Bulletin de la Societe de pathologie exotique最新文献

Three distinct noso-epidemiological cutaneous leishmaniasis (LC) entities coexist in Algeria: the so-called sporadic form of the North (LCN), the zoonotic form (LCZ) and the chronic form (LCC). The precise identification of the parasitic species involved in each of the forms makes it possible to specify the geographical distribution of each of the forms raised, to distinguish their clinical aspects, to guide the therapeutic behaviors and to adapt the control programs. Ninety-seven (97) human strains from 97 cases of LC were subjected to molecular characterization by PCR-ITS1 followed by sequencing of this inter-gene space. Our results confirm the endemicity of the three forms. The LCN, caused by L. infantum (17 isolates/97 i.e. 17.52%) is limited to the North of the country mainly (16 isolates/17). Its geographical distribution is superimposable to that of visceral leishmaniasis with an extension more and more reported in previously unaffected areas, such as the regions of Tlemcen and Oran in the West, Setif, Annaba and Collo in the East. The LCZ, due to L. major (70 strains/97 i.e. 72.16%), remains the dominant form in the arid and semi-arid zones (47 strains/70) with a progression towards the North (20/70 strains). Indeed, long confined to the Sahara, it shows a geographical extension outside its historic homes of Biskra and Abadla. This form is progressing dangerously towards the highlands and the steppe regions of the country. The most interesting fact was the identification of L. tropica for the first time in North-Central and North-West Algeria in Algerian patients who had never left the national territory. Out of the 10 strains of L. tropica identified, 8 belonged to patients of Syrian origin and 2 to Algerian patients. L. tropica was reported for the first time in 2008 in 6 patients living in Constantine (North-East Algeria) and in 2017, still in the North-East of the country, in Annaba. The observation of L. tropica in the North and Northeast center of the country, where L. infantum and L. major coexist, suggests changes in the epidemiology of cutaneous leishmaniasis in Algeria, which highlights the interest of more investigations to better understand the transmission cycle of the different entities.

This was a 50-year-old woman with a selling activity living in Lomé who came for a consultation in March 2016 for a facial flushing that had been going on for 2 months without pain or pruritus. On examination, there was a single, erythemato-squamous closet of the right hemiface. There was no infiltration of the right ear. There was moderate cutaneous heat compared to the left hemiface which was without any lesion. Examination of nails, hair, palms and plants was normal. There was no hypertrophy of the peripheral nerves (superficial cervical plexus, ulnar, median). The face was not fixed. Complementary examinations noted a normal blood count and negative HIV status. Histology performed on a biopsy fragment concluded tuberculoid leprosy. The patient was first put on WHO multidrug therapy during 6 months. But one month after stopping this treatment, the lesions resumed. She was referred to a multibacillary leprosy protocol during one year. She had been seen 4 months after stopping treatment, without recurrence. It is important not to ignore leprosy in case of atypical erythema of the face even in the absence of other evocative signs and to perform a biopsy to the slightest doubt.

The epidemiology of leishmaniasis is related with habitat and behavior of the sand fly vector. Each species of sand flies (Diptera: Psychodidae) has a specific characteristic of their sites for the development of their immatures. Information on natural breeding sites of phlebotomine sand flies is limited, due to the difficulty of isolation of immature from the soil. This study, realized from May 2014 to September 2014, aimed to determine the effect of properties of soil on behavior and abundance of sand flies in breeding habitat in Aichoun locality. Sand flies were collected using sticky papers (21 × 27.3 cm) coated with castor oil in four stations. The total of traps in each trapping campaign is 32. Soil samples were collected each month and they were extracted and tested. The different chemical parameters have been studied: electrical conductivity, equivalent humidity, total of calcareous, organic matter, assimilable phosphorus, and exchangeable potassium, pH, organic carbon. Statistical analysis was performed by principal component analysis (PCA). The dominant leishmaniasis vectors in Aichoun are Phlebotomus sergenti and Phlebotomus perniciosus. A total of 1685 sand flies were collected belonging to five species in the genera Phlebotomus and Sergentomyia, namely Ph. sergenti (84.62%), Ph. perniciosus (8.54%), Phlebotomus papatasi (6.17%), Phlebotomus longicuspis (0.35%) and Sergentomyia minuta (0.29%). The chemical tests of potential breeding sites of sand flies, determined for sixteen samples, showed a correlation between the abundance of sand flies (especially the ecological requirements of larval development of the three species incriminated in transmission of the disease of cutaneous leishmaniasis) and the chemical parameters studied. The results found in this work, realized for the first time in Morocco, will be of great contribution to the control program of sand flies vectors at local and national level and as an indicator for the determination of leishmaniasis risk areas as well as to establish effective control strategies.

We report the attitudes and practices of health care workers involved in the disclosure process to adolescents living with HIV (ALHIV) in a network including West and Central African French-speaking countries, and the experiences of young living with HIV (YLHIV). During a three-day workshop in Abidjan, Côte d'Ivoire, caregivers (doctors, psychologists, social workers) from 19 pediatric HIV treatment sites shared their practices and difficulties, and four YPLHIV their own disclosure experience. Thirty five participants from eight West/Central African countries (Benin, Burkina Faso, Ivory Coast, Cameroon, Mali, Democratic Republic of Congo, Senegal, Togo) contributed: 14 doctors, eight psychologists, six counselors, three social workers. The experience of the centers was variable, but the age at disclosure was late: 34% of 1296 adolescents between 10 and 12 years of age knew their status. The median age at disclosure was 13 years (range: 11-15 years). The practice of the disclosure was often complex, because of multiple factors (fear of the parents of the breaking of the secrecy, lack of communication between professionals). The individual disclosure was the main practice. Four centers practiced HIV disclosure in group sessions to facilitate mirror support, and one used peer-to-peer support. YPLHIV have advocated for an earlier disclosure, from 10 years. In West and Central Africa, the process of HIV disclosure remains complex for parents and caregivers, and occurs too late. The development of a good practice guideline for HIV disclosing adapted to socio-cultural contexts should help to improve this process.

Srongyloidiasis can sometimes be a source of diagnostic wandering in a patient with an autoimmune disease living in a tropical environment, despite systematic deworming with albendazole (400 mg/day/3 days), prior to the starting of a corticotherapy. We report an observation of a febrile gastroenteritis complicated by signs of intra and extracellular dehydration, in a 37-year-old lupus patient, including duodenal biopsies, and stool parasitology, which led to the diagnosis of strongyloidiasis effectively treated by ivermectin per os (two doses) of 200 micrograms/kg, once every 2 weeks apart), following failure of a first 5-days course of albendazole (400 mg/day).

The treatment of fungal mycetoma is essentially surgical. This carcinological-like surgery consists of amputation in case of bone involvement. The recurrences after amputation are rare and address the problem of the operative indication. We report 5 cases of recurrence of fungal black-grain mycetoma after amputation of leg or thigh. Case 1: a 52-year-old patient with a mycetoma of the knee evolving for 8 years. There is no history of surgery. A thigh amputation with ganglion dissection is performed. One year after the surgical procedure, the patient presents a recurrence on the amputation stump and on the lymph node dissection site. An indication of hip disarticulation is made and performed 17 months after amputation. Case 2: a 25-year-old patient who has a black-grain mycetoma of the foot with osteitis evolving since 10 years. A leg amputation was performed. The patient had a recurrence at the popliteal level at 15 months postoperatively. An indication of amputation of the thigh is posed and refused by the patient. Case 3: a30-year-old woman with black-grain mycetoma of the knee with bone involvement for more than 10 years. A thigh amputation was performed and at nine months postoperativeshe presented a recurrence in the amputation stump. She was lost of sight despite the decision of surgical revision. Case 4: a 43-year-old patient operated on his foot and leg mycetoma at least 5 timesbefore amputation in 2000. The recurrence occurred one year after amputation. 18 years after amputation, a new surgical procedure was difficult due to extension of the lesions in the pelvis. Case 5: a 50-year-old female patient operated in Mauritania in 2012 (thigh amputation for mycetoma of the knee). She presented a recurrence on the amputation stump in 2018. An indication of disarticulation of the hip was posed and refused by the patient. These recurrences were testified by to the persistence of grains on the preserved segment. They pose the problem of the level of amputation and therefore of preoperative planning. Good preoperative planning allows optimization of the surgical procedure and avoids certain recurrences.

We have studied the epidemiological and clinical profile of herpes zoster in patients consulting at different hospitals in Lomé (Togo). This is a retrospective study of the records of the patient consulting for herpes zoster in the dermatology departments of these hospitals from 2009 to 2018. Of the 20,548 patients seen in the different departments, 254 (1.2%) had herpes zoster. The mean age of the patients was 41.6 ± 16 years, and the sex-ratio (M/F) was 0.81. Thirty-one (12.24%) patients were known to be HIVpositive and 105 (41.33%) agreed to be tested for HIV after admission. Thirty-five (33.3%) of these 105 patients were found to be HIV positive. Factors associated with HIV infection in 136 patients with the known HIV status were as follows: history of herpes zoster (P < 0.01, compared with the seronegatives), hemorrhagic lesions (P < 0.001), multimetameric location (P < 0.0001), and involvement of the cephalic extremity (P < 0.0001). Post-herpetic pain was observed in 32 (12.6%) patients.

The objective of this study was to determine the factors associated with death in patients hospitalized for tetanus. This study collected prospectively over a twelve (12) month period, the epidemiological, clinical and evolutionary data, and proceeded to an analysis of the factors associated with the death of hospitalized patients. We collected 32 patients with tetanus, or 5% of the total number of hospitalized patients. The average age was 36 ± 14 years. The sex ratio was 15 (30/2). The iatrogenic entrance door was found in 5 (15%) patients. Respiratory complications were the most frequent, ie 9 cases (28%). The most commonly used treatment regimen (28 cases, 88%) was the combination of metronidazole, diazepam, and anti-tetanus serum with an average hospital stay of 23 days. A Dakar prognostic score greater than or equal to 3, the presence of complications and a hospital stay of less than or equal to 7 days were the main factors associated with the death. Tetanus remains common in Guinea with a high lethality rate. Improving immunization coverage is imperative.