Medecine tropicale : revue du Corps de sante colonial最新文献

Adult-onset Still's disease is a uncommon form of inflammatory rheumatism. It has rarely been reported in black Africa. The purpose of this report is to describe a case in a 49-year-old woman from Dakar, Senegal.

Leprosy elimination (<1/100 000) is almost reached all around the world, although, but disabled people are still a lot, and they need rehabilitation as soon as possible. The different lesions (neurological, dermatologic and joint) must be treated in order to protect from handicap. Physical rehabilitation medicine can help with a global and polyvalent coverage. Therapeutic education and reinsertion are an important part.

Background: Manifestations of sickle cell disease (SCD) are polymorphous from childhood to adulthood.

Objective: The purpose of this study was to assess outcomes of rehabilitation in the patients with SCD.

Method: This retrospective analytical descriptive study included 160 SCD patients rehabilitated from 1998 to 2006 at the National University Hospital in Cotonou, Benin.

Results: Mean patient was 31 years (range, 3 to 73 years). There was a female predominance (62.5%) with a sex ratio of 0.6. The type of SCD was HbAS in 53.1% of patients, HbSS in 21.3%, HbSC in 16.9%, and HbAC in 8.1%. The main clinical manifestations were classified as ischemic/infectious in 40% of patients, rheumatologic in 40%, and neurologic in 10%. Ischemic manifestations were observed in all patients with HbSS, HbSC, and HbAS while manifestations were preferentially neurological in patients with HbSS (p = 4,43.10(-3)) and rheumatologic in patients with HbAS (p<10(-3)). At the end of rehabilitation, persistent deficiencies, disabilities and limitations involved pain in 43.8% of patients, articular stiffness in 43.8%, muscular weakness in 46.9%, gait anomalies in 33.1%, amyotrophy in 21.2%, shortening of lower extremity in 16.9%, and tilting of the pelvis in 6.3%.

Conclusion: This study shows that SCD is a highly debilitating disease. Although rheumatologic manifestations are not specific to SCD, the other complications described including femoral head necrosis, osteomyelitis, and stroke have been extensively documented in the literature. If primary prevention is unfeasible, early multidisciplinary management appears to be the most effective approach to reducing SCD-related disability.

The epidemiological features and management practices associated with amputation in low-income countries, generally synonymous with the tropics, are different from those observed in Western countries. Unlike developed countries, amputation most frequently involves traumatic injury in young active people. However, Westernization of the lifestyle is leading to an increasing number of cases involving diabetes and atherosclerotic disease. In the developing world, leprosy and Buruli ulcer are still significant etiologic factors for amputation. In war-torn countries, use of antipersonnel landmines is another major cause of amputation with characteristic features. Management of amputees in the developing world is hindered by the lack of facilities for rehabilitation and prosthetic fitting. Many international organizations are supporting national programs to develop such facilities. In addition to being affordable, prosthetics and orthotics must be adapted to the living conditions of a mostly rural amputee population, i.e., heat, humidity, and farm work. The rehabilitation process must be part of a global handicap policy aimed at changing attitudes about disability and reintegrating amputees both socially and professionally.

Anthrax disease is an anthropozoonosis caused by Bacillus anthracis. It appears in three clinical forms: pulmonary, intestinal, and cutaneous. We report a case of pulmonary and cutaneous anthrax in a one-year-old Moroccan infant.

Negative pressure therapy (NPT) is widely used in developed countries where it a technique of choice in the management of wound healing on extremities. Because of the cost, the specific ressources necessary forNPT are scarce in austere environments. This report describes a simple, economical alternative technique using a "breathing bandage" that can be made from from widely used surgical products.

Purpose: The purpose of this article is to present a case of tuberculous arthritis of the knee and discuss the importance of early diagnosis and rehabilitatin in management outcome.

Case report: A 57-year-old Moroccan man with no medical history presented with a mass in the left knee associated with pain and fever. Analysis of aspirated fluid demonstrated sterile inflammatory liquid. Presumptive antibiotic therapy was ineffective. Diagnosis of tuberculous arthritis was made based on positive tuberculin skin test and interferon-release assays. Diagnosis was confirmed by arthroscopic biopsy. Physiotherapy allowed improvement in both function and analytical test findings.

Discussion: Tuberculous arthritis is rare occurring in only 2 to 5% of people with tuberculosis. It can be very destructive. Diagnosis is often delayed leading to joint pain, tissue damage, and functional disability (e.g. inability to walk). Since prompt treatment (antibiotics then physiotherapy) can limit complications, early diagnosis is necessary and often requires deep biopsy, except endemic zones. In the acute phase, immobilization of the extremity in a functional position is necessary. When inflammatory signs subside, physiotherapy can be undertaken in short but frequent sessions without excessive weight or resistance.

Conclusion: The functional outcome of tuberculous arthritis depends on early multidisciplinary care involving the rheumatologist, infectious disease specialist, orthopedic surgeon and attending physician.

The purpose of this prospective study is to describe a series of adult HIV-infected patients treated for peritoneal tuberculosis over a 36-month period in Lome, Togo. A total of 32 cases were included. Mean patient age was 38 years (range, 20 to 69). The M/F sex ratio was 0.52. Ascites with fever was observed in all cases. Ascitic fluid was exsudative in 10.6% of cases and lymphocytic in 93.7%. Peritoneal tuberculosis was isolated in 27 patients, associated with pleural involvement in 15.6 % of cases, hematological in 75% and hepatic in 21.9%. Patients responded poorly to therapy and prognosis was unfavorable with a mortality rate of 12.5%. HIV infection substantially alters the epidemiological, clinical and therapeutic profile of peritoneal tuberculosis.