Low prevalence of scabies and impetigo in Dakar/Senegal: A cluster-randomised, cross-sectional survey.

BACKGROUND: Scabies, a parasitic infection caused by Sarcoptes scabiei var. hominis, is a public health problem with significant morbidity worldwide, particularly in low-resource countries. Impetigo, a complication of scabies infection, is a risk factor for sepsis, glomerulonephritis and possibly acute rheumatic fever. Currently, the majority of epidemiological data has been collected in rural populations in the Pacific with limited applicability to urban populations in sub-Saharan Africa, where scabies is also believed to be a problem. To inform future public health programs, more reliable information about the burden of disease is required. METHODOLOGY/PRINCIPAL FINDINGS: In July/August 2022, we conducted a cross sectional, cluster-randomised, household survey in Pikine/Dakar using the 'International Association for the Control of Scabies (IACS)' criteria to diagnose scabies and impetigo. All participants underwent a standardised clinical examination by post-graduate dermatology students. For those diagnosed with scabies, an age-adapted 'Dermatology Life Quality Index (DLQI)' questionnaire was filled. We recruited and examined 1697 participants to detect 27 cases of scabies (prevalence: 1.6%, 95% CI 0.8-3.2), mostly in school aged children. Ten participants suffered from impetigo (prevalence: 0.6%, 95% CI 0.3-1.3), 5 of which were dually infected with scabies. Risk factors for scabies infection were young age, male gender and Koranic school attendance. Of those found to have scabies, in 7 out of 22 cases (31.8%) it had a large effect on their lives according to the DLQI questionnaires filled. CONCLUSIONS/SIGNIFICANCE: This study adds to the mapping of the burden of scabies across Africa to support public health action. With a low prevalence of scabies that is concentrated amongst poor households and children attending Koranic schools, a focused public health approach targeting Koranic schools and poor households seems to be most appropriate in this community.

Diagnosis, Management, and Outcome of Bart's Syndrome Observed in a Sub-Saharan African Country (Senegal, Dakar): 2 Case Reports.

Introduction: Bart's syndrome is an uncommon inherited congenital disorder associating congenital cutaneous aplasia of the extremities and inherited epidermolysis bullosa. Bilateral and symmetrical involvement of the limbs is exceptionally described on black skin. In most cases, the diagnosis is clinical; however, the management remains very difficult and the extended forms are a real therapeutic challenge. We report 2 cases of Bart's syndrome observed in a sub-Saharan African country (Senegal, Dakar). Case Presentation: It was about 2 premature female and male newborns. On physical examination, the girl presented with a total absence of skin on the limbs, associated with cutaneous detachment of the trunk representing a detached and detachable skin surface of 46%; the boy underwent a total absence of skin of more than 50% of the skin surface. The diagnosis of Bart's syndrome was set based on the typical clinical aspect. The blood count and CRP were normal for the girl whereas it revealed some disorders for the boy. The 2 newborns were urgently admitted to an incubator, and the intensive care was started with hyperhydration, anti-staphylococcal prophylaxis, and daily dermatological care with antiseptic baths and fatty dressings. Conclusion: Bart's syndrome is an uncommon genodermatosis characterized by a clinical triad associating congenital cutaneous aplasia of the extremities, inherited epidermolysis bullosa suspected in the presence of bubbles, and areas of cutaneous fragility and nail deformity. All types of which can be associated with this syndrome. The easy clinical diagnosis but the difficult management encumber the vital prognosis of our cases.

[Extrapodal mycetomas in Senegal: epidemiological, clinical and etiological study of 82 cases diagnosed from 2000 to 2020]. / Les mycétomes extrapodaux au Sénégal : étude épidémiologique, clinique et étiologique de 82 cas diagnostiqués de 2000 à 2020.

Objectives: Although the foot remains the main localization of mycetomas, extrapodal attacks, which are rarely studied, are also possible and occur either initially or following an extension. The objectives were to describe the epidemiological, clinical and etiological features of extrapodal mycetomas in Senegal. Methodology: Cross-sectional and retrospective study with multicentric enrollment in four reference department, two of which are in dermatology and two in orthopedics and traumatology. We included the files of patients with extrapodal mycetoma followed from January 2000 to December 2020. The data were analysed with SPSS software. Any p less than or equal to 0.05 was statistically significant. Results: We collected 82 cases representing 39% of mycetoma cases (n = 210). The average age was 41.9. The sex ratio was 3.1. Professionally, most patients were active farmers in 51% of cases (n = 33), pastoralists and housewives in 9 % (n = 6) respectively. The mean duration of evolution was 7.5 years. Exclusively extrapodal topographies were noted in 84% of cases (n = 69). Foot and extrapodal locations were concomitant in 16% of cases (n = 13). Mycetoma foci were distributed as follows: 59 in the trunk, 47 in the lower limbs, 9 in the upper limbs, 1 in the scalp and 1 in the neck. The etiology was actinomycotic in 46% of cases (n = 38), fungal in 38% (n = 31). It was not specified in 16% of cases (n = 13). Bone involvement occurs after 5 years (p = 0.001) unrelated to the etiology (p = 0.6). Conclusion: Extrapodal mycetomas are secondary to direct inoculation. However, extension to bone is exclusively due to diagnostic delay. Periodic consultations in endemic areas combined with training of resident health personnel are necessary for early diagnosis in order to improve the prognosis.

Kerion celsi due to Microsporum audouinii: a severe form in an immunocompetent girl.

A 9-year-old girl presented a large inflammatory cup-shaped scalp lesion with alopecia surrounded by pustules, dander, and suppuration associated with an occipital inflammatory lymphadenopathy for 1 month. Wood's light exam was positive as well as KOH mount showing ectothrix type hair involvement. Hair and pus culture on Sabouraud dextrose agar (SDA) added with chloramphenicol and supplemented with cycloheximide isolated a dermatophyte species identified as Microsporum audouinii according to the colonies features. Species identification was confirmed by matrix-assisted laser desorption-ionization-time of flight mass spectrometry (MALDI-TOF MS) and the patient was treated for kerion celsi with terbinafine tablets 125 mg per day associated with a ketoconazole-based shampoo. The evolution was favorable, with hair regrowth after 2 months.

[Cutaneous tuberculosis affecting the buttock in an immunocompetent adult patient]. / Une histoire de fesse: cas d'une tuberculose gommeuse de la fesse chez un adulte immunocompétent.

Tuberculosis is an endemic disease in Senegal. It rarely affects the skin. In these patients it is characterized by clinical polymorphism. It accounts for 2% of extra-pulmonary tuberculosis. We here report the case of an immunocompetent patient with tuberculosis affecting the buttock characterized by lesions gummy in consistency revealing active pulmonary involvement. This study involved a 47-year-old man admitted for a painful swelling in the right gluteal region that had evolved for four years. Physical examination objectified a polyfistulized hardened plaque characterized by confluent nodules and discharge of yellowish pus in the lower and inner face of the right buttock associated with bilateral inguinal inflammatory adenopathies. The diagnosis of skin tuberculosis was retained based on histological examination which showed tuberculoid granuloma and the detection of Alcohol-Acid Resistant Bacilli (BAAR) in the gastric fluid. Thoracoabdominopelvic CT scan showed multiple bilateral basal lung micronodules with a "bud tree" appearance. Serologic testing for HIV and HBV were negative. The patient achieved recovery after six months of tuberculosis treatment. In endemic areas, skin tuberculosis is characterized by clinical polymorphism. It should be suspected in patients with perineal abscess lesion.

Mycetoma epidemiology, diagnosis management, and outcome in three hospital centres in Senegal from 2008 to 2018.

Mycetoma is a neglected tropical disease caused by various actinomycetes or fungi. The disease is characterized by the formation of tumor like-swellings and grains. Senegal is an endemic country where mycetoma cases are under-or misdiagnosed due to the lack of capacities and knowledge among health workers and the community; and where the management of eumycetoma, burdened by a high amputation rate, is currently inadequate. This study aimed to update data on the epidemiology of mycetoma cases diagnosed in three hospital centres in Senegal over a 10 years-period. A total of 193 patients, diagnosed from 2008 to 2018, were included in the study. The most frequent presentation was eumycetoma (47.2%); followed by actinomycetoma (36.8%); it remained undetermined in 16.1% of the patients. The mean age was 38.3 years (68.4% of the patients were between 15 and 45 years-old); the male: female ratio was a 2.94; and most were farmers. One hundred fifty-six (80.8%) patients had used phytotherapy before attending the hospital. Mycetoma was mainly located to the lower limbs (91.2%). Grains were observed in 85% of the patients; including white (25.6%) and yellow (4.3%) grains. The etiological diagnosis was complex, resulting in negative direct microscopy, culture and/or histopathology findings, which explains that 16.1% remained uncharacterized. In most of cases, actinomycetoma were treated with a combination of cotrimoxazole, amoxicillin/clavulanic acid, and streptomycin; whereas eumycetoma cases were treated with terbinafine. The surgery was done in 100 (51.8%) of the patients including 9 in actinomycetoma, 78 in eumycetoma and 13 in undetermined form. The high number of uncharacterized mycetoma in this study, the delay in attending a qualified health-care facility, and the lack of available adequate antifungal drug, point out the need to strengthen mycetoma management capacities in Senegal.

[Primary breast tuberculosis in a man: a case report]. / Tuberculose mammaire primitive chez un sujet de sexe masculin : à propos d'un cas.

The breast tuberculosis accounts for 0.06 to 0.1% of extra-pulmonary localizations. Frequent in women, it remains exceptional in men. We report a rare case of primary breast tuberculosis occurring in a male patient. A 33-years-old patient presented with a chronic and fistulized non-inflammatory-right breast swelling with an atrophic cutaneous ulceration. The thoracic CT was in favor of a right breast abscess with a thick wall. The patient had received non-specific antibiotics (amoxicillin-clavulanate and metronidazole) for 10 days coupled with a surgical drainage before consulting us for persisting symptoms. The culture of the pus was sterile, the GeneXpert and the search for acid-fast bacilli (AFB) both performed on the swab of the ulceration were negative. Histopathological analysis of the lesion was in favor of a granulomatous mastitis. Given the chronic and atrophic nature of the ulceration, the histological aspect of granulomatous mastitis and the persisting symptoms despite the non-specific antibiotic therapy, we made a presumptive diagnostic of breast tuberculosis. The evolution was favorable with oral anti-tuberculosis treatment.

Epidemiology, clinical features, and associated factors in 78 cases of lichen planus on black skin.

BACKGROUND: The pathogenesis of lichen planus (LP) is mostly autoimmune, while psychological and infectious factors are recognized to trigger or aggravate the disease. An association with diabetes is reported. Our objective was to determine the epidemio-clinical characteristics of LP and its associated factors. METHODS: This multicentric, prospective study was conducted over a 6-month period. The histopathology was only performed for atypical forms. Patients with a notion of drug intake before the rash were excluded. Anti-hepatitis C Virus (HCV) antibodies screening was systematical in case of mucosal damage. The data were analyzed using the SPSS IBM 20 software. RESULTS: The average age was 38 years. Women represented 84.6% (n = 66) of the studied population. The patients were married in 61.5%. Obesity or overweight status was noted in 41%. A marital or relational conflict was found in 25.6%. History of LP was reported in 24.4% (n = 19). Pruritus was found in 96.2%. The locations were as follows: skin (97.4%), mucous membranes (15.4%), and hair and nails (5.1%). Lesions were diffuse in 56.4%. The clinical forms were as follows: typical (52.6%), erythematosquamous (17%), warty (14.5%), pigmented (14.5%), and blaschkolinear (one case). Histopathology confirmed the diagnosis of LP in 91.4%. Blood sugar level was high in one case. Hepatitis B surface antigen (HBsAg) was positive in 3.03%. Anti-HIV and anti-HCV antibodies were negative. CONCLUSION: Lichen planus is a relatively rare disease in sub-Saharan Africa and is seen more in adults. The clinical manifestations are polymorphic, but the mucosal damage is rarely isolated.

[Contribution of cutaneous manifestations to early diagnosis of periodic disease: a case study]. / Apport des signes cutanés sur le diagnostic précoce d'une maladie périodique: à propos d'un cas.

We here report a case of chronic periodic disease diagnosed on the basis of recurrent and persistent erysipelas in plaques in a patient under antibiotic therapy. Patient's interview, genetic testing and favorable outcome of colchicine helped to reach a diagnosis.

[Epidemiological and anatomoclinical features of scalp tumors in black Africans]. / Aspects épidémiologiques et anatomo-cliniques des tumeurs du cuir chevelu chez le noir africain.

INTRODUCTION: In Senegal, the studies on scalp tumors are almost non-existent. The purpose of our study was to determine the epidemiological and anatomoclinical features of scalp tumors in dermatology. METHODS: We conducted a prospective descriptive and analytical study in both Department of Dermatology at Dakar over a period of 16 months (01 March 2014-30 June 2015). Histopathological examination was used to confirm the diagnosis. RESULTS: We collected data from the medical records of 36 patients, of whom 14 had malignant tumors and 22 benign tumors. Sex ratio was 1.1, the average age of patients with malignant tumors was 51 years while the average age of patients with benign tumors was 39 years. Hospitalization rate was 0.18%. The average time of consultation in patients with malignant tumors was 14 months, while in patients with benign tumors was 52 months. In 11 patients with malignant tumors, first treatment was based on traditional therapy. Malignant tumors included: squamous cell carcinoma (n=8), basal-cell carcinoma (n=3), lymphoma, hidradenocarcinoma and Darier-Ferrand dermatofibrosarcoma (one case for each type). Benign tumors included: botriomycoma (n=5), trichilemmal cyst, sebaceous hamartoma, cylindroma and lipoma (2 cases for each type), heloid, syringocystadenoma papilliferum, schwannoma, neurofibroma and nevus (one case for each type). Tumor malignancy was associated to ulcero-budding appearance (p=0.003), diameter >4 cm (p=0.05), pain (p=0.009) and bleeding (p= 0.006). CONCLUSION: Scalp tumors in black people are usually benign. Squamous cell carcinoma is the most common malignant form.

Extranodal natural killer/T-cell lymphoma, nasal type, in Senegal.

INTRODUCTION: The distribution of extranodal NK/T-cell lymphoma (ENKTCL) is highly inhomogeneous throughout the world. In Sub-Saharan Africa, despite the precocity of Epstein-Barr virus (EBV) infection and its endemicity, ENKTCL remains exceptionally reported. The purpose of this study was to report the epidemiological, clinical, paraclinical, and evolutionary characteristics of ENKTCL at the Aristide LeDantec University Hospital in Dakar, Senegal. METHODOLOGY: A 5-year retrospective review of all patients with histopathological, immunohistochemical, and in situ hybridization proven cutaneous lymphomas RESULTS: We collected seven cases corresponding to a frequency of 1.4 cases per year. ENKTCL accounted for 10.5% of all cutaneous lymphomas, ranking second after T-cell lymphomas. Men were predominantly affected (M : F ratio of 6), and the mean age was 38.5 years ± 4.06. The mean time before consultation was 7.3 months. The lymphomas affected primarily the nasal cavity in five cases and the skin in two cases. At admission, six patients had nasal mucosa involvement, which was isolated in three cases, associated with cutaneous lesions in three cases and lymph node involvement in three cases. CD56 was positive in only one case, and Eber transcribed RNA of EBV was expressed by in situ hybridization in all patients. DISCUSSION: To our knowledge, we have reported the first and largest series of ENKTCL in Sub-Saharan Africa. Our study shows an intermediate prevalence between that reported from Asia, Latin America, and the West. It was also noted a young age of patients, a prolonged diagnostic delay, a frequent negativity of CD56 marker, and a very poor prognosis of the disease in our region.

Behçet's disease in black skin. A retrospective study of 50 cases in Dakar.

INTRODUCTION: Although Behçet's disease is well-documented in Eastern populations, epidemiologic data in Sub-Saharan African population is scarce. The aim of this study was to define the epidemiologic and therapeutic aspects as well as clinical course of Behçet's disease in African black population. RESULTS: The study included 50 patients with Behçet's disease. The average age was 32 (18-67) years. A total of 31 patients were men and 19 were women. Two patients had a positive family history of Behçet's disease. The oral and genital aphthous lesions were present in 100% of patients. The pathergy test was positive in 16 patients (32%). Following skin conditions were observed: pseudofolliculitis in 15 patients (30%), acneiform papules in 6 patients (12%), erythema nodosum in 4 patients (8%) and leg ulcers in one patient. Ocular involvement was reported in 22 patients (44%) and joint involvement in 20 patients (40%). Neurological abnormalities were noted in 12 patients (24%). Gastrointestinal involvement with wide and deep ulcerations in the ileocecal region was observed in a patient. As treatment, a combination of oral corticosteroids and colchicine was used in 97% of our patients. Thalidomide was introduced in 3 patients and anticoagulation treatment in 19 patients. Clinical improvement was noted in 25 patients (50%), recurrence in 14 patients (28%) and 3 patients were lost to follow (6%). CONCLUSION: The Behçet's disease is not uncommon in black skin and generally affects young adults. Severe aphthous ulcers of the oral cavity and genital area are the most consistent finding.

[Endemic Kaposi's sarcoma in Dakar: 29 cases]. / Maladie de kaposi endemique a Dakar: etude de 29 cas.

INTRODUCTION: There is a lack of data on endemic Kaposi's sarcoma in sub-Saharan Africa. The goal of this study was to clarify its epidemiological, clinical and therapeutic aspects in that region. PATIENTS AND METHODS: A 7-years retrospective study, including all patients with endemic Kaposi's disease diagnosis was carried out. RESULTS: We identified 29 cases of endemic Kaposi's representing 1.2% of total hospitalizations and an incidence of 4.4. The mean age and the sex ratio were 63.2 years 2.22 respectively. The average delayed time to seek for medical care was 6.75 months. Cutaneous manifestations were dominated by angiomatous papulonodular lesions in 15 cases (51.72%) ulcerated lesions in 8 cases (27.58%), lymphedema in 5 cases (17.24%), a sarcomatous degeneration in 2 cases and verrucous papules in one case. Mucosal involvement was observed in 7 cases (24.13%). The extracutaneous lesions were noted in 18 cases, with 6 cases of bone, 5 cases of lymph nodes, 5 cases of gastrointestinal and 2 cases of lung involvement. The outcome was favorable for single-agent chemotherapy with bleomycin in more than half of the cases. Recurrences were observed in 2 patients, 2 cases were died and 7 cases never came back. CONCLUSION: Endemic Kaposi's disease is more frequent in elderly people with a higher frequency of extracutaneous involvement and florid forms.

INTRODUCTION: En Afrique sub-saharienne il existe peu de données concernant la maladie de kaposi endémique. L'objectif de ce travail, était de préciser ses aspects épidémiologiques, cliniques et thérapeutiques. MALADES ET MÉTHODES: Une étude rétrospective d'une durée de 7 ans, recensant tous les malades présentant une maladie de kaposi endémique. RÉSULTATS: Nous avions recensé 29 cas de maladie de kaposi endémique représentant 1,2% des hospitalisés soit une fréquence annuelle de 4,14 cas par an. La moyenne d'âge était de 63,2 ans et le sex-ratio de 2,22. Le délai moyen de consultation était de 6.75 mois. Les manifestations cutanées étaient dominées par les lésions papulo-nodulaires angiomateuses dans 15 cas (51,72%), de lésions ulcérées dans 8 cas (27,58 %), d'un lymphœdème dans 5 cas (17,24%), une dégénérescence sarcomateuse sans 2 cas et des papules verruqueuses dans un cas. Les localisations muqueuses étaient notées dans 7 cas (24,13%). Les atteintes extracutanées notées dans 18 cas, étaient osseuses dans 6 cas, ganglionnaires dans 5 cas, digestives dans 5 cas et pulmonaires dans 2 cas. L'évolution était favorable sous monochimiothérapie à la bléomycine dans plus de la moitié des cas. Les récidives étaient observées chez 2 malades, des perdus de vus dans 7cas et 2 cas de décès. CONCLUSION: La maladie de kaposi endémique prédomine chez les personnes âgées avec une fréquence élevée des atteintes extracutanées et des formes florides.

The vitiligo in senegal.

The aim of our study was to determine the epidemiological and clinical aspects of vitiligo in the largest dermatology department of Senegal. A cross-sectional and descriptive study in a period of 5 months was performed covering all the vitiligo cases. Fifty patients were identified (26 women and 24 men). The mean age was 26.5 years. A family history of vitiligo was found in 11 cases and a psychoaffective disturbance in 6 cases. The clinical forms distinguished were generalized vitiligo (n = 33), localized vitiligo (n = 16), vitiligo universalis (n = 4), and segmental vitiligo (n = 1). The Koebner phenomenon was found in 7 cases. Associated diseases were atopic dermatitis (n = 2), contact dermatitis (n = 1), diabetes (n = 1), and Graves' disease (n = 1). The disgraceful character of Vitiligo was the predominance of generalized forms and the elective localization in sun-exposed areas. The family character, the psychoaffective disturbances, the Koebner phenomenon increased by the lifestyle and the itching dermatosis were the aggravating factors.

Epidemiologic and clinicopathologic aspects of Leprosy in Dakar; evaluation of 73 new cases.

Hundreds of new leprosy cases are still diagnosed in Dakar despite all the efforts in the struggle by the national program for elimination of leprosy by the Institute of Applied Leprosy in Dakar. The aim of our study was to evaluate the epidemiological, clinicopathological and outcome of new cases of leprosy. A prospective study was conducted over a period of one year listing all new cases of leprosy based on clinical diagnosis, bacteriology and histology. 73 new cases were recorded. The sex ratio was 1.5 and the mean age of 39.5 years. Children aged from 0 to 15 years old represented 12%. The clinical forms were rated in order of decreasing frequency Borderline 47.94%, 30.13% lepromatous lepromatous, indeterminate 8.21, borderline lepromatous 6.84, TT: 5.47%, 1.36 and neurological bb%. Neurological signs were enlarged nerve in 50 cases, a neurological deficit in 16 cases and a sensitive deficit in 16 cases. The complications were burns and ulcerations in 10 cases, a claw in 7 cases, a reversal reaction in 7 cases, erythema nodosum in 4 cases and neuritis in 8 cases. The number of new cases mutilated was 24.65%. The smear was positive in 42% and histology contribution in 91.37% of cases. Our study highlights the significant number of patients with multibacillary contagious, affected children, the high proportion of disability grade 2/OMS reflecting the delay in diagnosis. This delay is due to ignorance, to traditional treatments and low socio-economic status and lack of trained diagnostic teams in different areas apart from referral centres.