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B Saka,
D E Landoh,
B Kobara,
K E Djadou,
I Yaya,
K B Yékplé,
E Piten,
A Balaka, S Akakpo,
K Kombaté,
A Mouhari-Toure,
K Kanassoua,
P Pitché
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ABSTRACT: The purpose of this study was to describe the epidemiological, clinical, therapeutic profile and the outcome of Buruli ulcer (BU) in the National Reference Center for Buruli ulcer treatment (NRCBUT) in Togo. It was a retrospective and descriptive study of records of patients treated for BU in the NRCBUT between June 2007 and December 2010. During the study period, 119 patients (56.3% males) were treated in the NRCBUT for BU. The median age of patients was 14 years. The proportion of children (< 15 years) was 56.3%. On admission, 85 patients were at ulcer stage and 34 patients at the pre-ulcer stage. BU wounds were mainly located on lower limbs (50.4%), followed by upper limbs (32.6%) and trunk (13.3%). The location of the wounds on the lower limbs were more frequent in patients older than 15 years (P < 0.001), while those on the upper limbs (P = 0.002) and trunk (P = 0.03) were more frequent in patients aged less than 15 years. All patients had received medical treatment which was based on rifampicin-streptomycin combination for eight weeks. This treatment was coupled to surgery in 30 cases. The outcome was punctuated by complications in 7 patients, limb amputation in 3 patients, and sequels in 10 patients. This study confirmed that the BU is the prerogative of young subjects and the exposed areas in the skin facilitates transmission. Apart from these classic features, some unique aspects including the age-dependent distribution are related to the pathogenesis of this disease.
Bulletin de la Société de pathologie exotique 08/2012;
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ABSTRACT: This general review of the biomedical literature indexed on Medline (PubMed) and Pascal (INIST) over the past 40 years (1970-2010), supplemented by some unindexed studies, found 89 articles published about basidiobolomycosis. These case reports (n = 67) and series (n = 22) described 172 cases of basidiobolomycosis (84 in Asia, 47 in tropical Africa, 25 in North America, 12 in South America, two in Europe and two in Australia). Patients younger than 15 tears accounted for 70%, and the sex-ratio (M/F) was 2.1. Clinically, basidiobolomycosis results in firm subcutaneous plaques, sharply circumscribed, generally cold and painless, becoming hot and painful during flares. It can cause invasive disease of the gastrointestinal tract or lungs and can even be disseminated throughout the body. The main treatments are potassium iodide, trimethoprim-sulfamethoxazole, and the azole derivatives. The latter are very effective and well tolerated, unlike the former, which present a risk of recurrence or severe side effects.
Medecine et sante tropicales. 08/2012;
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Annales de Dermatologie et de Vénéréologie 08/2012; 139(8-9):564-6. · 0.72 Impact Factor
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ABSTRACT: The aim of this study was to determine the frequency and list of drugs responsible for fixed drug eruption (FDE) in Lomé (Togo). A descriptive retrospective study of patients with FDE treated from January 2006 to November 2011 in dermatology service at the teaching hospital of Lomé (Togo) was conducted. During the study period, 321 cases of FDE were reported among 472 cases of toxidermia observed. Mean age of the patients was 31.27 ± 14.01 years and sex-ratio (M/F) was 1.01. One hundred thirty-three (41.4%) of 321 patients had a previous FDE, against 58.6% who were in their first attack. The most common form was the hyperpigmented form (247 cases/321). The main locations of the lesions were the trunk (N = 127) followed by the lower limbs (N = 85), the upper limbs (N = 81) and external genital organs (N = 53). A drug was incriminated in 163 (50.8%) of the 321 patients, in whom 109 patients took their drug by self-medication. Antibacterial sulfonamides were the first drug involved (70.5%), followed by nonsteroidal anti-inflammatory drugs (9.8%), antimalarial drugs (7.4%) and antibiotics (3.7%). All patients received a banned drug. In addition, 111 patients were treated with antihistamines, 69 with corticosteroids, and 58 with topical antiseptics. During follow-up, 42 of 321 patients have been seen; all had a favorable outcome. Our study confirms the frequency of FDE and the role of antibacterial sulfonamides as the cause of FDE in Africa and documents the effects of self-medication in toxidermia in Togo.
Bulletin de la Société de pathologie exotique 06/2012;
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Annales de Dermatologie et de Vénéréologie 06/2012; 139(6-7):486-7. · 0.72 Impact Factor
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ABSTRACT: La basidiobolomycose est une mycose profonde qui atteint préférentiellement les jeunes ruraux en zone tropicale. Nous rapportons
un cas de basidiobolomycose traité avec succès par du kétoconazole. Il s’agissait d’un garçon de 9 ans d’origine rurale chez
qui le diagnostic de basidiobolomycose était évoqué devant un placard infiltré de l’hémithorax droit et de la face latérale
droite du cou. L’histologie mettait en évidence une inflammation granulomateuse de siège dermohypodermique à prédominance
de macrophages et de polynucléaires éosinophiles. L’enfant était traité avec succès par du kétoconazole en huit semaines.
Le traitement de la basidiobolomycose est basé sur les dérivés azolés qui sont très efficaces. L’histologie occupe une place
importante dans le diagnostic de cette affection, surtout en zone tropicale où elle peut simuler une infection à Mycobacterium ulcerans.
Basidiobolomycosis is a deep mycosis which preferentially affects rural young people in tropical countries. We report a case
of basidiobolomycosis successfully treated with ketoconazole. It was a 9-year-old boy of rural origin in whom the diagnosis
of basidiobolomycosis was suspected due to a deep skin infiltration involving the chest and neck. Histology revealed hypodermic
granulomatous inflammation with predominantly macrophage and eosinophils. The child was treated successfully with ketoconazole
in eight weeks. Treatment of basidiobolomycosis is based on azole derivatives which are particularly effective. Histopathology
is very important in the diagnosis of this affection, especially in tropical countries where it may simulate Mycobacterium ulcerans infection.
Mots clésBasidiobolomycose–Kétoconazole–Enfant–Hôpital–Lomé–Togo–Afrique intertropicale
KeywordsBasidiobolomycosis–Ketoconazole–Child–Hospital–Lomé–Togo–Sub-Saharan Africa
Bulletin de la Société de pathologie exotique 04/2012; 103(5):293-295.
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ABSTRACT: The aim of this study was to evaluate trends in sexually transmitted infections (STI) in Togo.
This retrospective descriptive study included all STI cases reported from 2005 through 2009.
During the study period, 241,561 STI cases were recorded in the six health regions of Togo, for an annual frequency of 48,312 cases. The mean age of patients was 27.4 ± 12.6 years, and those aged from 20 to 30 years accounted for 55.4% of all cases. The sex ratio (male/female) was 0.3. The most common STI syndrome was vaginal discharge (57.2%), followed by pelvic inflammatory disease (24%), urethral discharge (12.1%), and genital ulcer disease (5%). During the study period, the proportion of cases involving urethral discharge increased significantly, rising from 4.2‰ in 2005 to 4.5‰ in 2009 (p = 0.02), while the proportion involving genital ulcer disease remained stable (1.6‰ in 2005 and 2009). The proportion of cases involving vaginal discharge and pelvic inflammatory disease decreased significantly.
Overall, this study shows that the number of STI cases reported by health facilities in Togo was stable from 2005 to 2009. Continued epidemiological surveillance is important to document STI trends as part of the HIV control program.
Médecine et santé tropicales. 02/2012; 22(1):50-3.
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ABSTRACT: In order to determine the rate and the different causes of mortality associated with HIV/AIDS in health-care facilities we conducted a prospective study between 1 April and 30 September 2010 in the six health regions of Togo. We rationalized the choice of the healthcare facilities in order to cover the entire national territory. During the study period, 24,054 patients were hospitalized. HIV serology was positive in 1065 (18.2%) of the 5865 tested patients. Of the 24,054 patients, we recorded 2551 deaths (10.6%), including 309 HIV-infected patients (5.2%). The mortality rate associated with HIV/AIDS was 1.3% of the total number of inpatients and 5.3% of the number of patients tested for HIV. The mortality rate among HIV-infected patients was 29%. The causes of death in patients infected with HIV/AIDS were mainly anaemia and cerebral toxoplasmosis. This study shows that mortality associated with HIV/AIDS in health-care facilities in Togo remains relatively high.
Tropical Doctor 09/2011; 41(4):215-7. · 0.66 Impact Factor
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Annales de Dermatologie et de Vénéréologie 05/2011; 138(5):453-5. · 0.72 Impact Factor
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ABSTRACT: The purpose of this retrospective study was to obtain data on the epidemiology, clinical features, and outcome of bacterial dermohypodermitis (BDH) observed in a hospital setting hospital in Lomé, Togo. Cases of BDH treated in dermatology and internal medicine of the Lomé university hospital center from January 1999 to December 2009 were reviewed. A total of 104 patients were hospitalized for BDH during the study period. Mean patient age was 42.9 +/- 16.1 years and sex ratio (M/F) was 0.89. Infection by HIV was detected in 10 of 37 patients in whom serology was performed. The site of erysipelas was located on the legs and feet in 93 cases (89.4%), entire lower limb in 4 (3.9%), upper limbs in 4 (3.9%), thighs in 2 (1.9%), and buttock in 1 (0.9%). The main local and systemic risk factors were existence of an entry site in 89 cases, use of depigmenting drugs in 11, HIV infection in 10, previous history of erysipelas in 9 cases, and lymphoedema in 8. First-line treatment used penicillin G in 90 cases. Seven patients presented necrotizing fasciitis. Necrotizing fasciitis was associated with HIV infection in 2 cases, use of non-steroidal anti-inflammatory drugs (NSAID) in 2, and use of depigmenting drugs in one. Two deaths were recorded in the necrotizing fasciitis group including one HIV-infected patient. Recurrence was observed in 8 patients and secondary complications such as lower limb elephantiasis occurred in 7 patients.
Médecine tropicale: revue du Corps de santé colonial 04/2011; 71(2):162-4.
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ABSTRACT: To determine the prevalence of methicillin-resistant Staphylococcus aureus in community-acquired skin infections in Lomé, Togo.
A prospective study including 90 cases of skin infection observed in dermatological outpatients at the teaching Hospital of Lomé was carried out from 1st June 2003 to 30th May 2005. A bacteriological sample with antibiograms was obtained from all patients.
Mean patient age was 21 years (extremes, 6 months to 78 years). The male-to- female ratio was 0.84. Infection was primary in 80% of cases including impetigo in 42.2%, follicular infection in 28.9%, and abscess in 8.9% and secondary in 20% of cases including eczema in 8.9%, mycosis in 3.3%, and other in 7.8%. Staphylococcus aureus strains were isolated in a total of 84 cases (93.3%). Staphylococcus aureus occurred alone in 79 cases (87.8%) or in association with other bacteria in 5. A total of 30 of the 84 Staphylococcus aureus strains (35.7%) isolated were methicillin-resistant. Resistant strains were associated with primary infection in 24 cases and secondary infection in 6. CONCLUSION. Staphylococcus aureus is the most common cause of community-acquired skin infections in Lomé. One third of Staphylococcus aureus strains are methicillin-resistant. These findings should be taken into account in daily practice for prescription of antibiotics to patients presenting these infections.
Médecine tropicale: revue du Corps de santé colonial 02/2011; 71(1):68-70.
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ABSTRACT: The aim of this study was to evaluate the efficacy of treatment of AIDS-related and non AIDS-related Kaposi's sarcoma (KS) using vinblastine (Velbé®). A retrospective study was conducted between January 1990 and December 2009 in the Department of Dermatology at the Lomé teaching hospital. The therapeutic protocol is the administration of 10 injections of vinblastine every 15 days. Evaluation was done at 10 weeks, 5 months, 11 months and 17 months. Twenty-three patients including 11 cases of non AIDS-related KS and 12 cases of AIDS-related KS were included in our study. The average age of patients was 39.3 ± 11.2 years. The sex-ratio (M/F) was 6:7. At ten weeks, partial remission was 26% and failure rate was 74%. Side effects as a result of the first five injections were dominated by anemia. At 5 months, complete remission was 17% including 3 cases of non AIDS-related KS, partial remission was 26% including 4 cases of non AIDS-related KS. Side effects of the last five injections were dominated by anemia and nervous toxicity. At 11 months, one patient was lost to follow-up and complete remission persisted in 13% of the patients. At 17 months, complete remission persisted in 9% of the patients against 4% of relapses. No long-term side effects were identified. Our study shows a poor efficacy of vinblastine in the treatment of AIDS-related and non AIDS-related KS and confirms the hematologic and nervous toxicity of this drug. The efficacy is better in the non AIDS-related KS than in the AIDS-related KS.
Bulletin de la Société de pathologie exotique 02/2011; 104(5):339-41.
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ABSTRACT: Basidiobolomycosis is a deep mycosis which preferentially affects rural young people in tropical countries. We report a case of basidiobolomycosis successfully treated with ketoconazole. It was a 9-year-old boy of rural origin in whom the diagnosis of basidiobolomycosis was suspected due to a deep skin infiltration involving the chest and neck. Histology revealed hypodermic granulomatous inflammation with predominantly macrophage and eosinophils. The child was treated successfully with ketoconazole in eight weeks. Treatment of basidiobolomycosis is based on azole derivatives which are particularly effective. Histopathology is very important in the diagnosis of this affection, especially in tropical countries where it may simulate Mycobacterium ulcerans infection.
Bulletin de la Société de pathologie exotique 12/2010; 103(5):293-5.
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ABSTRACT: The aim of this study was to describe features of self-medication for skin conditions observed at public dermatology centres in Lome, Togo.
This cross-sectional study was conducted from July 1 to September 30, 2008 in 3 public dermatology centres in Lome-Commune. All patients consulting at the study centres for the first time were recruited, interviewed and examined.
Of 600 patients enlisted in the study, 264 (44%) had practiced self-medication. There were more women than men (sex ratio: 0.8). In most cases, products used for self-medication were recommended by a friend and/or relative (72%). Most products were obtained from either pharmacies (42.4%) or street vendors (37.9%). The average cost of self-medication was 520 FCFA (0.79 euros). Products applied by the topical route were the most common (72%) and most patients reported dissatisfaction with results (67.8%).
This study demonstrates that self-medication is widely practiced for dermatologic conditions in Lome and provides insight into the circumstances, reasons and sources of self-medication.
Médecine tropicale: revue du Corps de santé colonial 06/2010; 70(3):303-4.
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ABSTRACT: The purpose of this study was to document epidemiological features, outcomes, and aetiologies of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in a teaching hospital in Lomé, Togo.
A retrospective study of patients with SJS/TEN treated from January 2002 to April 2009 in a teaching hospital in Lomé was conducted.
During the study period, 89 patients were treated for SJS/TEN, i.e., SJS in 76 cases, TEN in 9, and overlapping SJS/TEN in 4. Mean age was 30.3 +/- 13.4 years and sex ratio (M/F) was 0.7. Serological testing for HIV was carried out in 75 patients and was positive in 41 (54.6%) including 36 patients with SJS, 3 with TEN and 2 with overlapping SJS/TEN. A total of 9 patients died including 4 with SJS, 4 with TEN and one with overlapping SJS/TEN. Six of the patients who died were HIV-infected. Complications included blindness in 3 cases, moderate dry eye syndrome in 1, vaginal synechiae in 2, synechiae of labial commeasures in 1, and hypertrophic scars in 1. Antibacterial sulphonamides (50.6%) were the most commonly implicated drugs followed by nevirapine (23.6%), non-steroidal anti-inflammatory drugs (5.6%), and anti-epileptic medications (3.4%).
Our results also document the high frequency of nevirapine as a new SJS/TEN cause unrelated to antibacterial sulphonamides. With increasing access to HIV medication in sub-Saharan Africa countries, practitioners should take these data into account for patient monitoring.
Médecine tropicale: revue du Corps de santé colonial 06/2010; 70(3):255-8.
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Annales de Dermatologie et de Vénéréologie 04/2010; 137(4):336-7. · 0.72 Impact Factor
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ABSTRACT: The aim of this retrospective study was to determine the relative frequency and trends of skin cancers in Togo.
The records of patients with primitive skin cancers diagnosed in the pathology laboratory of Lomé teaching hospital from 1994 to 2005 were reviewed.
During the study period, 223 cases of skin cancers were recorded. The overall mean patient age and male-to-female ratio were 42 +/- 17 years and 1.56 respectively. The most common forms of skin cancers observed were Kaposi's sarcoma in 103 cases (46.2%), skin carcinoma in 75 cases (33.6%), melanoma in 23 cases (10.3%), and dermatofibrosarcoma protuberans in 16 cases (7.2%). In the Kaposi's syndrome group, the average age and male-to-female ratio were 39 +/- 15 years and 2.68 respectively and the main location was the lower limbs (77.9%). In the cutaneous carcinoma group, 64 cases involved squamous cell carcinoma with an average age and male-to-female ratio of 48 +/- 17 years and 1.29 respectively. In 18 cases squamous cell carcinoma developed on chronic leg ulcer. In the melanoma group, the average age and male-to-female ratio were 55 +/- 16 years and 0.64 respectively and the main location was the distal extremities. In the dermatofibrosarcoma protuberans group, the average age and male-to-female ratio were 45 +/- 20 years and 0.78 respectively. The other types of skin cancers observed were mycosis fongoides in 4 cases (1.8%) and Paget's disease in 2.
This study showed that Kaposi's sarcoma was the most frequent skin cancer in Togo in conjunction with the current HIV infection epidemic. Findings also indicated that the incidence of other types of skin cancers was relatively stable.
Médecine tropicale: revue du Corps de santé colonial 04/2010; 70(2):169-71.
