[Leprosy and immune reconstitution syndrome in AIDS]. / Lèpre et syndrome de reconstitution immunitaire au cours du sida.

The immune reconstitution syndrome (IRS) has been typical of changes in the clinical presentations of opportunistic infections in AIDS patients since the introduction of HAART. Leprosy has joined the growing list of opportunistic infections associated with IRS.

[Delayed home screening of leprosy; experience of the screening team in Mayotte]. / Dépistage actif intra-domiciliaire différé de la lèpre : expérience de l'equipe de dépistage sur l'île de mayotte.

Mayotte, a French territory island located in the Indian Ocean near Madagascar, remains a leprosy endemic area. In 2006, leprosy was still a problem of public health with a prevalence of 3.94 per 10,000 inhabitants. There is practically no formal consensus about active screening (AS) on an index case. According to teams and their related staffs, the AS concerns intradomicilary contact individuals (IDC) restrictively or extended to extra-domicilary social and professional contacts. Date, number and frequency of these investigations depend on each team. Between 1997 and 2003, there was no AS planned in Mayotte, but all index case individuals have been encouraged to propose a screening to their relatives through specific campaign information and education. This procedure allowed to identify 10 new cases of leprosy infection among the IDC. Concurrently 12 IDC cases have been diagnosed by health workers. In 2003, we performed a postponed AS within IDC of every Mahorais case registered by passive detection between 1997 and 2003. 325 IDC have been examined and 15 new cases have been detected. All these new cases showed early leprosy features: 14 were paucibacillary forms, among which 9 cases with an isolated cutaneous lesion (7 had an infracentimetric lesion). One patient had multibacillary disease although he presented with an isolated skin lesion which developed within the 6 previous months. None presented with disability. Our results suggest that passive detection even reinforced by repeated individual information and education about leprosy is neither appropriate nor effective. The postponed AS seems to favour an increased self-esteem and a better involvement of the index patient in sanitary education together with the screening of his relatives. In the Mayotte background, the postponed AS has not been associated with a significant delay for diagnosis. Although WHO recommandations are to abandon immediate AS of IDC and to promote self-screening for leprosy our study suggests an intermediate position, namely delayed active screening for an enhanced effective detection.

Mycetomas in Mali: causative agents and geographic distribution.

Although Mali is situated in the African zone endemic for mycetomas, no report has been published on the characteristics of the disease in this country. We report a series of 54 cases observed in Bamako. The causative agents were Madurella mycetomatis in 20 patients, Leptosphaeria sp. in one patients, Actinomadura madurae in 12 patients, A. pelletieri in 15 patients, and Streptomyces somaliensis in three patients. In this series, the observed geographic distribution of the causative agents was in agreement with data on the causative agents and their geographic distribution in neighboring countries, and with those suggesting a relationship between the type of infectious agent and the annual rainfall.

Skin diseases of children in Mali: a public health problem.

In order to estimate the importance as a public health problem of skin diseases, we investigated the prevalence and severity of skin diseases in a representative sample of children in Mali. 1817 children were randomly selected in 30 clusters by probability-proportional-to-size sampling in Koulikoro region. The mean prevalence (+/- 2 SD) of skin diseases was 34 +/- 4%. The most frequent dermatoses were pyoderma (12.3 +/- 1.6%), tinea capitis (9.5 +/- 2.5%), pediculosis capitis (4.7 +/- 1.4%), scabies (4.3 +/- 1.5%), and molluscum contagiosum (3.6 +/- 1%). The most troublesome dermatoses were scabies and severe pyoderma. Pyoderma was the only dermatosis associated with poor individual or household hygiene. Public health services were little used by the population for skin diseases, probably because of the lack of an adequate response by the services and the high cost of treatment. The high prevalence and the severity of many of the lesions, and the discomfort caused, make pyoderma and scabies a significant public health problem in Mali.

[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.

[Bullous IgA linear dermatosis of children in Mali]. / La dermatose bulleuse à IgA linéaire de l'enfant au Mali.

INTRODUCTION: Bullous IgA linear dermatosis is relatively frequent in children in Africa. The aim of this study was to evaluate the frequency of this disease among autoimmune bullous diseases in children in Mali. PATIENTS AND METHODS: Children with chronic bullous disease seen at the Marchoux Institute in Bamako and for whom direct immunofluorescence of the perilesional skin demonstrated immunoglobulin and/or complement deposits were included in the study population. RESULTS: Twelve children were included. Direct immunofluorescence showed linear IgA deposit along the dermo-epidermal junction in 10, once with a pemphigoid aspect and once with a pemphigus aspect. The skin lesions in the children with linear IgA deposits were stereotypic: disseminated bullae, rosettes (9 out of 10), involving the external genital organs (10/10), the limbs, the face and the trunk. Histology showed subepidermal bullae (10/10), with neutrophil papillar abscesses (9/10). Indirect immunofluorescence of the cleaved skin NaCl in 5 patients showed that the cleavage always lied at the roof of the cleavage. All the children responded to dapsone (1 to 2.5 mg/kg/d) which gave complete (7/10), or incomplete remission. Local corticosteroids were used in 2 patients and general corticosteroids in 1. DISCUSSION: This confirms the frequency of bullous IgA linear dermatosis in Africa, in contrast with uncommon dermatitis herpetiformis. Diagnosis is facilitated with immunofluorescence. The low cost of this test makes it a useful diagnostic tool in these countries.

[Dermatologic complications of the cosmetic use of bleaching agents in Bamako (Mali)]. / Complications dermatologiques de l'utilisation cosmétique de produits dépigmentants a Bamako (Mali).

OBJECTIVES: This study was conducted to determine the dermatological complications related to the use of bleaching agents in Bamako, Mali. Patients who were referred to the Marchoux Institute with complications were studied retrospectively. Over a period of 1 year, 74 complications were observed including acne (n = 25), infectious dermatoses modified by the application of local corticosteroids, and in particular dermatophytosis (n = 15), dyschromia (n = 11, including 3 cases of exogenous ochronosis), contact eczema, papular annular lesions and vibices. This pathology is frequent in Bamako and the diagnosis is quite difficult since the patients usually deny use of bleaching agents.

[Skin diseases disclosing human immunodeficiency virus infection in Mali]. / Dermatoses révélatrices de l'infection par le virus de l'immunodéficience humaine au Mali.

INTRODUCTION: Several skin diseases are associated with human immunodeficiency virus (HIV) infection. In Africa, due to the difficult access to medical care and complementary examinations, certain diseases are of particular importance. In the present work, we report the skin manifestations observed in a dermatology unit of a large city in Africa over a 3 year period and which were the revealing signs of HIV infection. PATIENTS AND METHODS: All adult subjects (>15 years) with a positive HIV serology (confirmed by Western blot) that had been revealed by a skin disease seen at the Marchoux Institute at Bamako between June 1991 and September 1994 were included in the study. RESULTS: Two hundred sixty-three skin diseases revealed 233 cases of HIV infection. Diseases observed were: zoster (n = 71), seborrheic dermatitis (n = 43), Kaposi's sarcoma (n = 34), prurigo (n = 31), sexually transmitted diseases (n = 27), extensive dermatophytosis (n = 12), psoriasis (n = 12), molluscum contagiosum (n = 8), acquired ichthyosis (n = 3), cutaneous leishmaniasis (n = 2) and other skin diseases (n = 10). More than one disease were associated in 28 patients. Certain particular features were noted (superinfection of zoster, papular margin in dermatophytosis). DISCUSSION: In Africa, certain skin diseases often reveal HIV infection and some diseases have a high positive predictive value for HIV infection (zoster, seborrheic dermatitis, prurigo, Kaposi's sarcoma, extensive dermatophytotis). For prognosis, frequently associated diseases are signs of AIDS (Kaposi's disease, prurigo, molluscum contagiosum).

[Generalized eruptive histiocytoma. Apropos of a case. Review of the literature]. / Histiocytome éruptif généralisé. A propos d'un cas. Revue de la littérature.

About one case of generalized eruptive histiocytoma (G.E.H.) (the second French case) and about thirteen others cases mentioned in literature, the authors remind the clinical, histological, immuno-histochemical and evolutive aspects of this misunderstanding disease, described by Winkelmann in 1963. After having classed it, in the group of nodular, non X, non lipidique, benign histiocytosis, they expose the imprecision of this nosological limits of the G.E.H., in comparison to the bordering diseases. At last, they insist upon the fact that the few number of cases published up to this time, the lack of stand back and the casual transformation into a multicentric reticulo-histiocytosis must induce to watchfulness by requiring for each patient affected by G. E. H. and for a long time, a regular, clinical, radiological and hematological supervision.

[Subcutaneous phycomycosis successfully treated with itraconazole]. / Basidiobolomycose traitée avec succès par l'itraconazole.

INTRODUCTION: We report a case of basidiobolomycosis (subcutaneous phycomycosis), an uncommon deep mycosis in the entomophtoromycosis group. CASE REPORT: A 12-year-old girl presented a deep skin infiltration involving the back and buttocks. Histology reported filamentous formations without septa surrounded by Splendore-Hoepple phenomenon, the characteristic aspect of entomophtoromycosis. Outcome was favorable after treatment with itraconazole. DISCUSSION: Basidiobolomycosis is a deep mycosis rarely observed in children. Most reported cases have occurred in the tropics. The clinical presentation can simulate deep scleroderma or a tumoral disease. Treatment is currently based on imidazole derivatives which are particularly effective.

[Leprosy disclosed by polyarthritis]. / Lèpre révélée par une polyarthrite.

BACKGROUND: We report a case of leprosy observed in a French woman who had lived in Africa 30 years earlier. The clinical presentation was misleading, suggesting connective tissue disease. CASE REPORT: A 69-year-old woman was hospitalized in April 1996 for inflammatory joint disease. The first manifestations had developed three years earlier and the patient had been on systemic corticosteroid therapy associated with anti-malarials since 1993. The clinical presentation progressively included neurological and skin manifestations. Histology examination gave the diagnosis of lepromatous leprosy. Three-drug anti-leprosy treatment in one oral dose was initiated. DISCUSSION: Chronic Mycobacterium leprae infection usually leads to overt leprosy with neurological and cutaneous involvement. Rheumatological forms are less common and found almost exclusively during leprous reactions. The association of inflammatory join pain with neurological and skin manifestations wrongly suggested vasculitis. In addition, the general corticosteroid therapy certainly was implicated in disease activation and progression to a purely lepromatous form.

[An epidemiologic survey on the cosmetic use of bleaching agents by the women of Bamako (Mali)]. / Enquête épidémiologique sur l'utilisation cosmétique de produits dépigmentants par les femmes de Bamako (Mali).

In Mali, the cosmetic use of bleaching agents by black people has become a social phenomenon. How wide is this practice is not precisely known. We report the results of a survey conducted in Bamako among women aged from 15 to 45 years in order to evaluate the prevalence of this practice and its socio-economic factors. Two-hundred and ten women were questioned during the cluster survey. Among these, 53 (25 p. 100) used bleaching agents which were topical cortico-steroids (37), hydroquinone-containing products (21), mercury derivatives (11) and products of unknown composition (16). Dermatological side-effects were observed, but they did not hinder the use of these agents. Bleaching was particularly frequent in unmarried women (39 p. 100), literate women (34 p. 100) and female students (45 p. 100).

[Adult T-cell leukemia associated with HTLV-1 in a HIV-2 seropositive African]. / Leucémie/lymphome T de l'adulte associée au HTLV-I chez un Africain séropositif pour le VIH 2.

INTRODUCTION: The aim of this report is to describe an HIV-2 seropositive patient from Mali who had adult-T cell Leukaemia/Lymphoma associated with HTLV-I infection. CASE REPORT: The patient presented with erythroderma and foliate lymphocyte leukaemia. Skin biopsy showed an epidermotropic lymphoma. Tumoural cells expressed a mature T-cell phenotype CD4+/CD25+. High anti-HTLV-I titers and the evidence of monoclonal integration of HTLV-I provirus within circulating lymphoid cells led to the confirmation of HTLV-I as the causal agent in tumour cell transformation. HIV-2 serology was positive. DISCUSSION: Sub-Saharan Africa is a vast reservoir of HTLV-I virus with at least 5 million infected persons. Cases of adult-T cell Leukaemia/Lymphoma in Africans are exceptional. Lack of sufficient knowledge of the disease could partially explain this discrepancy. The main differential diagnosis in dermatology is primary T-cell lymphomas of the skin, particularly mycosis fungoides and Sézary syndrome.

[Review: update on erythema nodosum leprosum]. / Actualités de l'érythème noueux lépreux.

Erythema nodosum leprosum (ENL) is an immunological reaction corresponding to vascularitis due to circulating immune complexes usually occurring during treatment of lepromatous leprosy. The precise mechanism underlying ENL are unclear but involvement of tumor necrosis factor alpha (TNFalpha) is suspected. Based on this suspicion pentoxifylline has been used instead of conventional treatments such as corticosteroids and thalidomide.

[Cutaneous leishmaniasis in Algeria (author's transl)]. / La leishmaniose cutanée en Algérie.

Report of 27 cases and comments on their epidemiological, clinical, immunological features and on the question of their treatment and prophylaxis.

[The human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) in New Caledonia]. / Le virus de l'immunodéficience humaine (VIH) et le syndrome d'immunodépression acquise (SIDA) en Nouvelle-Calédonie.

The authors report on 15 HIV seropositive cases detected within 2 years in New Caledonia (150,000 inhabitants). Testing HIV antibodies was systematic among blood donors (9,917 persons) and was carried out in defined samples (1,475 persons): population at risk, rural area, and tests required by clinicians. All seropositive individuals belong to "high risk group". One certain AIDS case, group IV C (as defined by CDC Atlanta), another probable one (early death) and several opportunistic infections: herpes zoster, oral and candidosis, were observed. Biological exploration is quite good (Pasteur Institute in Noumea). However, therapy is problematic in this South Pacific Island, and management of seropositive patients is difficult.

[Malignant melanoma among the ethnic Melanesian population of New Caledonia]. / Mélanomes malins dans l'ethnie mélanésienne de Nouvelle-Calédonie.

Melanesian population amounts to 61,270 out of 145,368 inhabitants in New Caledonia according to the last census. Melanesians of phototype VI have no predisposition in regard to malignant melanoma. From 1977 to 1987, 7 cases have been reported. Localisations are always in some zones not exposed to sunlight: 3 acral-lentiginous melanoma of the sole, 2 tumorous nodules of the anus margin and the vulva, 2 choroidal localisations. So, incidence of cutaneous malignant melanoma is very low (0.7/100,000 per annum) and in accordance with classical data regarding black people. But one has to keep in mind its being in some characteristic localisations. All the above referred cases have been detected at an advanced local extension.