Africa, 5,431-458.
Accepted
for
publication
9th November, 1979.
Neel, J. V., Robinson, A. R., Zuelzer, W. W., Livingstone. F. B. & Sutton. H. E. (1961). The frequ&cy of elevations in- the A,‘ and fetal hemoglobin fractions in the natives of Liberia and adjacent regions, with data on haptoglobin and transferrin tvnes. American ‘fournal of Human Genetics, 13,262-278.
Journal
Haemoglobin
N in West Africa agree with FACER& BROWN (1979) in their
%+-We recent article on abnormal haemoglobins among Gambian children that HbN is uncommon in West Africa. However, it is by no means unknown there. HbN has been reuorted earlier from GuineaBissau (TRINCAO et al., 1960) and Liberia and environs (NEEL et al., 1961; WILLCOX, 1975) and during a recent survey in northern Liberia we found several “fast” haemoglobins with the mobility of HbN. The earlier data together with our present findings are summarized in Table I.* Electrophoretic mobility alone is not final proof of identity but our samples seem to behave as the “Liberian I” of ROBINSON et al. (1956). This variant was investigated by AGAR & LEHMANN (1958) and renamed HbN. They found it to be similar to the two “fast” haemoglobins from Nigeria and Ghana mentioned by Facer & Brown. Thus HbN appears to be widely scattered in West Africa. In Liberia, with one exception, all individuals with HbN trait hitherto discovered come from tribes speaking a Mande tongue (Mano, Kpelle, Lorma, etc.). Further, in our study we found the haemoglobin electrophoretic pattern A + S in 117 samples (3 *Q’$) and A + C in 12 (0.4%) suggesting that in this lmguistic group HbN is at about the same prevalence as HbC. This is to be investigated further. We are, etc., MICHAEL WILLCOX JOHAN BROHULT ELIAS BENGTSSON Yekepa Research and Training Unit of the Liberian Institute for Biomedical Research, Lamco Yekepa, Liberia, West Africa. References
Agar, J. A. M. & Lehmann, H. (1958). Observations on some “fast” haemoglobins: K, J, N, and “Bar&‘. British Medical Journal, i, 929-931. Facer, C. A. & Brown, J. (1979). Incidence of abnormal haemoglobin traits among Gambian children. Transactions of the Royal Society of Tropical Medicine and Hygiene, 73, 309-311. *See p. 694.
”
I
Robinson, A. R., Zuelzer, W. W., Neel, J. V., Livinastone, F. B. and Miller. M. T. (1956’1.Two “fast”hemoglobin components in Liberian blood samples. Blood, 11, 902-906. Trinclo, C., De Almeida France, L. T. and Noguiera, A. R. (1960). Abnormal haemoglobins in Portuguese Guinea.. Nature, 185, 326-327. Willcox, M. C. (1975). Thalassaemia in northern Liberia. A survey in the Mount Nimba area.
Accepted
of
for
Medical Genetics, 12, 55-63.
publication 28th December, 1979
Gram-negative
septicaemia complicating puerpural tetanus
%+--The need to consider the possibility of additional pelvic infection in the management of post-partum tetanus is illustrated by two cases. Case 1
A 25-year-old Hausa patient presented with tetanus five days after delivery at home. In addition to the tetanus she had poorly localized abdominal tenderness and a vaginal discharge. Treatment with intrathecal and intramuscular tetanus anti-serum, Chlorpromazine, Diazepam and benzyl penicillin was started on admission. A remittant fever persisted, and blood cultures taken at admission yielded Proteus, although no pathogen was isolated from high vaginal swabs. Gentamicin was given in addition to the penicillin and she recovered. Case
2
A 29-year-old Hausa patient delivered in her compound and ten days later presented with clear evidence of tetanus and also a tender bulky uterus and a vaginal discharge. The initial treatment was the same as in Case 1, but on the third day her condition deteriorated with hypotension and oliguria. The diagnosis lay between septicaemic shock and an autonomic complication of tetanus. The Gram-negative spectrum of her antibiotic treatment was broadened and she received steroids in high dosage. The Limulus lysate assay showed endotoxaemia and later E. coli was isolated from blood cultures. The renal failure required peritoneal dialysis which was continued until the 12th day. She developed bronchopneumonia in the third week and subsequently died after a pulmonary embolus. These patients had evidence of Gram-negative septicaemia arising from puerpural pelvic infection and complicating the course of tetanus. Precise figures relating the incidence of additional pelvic infection in puerpural tetanus are not available, and