[Leprosy. Developmental modalities]

The very broad clinical spectrum of the Mycobacterium leprae infection is due to the diversity of the underlying immunological and genetic factors. The evolutive modalities of leprosy are mainly determined by a dual pathogenesis: An infectious disease due to a bacillus of low virulence which, even when dead, persists in the body for several years, independently of the antibiotic therapy prescribed. A dysimmune disease maintained by a chronic discharge of antigens. Neuropathies and leprous reactions are still the most troublesome episodes in the course of the disease. They constitute the principal prognostic factor in both pauci- and multibacillary forms of leprosy.

[Human immunodeficiency virus (HIV) infection in Mali]

This review summarises epidemiological and clinical data of HIV infection who was recognized in Mali since 1985. The most important rate of seropositivity for HIV is observed in the prostitutes group (40%). The estimated seroprevalence for adult population is between 1% and 5%. 46 cases for AIDS are reported in both sexes. The mean age is 35 years. Main signs are weight loss (91%), fever (80%), diarrhea (70%) and lymphadenopathy (50%). Three among the five cases of Kaposi's sarcoma are aggressive. 19.5% of AIDS have antibodies to HIV1, 41.3% to HIV2 and 39.1% to HIV1 and HIV2. Death rate is more than 50%. These data are compared with other countries of Africa.

The incubation time of relapses after treatment of multibacillary leprosy with rifampicin containing regimens

In order to determine the duration of follow-up needed to evaluate the efficacy of short-course bactericidal regimens for multibacillary leprosy, information is needed on the incubation time of relapses after stopping treatment. Several groups of patients, who had been on rifampicin-containing regimens, were followed up for periods ranging from 4 to 10 years. Two groups of relapses were observed: early relapses occurring within 3.5 years after stopping treatment, with a median incubation time of 1 year and 10 months (upper limit of 95% confidence interval: 2 years); and late relapses occurring more than 3.5 years after stopping treatment, with a median incubation of 5 years. Early relapses are probably due to insufficient treatment, and late relapses to persisting bacilli or to reinfection. It is concluded that the efficacy of short-course RMP-containing therapeutic regimens can be evaluated by observing the occurrence of early relapses, 50% of which occur before 2 years after the end of therapy.

Facies leprosa: resorption of maxillary anterior alveolar bone and the anterior nasal spine in patients with lepromatous leprosy in Mali

Resorption of the anterior nasal spine and alveolar bone in the anterior maxilla was measured in 39 patients with lepromatous leprosy in Mali. Bone resorption occurred in both of these sites, but resorption in one did not predict resorption in the other. These data are interpreted to mean that resorptions of bone anterior (nasal spine) or inferior (alveolar bone) to bacillary populations in the nasal mucosa of patients with lepromatous disease in Mali occur independently.

[The role of personnel training in planning an anti-leprosy program]

The training of wealth officers is an essentiel component for Leprosy control. The West Africa States included in OCCGE provide training of specialized officers called "Specialistes-lèpre" and "Contrôleurs-lèpre", however multidrug therapy setting up and above all, health services integration induce a new concept in training objectives. In this perspective the OCCGE specialized institutions propose theoretical and practical training, based on multidrug therapy (MDT) setting-up, intended for medical or paramedical officers, specialized or non-specialized.