[Multiple sites extrapodal actinomycetoma: Favorable outcome to treatment with a combination of cotrimoxazole and NSAI]

Mycetoma is a bacteriological or fungal infectious disease affecting the skin and/or soft tissues, which can be complicated by bone involvement. The most common feature is a tumor of the foot, but extrapodal localizations have been described. We report one case of a 47-year-old man who presented with tumefaction of a leg with multiple skin fistulae. Histopathological examination permitted to confirm the diagnosis of actinomycetoma and TDM showed the degree of bone and soft tissues involvement. Our case was characterized by the very inflammatory aspect of the tumor, its localization to the leg without foot involvement, the modest functional signs compared to the importance of radiological bone involvements, the deep destruction of the fibula while the tibia was apparently intact and the good response to treatment. In spite of its characteristic features, diagnosis of mycetoma is still late in our country, often with bone and/or articular spread. Priority may be given to measures for reduction of mycetoma diagnosis lateness.

[Epidemiological and etiological aspects of superficial fungal infections among prison inmates in Ouagadougou, Burkina Faso]

OBJECTIVE

The fight against fungal infections in prisons is within the overall framework of the fight against these diseases in the general population. To contribute to the fight against these diseases, we conducted this study among inmates of the big prison of Ouagadougou. It aimed to analyze the epidemiological and etiological aspects of superficial fungal infections among prison inmates in Ouagadougou.

MATERIALS AND METHODS

It was a matter of an analytical descriptive study (December 2011-April 2012) that examined 212 selected using a stratified sampling detainees. It consisted firstly of a survey on risk factors. Secondly, samples were taken from prisoners with suspicious lesions of superficial mycoses. For each lesion, some fragments were examined directly between slide and coverslip in KOH (10% or 30%). The remaining fragments were cultured on Sabouraud-Chloramphenicol and Sabouraud-Chloramphenicol-Actidione. The media were then incubated at 27°C for 1 month before declaring any negativity.

RESULTS

The overall prevalence of superficial fungal infections among prison inmates Ouagadougou was 25.5%. The recent prison inmates (≤24 months) were the most affected (89.8%). Dermatophytes (15.56%) were more isolated than non-dermatophytes (12.26%) Anthropophilic species predominated among dermatophytes: T. mentagrophytes (7.0%), T. rubrum (3.3%), M. langeronii (23%), E. floccosum (1.41%) and T. violaceum (0.94%). M. gypseum (0.47%) was the only land-based species encountered. Non-dermatophytes were Malassezia sp. (11.79%) and Candida sp. (0.47%). Polyparasitism was less represented (7.4% of infected prisoners). Several body sites were mostly infected by one fungal agent. Pityriasis versicolor was the most common fungal infection (37.31%).

CONCLUSION

Considering the results, specific control measures are to be taken against the superficial fungal infections in prisons and in the general population.

[Epidemiological profile, clinical and therapeutic cutaneous leishmaniasis in the Department of Dermatology at University Hospital in Ouagadougou, Burkina Faso]

It is a retrospective study in the Service of Dermatology at the University Hospital Center Yalgado Ouédraogo of Ouagadougou (C.H.U.-YO). This study aimed to list the leishmaniasis clinical cases reported in the registers of this department from January 1999 to December 2007. In total, 251 leishmaniasis clinical cases have been reported. The hospital prevalence was 1,1%. Women represented 53% versus 47% men. The average age of patients was 22,78 ans +/- 121. The most frequent clinical forms were those often crusted (40.2%), papulo ulcerative (16.7%) and papulonodular (13.9%). Lesions most often sat on the lower limbs (33%) and thoracic limbs (45%). On the therapeutic level, the first line treatment meglumine antimonite (Glucantime) accounted for only 25.9% of prescriptions.

[Darier's disease: three cases of psychosocial difficulties in an African setting]

BACKGROUND

Darier's disease is a rare disease. Multiple clinical forms have been observed, but the psychosocial aspects in Africa are rarely described. We report three cases involving difficulties regarding social integration.

OBSERVATIONS

Case no. 1: a 19-year-old woman consulted for hyperchromic, greyish, keratotic papules, grouped in small plaques scattered all over the body. She had trouble finding a husband and was rejected by her peers. Case no. 2: a 20-year-old woman presented generalized keratotic, vegetative lesions. She was rejected by her husband because of the lesions. Like patient no. 1, she was unable to purchase her prescribed treatment. Case no. 3: a 33-year-old blacksmith presented Darier's disease with lesions on the interscapular region and chest. He was epileptic and depressive and was partly rejected by his family.

DISCUSSION

Darier's disease, diagnosed on the basis of anatomoclinical factors, had a major impact on the social integration of all three patients. These generalised disfiguring forms of the disease adversely affect the quality of life and their association with neuropsychiatric disorders is another major handicap.

CONCLUSION

Difficulties concerning social integration and therapeutic problems must be considered in the management of Darier's disease in Africa.

[Retrospective study of cases of neuromeningeal cryptococcosis at the University Hospital of Bobo Dioulasso since accessibility to antiretroviral in Burkina Faso]

AIMS OF THE STUDY

To study the prevalence of neuromeningeal cryptococcosis since the availability of antiretroviral drugs and to determine the epidemiological profiles, clinical and biological treatment of neuromeningeal cryptococcosis cases diagnosed in the service of parasitology and mycology of university hospital center of Bobo-Dioulasso from 2002 to 2010.

PATIENTS, MATERIAL AND METHODS

We included all patients diagnosed with neuromeningeal cryptococcosis for which the presence of the fungi was observed on microscopic examination of cerebrospinal fluid after staining with Indian ink. Data were collected from the registers of the clinical service and from the laboratory of the university hospital center of Bobo Dioulasso.

RESULTS

The prevalence of neuromeningeal cryptococcosis was 1.8% (61/5129). A decrease in the prevalence was observed from 2002 to 2010 (3.1%, to 0.2%). This decrease occurred even though the number of patients treated with antiretroviral drugs increase. Headaches were the predominant clinical signs (81.9%). The CD4 median count was 56/mm(3). All patients were successfully treated with fluconazole in relay to amphotericin B intravenous. Lethality rate is 27.8%.

CONCLUSION

The overall prevalence of 1.8% of neuromeningeal cryptococcosis observed in this study was lower than that in previous studies in the same laboratory in 2001. The arrival of antiretroviral drugs could have contributed to the decline in the prevalence of neuromeningeal cryptococcosis in this study.

[Cutaneous leishmaniasis due to Leishmania major involving the bone marrow in an AIDS patient in Burkina Faso]

BACKGROUND

Leishmaniasis covers three well-individualized clinical variants, each due to individual species found in different geographic areas. Herein we report the first case of cutaneous leishmaniasis due to Leishmania major involving bone marrow in an AIDS patient in Burkina Faso.

CASE REPORT

A 38-year-old HIV-positive man presented with generalized, copper-coloured, painless, infiltrated, itching, papulonodular lesions present over the previous 10 months. Skin biopsy confirmed the diagnosis of diffuse cutaneous leishmaniasis. The bone-marrow smear showed numerous leishmania. The culture was positive and L. major was identified. The patient was being treated with antiretroviral medication and a pentavalent antimonial compound. The disease progression consisted of attacks and remissions separated by an average of three weeks.

DISCUSSION

L. major is the Leishmania species identified in Burkina Faso. It is responsible for typical cutaneous leishmaniasis but particular clinical forms have been described in immunodeficient patients, especially with diffuse cutaneous involvement. The spread of L. major infection to bone marrow could represent a public health problem in our country, where the HIV epidemic is still not under control, and particular vigilance is thus called for.

[Conidiobolomycosis, a rare fungal tumor: a case report in Ouagadougou, Burkina Faso]

Conidiobolomycosis is a deep, rare mycosis, due to Conidiobolus coronatus which is a saprophyte of vegetation in decomposition. We report one case in Burkina Faso. A 17 years old man, shepherd, consulted for tumefactions on the face. It could date back insidiously to a traumatism, one year before. A month later some painless tumefactions appeared on the cheekbone, the right eyelid, the nose with epistaxis. The upper lip then the lower one had swollen. Dermatological exam revealed multiple, painless, hard, sub-cutaneous swellings, affecting the cheekbone, the eyelids, the root and the ala of the nose. This tumefaction sometimes adhered to underlying tissues and to the overlying skin, sometimes mobile; painless and hard swelling of the two lips was also noted. ENT exam showed an inflammation of the nasal mucous without ulceration and the permeability of the nasal tracts was subnormal. The cephalic tomodensitometry showed a thickness of the soft tissues of the lips and the nose with an infectious feature associated to a pansinusitis without bone lesion. Histology was in favour of conidiobolomycosis. The patient was treated with fluconazole and the swelling progressively disappeared. Conidiobolomycosis is a disease generally reported in some humid tropical countries. It begins in the nasal cavities leading then to a nasal obstruction. This case was singular by the fact it happened in a dry Sudano-Sahelian climate and by its clinical features.

[Disseminated subcutaneous cysticercosis: a report of six cases in Burkina Faso]

Cysticercosis is an infection resulting from the larval form of the pig tapeworm, Taenia solium. The subcutaneous localizations are frequent and can have serious consequences such as neurological attacks. We report six cases among whom five men and a woman, in order to point out the severity of the disease and its possible dissemination. The patients' age was ranging from 25 to 57 years old. Three of them had neurological complications as convulsions and headaches. The nodules were painful in one case. We recommend sanitary education to eradicate the affection and to sensitize patients in order to consult physicians at early stage.

[Cutaneous manifestations of arsenicisme in Burkina Faso: epidemiological and clinical features]

The main aetiology of human arsenic toxicity provide from natural geological source. The characteristic skin lesions of arsenic toxicity may be used as an indicator of high exposure. We have registered 45 cases. The age bracket was one to 70 years. We have registered 27 women (60%) and 18 men (40%). The cutaneous manifestations have been dominated by the palmo plantar hyperkeratosis and hyperpigmentations (77,8% each one). The urinary concentrations of arsenic were 13 microg/l to 212 microg/l; they were 69 to 101 microg/l in the drinking water localized in the golden area, however they were normal outside this area. The clinical features were similar with the description of the literature. Intoxication of drinking water is problem of public health and we recommend checking all the other golden areas to find some appropriate solutions.

[Herpes zoster and human imunodeficiency virus in the medical centers of Ouagadougou]

Herpes zoster is an acute posterior ganglio-radiculitis related to the reactivation of the chicken pox-herpes zoster virus remained quiescent in the neurons of the nerve-knots. It usually occurs at the subject after 60 years old. For young patient, it is closely related to the infection by the HIV. Our exploratory descriptive and analytical study was carried out from 1 October 2002 to 30 September 2003, in order to describe the epidemiological, clinical aspects of the herpes zoster in the medical formations of the town of Ouagadougou (Burkina Faso) and to determine the prevalence of the infection by the HIV in the patients. We have collected 118 patients who have a herpes zoster through 6500 consultants. There were 79 women and 39 men. The average age was 34.4 years. The age bracket from 20 to 40 years was the most touched. The blistered eruption was the first reason for consultation; the light with type of burn, intermittent pain prevailed. The lesions healed in one month but there were 28 ulcerated necrotic cases. Post zoster pains have been observed in 33 cases. The localizations were the members in 44 cases (37.29%), the head in 35 cases (29.66%) and the trunk in 40 cases (33.90%). We have observed a case with double localization of herpes zoster. On 65 patients tested for the HIV, 58 (89.2%) were infected. The age bracket from 20 to 40 was the most concerned. A case of corneal necrosis isolated, with blindness and another with an opposed, spasmodic and total hemi paresis were notified. Fourteen patients having an antecedent of herpes zoster were all infected by HIV. Since the pandemic infection by the HIV, the incidence of the herpes zoster increases within the young population. The high frequency of HIV infection among our patients (89.2%) showed that the herpes zoster is closely related to this disease.