Cutaneous leishmaniasis in Niger.

This is the first report of cutaneous leishmaniasis in Niger subsequent to the initial finding in 1911 and the report of a second case in 1943. The clinical, histopathological, and epidemiological features of 64 parasitologically confirmed cases are described. Lesions were mostly multiple, situated on exposed areas of skin, but rarely on the face. Two clinical forms were predominant: ulcero-crusted and humid-ulcerous. Nodular lymphangitis was not uncommon. Patients were mostly from rural areas, but urban transmission did occur. The majority of lesions appeared during the June-October rainy season. All features appeared to be similar to those of this disease in other countries in the sahelian endemic zone.

Lympho-cutaneous Kaposi's sarcoma in an African pediatric AIDS case.

A case of disseminated Kaposi's sarcoma with lymphoid and mucocutaneous involvement in an African infant with acquired immune deficiency syndrome is reported. The child died within 2 months after recognition.

PIP: Co-infection with acquired immunodeficiency syndrome (AIDS) and Kaposi's sarcoma is not uncommon in Europe, but is rare in Africa and not previously reported in infants. This article documents the case of an 11-month-old African boy with lymphocutaneous Kaposi's sarcoma. The infant was brought to a hospital in the Central African Republic with chronic diarrhea and disseminated lymphadenopathy. Also present were fever, cough, weight loss, a gingivostomatitis with herpes-like vesicles, hepatomegaly, splenomegaly, and cervico-axillo-inguinal lymphadenopathy. The adenopathies 1st occurred when the infant was 7 months of age and were followed 1 month later by the emergence of 12 dark brown or black velvet raised cutaneous nodules. The diagnosis of Kaposi's sarcoma was confirmed by lymph node and skin nodule biopsies. Also indicative of Kaposi's sarcoma was the presence of abortive vascular foci at a distance from the skin's surface and the cell proliferation. Both the infant and his asymptomatic mother were seropositive for antibodies to human immunodeficiency virus (HIV)-1. The skin lesions in this case presented the special infiltrative characteristic of AIDS-related Kaposi's sarcoma. The infant died 2 months after presentation at the hospital. By the last weeks of his life, the cutaneous nodules had covered the entire body. Death was from pleuropneumopathy. Given the high prevalence of HIV-1 infection in the Central African Republic, more such cases can be expected.

Lesions produced by Clostridium butyricum strain CB 1002 in ligated intestinal loops in guinea pigs.

Heated spores (80 degrees C, 10 min) of Clostridium butyricum strain CB 1002 isolated from a fatal case of necrotising enterocolitis in a human neonate were inoculated into ligated intestinal loops prepared in young conventional guinea pigs. Necropsy findings 18 h later included congestion, patchy haemorrhage of the intestinal mucosa and bacteraemia. No abnormalities were observed in control loops given inocula of inactivated spores (heated at 100 degrees C for 10 min) or TYG 6 medium. The results suggest that vascular lesions are produced by C. butyricum in the intestine of young conventional guinea pigs.

[Tropical entomophthoromycoses]. / Les entomophthoromycoses tropicales.

A review was made about human entomophthoromycosis observed in tropical areas due to fungi of the order Entomophthorales. Rhinophycomycosis is caused by Entomophthora coronata, a cosmopolitan fungus which is only pathogen in wet tropical and subtropical climates. The disease, a muco-cutaneous infection of the face, induces monstruous deformations. Basidiobolomycosis is caused by Basidiobolus meristosporus, a saprophyte of different amphibians and reptiles very often present in the family Agamidae. The disease interests the subcutaneous tissues and is mainly located at the trunk, shoulders and upper part of the limbs. The epidemiology, clinic and therapeutic were reported. Histopathological lesions and morphology of both fungi were studied. The etiology of the casual agents of these mycoses was discussed.

[Morbidity due to bilharziasis caused by S. haematobium. Relationship between the bladder lesions observed by ultrasonography and the cystoscopic and anatomo-pathologic lesions]. / Morbidité due à la bilharziose à S. haematobium. Relation entre les lésions vésicales observées en échographie et les désordres cystoscopiques et anatomo-pathologiques.

Twenty-seven patients with proved urinary schistosomiasis and echographic bladder lesions were selected for cystoscopic examination and biopsy. All patients had specific lesions at cystoscopic investigation. Histologic examination confirmed diagnosis 26/27 cases. Ultrasonography appears as a very efficient method for detection of schistosomiasis bladder pseudo-tumors.

Immunohistochemical identification of ferritin, lactoferrin and transferrin in leprosy lesions of human skin biopsies.

Granulomatous lesions of human leprosy contained ferritin and lactoferrin but little or no transferrin, as demonstrated by the avidin-biotin complex immunoperoxidase method. Lactoferrin was found in the neutrophils. These results suggested that the cells of the host mononuclear phagocyte system in leprosy granulomas provide an adequate nutritional environment for iron acquisition by M. leprae. A possible role of iron binding proteins in the granulomas is discussed in relation to previous data on bovine paratuberculous granulomas.

[Cutaneous malignant melanoma in New Caledonia (South Pacific) 1973-1991. A study of 97 cases]. / Le mélanome malin cutané en Nouvelle-Calédonie (Pacifique Sud) 1973-1991. Etude de 97 observations.

The Cancer Registries have been operational in the South Pacific since 1958 (Papua New Guinea), Fiji (1965) and New Caledonia (1977) and complete cancer incidence rates are available, based on histologic data. We studied 97 melanomas, histologically confirmed, which were diagnosed in New Caledonia from 1973 to 1991. New Caledonia is located in the same latitude as Queensland in Australia, known for having the highest incidence of melanoma in the world. Standardised incidence rates (world population) were 9.82 and 7.65/100,000/year for European males and females, compared to 1.65 and 1.05 for Melanesian and Polynesian males and females. The European population is exposed and Melanesians/Polynesians are relatively protected as are black Americans or Africans. The mixed populations are protected, but no study is available as to the exact proportion of mixed people (20%?) in the entire population. For Europeans, among males, the main areas in which melanomas occur are the trunk (45%) the arm (13%) and the leg (13%). Among females, the main areas are the leg (27%), the trunk (20%) and the head (18%). Screening for melanoma has been more effective in the last 6 years, a period in which we diagnosed half the total cases and generally at earlier stages. Prognosis was poor for this period (1973-1991): the five year survival rates were 64% +/- 8%, not as good as in Europe or Australia, but these lesions were diagnosed between 1973 and 1985 and were generally more invasive. A better prognosis will probably be observed in a few years, and another evaluation of melanoma screening should be made in the future as well the study of precursors and early lesions.

Cancer in Cameroon: a relative frequency study.

Some 1,390 male and 1,418 female cancer cases examined histologically in Cameroon--1969-1973--were analysed. The relatively most frequent cancers were: Males: skin 30%, malignant lymphomas 13%, primary liver cancer 11%. Females: skin 20%, uterine cervix 16%, breast 10%. Kaposi's sarcoma comprised 31% of all male skin cancer with a high male-female ratio (157/14). Tumours of the lung and intestinal tract were rare. Ethnic differences were noted with regard to cancer of the liver, skin, buccal cavity, lung and bladder. Possible sources of bias are discussed.

Fulminant hepatitis with microvesicular steatosis (a histologic comparison of cases occurring in Brazil--Labrea hepatitis--and in central Africa--Bangui hepatitis).

A similar histopathologic picture of fatal hepatitis associated with widespread acute fatty changes in hepatocytes and single-cell necrosis was seen in epidemic cases occurring in two distinct equatorial areas having high prevalences of HBV and HDV infections. The cases were previously considered to be two different entities; Labrea hepatitis in Brazil, and Bangui hepatitis in the Central African Republic. However, the histopathologic findings suggest that they are pathogenetically and etiologically related to HBV and HDV infections, probably modified by some as yet unknown factor(s) present in equatorial forest zones.

Parasitological diagnosis of mucocutaneous leishmaniasis due to Leishmania b. braziliensis in Bolivia.

Parasitological diagnosis, using stained smears, culture and pathological examination of biopsy, was studied in 146 patients infected with mucocutaneous leishmaniasis, in Bolivia and Peru. The most efficient parasite detecting technique appeared to be the smear examination in cutaneous lesions (33% positive) and the pathology in case of mucous lesions (28% positive). In both, cutaneous and mucous lesions, the parasites were found most frequently in old lesions.

Immunohistochemical analysis of the mucosal lesion in mucocutaneous leishmaniasis.

Using antibodies against surface antigens of inflammatory cells and against extra-cellular matrix components, immunocytochemical studies permit the investigation of the in situ cellular immune response and the associated fibrosis, in mucosal lesions. 57 paraffin embedded skin biopsies of mucocutaneous leishmaniasis originating from Bolivia, and due to Leishmania (Viannia) braziliensis, were studied. Memory T cells predominate within a non-organized granulomatous reaction, in which were observed proliferating macrophages. At the top of the lesion, epithelial cells expressed HLA-DR. Some characteristics of this lesion, particularly its chronic destructive pattern, presently lack any clear explanation.

[Mycetoma in Mauritania: species found, epidemiologic characteristics and country distribution. Report of 122 cases]. / Mycétomes en Mauritanie, espèces rencontrées, caractères épidémiologiques et répartition dans le pays. A propos de 122 cas.

A two year investigation conducted at Nouakchott's Centre Hospitalier National supplied 122 histologically confirmed cases of mycetoma. 75% of those were of mycotic origin, of which the most common species was Madurella mycetomatis. The mean ages were 28 to 29 years at the beginning of the disease and 38 years at the time of examination. The duration of the evolution was between 6.3 and 8.4 years. Madurella mycetomatis seem to appear at a lower age (mean age beginning at 21.2 years, consultation at 27). Patients with bone involvement are older than others (38 versus 28 years). There is a statistically significant relation between spontaneous pain and bone involvement.

[Deep mycoses observed in New Caledonia. Evaluation of observations from the laboratory of pathologic anatomy of the Pasteur Institute of New Caledonia 1975-1990]. / Les mycoses profondes observées en Nouvelle-Calédonie. Bilan des observations du laboratoire d'anatomie pathologique de l'Institut Pasteur de Nouvelle-Calédonie 1975-1990.

All cases of deep mycotic diseases observed between 1975 and 1989 in the Laboratory of Anatomical Pathology at Nouméa's Pasteur Institute have been studied retrospectively together with all available data concerning this pathology both in New Caledonia and the Pacific area. During the period under review, two cases of histoplasmosis, 4 of actinomycosis, 3 sporotrichosis, 5 mycetoma and 5 chromoblastomycosis were recorded in New Caledonia. Clinical and histological data appear to be identical to those observed in other Pacific Islands. Diagnosis is most usually supported only by histological examination and, thus, for future studies it is vital that specific mycologic culture of all cases be carried out.

[Human protothecosis and environment]. / Protothécoses humaines et environnement.

Protothecosis are uncommon infections caused by Prototheca, considered to be achlorophylous algae. Nearly 80 human cases are reported in the literature since the first case described by Davies and Wakelin in 1964 in Sierra Leone (11). The disease have been identified in Europe, Asia (Japan, Thailand, China), Oceania and in the United States with 40 cases, particularly in the Southeast. Clinically, three clinical manifestations can be observed: 1) cutaneous lesions: papules, plaques or eczematoid, papulo-nodular areas of the extremities, 2) olecranon bursitis which occurred in 25% of cases, 3) systemic protothecosis. An immunosuppressive factor local or general can be found in half of the cases and the first description of algal meningitis was reported in a patient with AIDS in association with Cryptococcus neoformans. Because the disease is clinically not suspected, the diagnosis is often provided by histology showing a dermic granuloma with endospores. The characteristic feature of protothecosis in tissues is the presence of specific mature sporangia of Prototheca wickerhamii with the pattern of morula. The organism was PAS, Grocott and mucicarmin positive. The ecology was studied by Clark (7), Pidoux (23), Pore (25) and Sudman (27). Prototheca are ubiquitous inhabitants of sewages and are found in slime flux and animal wastes contaminating different aquatic systems. The transmission generally occurred by traumatic inoculation. Prototheca are also found in the digestive system of man and animals without never invasion of the epithelium and mucosae in experimental models. The pathogenicity and virulence are moderate and they are considered as rare opportunistic agents.

[5 new cases of entomophthoromycosis observed in Cameroon. Role of immunofluorescence in thr diagnosis]. / Cinq nouveaux cas d'entomophthoromycose observés au Cameroun. Place de l'immunofluorescence dans le diagnostic.

The authors present five new cases of entomophthoromycosis observed during three years of histopathology in Cameroon. Three classic cases of rhinoentomophthoromycosis. In one case, Conidiobolus coronatus was isolated. Two cases of subcutaneous entomophthoromycosis, without isolation of the germ. In one observation, the clinical and histological aspect suggested mucormycosis post entomophthoromycosis. An immunofluorescence technique showed the Basidiobolus haptosporus to be the real cause.

[Histopathology of mucocutaneous leishmaniasis caused by Leishmania (Vianna) braziliensis]. / Histopathologie de la leishmaniose cutanéo-muqueuse à Leishmania (Viannia) braziliensis.

A histopathological study of mucocutaneous leishmaniasis due to Leishmania (Viannia) braziliensis was carried out on 28 cutaneous and 114 mucosal biopsies, taken from Bolivian and Peruvian patients. This study showed similar histopathological findings in cutaneous and mucosal lesions. The cutaneous biopsies showed a strong epidermal hyperplasia occasionnally budding in the dermis. In the ulcerative area, the epidermis was totally necrosed and replaced by a fibrino-leucocytic edge. In the dermis, histio-lympho-plasmocytic infiltration was constantly found. The histiocytes often gathered in follicles sometimes with diffuse fibrosis. The parasites were encountered in 28.6 p. 100 of the biopsies. Whatever the mucosa concerned (i.e. nasal, palatal or lingual), the mucosal lesion was not different from the cutaneous lesion. The malpighian epithelium is either absent or the seat of a pseudo-epitheliomatous hyperplasia. Major histio-lympho-plasmocytic infiltration was found and extended through the depth of the lamina propria. Suppurative and fibrinoid necroses coexisted superficially and sometimes penetrated in depth. The parasites were found in about 30 p. 100 of the cases.

[Histopathology of mycoses in ORL]. / Histopathologie des mycoses en O.R.L.

This article is a histopathological review of fungus and actinomycosis infections seen in otorhinolaryngology. Actinomycosis with its charactéristic grains but sometimes difficult to differentiate from saprophytic bacterial granules. Aspergilloma and aspergillosis are seen frequently. Aspergillus filaments may be differentiated from those of Mucorales and those of Entomophtorales, agents responsible for tropical phycomycoses, the latter being characterised by the fibrinoid cuff which surrounds them. Candidiasis and yeast mycoses in the tissues also represent a very important area. Alongside cryptococcosis and sporotrichosis, emphasis is placed upon the frequency of mucosal localisations of histoplasmosis due to H. capsulatum. Sources of error related to false mycoses can be avoided by the routine use of PAS and Gomori-Grocott stains and careful morphological study.

[Kaposi's sarcoma in Burundi and the Central African Republic in the framework of acquired immunodeficiency syndrome (AIDS)]. / Le sarcome de Kaposi au Burundi et en République centrafricaine dans le cadre du syndrome d'immunodépression acquise (S.I.D.A.).

The authors carried out in 1985 a survey in two French speaking States in Central Africa, namely Burundi and Central African Republic (C.A.R.), in order to study the links between Kaposi sarcoma (K.S.) and A.I.D.S. In Burundi the prospective study conducted in Bujumbura, lead to collect in one year 25 cases of K.S. out of them 24 linked to A.I.D.S. No group at risk has been identified. The 24 K.S. linked to A.I.D.S. present a stage IV (cutaneous and visceral form) in 21 cases. 20 of them got an associated affection, 5 being tuberculosis bacteriologically confirmed. All of them present a cellular immunity deficiency. Evolution was fatal in 22 cases out of 24, average presumption of survival was 10 months. In C.A.R., retrospective survey conducted in Bangui made possible to find out 24 cases in 4 years, of which 20 having had a L.A.V. antibodies research, were considered. 9 of them were linked to A.I.D.S. No group at risk. 7 patients presented a sporadic form, 6 an African endemic form, 7 an epidemic form with associated infection. Out of 9 LAV positive patients, 5 deceased. Out of 11 LAV negative patients, 3 deceased with a A.I.D.S. clinical aspect. This survey carried out in Burundi and in C.A.R. demonstrates that K.S. is significantly in increase in these two countries. In Burundi it is significantly linked to A.I.D.S. In C.A.R., classical African K.S. do exist (sporadic, endemic), as well as K.S. linked to A.I.D.S., as underlined recently in Bayley's publications in Zambia. Since A.I.D.S. has been detected, it does exist an outbreak and a new clinical form of K.S. in Central Africa.

[An isolated neurinoma in the pancreas (author's transl)]. / Neurinome isolé du pancréas. A propos d'une observation.

The authors report the clinical record of an isolated neurinoma in the pancreas of a fifty year old African woman. Thanks to this observation and ten other cases previously described by literature, they remind of the rarity of this localization as of the polymorphous clinical aspects in this disease. They point out the difficulty of anerting the positive diagnostic as well as the importance of the histological investigation which alone can authenticate the lesion and precise its benign ou malignant nature.

[Mesenteric fibroma]. / Fibrome du mésentère.

The authors report a case of mesenteric fibroma in an 18 year old African woman revealed by an increase in the size of her abdomen without any accompanying symptoms. The complete removal of the tumor required resection of 50 cm of intestine. The postoperative course was uneventful. In view of this case, the authors recall the rarity of this kind of abdominal tumor, and the difficulty in diagnosis preoperatively.