Corynebacterium diphtheriae Infection in Mahajanga, Madagascar: First Case Report.

Diphtheria is an infection that has been unreported for more than two decades in Mahajanga. A child, aged 4, presented with a pseudomembranous pharyngitis was associated with a dysphagia. He was from a rural municipality of Ambato Boeny at Mahajanga province and was admitted to the Pediatric Unit of the University Hospital Center. The child was not immunized against diphtheria. A throat swab was performed and cultured, from which Corynebacterium diphtheriae was identified. The strain, of biovar Mitis, was confirmed as diphtheria toxin (DT)-gene positive and produced DT (Elek test). Unfortunately, the child developed cardiac and neurological complications and died of respiratory and heart failure.

[Neglected parotid tumors: case report]. / Tumeurs parotidiennes négligées: rapport de cas.

Tumors of the parotid gland can be challenging if left untreated. We report three cases of patients with initial clinical and therapeutic manifestations of neglected parotid tumours in Madagascar: two women and one man aged 42, 47 and 51 years, with tumours that had been developing for 4, 7 and 11 years respectively. One patient was suspected to have malignant tumour due to skin necrosis. The diagnosis was then confirmed by cytopuncture. After obtaining the informed consent, total parotidectomy was performed in all patients. Facial nerve sacrifice with cervical lymph node dissection was established in the patient with a malignant tumour. No intraoperative adverse events were reported. Parotid tumors can become cancerous without proper treatment. Socio-economic factors are involved in delayed consultation. However, early consultation in patients with parotid tumors would prevent management risks.

[Role of sugarcane pollen in allergic rhinitis: a case-control study]. / Implication du pollen de canne à sucre dans les manifestations de la rhinite allergique: étude cas témoins.

The identification of allergens is essential in the management of allergic rhinitis. Sugarcane produces anemophilic pollen. The purpose of our study is to assess the role of sugarcane pollen in the occurrence of allergic rhinitis. We conducted a case-control analytical study of patients living in a Malagasy rural commune in which sugarcane cultivation and processing are important sources of employment, from July 2017 to June 2018. We enrolled 182 patients (91 cases and 91 controls). Factors associated with the occurrence of symptoms of allergic rhinitis were: a distance of less than 500 meters between homes and sugarcane fields (OR = 1.50), being a sugarcane worker (OR=1.16) and having a family history of allergic rhinitis (OR=13.67). In addition, exposure to wind gusts (OR=0.84) and outdoor occupation (OR=0.92) were protective factors. Exposure of patients to sugarcane pollen is associated with clinical manifestations of allergic rhinitis and confirms the role of this allergen in the occurrence of the disease. Avoidance and hygiene measures are the basis of treatment.

[Peripheral facial palsy in children: an unusual manifestation of foreign body in the ear]. / Paralysie faciale périphérique de l´enfant: une manifestation inhabituelle d´un corps étranger de l´oreille.

Foreign bodies in the ear are common in children but they rarely lead to complications. We here report a rare case of homolateral facial palsy in a 4-year old female child that occurred 15 days after introduction of toxic foreign body (Abrus precatorius seed) in her ear. The patients had signs of local necrosis associated with external otitis, without systemic involvement. Foreign body extraction was performed using micro-hook. Local and general treatments as well as corticosteroid therapy and physiotherapy were started with good outcome after three weeks. Prolonged stay of the foreign body in the ear can cause local infection resulting in potential functional complications. Early extraction and local treatment are the basis for treatment.