Forty years of chromoblastomycosis in Madagascar: a review.

Confirmed cases of chromoblastomycosis in Madagascar from 1955 through 1994 were studied retrospectively. The total number of cases reported was 1,343, of which 98.5% were confirmed by histopathology. Only 30.8% of the cases showed a positive cultivation on mycologic media, and Fonsecaea pedrosoi was identified from 61.8% of the fungal strains. Two distinct areas of endemic chromoblastomycosis, each with a characteristic ecosystem and a single species, are identified. Madagascar represents the most important focus of this fungal disease described to date in the world.

Schistosoma haematobium induced lesions in the female genital tract in a village in Madagascar.

Female genital schistosomiasis, FGS, was investigated in a gynaecological study as part of an overall community based morbidity survey, including parasitological and ultrasonographical examination, of a Schistosoma haematobium endemic area in Madagascar. Women (103), of childbearing age (15-49 years), were included for a gynaecological examination and visible lesions of vagina and cervix were biopsied in order to determine the origin of the lesion. Furthermore all women were screened for the presence of schistosome ova using PAP smears from the vagina and the endo/exo cervix. In total 15 women showed schistosome ova in the vagina and/or cervix (median age 24 years and range 15-36 years). Of 36 women with cervical abnormalities, 12 eggs were detected by cervical biopsy (33%). In addition, two of the 12 presented vaginal induration, which contained eggs. Six women had eggs in their PAP smears of which three were egg negative by cervical biopsy. The prevalence of positive S. haematobium egg excretion in the urine among the 103 women was 69% and the geometric mean egg count of positive individuals was 51 eggs/10 ml of urine. Five of the 15 women with confirmed FGS had < or = 1 egg/10 ml of urine. Bladder lesions and congestive changes in the kidneys were demonstrated by ultrasonographic examination in 33 and 9% of the 103 women, respectively. None of the 15 women with confirmed FGS had renal congestion. Our study demonstrates that FGS is a common manifestation of the infection with S. haematobium, even in lightly infected individuals.

[Anti-rubella antibodies in pregnant women in Niamey (Niger)]. / Anticorps antirubéoliques chez les femmes enceintes a Niamey (Niger).

A total of 345 serum samples from pregnant Nigerian women were tested for the presence of anti-rubella antibodies. A technique of inhibition of haemagglutination was used and 40 or more was considered as a positive titer. Rubella antibodies were found in 244 (70.7%) of the samples. These results are quite similar to those from other west African surveys.

[Evolution of the seroprevalence of HIV-1 and HIV-2 infections in the national hospital of Niamey, Niger]. / Evolution de la séroprévalence des infections à VIH1 et VIH2 à l'hôpital national de Niamey, Niger.

For 25,368 serologies examined in the biological laboratory of National Hospital of Niamey, Niger, from March 1987 to May 1990, the authors studied seroprevalence HIV1, HIV2 and HIV1 + HIV2 during this periode in the different groups studied: Blood donors, in women patients of child bearing age, pregnant women, prostitutes, prisoners and during systematic visits. It appears there is a tendancy of an increase in HIV1, a decrease in HIV2 and relative stability for the two profiles together.

[Cancer in Madagascar. Experience of the Institut Pasteur de Madagascar from September 1992 to June 1996]. / Le cancer à Madagascar. Expérience de l'Institut Pasteur de Madagascar de début septembre 1992 à fin juin 1996.

The Unit of the anatomo-pathology in the "Institut Pasteur de Madagascar" (IPM) examined in the period from September 1992 to June 1996 tissue specimens from 10,275 patients. Tumorous pathology presented 40% of the tissues and half of which were of malign etiology. 64% of the cancer diagnosed were in females. Cervical cancer was most frequently observed (17%), followed by breast cancer (16%). Cancer in the gastro-intestinal tract (15%) was most often located in the colon without sex difference. Stomach cancer occurring predominantly in males presented 25% of the total cases of cancer in the gastro-intestinal tract. Cancer of liver is rarely diagnosed despite the high prevalence of infection with hepatitis B virus. Skin cancer constituted 9% of the malign diagnosis and was mainly found in males. Children under 15 years old presented 7.4% of the total cases of malignancy with the haematopoietic tissues (30%) and the eyes (17%) as the most frequent topic locations. Due to a very low seroprevalence of the HIV in Madagascar, malign tumours associated to AIDS were only seen in a few rare cases. The review of cancer cases in the IPM may not be representative for the cancer epidemiology of Madagascar because of a general very low level of health care coverage, especially in the rural areas. Furthermore, a major part of the specimens originates from easily accessible organsystems, whereas other organs seem less investigated due to lack of appropriate available technique. Therefore, it is not feasible for the moment to establish a cancer register in Madagascar, although the Unit of Pathology in the IPM can offer a valid cancer diagnostical service.

[Prevalence of toxoplasmosis in Tananarive. Study conducted at the Pasteur Institute of Madagascar (PIM) on a sample of 2354 subjects]. / Approche de la prévalence de la toxoplasmose à Tananarive. Etude réalisée à l'Institut Pasteur de Madagascar (IPM) sur un échantillonnage de 2354 sujets.

The prevalence of Toxoplasma antibodies was studied in 2,354 individuals in Tananarive, at the Institut Pasteur of Madagascar. The seroprevalence among the malagasy population amounts to 52.1%. At the age of 10 years old, 36.3% of our sample have already acquired toxoplasma antibodies, proving an early infection. No differences have been observed between sexes. The toxoplasmosis prevalence among the female population coming from France, India and Pakistan and living in Tananarive seemed the same than in their home countries, whereas female population coming from China had shown a different seroprevalence compared to their home country.

[Squamous cell carcinoma arising from chromomycosis. Report of two cases]. / Carcinome épidermoïde développé sur des lésions de chromomycose. A propos de deux observations.

Madagascar is the principal area of endemic chromomycosis in the world with 1 400 cases registered from 1955 to 1996. Malignant transformation is rare and only 12 cases have been reported. We describe herein two new cases of squamous carcinoma arising from chronic lesions of chromomycosis. These carcinomas which develop slowly and are non invasive, are similar to those arising from burns, tropical phagedenic ulcers and chronic leprosy ulcers. Epidemiological aspects, histopathology and treatment are described.

[Juvenile multiple myeloma. A Nigerian case]. / Myélome multiple juvénile. Un cas nigérien.

One case of juvenile multiple myeloma of the IgG-kappa type, with lytic lesions of the skull, is reported in a 14-year old Nigerian Fulani girl. The outcome was rapidly fatal. This disease is extremely rare: only 2 other documented cases (2 girls aged 13 and 12) have been found in the literature, under the age of 15.

[Shigellosis in Tananarive (Madagascar) I - Epidemiologic and clinic features (author's transl)]. / Les shigelloses à Tananarive (Madagascar). I. - Aspects epidémiologiques et cliniques.

Reviewing 67 cases of human adult shigellosis observed in Madagascar, the authors emphasize some epidemiologic and clinic features : high frequency during rainy season, usual dysenteriform aspect or diarrhoeas with fever, hemorragic forms, severity according to anterior state of colon and rectum, severity if cases associated with amoebiasis or schistosomiasis (Schistosoma mansoni).

[Schistosomiasis of vulvae (case report and comments) (author's transl)]. / La bilharziose vulvaire (à propos d'une observation).

Report of a case observed in Malagasy Republic, caused by Schistosoma haematobium and associated with a urinary envolvement. A niridazol treatment lead to rapid recovery. Pathogenic processes of this localization are reviewed with regard to venous anatomy and parasitologic features. Venereal diseases, tuberculosis and cancer are the main affections capable to lead to mistaking. Pathology is a necessary and reliable control. Treatment is easy with niridazol or, in case of failure, with the various other specific drugs.

[Madagascar: esophagogastroduodenoscopy. Descriptive analysis of 12,000 examinations and problems encountered in the tropics]. / Madagascar : la fibroscopie oeso-gastro-duodénale. Analyse descriptive de 12000 examens et problèmes rencontrés sous les tropiques.

The experience of the Digestive Endoscopy Center of the Soavinandriana Hospital in Antananarivo provides insight into not only esogastroduodenal disease in Madagascar but also technical problems involved in performing esophago-gastro-duodenoscopy in tropical areas. From September 1990 to March 1995 a total of 12000 esophago-gastro-duodenoscopy procedures were performed without complication. The main finding was duodenal ulcer which observed in 3580 cases (29.8% of patients) followed by peptic esophagitis due to gastroesophageal reflux in 555 cases and gastric ulcer in 460 cases. Esophageal cancer was detected in 16 cases and malignant gastroduodenal tumor in 82 cases including 63 adenocarcinomas and 5 digestive lymphomas. Overall 4156 procedures (34.6%) were normal and 1130 procedures (9.4%) were performed to investigate digestive tract hemorrhage. These findings document the high incidence of duodenal ulcer in Madagascar where treatment of this condition is difficult due to the high cost. This study underlines the problems encountered in operating an endoscopy department in tropical areas especially with regard to desinfection of equipment and training of endoscopists.

[Shigellosis in Tananarive (Madagascar). II : Bacteriologic and therapeutic features (author's transl)]. / Les shigelloses à Tananarive (Madagascar). II. - Aspects bactériologiques et thérapeutiques.

In acute dysenteries or diarrhoeas shigellae are the bacterial organisms which are the most frequently isolated from coprocultures. The most frequent sub-group is sub-group B (S. flexniri). In vitro, shigellae are sensible to all antibiotics but often resistant to sulfamids. Treatment is not difficult.

[Study of 3985 female genital smears from the Clinical Biology Center of the Pasteur Institute in Madagascar]. / Etude de 3985 prélèvements génitaux féminins effectués au Centre de Biologie Clinique de l'Institut Pasteur de Madagascar.

A microbiological study of 3985 cervico-vaginal swabs has been carried out on patients from Pasteur Institute of Madagascar, most of them suffering from leucorrhea. This puts forward the predominance of non-specific vaginitis as well as cervicitis caused by mycoplasmas.

[Peritoneal tuberculosis in Madagascar, 55 cases at the Soavinandriana Hospital Center in Antananaviro]. / La tuberculose péritoneale á Madagascar, á propos de 55 observations recueillies au Centre Hospitalier de Soavinandriana a Antananarivo.

This retrospective study conducted in Antananarivo for a 42 months period, from September 1991 to March 1994, allowed to record 55 peritoneal tuberculosis, all of them in malagasy patients. The sex ratio was 0,83 and the mean age 36 years old. Ascites puncture was done each time there was an effusion (44 cases). For all cases. For all cases, the diagnosis based on laparoscopy allowed an investigation of the liver and the peritoneum, and 10 peritoneum biopsies could be done. The tubercular bacillus has been isolated in 2 ascites fluids out of 8 incubations, and in 5 biopsies of peritoneal granulation out of 8. For 8 cases, another tubercular localization has been discovered: 5 pleurisis, 2 evolutive tuberculosis and 1 pericardial effusion. All the patients have been put under antitubercular treatment and have regained health. Peritoneal tuberculosis has become rare in the West but is still a frequent pathology mostly in young women, in Africa and up in Madagascar.

[History of a hepatic lesion: Schistosoma mansoni bilharziasis]. / Histoire d'une lesion hépatique: la bilharziose à Schistosoma mansoni.

Schistosomiasis mansoni is a widespread tropical disease affecting about 200 million people in the world (data from the World Health Organization). The adult worms, settled in the mesenteric venous plexus, can survive in the host during 5 to 20 years. They evade the immune response and are not, by themselves, the main cause of the pathological events. Most eggs are swept into the portal circulation and trapped in different systemic organs, including the liver. The continuous egg deposition results in a T cell-mediated granulomatous response that is responsible for the disease syndrome (chronic hepatitis associated with a dense fibrosis and a concurrent portal hypertension). Current immunological and molecular concepts on the modulation of the granuloma, and the associated fibrosis, lead to a better understanding of the pathogenesis of human schistosomiasis. Chemotherapy with praziquantel is presently the main approach of morbidity control, before using in conjunction a human vaccine still in development.

[Hepatic hydatidosis in Madagascar: a case of autochthonous origin]. / Hydatidose hépatique à Madagascar: a propos d'un cas d'origine autochtone.

Hydatid disease, due to the larval stage of Echinococcus granulosus, is described for the second time at liver level, in Madagascar. Even with a low level of endemic animal disease and an uncontrolled population of stray dogs, the human parasitosis is very rare in Madagascar. It is interesting to note that, since a hundred of years, the epidemiological status of this Zoonosis has not really changed in the great island.

[Entomophthoromycoses in Madagascar (three cases)]. / Les entomophthoromycoses à Madagascar (à propos de trois cas malgaches).

The authors present three new cases of Entomophthoromycosis observed in Madagascar: Two cases of subcutaneous entomophthoromycosis without isolation of germ. An immunofluorescence technique showed the Basidiobolus ranarum to be the real cause. One case of rhinoentomophthoromycosis with isolation of Conidiobolus coronatus (first isolation in Madagascar).