[Contribution of the Xpert MTB / Rif test in the diagnosis of tuberculosis of any form in Saint-Louis]. / Apport du test Xpert MTB/Rif dans le diagnostic de la tuberculose toute forme a Saint-Louis.

INTRODUCTION: The Xpert MTB / RIF assay has a dual advantage on the one hand, the rapid diagnosis of even difficult cases by the standard technique of direct microscopic examination and on the other hand by the detection of resistance to rifampicin. Our objective was to determine the contribution of the Xpert test in the diagnosis of tuberculosis of all forms. MATERIALS AND METHOD: retrospective, descriptive and analytical study carried out in the Pneumophtisiology department of the CHRU of Saint-Louis. All suspected tuberculosis cases who had received an Xpert test from 2018 to 2020 were included. The parameters studied were socio-demographic, clinical and biological data. RESULTS: 524 patient records included in the study with a sex ratio of 1.3. The mean age of the patients was 37 +/-15 years. There were 285 positive GeneXpert samples, of which 224 were of pulmonary origin and 61 of extra-pulmonary origin. The number of rifampicin resistant samples was five, all of respiratory origin. CONCLUSION: the Xpert test is a new molecular technique recommended by the WHO in the diagnosis of pulmonary tuberculosis.

INTRODUCTION: le test Xpert MTB/RIF présente un double avantage d'une part le diagnostic rapide des cas mêmes difficiles par la technique standard de l'examen direct à la microscopie et d'autre part par la détection de la résistance à la rifampicine. Notre objectif était de déterminer l'apport du test Xpert dans le diagnostic de la tuberculose toutes formes confondues. MATÉRIELS ET MÉTHODE: étude transversale, descriptive à collecte rétrospective menée dans le service de Pneumophtisiologie de CHRU de Saint-Louis. Tous les cas suspects de tuberculose qui avaient bénéficié d'un test Xpert de 2018 à 2020avec un dossier médical accessible et exploitable ont été inclus. Les paramètres étudiés étaient les données sociodémographiques, cliniques et biologiques. RÉSULTATS: Nous avions colligés 524dossiers de malades avec un sex-ratio de 1,3. L'âge moyen des patients était de 37 ans+/-15 ans. Il y'avait 285 prélèvements positifs au GeneXpert dont 224 d'origine pulmonaire et 61d'origine extra pulmonaire. Le nombre d'échantillons résistants à la rifampicine était de cinq, tous d'origine respiratoire. CONCLUSION: le test Xpert est une nouvelle technique moléculaire recommandée par l'OMS dans le diagnostic de la tuberculose pulmonaire. Toutefois il doit être évaluer dans le diagnostic de la tuberculose extra pulmonaire.

Risk factors associated with necrotizing fasciitis of the lower limbs: A multicenter case-control study.

OBJECTIVE: The aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs. PATIENTS AND METHODS: We conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (±5 years) and sex. We analyzed local and general factors. RESULTS: During the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5±15.8 years for cases and 46.5±16.2 years for controls (P=0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR]=2.10; 95% confidence interval [CI]: 1.21-3.42), diabetes (OR=3.97; 95% CI: 1.95-6.13), nicotine addiction (OR=5.07; 95% CI: 2.20-11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR=7.85; 95% CI 4.60-14.21) and voluntary cosmetic depigmentation (OR=2.29; 95% CI: 1.19-3.73). CONCLUSION: Our study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.

[Epidemiological, clinical and etiological profile of tinea capitis in adult patients in Dakar, Senegal]. / Profil épidémio-clinique et étiologique des teignes du cuir chevelu chez l'adulte à Dakar (Sénégal).

OBJECTIVE: To determine the epidemiological and etiological profile of tinea capitis in adults in Dakar (Senegal). PATIENTS AND METHODS: A 9-month prospective, multicenter, descriptive and analytic study. Patients included were aged over 18 years. Mycological tests were used to confirm the diagnosis. RESULTS: 121 patients were included with a mean age of 36.1 years and a hospitalisation frequency of 0.8%. The age range of 64.4% of patients was between19 and 38 years. 51% of patients were housewives. A low socioeconomic level was found in 72.8% of cases. In 3.3% of patients, the disease began in childhood. 31.4% of patients had already consulted a traditional healer. Similar familial cases were noted in 60.3% of patients. Contact with a sheep was noted in 32.2% of cases, deliberate skin lightening in 64% of women, hair salon attendance in 46.7% of women, and immunosuppression in 17.3% of patients, while itching was present in 95.5%. Dermatologic examination showed scaled plaques and a diffuse form, with 92.6% and 64% (n=75) respectively. Wood's light examination was positive in 40.2% of patients. A positive culture test was found in 71%. The most frequently encountered species were: T. soudanense (65%), M. audouinii (21%), T. rubrum (4.7%), M. gypseum (3.5%), T. violaceum (2.3%), T. verrucosum (2.3%) and M. canis (1 case). The clinical course was favorable under treatment with griseofulvin or terbinafine. CONCLUSION: Tinea capitis in adults mainly affects young women. The diffuse form is the most common. The most frequently encountered species was T. soudanense.

[Epidemiology of primary lung cancer among non-smokers in Senegal]. / Épidémiologie des cancers bronchopulmonaires primitifs des non-fumeurs au Sénégal.

INTRODUCTION: According to global data for 2002, one quarter of new cases of primary bronchopulmonary cancer were non-smokers. We undertook this study with the aim of describing the epidemiological characteristics of non-smokers with primary bronchopulmonary cancer in the Dakar region of Senegal. METHODS: A multicenter descriptive study that included all non-smokers who presented with primary bronchopulmonary cancer between January 1st 2014 and December 31st 2015. The data were captured on an Excel file and then transferred to Epi InfoTM 7 software for analysis. RESULTS: The rate of diagnosis for primary bronchopulmonary cancers was 72.1 %. The prevalence of non-smokers was 33.3 %. The sex ratio was 1.27. The average age was 54.6 years. More than a third of the sample were housewives. Carpenters and craftsmen exposed to metals predominated. Exposure to cooking oils was reported in one case. Three patients presented sequelae of pulmonary tuberculosis. Adenocarcinoma was the most common histological type and predominated in young subjects. CONCLUSION: The proportion of primary bronchopulmonary cancers diagnosed among non-smokers is increasing in Dakar. An analytical study of suspected risk factors would be helpful for prevention.

[Epidemiological, Clinical And Radiological Profile Of Positive Microscopy Pulmonary Tuberculosis (PMPT) At The Regional University Hospital Of Saint-Louis]. / Profil Epidemiologique, Clinique Et Radiologique De La Tuberculose Pulmonaire A Microscopiepositive (TPM+) Au Centre Hospitalier Regional Universitaire De Saint-Louis (CHRU SL).

Pulmonary tuberculosis is still a global scourge, especially in developing countries, despite the control measures that have been in place for decades. The aim of this work was to describe the epidemiological, clinical radiological and evolutionary aspects of PMPT at the Saint-Louis Regional Hospital Center. This was a retrospective descriptive study on 191 PMPT files, hospitalized in the medical department from January 1, 2016 to December 31, 2017. PATIENTS AND METHOD: Were included in the study, all cases of pulmonary tuberculosis proved by the presence of bacillus Koch on direct examination of sputum. Were excluded from the study, cases of pulmonary tuberculosis with negative microscopy and cases of pulmonary tuberculosis in patients younger than 14 years. RESULTS: Of 1417 hospitalizations, 191 patients had a PTPM. The average age was 36.5 years with extremes of 14 to 81 years. The sex ratio was 2.2 in favor the male. Fishermen were the most affected with 34% of cases. A family tuberculosis was noted in 61 patients. One hundred and forty-six new PMPT cases were noted. CONCLUSION: Positive microscopy pulmonary tuberculosis remains a public health problem in Senegal. Much work remains to be done in Saint-Louis, which a region with a high burden of tuberculosis.

INTRODUCTION: la tuberculose pulmonaire demeure encore un fléau mondial en progression surtout dans les pays en voie de développement, malgré les actions de lutte mises en place depuis des décennies. Le but de ce travail était de décrire les aspects épidémiologiques, cliniques radiologiques et évolutifs de la TPM (+) au centre hospitalier régional de Saint-Louis. Il s'agissait d'étude descriptive rétrospective portant sur 191 dossiers de TPM+, hospitalisés au service de médecine du 1er Janvier 2016 au 31 Décembre 2017. Étaient inclus dans l'étude, tous les cas de TPM+ prouvée par la présence de BAAR à l'examen direct des crachats. Étaient exclus de l'étude les patients de moins de 14 ans, les cas de TPM(-) Résultats : Sur 1417 hospitalisations, 191 patients avaient une TPM+. L'âge moyen était de 36,5 ans avec des extrêmes de 14 à 81 ans. Sex-ratio de 2,2. Les pêcheurs étaient les plus touchés avec 34 % des cas. Un contage tuberculeux familial était noté chez 61 malades. Cent quarante six nouveaux cas de TPM(+) ont été notés. Conclusion : la TPM(+) demeure un problème de Santé Publique au Sénégal. Beaucoup d'efforts restent à faire dans la région de Saint-Louis à forte charge de tuberculose.

Non-tubercular caseous adenopathy in Senegal.

The authors report the case of a 22-year-old man referred seven months after the onset of papulo-nodular skin lesions, lymphadenopathy, splenomegaly and hepatomegaly. Mycologic and histologic examination of skin lesions enabled the diagnosis of African histoplasmosis, by Histoplasma capsulatum var duboisii. The lymph nodes were caseous. The culture in Lowenstein-Jensen medium was negative.

Cutaneous leishmaniasis in Senegal: a series of 38 cases at the Aristide Le Dantec University Hospital in Dakar.

Our aims were to study the epidemiological, clinical, and parasitological aspects of cutaneous leishmaniasis in the dermatology department of the Aristide Le Dantec hospital. This retrospective study reviewed records of cases treated over a 4-year period (from April 2010 through April 2014) at the HALD Dermatology department. The study included all patients with cutaneous leishmaniasis during the study period. The diagnostic criteria were clinical, parasitological, and histological. The study included 38 patients, corresponding to 9.5 cases per year. Patients' average age was 25 years (4-65 years) and the sex ratio was 1.6. The mean time from symptom outset to consultation was 3.2 months. The disease was located in limbs in 23 cases (63.8%), the face in 6 cases (16.6%), and disseminated in 9 (19.6%). The clinical presentation was ulcerated and crusted in 17 patients (44.7%), sporotrichoid in 13 (28.9%), pseudo-lepromatous in 4 (10.5%), and lupoid in 3 cases (7.9 %). It included warts, mucosa, and tropical sores (Aleppo boils) in all cases. We observed 3 cases associated with HIV; one had a pseudo-lepromatous presentation and resulted from immune restoration syndrome, while two patients had clinical forms of associations: ulcerative and crusted lesions associated with mucosal leishmaniasis in a 55-year-old patient, and cutaneous ulcerative, lupoid, and crusted multifocal (cutaneous, medullary, and lymph nodes) lesions in a 4-year-old infected with Leishmania infantum. Crusted ulcerative cutaneous leishmaniasis is the predominant form of cutaneous leishmaniasis. Infection with HIV can be an important factor in clinical and parasitological atypia.

Hepatic cytolysis and bicytopenia after 15 days of four-drug tuberculosis treatment in Senegal.

We report the case of a 31-year-old immunocompetent woman residing in Senegal, with localized microscopy-proved pulmonary tuberculosis, complicated by macrophage activation syndrome and associated with viral hepatitis B, identified due to hepatic cytolysis and a bicytopenia.

[Etiology of intertrigo in adults: A prospective study of 103 cases]. / Les étiologies des intertrigos chez l'adulte : étude prospective de 103 cas.

INTRODUCTION: The etiologies of intertrigo in adults are numerous and different. The objective of our work was to study the epidemiological, clinical and the risk factors of intertrigo in adults. METHODS: We conducted a prospective study for a period of seven months in two Dermatology Units in Dakar (Senegal). All adults patient with intertrigo seen during this period who gave consent were included. RESULTS: One hundred and three patients with intertrigo were diagnosed with a hospital prevalence of 2.54%. The sex -ratio was 0.63 and the average age was 41. The study of habits and lifestyles of the patients found a history of intensive skin lightening, sport, wearing synthetic clothes and smoking in 26, 22, 20 and 22 cases, respectively. Infectious complications mainly bacterial (3.88%) and viral (1.94%) were reported in nine cases (8.7%). A dry erythroderma was noted in 3 cases (2.9%). It was found that the intertigo was commonly caused by fungal infections with a prevalence of 48.5% followed by immuno-allergic reactions with a prevalence of 34.9%, suppurative hidradenitis and inverse psoriasis with the same prevalence of 2.9%. Fifty-eight percent of cases with tinea and 63% of cases with candidiasis were women. Thirty-five percent of tinea cases and 45% of candidiasis cases were found to have a history of intensive skin lightening. CONCLUSION: The cause of intertrigo in adults are mainly infectious, particularly fungi, infections and immuno-allergic diseases. There are predisposing factors and some professions are more at risk.

[Cutaneous leishmaniasis due to Leishmania infantum associated with HIV]. / Leishmaniose cutanée à Leishmania infantum associée à une infection par le VIH.

BACKGROUND: In Senegal, reported cases of cutaneous leishmaniasis are often due to Leishmania major. Immunosuppression related to HIV infection contributes to the emergence of leishmaniasis in humans and to cutaneous localization of viscerotropic species. We report the first observed case in Senegal of opportunistic cutaneous leishmaniasis due to Leishmania infantum associated with HIV. PATIENTS AND METHODS: A 5-year-old boy presented crusted ulcerative lesions of the scalp and left forearm, together with axillary and cervical lymphadenopathy present for two months. Direct parasitological examination of the scalp and arm lesions, coupled with liquid aspiration of lymph nodes and bone marrow, enabled identification of amastigote forms of Leishmania. Polymerase chain reaction performed on skin, lymph node and bone marrow biopsy samples allowed identification of L. infantum. The child was positive for HIV1. Treatment of HIV infection and leishmaniasis resulted in clinical improvement. DISCUSSION: Co-infection with cutaneous leishmaniasis due to L. infantum and HIV is a complex combination in terms of the related therapeutic issues. The clinical and laboratory outcomes depend on restoration of immunity and on the efficacy, safety and availability of anti-leishmaniasis drugs.

[Multifocal histoplasmosis due to Histoplasma capsulatum var. duboisii in a 22 year-old Senegalese patient without proven immunodepression]. / Histoplasmose multifocale à Histoplasma capsulatum var. duboisii chez un Sénégalais de 22ans sans immunodépression prouvée.

The authors report a case of multifocal African histoplasmosis with polymorphic skin involvement occuring in a patient without proven immunosuppression. He was a young 22-year-old patient from eastern Senegal - but born in Ouganda - who presented with polymorphic skin lesions: ombilicated papulo-nodules, gums and ulcerative and budding lesions. He showed lymphadenopathies without clinical inflammation and with a cheesy appearance of the biopsy but without tuberculosis and also hepatosplenic and bone involvement. Mycological samples of the skin and lymph nodes biopsies revealed yeasts of Histoplasma capsulatum var. duboisii with a positive culture on Sabouraud medium. HIV serology, HTLV1et 2, the serum proteins electrophoresis were unremarkable. Treatment with amphotericin B was irregular because of its inaccessibility in the national territory and its cost. The patient died of sepsis together with the aggravation of his disease.

[Efficacy of sodium hydroxide at 2.5 %, chlorhexidine gluconate at 0.5 % and calcium hydroxide against Candida albicans]. / Étude de l'efficacité de l'hypochlorite de sodium à 2,5 %, de la chlorhexidine à 0,5 %, et de l'hydroxyde de calcium sur Candida albicans.

INTRODUCTION: Endodontic flora is dominated in the apical part of the channels by strict anaerobic and some facultative anaerobic bacteria but also by Candida yeasts, especially Candida albicans species that are involved in the maintenance and persistence of endodontic infections. Their elimination of the canal system in practice by chemo-mechanical methods of disinfection is not always guaranteed. Thus, this in vitro study was performed to determine the sensitivity of C. albicans with sodium hypochlorite (NaOCl) dosed at 2.5 %, the chlorhexidine digluconate 0.5 % and calcium hydroxide used in inter-session medication. METHODS: The diffusion method was used initially to test the sensitivity of C. albicans strains with the above products. Then a dilution technique has allowed us to determine the minimum inhibitory concentration of these active products on C. albicans. RESULTS: Strains from infected pulp teeth of patients showed a sensitivity of C. albicans to sodium hypochlorite to a minimum inhibitory concentration less than 70µg/mL and 30µg/mL for chlorhexidine. CONCLUSION: This study demonstrated a sensitivity of C. albicans to sodium hypochlorite and chlorhexidine.

[Presence of yeasts in primary endodontic infections and study of their susceptibility to disinfection with sodium hypochlorite at 2.5]. / Recherche de levures dans les primo-infections endodontiques et étude de leur sensibilité à une désinfection à l'hypochlorite de sodium à 2,5.

INTRODUCTION: Endodontic infections are characterized by their microbial polymorphism with the presence of pathogenic agents such as bacteria. The aim of this study was to investigate the presence of yeast in the root canals of teeth with pulp necrotic with or without apical periodontitis and to study the sensibility of these at disinfection at sodium hypochlorite to 2.5 %. METHODS: Root canal samples, taken with paper points before and after disinfection with sodium hypochlorite dosed at 2.5 % on 50 single rooted teeth in 38 patients, were seeded in petri dishes containing Sabouraud Chloramphenicol (SC) (Conda Laboratories, Madrid). These stains were incubated in an incubator at 37°C for 48hours. The presence of yeast was confirmed by white colonies on the entire circumference of the tip paper. The identification of species was done by macroscopic and microscopic examinations associated with Blastese test. RESULTS: The yeast colonies were isolated from 7 teeth (14 %) out of 50. All positive samples were from teeth with an open necrotic pulp (P<0.001). The only species found was Candida albicans. Immediate disinfection with sodium hypochlorite at 2.5 % did not show a complete elimination of yeasts. CONCLUSION: The results of this study show that the canal of necrotic teeth with or without apical periodontitis may shelter yeasts even after immediate disinfection with sodium hypochlorite 2.5 %.

[Leg ulcers in sickle cell disease: A retrospective study of 40 cases]. / Ulcères de jambe au cours de la drépanocytose: étude rétrospective de 40 cas.

BACKGROUND: In Africa, studies primarily devoted to chronic leg ulcer due to sickle cell disease are rare. The objectives of the study were to determine the epidemiology, diagnosis and progression of chronic leg ulcers in sickle cell disease. PATIENTS AND METHODS: A 5-year multicentre, retrospective study was conducted in three university hospitals in Dakar. We included all patients with chronic leg ulcers occurring in a setting of sickle cell disease. RESULTS: We identified 40 cases of chronic leg ulcers associated with sickle cell disease, representing 3.4% of the current population of sickle cell patients in our institutions. The average patient age was 25.9 years and the sex ratio was 2.33. Chronic leg ulcer was the presenting feature enabling diagnosis of sickle cell disease in one third of the cases. The average time to consultation from onset was 5.4 years. Pain was reported in 22 cases (48%). Ulcers were isolated in 76% and multiple in 24% of cases. The most common site was the medial malleolus (39%). A CBC allowed identification of anaemia in 35 cases. Haemoglobin electrophoresis was performed and homozygous sickle cell SS disease was identified in 39 cases and heterozygous SC disease in 1 case. Local treatments included physiologic serum, topical antibiotics and skin grafting. Systemic treatment included supplementation with folic acid in all patients, blood transfusion in 16 cases, vasodilators in 11 cases and antibiotics in 25 cases. The outcome was favourable in 61.8% of cases. DISCUSSION: In Dakar, sickle cell disease is a common cause of chronic leg ulcer and is frequently revealed by chronic leg ulcer.

Preliminary Upper Estimate of Peak Currents in Transcranial Magnetic Stimulation at Distant Locations From a TMS Coil.

GOALS: Transcranial magnetic stimulation (TMS) is increasingly used as a diagnostic and therapeutic tool for numerous neuropsychiatric disorders. The use of TMS might cause whole-body exposure to undesired induced currents in patients and TMS operators. The aim of this study is to test and justify a simple analytical model known previously, which may be helpful as an upper estimate of eddy current density at a particular distant observation point for any body composition and any coil setup. METHODS: We compare the analytical solution with comprehensive adaptive mesh refinement-based FEM simulations of a detailed full-body human model, two coil types, five coil positions, about 100 000 observation points, and two distinct pulse rise times; thus, providing a representative number of different datasets for comparison, while also using other numerical data. RESULTS: Our simulations reveal that, after a certain modification, the analytical model provides an upper estimate for the eddy current density at any location within the body. In particular, it overestimates the peak eddy currents at distant locations from a TMS coil by a factor of 10 on average. CONCLUSION: The simple analytical model tested in this study may be valuable as a rapid method to safely estimate levels of TMS currents at different locations within a human body. SIGNIFICANCE: At present, safe limits of general exposure to TMS electric and magnetic fields are an open subject, including fetal exposure for pregnant women.

Negative cutaneous effects of medicinal plants in Senegal.

Use of medicinal plants is common and widespread throughout Africa, including in Senegal. Because efficacy has been demonstrated, public policies have been instituted that have allowed plant-based therapies to have an important role in general primary care. However, little is known about the cutaneous safety of many plant-based therapies. In this 6-month prospective study all cases of dermatitis induced or aggravated by exclusive use of medicinal plants were evaluated via skin allergy testing. The results were classified and compared with the available literature. Forty-three cases of plant-therapy-associated cutaneous reactions were identified, including worsening of existing conditions (56%), recurrence of a previously resolved condition (16%) and new dermatitis arising spontaneously (28%). In the cases where the condition was new, generalized exfoliative dermatitis occurred in 42% of cases with an average time of onset of 9 days. Specific plants were identified in 65% of cases and included 18 varieties. The frequency and severity of plant-induced cutaneous reactions should be the basis for the creation of a phytovigilance programme and re-evaluation of how traditional medicine is used in the general population. When irritation occurs, identification of the responsible plant and allergy testing should be the first steps towards relieving symptoms.