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.

Fungal mycetoma and pregnancy: An association with costly and difficult management, about a case.

Mycetomas are endemic diseases in tropical and sub-tropical countries of Africa, Asia and America, mainly affecting rural populations living below the poverty line. We report a particular case of a mycetoma associated with pregnancy whose evolution was good, but at the cost of significant financial expenses. This was a 39-year-old woman who developed a fungal mycetoma due to Madurella mycetomatis from the ingunocrural region. The patient had to develop several previous pregnancies on this site of mycetoma, the outcome of which was favorable. The last pregnancy was accompanied by an aggravation of the mycetoma in the form of polyfistulized inflammatory swelling of the right inguino-crural region emitting black grains. Magnetic Resonance Imaging (MRI) of the region showed invasion of the adductor muscles at the level of the root of the thigh on its antero-internal side with no sign of pelvic extension or underlying bone lesion. The patient was treated by surgery associated with antifungal treatment. The evolution was favorable for pregnancy and mycetoma.

[Study Of The Availability Of Medicine For Childhood In Senegal]. / Etude De La Disponibilite Des Medicaments Utilises Dans La Prise En Charge Therapeutique Des Enfants Ages De Moins De 5 Ans Dans La Region De Dakar Au Senegal.

INTRODUCTION: In Senegal, the main causes of death are the pneumonia, the diarrhea and the malaria. The malnutrition is an underlying factor in more than a third of the deaths, because it returns the more vulnerable children to the serious illnesses. The general objective of this research is to study the availability and the price of medicine in the therapeutic care of the children of less than 5 years old in the region of Dakar in Senegal. METHODOLOGY: Our study is of transverse, descriptive concerned the public sanitary, the wholesalers, the private pharmacies, The population of study concerns the old children at least of 5ans. The methods used were the interviews by means of questionnaire. RESULTS: The group of antibiotics, acid anti, antidotes, vitamins, diuretics, antiemetic's, and psychotropic were not available. As regards generic medicines, relatively low availability of 30,4 %, 23,8 % and 16,7 % is respectively observed in the public, private and denominational sectors. The availability of generic medicines in Dakar was from 81 % in the public sector and from 113 % in the private sector. CONCLUSION: The findings make it imperative for all other relevant medicine drugs in order to reduce the mortality rate.

INTRODUCTION: Au Sénégal, les principales causes de mortalitéchez les enfants de moins de 5ans sont la pneumonie, la diarrhée et le paludisme. La malnutrition est un facteur sous-jacent dans plus d'un tiers des décès, car elle rend les enfants plus vulnérables aux maladies graves. MÉTHODE: Notre étude est de type transversal, descriptif et a porté sur les formations sanitaires publiques les grossistes, les pharmacies privées, L'objectif général de cette recherche est d'étudier la disponibilité et le prix des médicaments dans la prise en charge thérapeutique des enfants âgés de moins de 5 ans dans la région de Dakar au Sénégal. La méthode utilisée était des questionnaires et entrevues. RÉSULTATS: Le groupe des antibiotiques, des anti acides, des antidotes, des vitamines, des diurétiques, des antiémétiques et des psychotropes n'étaient pas disponibles. Concernant les médicaments génériques, des disponibilités relativement faibles de 30,4 %, 23,8% et 16,7% sont respectivement observées dans les secteurs public, privé et confessionnel. La disponibilité des médicaments génériques à Dakar était de 81% dans le secteur public et de 113% dans le secteur privé. CONCLUSION: Les résultats prouvent l'impérieuse nécessité de rendre disponibles les médicaments pédiatriques si nous voulons réduire la mortalité des enfants de moins de 5ans.

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.

[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.

Risk factors associated with abscess formation among patient with leg erysipelas (cellulitis) in sub-Saharan Africa: a multicenter study.

BACKGROUND: Abscess formation is a frequent local complication of leg erysipelas. In this study we aimed at identifying factors associated with abscess formation of leg erysipelas in patients in sub-Saharan African countries. METHOD: This is a multicenter prospective study conducted in dermatology units in eight sub-Saharan African countries from October 2013 to September 2014. We performed univariate and multivariate analysis to compare characteristics among the group of patients with leg erysipelas complicated with abscess against those without this complication. RESULTS: In this study, 562 cases of leg erysipelas were recruited in the eight sub-Saharan African countries. The mean age of patients was 43.67 years (SD =16.8) (Range: 15 to 88 years) with a sex-ratio (M/F) of 5/1. Out of the 562 cases, 63 patients (11.2%) had abscess formation as a complication. In multivariate analysis showed that the main associated factors with this complication were: nicotine addiction (aOR = 3.7; 95 % CI = [1.3 - 10.7]) and delayed antibiotic treatment initiation (delay of 10 days or more) (aOR = 4.6; 95 % CI = [1.8 - 11.8]). CONCLUSION: Delayed antibiotics treatment and nicotine addiction are the main risk factors associated with abscess formation of leg erysipelas in these countries. However, chronic alcohol intake, which is currently found in Europe as a potential risk factor, was less frequent in our study.

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.