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ABSTRACT: Nous décrivons un cas exceptionnel de volumineux aspergillome développé au sein d’une bronchectasie par traction d’une fibrose
pulmonaire secondaire à une sclérodermie systémique avec atteinte multiviscérale. C’est une femme de 58 ans, sans antécédent
de tuberculose pulmonaire, présentant une altération de l’état général associée à une hémoptysie récidivante, à une dyspnée,
à une dysphagie, à une sclérodactylie, à une sclérose cutanée généralisée et à un phénomène de Raynaud. La malade avait une
hypertension artérielle pulmonaire (HTAP) au stade de coeur pulmonaire chronique en décompensation cardiaque droite. La sérologie
aspergillaire était positive et le bilan immunologique confirmait la sclérodermie. La tomodensitométrie (TDM) thoracique montrait
une volumineuse opacité oblongue en grelot du lobe supérieur gauche, développée au sein d’une bronchectasie par traction,
et des aspects de fibrose pulmonaire bilatérale. Même si la chirurgie reste le traitement de référence d’un aspergillome,
la prise en charge de notre malade était avant tout médicale devant les contre-indications opératoires. L’évolution était
marquée par des épisodes d’hémoptysies récidivantes et de la stabilité des lésions pulmonaires après un recul de deux ans.
La prise en charge de cette entité reste difficile et compliquée, et le pronostic qui est en général défavorable dépend à
la fois de l’évolution de la sclérodermie et de l’infection aspergillaire.
We report a rare case of a huge aspergilloma developed within a bronchiectasis due to pulling by a pulmonary fibrosis of systemic
scleroderma. The patient is a 58-year-old woman presenting a deterioration of the general state associated with repeating
hemoptysis, dyspnea, dysphagia, sclérodactylia, generalized cutaneous sclerosis and Raynaud’s phenomenon. There was no antecedent
pulmonary tuberculosis. The patient had a pulmonary arterial hypertension complicated by a chronic pulmonary heart at the
stage of right cardiac decompensation. Aspergillosis serology was positive and the immunological assessment confirmed scleroderma.
The computed tomography showed a huge oblong opacity in a small round bell shape (“signe du grelot”, Monad’s sign) in the
left upper lobe developed within a bronchiectasis, and a bilateral pulmonary fibrosis. Although surgery remains the recommended
treatment of an aspergilloma, the management of our patient was medical in front of contra-indication for surgery. The evolution
was marked by repeating hemoptysis and stability of the pulmonary lesions 2 years later. The management of this entity remains
difficult and complicated; the prognosis is in general unfavourable and depends at the same time on the evolution of scleroderma
and the aspergilloma infection.
Mots clésAspergillus–Aspergillome pulmonaire–Sclérodermie systémique–Fibrose pulmonaire–Bronchectasie–Hôpital–Antananarivo–Madagascar–Océan Indien
KeywordsAspergillus–Pulmonary aspergilloma–Systemic scleroderma–Pulmonary fibrosis–Bronchiectasis–Hospital–Antananarivo–Madagascar–Indian Ocean
Bulletin de la Société de pathologie exotique 04/2012; 104(5):325-328.
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ABSTRACT: L’histoplasmose africaine est une maladie rare, mais non exceptionnelle, récemment découverte à Madagascar. Nous décrivons,
ici, le cinquième cas malgache touchant la peau et les nodules chez un patient immunocompétent. La prise en charge de l’histoplasmose
africaine se heurte à de nombreux problèmes concernant la disponibilité de l’amphotéricine B et le coût des tests biochimiques
pour éviter les principaux effets indésirables en cas d’échec du traitement antimycotique oral.
African histoplasmosis is a rare but not an exceptional condition and recently discovered in Madagascar. We report the fifth
Malagasy case involving skin and nodes in an immunocompetent patient. Management of African histoplasmosis encountered many
problems because of the availability of amphotericin B and cost of the biochemical tests in order to prevent major side effects
in case of failure of oral antimycotic drug.
Mots clésHistoplasmose-
Histoplasma capsulatum var. duboisii
-Immunocompétence-Itraconazole-Amphotéricine B-Hôpital-Madagascar
KeywordsHistoplasmosis-
Histoplasma capsulatum var. duboisii
-Immunocompetency-Itraconazole-Amphotericin B-Hospital-Madagascar
Bulletin de la Société de pathologie exotique 04/2012; 103(1):19-21.
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ABSTRACT: Streptococcus milleri meningitis is relatively rare. Sinusitis complicated by isolated superior ophthalmic vein thrombophlebitis is rare. We report a case of infection caused by S. milleri involving meningitis and sphenoid sinusitis complicated by right superior ophthalmic vein thrombophlebitis controlateral. S. milleri is responsible for a serious infection, even for an unusual location.
Revue Médicale de Madagascar. 04/2012; 2(1):117-119.
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J L Rakotoson,
H M D Vololontiana,
R E Raherison,
R L Andrianasolo,
J R Rakotomizao,
H Rakotoharivelo,
J Rajaoarifetra, M J D Randria,
R F Rapelanoro,
A C F Andrianarisoa,
H R Rajaona
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ABSTRACT: In pulmonary aspergilloma, Aspergillus colonizes and proliferates as a saprophyte in deterged cavities deprived of local defense. Although pulmonary tuberculosis constitutes the one well-know predisposing factor, other causes can create favorable conditions. We describe a first published case of a huge aspergilloma which developed within a zone of pulmonary fibrosis secondary to systemic scleroderma. The patient was a 58-year-old woman in poor general health who experienced repeated episodes of hemoptysis and dyspnea. Physical examination disclosed sclerodactyly, generalized cutaneous sclerosis and Raynaud's phenomenon. There was no clinical history of pulmonary tuberculosis or bronchectasis. Aspergillosis serology was positive. Broncho-alveolar liquid was positive for Aspergillus fumigatus at direct examination and after culture. Immunological assessment confirmed scleroderma. The chest computed tomography scan showed a huge oblong-shaped opacity in the upper left lobe which had developed within a zone of pulmonary fibrosis. Medical management was instituted. The clinical course was marked by repeating hemoptysis and the stability of pulmonary lesions after two years. Management of scleroderma-related pulmonary aspergiloma remains difficult and complicated. Prognosis depends on the course of both conditions, scleroderma and aspergillosis.
Revue de Pneumologie Clinique 02/2012; 68(1):31-5. · 0.24 Impact Factor
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ABSTRACT: Post-malaria neurological syndrome is a rare complication of malaria. Typically, it occurs in case of severe malaria. Here we report a case in a Malagasy patient presenting a non-severe Plasmodium falciparum malaria complicated by post-malaria neurological syndrome. The management of such a syndrome is radically different from non-severe malaria. No specific treatment is needed.
Bulletin de la Société de pathologie exotique 01/2012; 105(3):199-201.
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ABSTRACT: We report a rare case of a huge aspergilloma developed within a bronchiectasis due to pulling by a pulmonary fibrosis of systemic scleroderma. The patient is a 58-year-old woman presenting a deterioration of the general state associated with repeating hemoptysis, dyspnea, dysphagia, sclérodactylia, generalized cutaneous sclerosis and Raynaud's phenomenon. There was no antecedent pulmonary tuberculosis. The patient had a pulmonary arterial hypertension complicated by a chronic pulmonary heart at the stage of right cardiac decompensation. Aspergillosis serology was positive and the immunological assessment confirmed scleroderma. The computed tomography showed a huge oblong opacity in a small round bell shape ("signe du grelot", Monad's sign) in the left upper lobe developed within a bronchiectasis, and a bilateral pulmonary fibrosis. Although surgery remains the recommended treatment of an aspergilloma, the management of our patient was medical in front of contra-indication for surgery. The evolution was marked by repeating hemoptysis and stability of the pulmonary lesions 2 years later. The management of this entity remains difficult and complicated; the prognosis is in general unfavourable and depends at the same time on the evolution of scleroderma and the aspergilloma infection.
Bulletin de la Société de pathologie exotique 06/2011; 104(5):325-8.
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ABSTRACT: The authors describe clinical and epidemiologic characteristics of severe presentations of Rift valley fever (RVF) during the 2008 epidemic in Madagascar.
The diagnosis was confirmed by RVF virus polymerase chain reaction (PCR), or detection of specifics antibodies by Elisa.
Sixteen cases of severe RVF were recorded. The sex-ratio was 7/1 and median age was 32 years (20/59 years). The risk factors of infection were: contact with infected animals or their meat (n=8), and travelling to a risk area (n=2). Hemorrhagic, neurological, and ocular manifestations were observed respectively in 87.5%, 43.8% and 6.3% of cases. All patients who died (n=4) presented with a hemorrhagic form of the disease.
The hemorrhagic form was the most frequent presentation of RVF and was responsible for a high level of mortality. Epidemiologic surveillance must be implemented.
Médecine et Maladies Infectieuses 02/2011; 41(6):318-21. · 0.72 Impact Factor
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ABSTRACT: The objective of our study was to describe the discrimination profile of healthcare personnel towards people living with HIV/AIDS (PLWHA) in medical settings in Madagascar.
A prospective, multicentric, descriptive, and analytic study was made with a questionnaire filled in anonymously, between February and August 2009, in 17 Madagascar hospitals (public and private).
Thirty-six percent of PLWHA reported that they had been confronted with discrimination in the medical field. The age (30-40 years) and the level of education had an impact on discrimination in our study (p<0.05). Paramedics were the most responsible for discrimination (n=8/13) (61.5 %). Discrimination in the medical field was listed as: refusal of the patient to be managed in the hospital (n=5/27) (18.5 %) because of the fear of discrimination (n=4/5) (80 %) and sharing serological status with healthcare providers. Discrimination by the medical staff was listed as the unjustified use of some tools (stethoscope, tensiometer, thermometer) and by the refusal to manage PLWHA (p>0.05). Fifty-three percent of healthcare providers answered the question on HIV transmission mode correctly. Fifteen percent replied that HIV was transmitted by saliva, and 20 % by physical contact.
As elsewhere, discrimination of PLWHA in the medical field is present in Madagascar. Fighting discrimination should be included in the strategy against propagation of HIV infection.
Médecine et Maladies Infectieuses 01/2011; 41(1):2-6. · 0.72 Impact Factor
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ABSTRACT: African histoplasmosis is a rare but not an exceptional condition and recently discovered in Madagascar. We report the fifth Malagasy case involving skin and nodes in an immunocompetent patient. Management of African histoplasmosis encountered many problems because of the availability of amphotericin B and cost of the biochemical tests in order to prevent major side effects in case of failure of oral antimycotic drug.
Bulletin de la Société de pathologie exotique 02/2010; 103(1):19-21.
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ABSTRACT: Diagnosis of malaria cases depends on parasitological examination. Since 2006, the Department of Infectious Diseases at the Joseph Raseta Befelatanana University Hospital in Madagascar has been using the malaria rapid diagnostic test. The percentage of malaria cases (presumed or confirmed) in relation to the number of hospitalized patients has decreased. It was 23.4% in 2003, 10.3% in 2006 and 4.3% in 2008 (p<0.01532). To improve management of malaria cases and rationalize use of antimalarial agents, diagnosis should be confirmed by rapid diagnostic tests.
Médecine tropicale: revue du Corps de santé colonial 02/2010; 70(1):103-4.
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ABSTRACT: Few data are available about severe malaria in Madagascar. Our aims were to describe epidemiological, clinical and therapeutic aspects of severe malaria in patients in Antananarivo. We conducted a retrospective study from 1 March 2006 to 31 March 2008 at the infectious disease department. We recorded 61 cases of severe malaria among 1,803 in patients. Sex ratio was 2 and average age was 35.3 years old. Three pregnant women were recorded among women (15.8%). Self-medication was registered in 23%. Among 35 patients who received first medical care, no one had parasitological examination. The treatment was inadequate for all patients (n = 19). Conscience impairment (65.6%), jaundice (24.6%), seizure (18%) and prostration (14.8%) were the major severe signs. Diagnosis was made 6.54 days after the onset of the disease. Mortality rate was 11.5%. Self-medication, inappropriate primary care and delayed diagnosis represented risk factors for severe malaria in our cohort.
Bulletin de la Société de pathologie exotique 10/2009; 102(4):215-6.
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ABSTRACT: Helicobacter pylori is a worldwide infection. However very few data are actually available on H. pylori seroprevalence in the Malagasy population. We carried out a transversal study in a sample of persons who met the following criteria: older than 15 years old, presence in the medicine internal unit 2 (University Hospital Center of Antananarivo) during the period of the study whatever the reason. H. pylori infection was identified serologically by using ELISA (G.A.P IgG H. pylori ELISA, Bio-Rad, France). Several factors were evaluated including serological status, demographic information, the reason of the presence in the unit, factors influencing H. pylori infection: socio-economic status, siblings, promiscuity consumption of alcohol, use of tobacco, water source and history of gastroscopy. The presence of clinical symptoms, such as dyspepsia and abdominal pain, was determined. Forty-five men and 45 women were included (mean age: 41.8 +/- 3.4 years). The seroprevalence of H. pylori infection was 82%. H. pylori infection was higher in men than in women (p < 0.02). Promiscuity constituted the principal factor influencing H. pylori infection. The seroprevalence of the H. pylori infection appears to be comparable to the rate encountered in developing countries. Considering this high rate of the H. pylori infection, eradication of H. pylori should be commonly recommended when facing gastrointestinal pathologies potentially induced by H. pylori.
Bulletin de la Société de pathologie exotique 02/2007; 100(1):57-60.
