The Role of Candida Albicans in Routine Clinically Suspected Otomycosis.

BACKGROUND: Candida albicans and non-albicans Candida species are considered as commensal yeasts of many cavities including the external auditory canal (EAC) in healthy individuals. These fungal microorganisms can also act as opportunist pathogens and cause otomycosis. In this study, the patients of clinically suspected otomycosis were specifically investigated mycologically to elucidate the role of Candida albicans and non-albicans Candida species. MATERIAL AND METHODS: A prospective observational study was conducted from July 2016 and June 2017 at the Laboratory of Parasitology and Mycology of the Sourô SANOU University Hospital in Bobo-Dioulasso, Burkina Faso. Identification of Candida isolates was using conventional phenotypic methods. Antifungal susceptibility tests were carried out by disk diffusion method in accordance with CLSI standard document M44-A for yeasts. RESULTS: Out of 160 patients with clinically diagnosed otomycosis, 77(48.1%) were investigated positive for Candida species. Candida albicans (61%) was the most isolated species and non-albicans Candida species accounted for 39% of the isolates, with mainly Candida spp (22.1%), Candida krusei (10.4%), Candida dubliniensis (5.2%) and Candida glabrata (1.3%). Nystatin showed the highest efficacy (95.9%), followed by ketoconazole (90.4%), clotrimazole (83.6%), miconazole (72.6%) and amphotericin B (63.0%). CONCLUSION: Otomycosis due to Candida species should be especially considered, since they have a wide number of potential virulence factors that cause fungal infections. Also, antifungal susceptibility testing should be performed in order to select the appropriate antifungal therapy.

CONTEXTE: Candida albicans et les espèces de Candida non albicans sont considérées comme des levures commensales de nombreuses cavités, y compris le conduit auditif externe (CAE) chez les individus sains. Ces micro-organismes fongiques peuvent également agir comme des agents pathogènes opportunistes et provoquer une otomycose. Dans cette étude, les patients cliniquement suspectés d'otomycose ont été spécifiquement étudiés mycologiquement pour élucider le rôle des espèces de Candida albicans et non albicans Candida. MATÉRIEL ET METHODS: Une étude observationnelle prospective a été menée de juillet 2016 à juin 2017 au Laboratoire de Parasitologie et Mycologie du CHU Sourô SANOU à BoboDioulasso, Burkina Faso. L'identification des isolats de Candida utilisait des méthodes phénotypiques conventionnelles. Des tests de sensibilité aux antifongiques ont été réalisés par la méthode de diffusion sur disque selon le document standard CLSI M44-A pour les levures. RÉSULTATS: Sur 160 patients atteints d'otomycose cliniquement diagnostiquée, 77 (48,1 %) ont été testés positifs pour les espèces de Candida. Candida albicans (61 %) était l'espèce la plus isolée et les espèces non albicans Candida représentaient 39 % des isolats, avec principalement Candida spp (22,1 %), Candida krusei (10,4 %), Candida dubliniensis (5,2 %) et Candida glabrata (1,3%). La nystatine a montré l'efficacité la plus élevée (95,9 %), suivie du kétoconazole (90,4 %), du clotrimazole (83,6 %), du miconazole (72,6 %) et de l'amphotéricine B (63,0 %). CONCLUSION: L'otomycose due aux espèces de Candida doit être particulièrement considérée, car elles ont un grand nombre de facteurs de virulence potentiels qui provoquent des infections fongiques. En outre, des tests de sensibilité aux antifongiques doivent être effectués afin de sélectionner le traitement antifongique approprié. Mots-clés: Candida albicans; Otomycoses; routine; sensibilité antifongique; Burkina Faso.

Epidemiological and Clinical Aspects and Therapy of Chronic Otitis Media in the "ENT" and Cervicofacial Surgery Ward in the University Hospital of Ouagadougou.

Objectives. The aim of this study was to analyze the epidemiological and clinical aspects of chronic otitis media and its therapeutic processes in our context. Patients and Methods. In a prospective study over a period of 1 year (March 2009-February 2010), 79 patients with chronic otitis media have been cared for in the otolaryngology ward of the University Hospital of Ouagadougou. Results. Chronic otitis media (COM) commonly occurs in the age group from 0 to 15 years (40.50%). Otorrhea was the main reason for consultation in 53 cases (67.10%); the most frequently encountered clinicopathological forms were simple COM (71%) followed by otitis media with effusion (24.30%). Intra-auricular instillations of traditional products (46.09%) were the dominant favoring factor. Treatment was essentially through medication in 59 cases with a stabilization of lesions. Endotemporal complications were noticed in 6 cases. Conclusion. The fight against chronic otitis media is carried out through preventive measures of education the of people.

[Bacteriological profile of chronic otitis media in the ENT and neck surgery department at the Ouagadougou University Hospital Center (Burkina Faso)]. / Profil bactériologique des otites moyennes chroniques au CHU de Ouagadougou (Burkina Faso).

UNLABELLED: The specific germs that cause chronic otitis media determine the treatment necessary. The purpose of this study was to identify the pathogens involved in this disease and to determine the sensitivity of the antibiotics commonly used in order to improve treatment. METHODS: This prospective study took place over 12 months and recorded 53 cases of chronic otorrhea in the ENT department of Ouagadougou University Hospital: 41 underwent cytologic and bacteriologic analysis. RESULTS: We identified 34 cases of bacterial infection (83%), 2 cases of fungal infection (5%) and 5 sterile cultures (12%). The bacteria isolated most frequently were Staphylococcus aureus (29%), Pseudomonas aeruginosa (26%) and Proteus mirabilis (18%). These organisms were most sensitive to fluoroquinolones (84%) and third-generation cephalosporins (77%). However, amoxicillin and tetracycline were fairly active against these pathogens, with sensitivity rates of respectively 19% and 7%. CONCLUSION: These data could help guide regional practitioners in choosing probabilistic antibiotic treatment. Sensitivity testing nonetheless remains needed in chronic otorrhea, to verify the efficacy of initial treatment and guide adequate care.

[Rhinoscleroma: two cases in Bobo-Dioulasso in Burkina Faso]. / Le rhinosclérome: deux observations à Bobo-Dioulasso au Burkina Faso.

INTRODUCTION: Rhinoscleroma is a chronic granulomatous infection of the respiratory tract due to Klebsiella rhinoscleromatis (K. rhinoscleromatis). PATIENTS AND METHOD: We observed two cases of rhinoscleroma in the Souro-Sanou university hospital of Bobo-Dioulasso, Burkina Faso, over a 9-year period (2009 to 2010). RESULTS: A 19-year-old man and a 38-year-old woman both consulted with obstructive granuloma of the nasal fossae; one also had a velar localization. The treatment consisted of surgical debridement and antibiotic therapy (ciprofloxacin). Good results followed the surgery. On follow-up after two and one and a half years, we observed no relapse. CONCLUSION: The diagnosis of rhinoscleroma should be considered for any obstructive tumor of the nasal fossae. Histopathological examination contributes to the diagnosis.

[Major sickle cell anaemia and hypoacusia: about 112 cases in Yopougon, Côte d'Ivoire]. / Drépanocytose majeure et hypoacousie: à propos de 112 cas relevés à Yopougon, Côte d'Ivoire.

The objective of this study is to evaluate the impact of major sickle cell anaemia on the auditory function of the patients. It was a prospective survey conducted in the university hospital of Yopougon (Republic of Côte d'Ivoire). The auditory function of 112 major sickle cell anaemia patients 5- to 40-five-years-old, was compared with 112 healthy controls. 17% (19/112) of major sickle cell anaemia patients presented hearing loss from 30 dB to 65 dB versus 4% of controls. The average age of deaf patients was 26-years-old (7 years to 40-years-old). The sex-ratio was 0,73. The SC form with 47% (9/19) of deafness was the form the most frequently found followed by form SS, 37% (7/19) and form S beta+ thalassaemia 16% (3/19). The form S beta 0 thalassaemia did not record deafness patients. However the form having shown the highest rate of attack was the form S beta+ thalassaemia with 25% (3/12) followed by form SC 21% (9/43) and form SS 14% (7/51) of deafness. Deafness was generally light 73, 7% of the cases and often bilateral (52.6% of the cases). The audiometric loss affected both extremes of the hearing range, but was more significant in lower tones (58% of cases). Higher tones represented 5% of the cases. It was often sensorineural hearing loss 58% of the cases. Mixed hearing loss represented 42% of the cases.

Starting a new program of split liver transplantation after a low learning curve: a reality in centers with large experience in liver surgery and whole liver transplantation.

BACKGROUND/AIMS: Split liver transplantation (SLT) is nowadays, considered an adequate surgical solution to expand the grafts from the existing pool of cadaveric donors. METHODOLOGY: A total of 897 liver transplantations were performed between 1986 and 2002; 20 were SLTs (2.3%). A 30% were children. RESULTS: Mean follow up of 15.15 months +/- 13.85. Median age was 42.27 +/- 25.65 yrs. Median recipient weight was 52.29 +/- 20.87 Kg. Mean donor weight was 76.1 +/- 13.11. The majority was "in situ" SLT (65%). There was no primary graft dysfunction. Two patients developed biliary complications (none in situ SLT). Early HAT occurred in 2 patients and delayed HAT in one. Four patients were retransplanted but none were performed because of primary graft dysfunction. Five patients died in the hospital. Fifteen patients (75%) survived the postoperative period and 3 patients died during follow-up. Mean patient survival time was 42 months (95% CI: 31-52). Actuarial patient survival was 93.3%, 84.4%, 84.4% at 6 months, 1 year and 3 years. Mean graft survival was 36 months (95% CI: 25-48). Actuarial graft survival was 87%, 72%, 72% at 6, 12, 36 months. Univariate analysis of risk factors for graft loss showed that the type of splitting technique (p=0.019), and the UNOS (1 and 2a) status of the recipient (p=0.001) were significantly associated with graft loss. CONCLUSIONS: In the context of large volume full cadaveric liver transplantation, split liver can provide adequate results (even after a short learning curve) mainly in elective cases and with the in situ technique.

Incidence of de novo nonmelanoma skin tumors after liver transplantation for alcoholic and nonalcoholic liver diseases.

INTRODUCTION: Skin tumors are the most common malignancies after orthotopic liver transplantation (OLT). They have been related to sunlight exposure, tobacco consumption, and immunosuppression. The aim of this study was to compare the incidence of de novo skin tumors (nonmelanoma) in patients who underwent liver transplantation for alcoholic cirrhosis versus nonalcoholic diseases. PATIENTS AND METHODS: Between April 1986 and July 2004, we performed 1000 OLT in a population of 888 recipients. This study was performed in a sample of 701 adult recipients who survived >2 months after transplantation: 276 patients (39.4%) underwent OLT for alcoholic cirrhosis (AC-group), and 425 (60.6%) for nonalcoholic disease (N-AC). The overall incidence of de novo skin tumors was 3.5% (25 tumors): 5.4% (15 tumors) in the AC-group and 2.4% (10 tumors) in the N-AC group (P = .027). Two patients developed two tumors. There were 19 men and 4 women, mean age at OLT of 54.4 +/- 6.8 years (range, 40 to 66 years). The mean time from OLT to tumor diagnosis was 66.1 +/- 51.4 months (range, 3 to 165 months): 56.4 +/- 44.4 months in the AC-group versus 80.6 +/- 59.8 months in the N-AC group (P = NS). Histologically, 17 tumors (68%) were basal cell carcinomas and eight tumors (32%) were squamous cell carcinomas (P = .128). Fourteen patients (60.8%) were smokers: 11 patients (84.6%) in the AC-group versus 3 patients (30%) in the N-AC group (P = .012). All the patients underwent tumor resection, with only one patient dying, because of lymph node invasion of the neck. CONCLUSION: There was a higher incidence of de novo skin tumors among patients who smoked who underwent OLT for alcoholic cirrhosis.

Long-term results of laparoscopic extended surgery in advanced gastric cancer: a series of 101 patients.

BACKGROUND/AIMS: The objective of our paper is to report on the remote results of patients with gastric cancer treated by mini-invasive surgery as a surgical tool with the "intention to treat with laparoscopy". METHODOLOGY: Between June 1993 and January 2004, 101 patients comprising 72 men and 29 women with gastric adenocarcinoma were prospectively selected by two hospitals based on prior agreement (the CHU Charleroi, Belgium, and Zumárraga Hospital, the Basque Country, Spain). Patients with adenocarcinoma of the cardia were excluded. Average age of the patients was 67 (37-83). RESULTS: Postoperative mortality within 60 days of operation was of 5 patients; 87 patients were therefore properly followed-up for an average of 41 months (7-129). Average survival time for 10 non-resected patients was 4.5 months. Average survival rate of the 10 palliatively resected patients was 7.1 months. Actuarial 5-year survival rate RO-type surgery was 34%. The global actuarial 5-year survival rate after resective surgery was 29%. CONCLUSIONS: Laparoscopic gastrectomy with any kind of lymphadenectomy is a heavy but safe operation, and produces acceptable mortality and morbidity rates in patients with advanced gastric cancer in a general poor condition. Laparoscopic gastrectomies for locally advanced cancers are equivalent to those reported by laparotomy as far as long-term oncological results are concerned.

Exceptional bilateral adrenalectomy after secondaries from colorectal cancer.

We report a very uncommon case of bilateral adrenal metastasis treated at our institution. The patient was 65 years old, with a history of low anterior resection for colorectal cancer in 2001. One year later, he was diagnosed with bilateral adrenal metastasis, based on the results of abdominal computed tomography-scan. A bilateral adrenalectomy extended to distal pancreatectomy and splenectomy was performed. Postoperative course was uneventful. He is alive and free of disease 12 months after adrenalectomy. We conclude adrenal metastasis from colorectal cancer should be managed surgically, even if they are bilateral.

Live liver donation: a prospective analysis of exclusion criteria for healthy and potential donors.

INTRODUCTION: Living donor liver transplantation represents a controversial option to increase the donor pool. DESIGN: Prospective and descriptive clinical study. OBJECTIVE: (1) To identify risk factors (exclusion criteria) for live donation; (2) to determine the rate of recipients that benefit from a living donor. METHODS: Between May 1995 (first adult-to-adult living donor liver transplantation in Spain) and November 2002, we evaluated 74 healthy volunteers and performed 12 living donor liver transplants (no donor mortality). RESULTS: All actual donors and volunteers are alive and healthy. After a mean time of 3.2+/-0.5 weeks, 72% of potential donors were considered unsuitable for live donation. Exclusion criteria were grouped in three categories: (primary) donor safety reasons (68%); (secondary): ABO mismatch (17%) and (tertiary): cadaveric graft transplantation (15%). Consequently, just 43.7% of the recipients presenting to us with a potential living donor, did finally benefit from these organs. The mortality rate was 8.3% for 43 recipients presenting with a living donor in comparison to 15% for those who did not (321 recipients between May 1995 and November 2001). CONCLUSIONS: ALDLT can benefit a significant number of recipients on the waiting list (43.7% of those presenting with a donor). The most frequent exclusion criteria concern donor safety, namely, unsuspected chronic liver diseases and unsuspected thrombophilic disorders.

Prognostic factors in invasive lobular carcinoma of the breast: a multivariate analysis. A multicentre study after seventeen years of follow-up.

BACKGROUND AND GOALS: The purpose of this study was to characterize the biologic determinants that affect the behavior of invasive lobular carcinoma of the breast. MATERIAL AND METHODS: A prospectively accrued data base containing 9,619 breast cancer cases was queried for specific pathological features. From this data base, 390 patients with invasive lobular carcinoma of the breast treated and followed at any of these three centers: San Carlos Hospital, Doce de Octubre Hospital or The Jimenez Diaz Foundation in Madrid (Spain) were reviewed and results, in terms of overall survival and disease-free survival were recorded for a long-term follow-up of 206 months (17 years). RESULTS: The parameters that showed an important statistical influence on survival were the stage at diagnosis, the tumor size and nodal status, as well as the tumor grade. Age showed a limited influence, and multicentricity, or the type of surgical procedure had no statistical impact on survival. CONCLUSIONS: Our analysis specifies the clinico-pathological features that influence the prognosis of invasive lobular carcinoma of the breast, and confirms that conservative therapy may be an appropriate treatment for this type of cancer.

[Anti-Haemophilus influenzae b (Hib) natural immunity in children in Burkina Faso]. / Immunité naturelle anti-Haemophilus influenzae b (Hib) chez l'enfant au Burkina Faso.

BACKGROUND: Natural immunity to Haemophilus infection type b that is acquired by the mothers and passively transmitted to their newborns is not well-known in developing countries, where the frequency of Haemophilus meningitis in infancy is high. POPULATION AND METHODS: Blood samples (5 ml) were taken from 89 women at the time of delivery and from the cord of their babies. Blood samples were also taken from 290 infants and children, distributed into nine subgroups as a function of their age. Children with protein-calorie malnutrition and immune deficiency were excluded from the study. Antibodies against Haemophilus influenzae were measured by Elisa and radioimmunologic methods. Blood concentrations of 0.15 pg/ml or more were considered to be protective. RESULTS: All the blood samples of mothers and cords contained protective levels of antibodies, as did the samples from 30% of those infants aged 0-60 days (all the infants were less than 1 month). No infant in the subgroup 12-23 months had protective levels of antibodies. The incidence of Haemophilus meningitis was correlated with the absence of antibodies. CONCLUSION: Maternal immunity is gradually lost by babies during their first 2 months of life, earlier than in developed countries. Early vaccination, at 3 months of age, is mandatory.

[Focal neuropsychological deterioration by posterior lobar atrophy (posterior cortical dementia)]. / Deterioro neuropsicológico focal por atrofia lobar posterior (demencia cortical posterior). Correlación clinicorradiológica.

A right-handed 59 year old man who presented difficulties in the performance of complex acts (praxic) and spatial disorientation is described. Neurophysical exploration showed deterioration of the capacities linked to perceptive and spatial organization preserving the verbal capacities including the memory. After two years and a half of follow up practically no variation has been observed in his clinical manifestations with no implication of other superior mental function. CAT and MR findings revealed important posterior atrophy with an increase in the occipital loops. SPECT demonstrated cold images due to a bilateral parietal-temporal perfusion deficit. Discussion of the case leads to the needs of unifying the criteria and terminology for these focal degenerative processes.

[Paraganglioma of the cauda equina]. / Paraganglioma de la cauda equina.

The case of a 36 year old woman with a paraganglioma of the cauda equina was studied. This localization is rare and special emphasis is made concerning the peculiarities of presentation, aggravating factors of the clinical manifestations and neuroradiologic findings. A review of the 66 paragangliomas of the cauda equina published to date is carried out. This entity deals with a tumor in the adult, with slight male predominance and a clinical presentation not differing from that of other lesions occupying the space of the cauda equina. The most frequent initial symptom is low back pain with or without sciatic irradiation. Total resection of the tumor may cure the patient.

[Amyotrophic lateral sclerosis syndrome and hyperthyroidism. Cure with antithyroid drugs]. / Syndrome de sclérose latérale amyotrophique et hyperthyroïdie. Guérison sous antithyroïdiens.

We report the case of a 62-year old man presenting with generalized muscular weakness, amyotrophy, dysarthria and dysphagia. Neurological examination showed bilateral pyramidal signs and lingual fasciculations. The clinical diagnosis was amyotrophic lateral sclerosis, since only shivers and weight loss pointed to hyperthyroidism. However, after several months the patient developed typical manifestations of hyperthyroidism. After treatment of hyperthyroidism, the neurological symptoms disappeared. Although this association is extremely rare, one must have in mind the possibility of thyroid dysfunction when studying patients with amyotrophic lateral sclerosis.

Hydrocephalus in neurofibromatosis. Contribution of magnetic resonance imaging to its diagnosis, control and treatment.

Cerebral ventricular dilation and/or frank hydrocephalus unrelated to brain tumors is not a rare feature of von Recklinghausen neurofibromatosis (NF-1). In our experience, it was observed in 23% of patients consulting for neurological problems. From 1984 to 1989, 30 patients with documented NF-1 were referred to for cranial or spinal magnetic resonance imaging (MRI). In 9 of these patients, clinical features or previous computed tomographic scanning revealed hydrocephalus or ventriculomegaly. One patient had biventricular hydrocephalus (enlarged lateral ventricles), 7 had triventricular hydrocephalus (aqueductal stenosis) and 1 had tetraventricular hydrocephalus (obstruction of the foramina of Magendie and Luschka). MRI showed anomalies in all 9 patients. The importance of MRI for the diagnosis, control and treatment of the hydrocephalus as well as for understanding the embryologic pathogenesis of these conditions is emphasized.

Optic pathway gliomas in neurofibromatosis.

Two patients, a 5-year-old girl and a 3-year-old boy, with documented neurofibromatosis (NF-1) and visual pathway gliomas are reported. In the first patient, the tumor was a typical pilocytic astrocytoma confined to the proximal half of the right optic nerve just near the globe. The tumor was excised; after a follow-up of 7 years recurrence has not occurred. The second patient had a glioma of the left optic nerve, with involvement of the chiasm, optic tracts, probably lateral geniculate body, optic radiations and basal ganglia. Biventricular hydrocephalus, possibly due to the occlusion of Monro's foramina, was also noted. In this case, magnetic resonance imaging (MRI) was superior to computed tomography for visualizing the posterior extension of the lesions. The patient received X-ray therapy and after a follow-up of 3 years the clinical symptomatology remains stationary. It is suggested that the optic pathway involvement detected by MRI may represent a dysplastic element NF-1 rather than a truly neoplastic change.