[Conidiobolomycosis (rhinofacial entomophthoromycosis) in Gabon. About of one case]

Background

Entomophthoromycosis constitutes a nosological group of subcutaneous mycoses including conidiobolomycosis (rhinofacial form) and basidiobomomycosis (subcutaneous form involving the trunk and the limbs). Conidiobolomycosis is characterized by a progressive nasal and facial deformity giving, in the evolved forms, a "hippopotamus snout". The literature review finds a hundred cases, with a tropism for the humid tropical regions. Methods. We report the observation of a 25-year-old patient, living in the equatorial zone, in the south of Gabon in a humid forest area, presenting a swollen aspect of the face mainly involving the eyelids, the nose and the upper lips.

Results

The diagnosis of entomophthoromycosis was compatible with the histopathological and clinical aspects. The evolution was favorable in terms of facial aesthetics under itraconazole 300 mg/day for 2 months and corticosteroid therapy (bolus of methylprednisone 240 mg/day for 3 days relayed per os at a dose of 0.5 mg/kg/day, i.e. 30 mg/day) of prednisone), maintained for 3 months. The average nasal improvement could not be completed by surgery and the patient was lost to follow-up.

Conclusion

This second observation of conidiobolomycosis in Gabon in the same province makes Ngounié a privileged ecosystem for this affection.

Profil socio-démographique et économique des adultes drépanocytaires régulièrement suivis au Centre Hospitalier Universitaire de Libreville

La drépanocytose est une maladie génétique héréditaire de transmission autosomique récessive. L´organisation depuis septembre 2016 au Centre Hospitalier Universitaire de Libreville (CHUL), d´une consultation d´hématologie dédiée à l´adulte drépanocytaire, a été l´occasion de mener cette étude dont le but était de décrire le profil socio-démographique et économique des patients régulièrement suivis. Il s´agissait d´une étude rétrospective, descriptive et non comparative, qui s´est déroulée de septembre 2016 à juin 2019 inclus au service de Médecine Interne du CHUL. Les patients drépanocytaires homozygotes de 18 ans et plus, de tous les genres, suivis durant la période de l´étude, capable de répondre aux questions et qui avaient effectué au moins trois consultations d´hématologie ont été inclus. Un total de 88 patients répondait aux critères d´inclusion sur les 233 vus durant la période de l´étude. Les femmes étaient les plus nombreuses. Le sex ratio était de 0,5 et l’âge moyen de 30,4 ± 7,8 ans, 42% avaient un niveau d´étude supérieur, 88,6% avaient une assurance maladie qui permettait à 31,8% d´entre eux de se prendre en charge en plus de leurs revenus mensuels. La drépanocytose était un obstacle dans la vie quotidienne et professionnelle des patients qui trouvaient un soutien dans leur famille et chez leurs amis. Cette étude a permis de montrer que les patients drépanocytaires qui adhèrent au suivi sont intégrés dans la société. Ils ont pour la plupart un niveau d´instruction qui leur permet de comprendre leur maladie et une assurance santé qui constitue une aide pour leur prise en charge.

[Mixed connective tissue disease: prevalence and clinical characteristics in African black, study of 7 cases in Gabon and review of the literature]

The literature reports that mixed connective tissue disease seems more frequent in the black population and among Asians. This study aims to determine the prevalence of mixed connective tissue disease (MCTD) among connective tissue disorders and all rheumatologic pathologies in a hospital population in Gabon as well as to describe the clinical features of this disease. We conducted a retrospective study by reviewing the medical records of patients treated for mixed connective tissue disease (Kasukawa criteria) and other entities of connective tissue disorders (ACR criteria) in the Division of Rheumatology at the University Hospital in Libreville between January 2010 and December 2015. For each case of MCTD the parameters studied were articular and extra-articular manifestations, anti-U1RNP antibodies levels, patient's evolution. Over a period of 6 years, data were collected by medical records of 7 patients out of 6050 patients and 67 cases of connective tissue disorders, reflecting a prevalence of 0.11% and 10.44% respectively. the 7 patients were women (100%), with an average age of 39.5 years. Articular manifestations included: polyarthritis, myalgias, chubby fingers and Raynaud's phenomenon in 87.5%, 87.5%, 28.6% and 14% respectively. The 7 patients had high anti-U1RNP antibodies levels, ranging between 5 and 35N (N≤ 7 IU). A case of death due to pulmonary arterial hypertension (PAH) was certified. This is the largest case series of MCTD reported in Black Africa. The disease seems to be rare among the black Africans; the reason could be genetic. The demographic and clinical aspects appear similar to those in Caucasians, Asians and Blacks except for a low frequency of Raynaud?s phenomenon among Blacks.