Journal: Medecine et sante tropicales
Context. This study was conducted at the National Tuberculosis Center in Burkina Faso from October 2007 through May 2008. Objective. Our objective was to compare the diagnostic performance of three staining methods: Kinyoun, auramine O, and Ziehl-Neelsen. Methods. Ziehl-Neelsen staining served as the reference method to assess the diagnostic performance of Kinyoun and auramine O staining. In all, 616 sputum smears from 233 patients were read with each method to detect acid-fast bacilli. SPSS was used for data analysis. Results. The results of auramine O staining showed positive diagnoses in 15.9% of the samples; sensitivity was 100%, specificity 95.6%, and the positive and negative predictive values 75.7% and 100% respectively. Kinyoun staining produced a positive diagnosis rate of 12%, sensitivity of 96.4%, specificity of 99.5%, and positive and negative predictive values of 96.4% and 99.5%. Conclusion. Our study indicates that auramine O staining had a better sensitivity for detecting acid-fast bacilli than Kinyoun staining. Accordingly, the use of auramine O staining should increase the detection rate for pulmonary tuberculosis in Burkina Faso.
The authors report the results of parasitological analyses of stool samples in N'Djamena (Chad) since 1963 and in Garoua (North Cameroon) since 1990. The number of positive stool examinations has fallen, with a significant decline in helminthiases, although the level of protozoan infections has remained essentially the same.
Colonic ameboma is a rare inflammatory pseudo-tumor of the colon that can mimic cancer development. This case was located in the cecum and appeared malignant from a macroscopic view. Accordingly a right hemicolectomy was performed, followed by an end-to-side ileocolic anastomosis. The pathology study enabled us to correct the diagnosis and affirm its amebic origin.
Plasmodium knowlesi is typically found in macaques and has recently been recognized as the fifth Plasmodium species to cause malaria in humans. Several cases of P. knowlesi malaria have been reported in people in Southeast Asia. Most cases are simple but approximately one in 10 patients develops complications. The morphology of P. knowlesi parasites in human infections closely resembles that of Plasmodium malariae or Plasmodium falciparum, so a molecular method is the optimum diagnostic procedure. The treatment of choice for uncomplicated P. knowlesi malaria is oral chloroquine, whereas severe infection should be treated with intravenous quinine.
The dihydroartemisinin-piperaquine combination is an antimalarial agent newly available in Europe. It is an artemisinin-combined therapy (ACT) that has been used for more than 10 years in malaria-endemic areas and is recommended since 2010 by the WHO as a first-line treatment of uncomplicated Plasmodium falciparum malaria. In Europe, it has recently been authorized for the treatment of uncomplicated P. falciparum malaria in adults, children, and infants aged 6 months or older and weighing at least 5 kg. Its efficacy is similar to the combination of artemether and lumefantrine, and the regimen is easier. The tolerability profile is nearly the same as the other ACTs. Prolongation of the QT interval appears to be greater than with the artemether-lumefantrine combination in the first 48 hours of treatment, although no clinical consequences have been described. This side effect requires the use of electrocardiographic monitoring in some patients. A risk management plan has been set up by the manufacturer.
We evaluated the outcome of treatment of uterine synechiae (or adhesions, also known as Asherman syndrome) by cervical dilatation and sequential estrogen and progestogen administration for three months. This retrospective cohort study examined records of 86 women with infertility or menstrual disorders or both and treated from October 2004 to November 2011 for synechiae diagnosed by hysterosalpingography. The data analyzed included age, presenting complaint, and treatment outcome. During the study period, 86 women were seen for uterine synechiae but only 81 files could be included. The patients' mean age was 25.52 (range: 19-40 years), with 37% in the age group of 25-29 years. Of these 82 women, 71 reported menstrual disorders and 60 infertility. After treatment, 11/60 (18%) became pregnant and 35/71(49%) recovered normal menstrual profiles. The reference treatment for uterine synechiae is hysteroscopy, which yields good results. In poor settings, however, hysteroscopy remains inaccessible, and the old method of cervical dilation and sequential estrogen and progestogen therapy is an acceptable alternative.
The aim of this study was to describe the epidemiologic, clinical, and therapeutic profiles of cases of lichenoid dermatosis in Lomé, together with their outcomes. This retrospective descriptive study reviewed records of patients receiving care for lichenoid dermatosis from January 1997 to December 2016 in the dermatology departments of Lomé. In total, 959 (2.2%) cases of lichenoid dermatoses including 813 (84.8%) of lichen planus and 123 (12.8%) of lichen striatus were recorded. The mean age of the patients was 29.60 +/- 14 years and the sex ratio (M/F) was 0.7. Lichen planus was papular and found most often on the lower limbs (56.0%). Lichen striatus was banded along the lines of Blaschko, mainly on the lower limbs (55.3%). There were 23 patients with lichen nitidus lesions, most often on the trunk (47.8%). The treatment was based on corticosteroid therapy. Recurrences were noted in 40 (11.6%) cases of lichen planus and 4 (3.2%) of lichen striatus. This study shows that the principal lichenoid dermatoses in Lomé are lichen planus, and their management is based on corticosteroid treatment.
to assess : the frequency of emergencies among patients admitted to dermatology departments in Dakar, their most common causes, mortality rate, and the most frequent dermatoses. This one-year prospective study took place in the two reference departments for the treatment of dermatological diseases in Dakar. We have included all patients with a dermatological emergency, regardless of age and gender, as determined by the doctor receiving the patient. The data were entered in Excel and analyzed with R software, version 3.1.2. the study included 189 patients, 40 % of all dermatology department admissions. The sex ratio was 0.89 (M/F) and the average age 49 years. The mean time from arrival to treatment was 30 minutes. Absolute emergencies accounted for 45.4 % of these emergencies, and relative emergencies 54.6 %. Absolute emergencies were dominated by severe drug eruptions (17 %) and relative emergencies by infectious dermatoses (38 %). Emergency measures were carried out in all cases, associated with etiological treatment. The mortality rate was 7 % (n=14), and 5 (36 %) of these deaths were due to severe drug eruptions. Infectious dermatoses and severe drug eruptions are the most frequent emergencies. The high mortality rate, related mostly to drug eruptions, indicates the need for early management and an adequate technical platform.
The aim of this study was to document the profile and causes of chronic leg ulcers (CLU) in patients hospitalized in Lomé, Togo. This retrospective study reviewed records from the dermatology departments (CHU Sylvanus Olympio and Campus, and the dermatology center of Gbossimé) from 2000 to 2017 and from the general surgery department of CHU Sylvanus Olympio from 2013 to 2017 to identify cases. In all, 125 cases of CLU were identified during the study period. The patients' mean age was 56.6 years and the sex ratio (M/F) was 0.89. The average time from CLU onset to consultation was 10.9 weeks (range : 7 weeks to 4 years). They were mainly associated with a history of diabetes (32 cases), arterial hypertension (16 cases), varicose veins (14 cases), and malnutrition (14 cases). The main causes were : ulcers of infectious origin in 49.6% of cases (including 38 with phagedenic ulcers), ulcers of vascular origin in 36% (including 21 cases with a venous ulcer) and diabetic ulcers in 8.8% of cases. The ulcer was unilateral in 122 patients (67 on the right and 55 on the left) and bilateral in 3 patients. The locations were the foot in 56 cases, the leg in 37 cases, and leg and foot in 32 cases. In addition to dressings, surgical debridement was performed in 23 patients, followed by skin autografts for 16. Amputation was performed for 31 patients. Sixteen (12.8%) of the 125 patients died. Our study observed a high rate of phagedenic ulcers among CLU in Togo. It also pointed to a problem explaining the very high mortality rate: delayed consultation by patients who arrive only after the onset of complications.
A 2-year-old child was accompanied by his parents to the pediatric emergency room for refusal to eat, trismus and generalized contractures four days after the application of a traditional topical treatment (Cassava leaves) on lesions of a severe thermal burn. A temperature of 38̊C, a heart rate of 114 beats/min, and a blood pressure of 90/60 mm Hg were recorded. The tetanus vaccination was not up to date. The diagnosis of tetanus was immediately suggested. Antitetanus serum (immunoglobulin), an antibiotic (amoxicillin and clavulanic acid), and a myorelaxant (benzodiazepine) were administered. Local treatments were also performed. The child died within 24 hours.