[HUMAN SCABIES IN THE GENERAL POPULATION OF PARAKOU (BENIN): EPIDEMIOLOGICAL AND CLINICAL ASPECTS IN 2022]. / Gale humaine en population générale à Parakou (Bénin) : aspects épidémiologique et clinique en 2022.

Introduction: La gale, "maladie tropicale négligée" depuis 2017, est un problème de santé publique dans de nombreuses régions tropicales. L'objectif était d'étudier les aspects épidémiologique et clinique de la gale humaine en population générale à Parakou en 2022. Méthodes: Il s'est agi d'une étude transversale descriptive et à visée analytique menée à Parakou du 16 mai au 26 juin 2022. Un échantillonnage par sondage en grappes a été réalisé et l'analyse des données a été effectuée avec le logiciel Epi info version 7.2.4. Résultats: Au total, 727 sujets ont été enquêtés et 653 répondaient aux critères d'inclusion parmi lesquels 49 présentaient la gale humaine (7,5%). Parmi ces derniers, une prédominance masculine 51,1% a été observée (sex-ratio 1,23). L'âge moyen était de 21,4±14,4 ans avec des extrêmes de 1 et 70 ans. Le prurit généralisé est observé chez tous avec une notion de contage familial dans 40,8% des cas. La vésicule perlée était le principal signe (77,1%) et les mains constituaient le siège de prédilection des lésions cutanées (79,2%). Le bas niveau d'instruction universitaire (p=0,027), l'utilisation de lait corporel dépigmentant (p=0,023), les faibles fréquences de changement de vêtements (p=0,034) et de la literie (p=0,001) ainsi que le nombre élevé de personnes par lit (p=0,001) étaient les principaux facteurs associés. Conclusion: La prévalence de la gale humaine demeure non négligeable à Parakou. Il urge d'œuvrer à divers niveaux pour limiter sa propagation au sein de la population béninoise. Mots clés: Gale, épidémiologie, clinique, Parakou.

Comorbidities and Environmental Factors Associated with Atopic Dermatitis in Children and Adults in Dermatology-Venereology in Cotonou, Benin.

INTRODUCTION: The objective of this work was to document the comorbidities and environmental factors associated with atopic dermatitis (AD) in dermatology Venereology in Cotonou. METHODS: A cross-sectional, prospective, and analytical study included, from January 2016 to December 2018, in the Dermatology-Venereology Department of the National Teaching Hospital Hubert Koutoukou Maga (CNHU-HKM) of Cotonou, children and adults after free and informed consent, in whom the diagnosis of AD was retained according to the criteria of the United Kingdom Working Party. Severity was assessed using SCORAD (severity scoring of atopic dermatitis). RESULTS: The overall prevalence of AD was 7.7%. AD was more frequent in children (56.8% and 40.6%) and adults (59.8% and 37.4%) from urban and periurban areas (0.003 < p < 0.034). It was more frequent in children who regularly dewormed and those with complete vaccination (0.001 < p < 0.01). In 54.8% of children and 58.9% of adults, flare-ups occurred during the warm season. The main associated comorbidities were rhinitis and conjunctivitis in both children (49.7% and 36.1%, respectively) and adults (32.7% and 26.2%, respectively). The main triggering factors in children were heat (43.2%), pneumallergens (28.4%), and skin irritants (22.6%). In adults, we noted skin irritants (58.9%), heat (47.7%), and psychological factors (34.6%). In adults, the use of detergent soaps was associated with lichenified and severe AD (0.003 < p < 0.006) and that of lightening soaps with acute AD (p=0.042). CONCLUSION: AD in the Dermatology-Venereology Department of the CNHU-HKM of Cotonou was associated with comorbidities. It was influenced by environmental factors related to the tropical climate and by skin irritants or allergens.

The Management of Primary Hyperaldosteronism in a Poor Technology Environment.

We report a case of Conn's adenoma in a 35-year-old female successfully managed in a poor hospital technology environment.

Epidemic, Endemic, or Stewart-Bluefarb? When Several Forms of Kaposi Seem to Dispute Paternity.

The role of human herpes virus 8 (HHV8) is demonstrated in the occurrence of Kaposi's disease, but the role of cofactors is still hardly known. We report a case of Kaposi's disease which occurred 10 years after a local trauma in an HIV-positive patient from Central Africa. A 38-year-old female, from and living in Central Africa, consulted for angiomatous papulo-nodules associated with purple-colored macules and painful lymphoedema of the right leg and foot that had been developing for 6 months. She reported a history of posttraumatic lymphoedema of the affected limb as a result of a road accident that occurred ten years earlier. The mucous were healthy. There was no sign of systemic lesions. The diagnosis of Kaposi's disease was evoked with, in differential, a Stewart-Bluefarb syndrome-type of pseudo-Kaposi and an epidemic Kaposi disease. Retroviral serology was positive to HIV1 with a CD4 count of 600 cells/mm3. Histopathology of the lesions and duplex ultrasonography could not be performed. The rest of the biological assessment was without particularity. The diagnosis of epidemic Kaposi's disease associated with cofactors involved in endemic Kaposi's disease and Stewart-Bluefarb syndrome was retained. An antiretroviral treatment (emtricitabine, tenofovir, and efavirenz) allowed to obtain after 6 months a noticeable improvement of the lesions and a disappearance of the pain with however the persistence of a residual lymphoedema. This is a special case of Kaposi's disease that seems to involve several factors. The role of cofactors in Kaposi's disease remains to be elucidated.

Epidemiological and Clinical Profile of Dermatoses Observed in Chronic Hemodialysis Patients at the National Teaching Hospital (NTH-HKM) of Cotonou, Benin.

Introduction. Dermatological damage in chronic hemodialysis patients is not uncommon. In Benin, to date, no study on the dermatological manifestations of chronic hemodialysis patients has been carried out. However, the presence of cutaneous signs is evident in these patients, and the need for dermatological care is not negligible. The objective of this study was to identify the epidemiological and clinical profile of the main dermatological manifestations presented by chronic hemodialysis patients at the NTH-HKM of Cotonou (Benin). METHODS: This was a descriptive cross-sectional study conducted in chronic hemodialysis patients from May 15th to September 15th, 2018. Included were all patients seen during the study period who had been on hemodialysis for at least three months, had at least one dermatological manifestation, and gave verbal or written consent. Chronic hemodialysis patients who did not wish to participate in the survey were excluded. RESULTS: 87 patients were included in the study for a hospital frequency of 33.8%. The sex ratio (male to female) was 2. The median age was 49 years (IQ [40.75-59]). Median age in hemodialysis was 36 months with two weekly sessions. The main dermatological manifestations were xerosis (48.3%), pruritus (34.5%), alopecia (14%), nail dystrophy (9.2%), equisegmented nails (8%), and melanoderma (8%). Pruritus was associated with a longer duration of hemodialysis sessions (p=0.01), while xerosis, alopecia, and melanoderma were associated with seniority in hemodialysis. CONCLUSION: Cutaneous manifestations in hemodialysis patients were frequent and dominated by xerosis, pruritus, and alopecia. Factors associated with some of these dermatologic manifestations were seniority in hemodialysis, long duration of the hemodialysis session, and female gender.

[Scalp disorders in black Africans treated in a dermatology department in Cotonou (Benin): age-sex-specific epidemiological and clinical features]. / Pathologies du cuir chevelu chez le Noir africain en dermatologie à Cotonou (Bénin): aspects épidémiologiques et cliniques en fonction du sexe et de l´âge.

INTRODUCTION: scalp disorders are related to several factors including ethnicity, gender or age. In black people, they can be caused by intrinsic and extrinsic factors. Very few studies have been conducted in this ethnic group residing in black Africa, hence the purpose of our survey was to highlight the epidemiological and clinical features of age-sex-specific scalp disorders in patients treated in a dermatology department in Cotonou (Benin). METHODS: we conducted a retrospective and descriptive study of all the medical records of new patients coming to consultation in the dermatology department at the National Hospital and University Center (CNHU) of Cotonou over a period of seven years. The main reason for consultation was scalp disorder. Data on epidemiological and clinical features were collected and analyzed with the EPI-Info 7 software. RESULTS: prevalence of scalp disorders was 2.4% (181/7554). Children (0-18 years) accounted for 38.7% (70 patients) and adults 61.3% (111 patients). Children aged 0-10 (54; 29.8%) and adults aged 25-40 (51; 28,2%) were the most affected. Sex ratio was 1.8. Non-alopecizing dermatosis was diagnosed in 10; 5.5% of cases while alopecizing dermatosis in 171 patients (94.5%), of whom 82.9% (151/171) had non-scarring dermatosis and 11.7% (20/171) had scarring dermatosis. The most common conditions were ringworm (41; 22.6%), mainly occurring in 0-10-year-old boys, chronic non-scarring folliculitis (39; 21.5%) mainly occurring in 0-5-year-old boys and 19-40-year-old men, pelade (38; 21%) occurring in both male and female sexes, especially between the ages of 6-10 and 25-40, traction alopecia (17; 9.4%) occurring exclusively in women and mainly in the 25-40-year-old age group, fibrous folliculitis at the nape of the neck (12; 6.6%) occurring exclusively in men from 19 to 50 years, trichotillomania (9; 5%) occurring in both male and female sexes, mainly in children aged 6-10 years and in adults aged 25-40 years, Quinquaud folliculitis decalvans (6; 3.3%) occurring uniformly in both male and female sexes and mainly between 25-40 years of age. CONCLUSION: scalp disorders mainly affect male patients before puberty and young adults. They were arranged in descending order in non-scarring alopecizing dermatoses, scarring alopecia and non-alopecizing dermatoses.

Prurigo in Children of Tropical Zone: Epidemiological, Clinical, and Etiological Characteristics in a Dermatology Department in Cotonou (Benin).

INTRODUCTION: The objective of this work is to document the epidemiological, clinical, and etiological features of prurigo in children. METHODS: This is a descriptive and retrospective study done from January 2013 to September 2018 in the Dermatology Department of National and Teaching Hospital HKM of Cotonou. All children from 0-18 years diagnosed clinically with prurigo were the study sample. Visual analog scale was used to assess the severity of pruritus. The data were entered and analyzed with EpiData and Epi Info 7 software. RESULTS: The prevalence of prurigo was 14.9% (234/1565) in the pediatric population. The mean age of the children at the onset of the disease was 5.4 years ± 4.9 years. Their sex ratio was 0.8. Pruritus was reported in 97.8% of cases; it was moderate in 50% and severe in 50%. Several phenotypes were described, including erosivo-crusted prurigo (36.3%) and papulo-vesicular prurigo (32%). Frequently observed clinical forms were chronic (44.4%), acute (38.9%), impetiginized (8.1%), and lichenified (4.3%). Prurigo predominated on the lower limbs (74.8%), upper limbs (47.9%), and buttocks and trunk (24.8% each). The main etiologies were prurigo strophulus (PS) (55.5%), scabiosis (20.5%), prurigo of Besnier (10.7%), and hookworm cutaneous larva migrans (HCLM) (8.5%). The PS was seasonal (p=0.036), while prurigo of Besnier, scabies, and HCLM were perennial. CONCLUSION: The main etiologies of prurigo in the study participants were PS, prurigo of Besnier, scabiosis, and HCLM. It affected with predilection the limbs of children of less than 5 years. Prurigo was almost always itchy and often evolved in an acute or chronic mode.

Un cas de polysensibilisation à neuf allergènes de contact au Bénin

Introduction : La polysensibilisation est définie par une réaction positive à au moins trois allergènes de contact chez la même personne. Nous rapportons ici le premier cas de polysensibilisation à neuf allergènes de contact observé dans notre pays. Observation : il s'agissait d'un cas de patch-test réalisé chez un homme de 35 ans qui était suivi pour un eczéma chronique récidivant des mains et des pieds sur un terrain d'atopie. Résultat : la lecture faite à 48 h et à 96 h a objectivé une polysensibilisation à neuf allergènes de contact. Discussion : Il s'agit du premier cas de polysensibilisation à neuf allergènes de contact décrit au Bénin. Dans une publication récente nous avions présenté les trois cas de polysensibilisation à six allergènes de contact observés dans notre pays. Conclusion : l'originalité de cette observation réside à la fois dans le nombre impressionnant d'allergènes de contact positifs et dans la forte intensité de ces réactions pour les neufs allergènes

A case of reccuring giant condyloma of vulva in infant without sexual abuse successfully treated with electrocoagulation in Benin.

We report here a case of giant vulval condyloma in a two-year-old infant infected by her "baby sitter" without sexual abuse. Treated by surgical excision coupled with electrocoagulation, it was noted a rapid recurrence two weeks after treatment requiring a second electrocoagulation session. More than a year later, no lesion was noted, thus demonstrating therapeutic success. The unavailability of imiquimod in our context requires a systematic use of invasive treatment regardless of the age of the patient.

Regression of cutaneous xerosis with emollient treatment in sub-Saharan African patients.

Emollients have proven effective in improving cutaneous xerosis in various populations; however, no clinical data are available for African patients. The observational study "Xerafrica" was conducted by dermatologists in seven sub-Saharan countries to assess the evolution of xerosis after an 8-week treatment with an emollient. Patients were children above 3 years or adults. Secondary objectives were to assess pruritus, improvement in symptoms, quality of life, satisfaction, and tolerance. An analysis of 185 patients was made. After 8 weeks of emollient treatment, the relative reduction of the "Scaling Roughness Redness Cracks" (SRRC) score was -83.9% and -80.4% in children and adults, respectively. The effect was significantly stronger when topical steroids were co-prescribed with the emollient and in patients with co-dermatosis. To a lesser extent, the effect of emollient was also observed at week 4. Similarly, pruritus and quality of life strongly improved during follow-up. Skin lesions improved in almost all patients, with a high level of satisfaction noted by both dermatologists and patients. The "Xerafrica" study addressed, for the first time, the treatment of xerosis by emollients in an African population. In this specific context, the emollient markedly reduced xerosis as soon as 4 weeks and resolved it almost totally by 8 weeks. The study confirms, under real-life conditions, the efficacy and tolerability of an emollient in improving xerosis.

Vitiligo on black skin: epidemiological and clinical aspects in dermatology, Cotonou (Benin).

BACKGROUND: Vitiligo is unsightly on darkly pigmented skin and leads important stigmatization because of the mix-up with leprosy. PATIENTS AND METHODS: We analyzed retrospectively the epidemiological and clinical patterns of vitiligo on darkly pigmented skin between 1988 and 2008 in the Department of Dermatology in Cotonou (Benin). The diagnosis was made based on the clinical characteristics of vitiligo. RESULTS: Two hundred and forty-six patients were seen, representing 0.9% of new consultations. The gender ratio was 1 : 1, and the mean age of patients was 25.9 years. The mean duration of the lesions was 30.9 months. Among the 246 patients, an associated pathology was found in 26% of cases. These included atopy (23.2%), diabetes (1.6%), thyroid disease (0.8%), and alopecia (0.4%). A family history of vitiligo was present in 1.2% of cases. The sites of the lesions were in descending order of frequency: head (60.6%), lower limbs (40.2%), upper limbs (33.3%), trunk (22.4%), genitals (13.0%), and neck (8.9%). On the head, the most common sites affected were the lips (65.1%), cheek (20.8%), and ears (16.8%). According to the different clinical forms, vitiligo was achromic (76%), speckled (12.6%), and trichromic (11.4%). Vitiligo vulgaris was the commonest form of the disease (52.4%), followed by localized vitiligo (36.2%), segmental vitiligo (9.8%), and vitiligo universalis (1.6%). Triggering factors were identified in 4.5% of patients. CONCLUSION: Our survey shows that the patterns of vitiligo are similar to that reported from other African countries with a few distinguishing particularities.

Allergènes de contact au Bénin: études transversale à propos de 30 cas

Dans une étude transversale portant sur 30 patch-tests réalisés sur trois ans dans un cabinet privé de Dermatologie au Bénin, le taux de positivité était de 90% avec un sex ratio de 1,7. Les quatre allergènes les plus souvent positifs étaient : Paraphénylène diamine, Baume de Pérou, Bichromate de potassium et Sesquiterpène lactone Mix

Incidence of malaria-related fever and morbidity due to Plasmodium falciparum among HIV1-infected pregnant women: a prospective cohort study in South Benin.

BACKGROUND: Malaria and HIV are two major causes of morbidity and mortality among pregnant women in sub-Saharan Africa. Foetal and neonatal outcomes of this co-infection have been extensively studied. However, little is known about maternal morbidity due to clinical malaria in pregnancy, especially malaria-related fever, in the era of generalized access to antiretroviral therapy and anti-malarial preventive strategies. METHODS: A cohort study was conducted in order to estimate the incidence rate and to determine the factors associated with malaria-related fever, as well as the maternal morbidity attributable to malaria in a high-transmission setting of South Benin among HIV-infected pregnant women. Four-hundred and thirty-two women who participated in a randomized trial testing strategies to prevent malaria in pregnancy were included and followed until delivery, with at least three scheduled visits during pregnancy. Confirmed malaria-related fever was defined as axillary temperature >37.5°C and a concomitant, positive, thick blood smear or rapid diagnostic test for Plasmodium falciparum. Suspected malaria-related fever was defined as an axillary temperature >37.5°C and the concomitant administration of an anti-malarial treatment in the absence of parasitological investigation. RESULTS: Incidence rate for confirmed malaria-related fever was of 127.9 per 1,000 person-year (PY) (95% confidence interval (CI): 77.4-211.2). In multivariate analysis, CD4 lymphocytes (Relative Risk (RR) for a 50 cells/mm3 variation = 0.82; CI: 0.71-0.96), antiretroviral treatment started before inclusion (RR = 0.34; CI: 0.12-0.98) and history of symptomatic malaria in early pregnancy (RR = 7.10; CI: 2.35-22.49) were associated with the incidence of confirmed or suspected malaria-related fever. More than a half of participants with parasitaemia were symptomatic, with fever being the most common symptom. The crude fraction of febrile episodes attributable to malaria was estimated at 91%. CONCLUSIONS: This work highlights that malaria is responsible for a substantial morbidity in HIV-infected pregnant women, with cellular immunodepression as a major determinant, and establishes the possible advantage offered by the early initiation of antiretroviral treatment. TRIAL REGISTRATION: PACOME Study has been registered under the number NCT00970879.

Cotrimoxazole prophylaxis versus mefloquine intermittent preventive treatment to prevent malaria in HIV-infected pregnant women: two randomized controlled trials.

BACKGROUND: Malaria during pregnancy has serious consequences that are worsened by HIV infection. Malaria preventive measures for HIV-infected pregnant women include cotrimoxazole (CTX) prophylaxis given to prevent HIV-related opportunistic infections and also protective against malaria, or intermittent preventive treatment (IPTp) with an antimalarial drug. Here, we present the first study evaluating CTX efficacy versus mefloquine (MQ)-IPTp, alone and in combination, in HIV-infected pregnant women. METHODS: We conducted 2 randomized, open-label, noninferiority trials in Benin. In the CTX-mandatory trial, HIV-infected women with CD4 counts of <350 per cubic millimeter received CTX either alone or with MQ-IPTp (N = 292). In the CTX-not-mandatory trial (CD4 count >350/mm), CTX was compared with MQ-IPTp (N = 140). In both the trials, the primary end point was microscopic placental parasitemia. RESULTS: At delivery, 1 woman in each CTX-alone treatment group exhibited placental parasitemia, versus no women in the groups receiving MQ. CTX alone demonstrated noninferiority in the CTX-mandatory trial. However, polymerase chain reaction-detected placental parasitemia was markedly reduced in the CTX + MQ group compared with CTX alone (0/105 vs. 5/103, P = 0.03). Because of insufficient recruitment in the CTX-not-mandatory trial, noninferiority could not be conclusively assessed. Dizziness and vomiting of moderate intensity were reported by 34%-37% of women receiving MQ in both the trials, versus 0%-3% in CTX groups (P < 0.0001). No serious adverse events related to these drugs were found. CONCLUSIONS: CTX alone provided adequate protection against malaria in HIV-infected pregnant women, although MQ-IPTp showed higher efficacy against placental infection. Although more frequently associated with dizziness and vomiting, MQ-IPTp may be an effective alternative given concerns about parasite resistance to CTX.

[Pattern of systemic lupus erythematosus in Benin and West African patients]. / Lupus érythématuex systémique: particulatités au Bénin et en Afrique de 'Ouest.

AIMS: To describe the clinical features, laboratory characteristics and the treatment of systemic lupus erythematosus (SLE) among Benin people and West Africa people. METHODS: This is a part of a retrospective study which initially concerned patients seen in the rheumatology, dermatology and internal medicine departments of National Hospital University of Cotonou during January 2000 to March 2013 (14 years). Patients included in the study were all older than 16 years and fulfilling at least four of ACR criteria 1997 for Systemic lupus erythematosus. In a second step, we collect the data of the countries of West Africa where the work on the systemic lupus erythematosus have been published through a literature review including all articles published in the local, regional and international journals. Demographic, clinical and outcomes data were analyzed. RESULTS: 33 cases of lupus were diagnosed in 14 years in Cotonou. The sex ratio was 32/1 and means age 28.76 ± 8.01 [16-51]. The mean delay before diagnosis was 15 months [1- 84 months]. Polyarthralgia/ polyarthritis were the most common presentations (94.3 %) followed by systemic manifestations (78.9 %). Nineteen (19) patients achieved serological profiles. The anti- ds DNA were positive in 15 cases, anti- Sm in 10 cases and anti -SSA in 5 cases. Anti - phospholipids and lupus anticoagulant were absent. Treatment modalities were: corticosteroids (n = 21) antimalarials (n=15) , methotrexate (n = 4) , body corticosteroids (n=5), clinical monitoring without treatment (n = 3). Outcome was satisfactory in 25 cases. Eight (8) patients developed complications, 4 cases of death were observed and 8 patients lost to follow. These data are congruent with those published in the countries of West Africa. CONCLUSION: SLE seems rare in Benin. In general, in West Africa, the diagnosis is difficult because the clinical polymorphism by misdiagnosis and access serological profiles difficulty. However, the disease appears to be well controlled by treatment dominated by corticosteroids.

Stevens-Johnson syndrome and toxic epidermal necrolysis in sub-Saharan Africa: a multicentric study in four countries.

OBJECTIVE: The purpose of this study was to document the clinical profile, etiologies, and outcomes of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in hospitals in four sub-Saharan African countries. PATIENTS AND METHODS: A retrospective study on cases of SJS/TEN treated in dermatology departments and/or intensive care units in four sub-Saharan African countries (Benin, Burkina Faso, Central African Republic, and Togo) from 2000 to 2010. The study focuses on variables such as age, sex, type of SJS/TEN, epidermal detachment of the skin surface, HIV status, drug(s) involved, and outcomes (death and sequelae). RESULTS: This study identified 177 cases of SJS/TEN from 2000 to 2010: 129 with SJS; 37 TEN; and 11 overlapping SJS/TEN. The average age of patients was 32.3 ± 15.4 years, and the sex ratio (M/F) was 0.6. HIV serology was positive in 69 (54.8%) of the 126 patients tested. Antibacterial sulfonamides (38.4%) were the most commonly used drugs followed by nevirapine (19.8%) and tuberculosis drugs (5.6%). We recorded 22 deaths (i.e. six cases of SJS, 15 of TEN, and one of overlapping SJS/TEN). Of the 22 patients who died, 16 were infected with HIV; among them, seven had an opportunistic infection (four cases of cerebral toxoplasmosis and three of pulmonary tuberculosis). Twenty-seven cases of sequelae were noted with a large part of eye complications. CONCLUSION: This study has highlighted: (i) the high proportion of patients infected with HIV among patients who had SJS/TEN in sub-Saharan Africa; (ii) the high frequency of antiretroviral drugs as new SJS/TEN causes in sub-Saharan Africa; and (iii) the impact of HIV infection on morbidity and mortality of these affections.

Tolerability of mefloquine intermittent preventive treatment for malaria in HIV-infected pregnant women in Benin.

OBJECTIVE: To investigate the tolerability of mefloquine intermittent preventive treatment (MQ IPTp) for malaria in HIV-infected pregnant women compared with HIV-negative women. DESIGN: Prospective cohort study comparing samples of HIV-negative and HIV-infected pregnant women from 2 clinical trials conducted in Benin. METHODS: One hundred and three HIV-infected women from the ongoing PACOME trial were compared with 421 HIV-negative women from a former trial, both trials aiming to evaluate the efficacy and tolerability of MQ IPTp, administered at the dose of 15 mg/kg. Descriptive analysis compared the proportion of women reporting at least 1 adverse reaction, according to HIV status. Multilevel logistic regression identified factors associated with the probability of reporting an adverse reaction for each MQ intake. RESULTS: Dizziness and vomiting were the most frequent adverse reactions. Adverse reactions were less frequent in HIV-infected women (65% versus 78%, P = 0.009). In multilevel analysis, HIV infection [odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.08 to 0.61] decreased the risk for adverse reactions, whereas detectable viral load (OR = 2.46, 95% CI = 1.07 to 5.66), first intake (versus further intakes, OR = 5.26, 95% CI = 3.70 to 7.14), older age (OR = 1.62, 95% CI = 1.13 to 2.32), and higher education level (OR = 1.71, 95% CI = 1.12 to 2.61) increased the risk. Moderate and severe adverse reactions were more frequent when antiretrovirals were started concomitantly with a MQ intake. CONCLUSIONS: This study provides reassuring data on the use of MQ IPTp in HIV-infected pregnant women. However frequent, adverse reactions remained moderate and did not impair adherence to MQ IPTp. In this high-risk group, MQ might be an acceptable alternative in case sulfadoxine-pyrimethamine loses its efficacy for intermittent preventive treatment.

Les condylomes acuminés génitaux chez un nourrisson de sexe masculin: abus sexuel ou non ?

Nous rapportons un cas de condylomes acuminés chez un nourrisson de sexe masculin âgé de 16 mois. Les condylomes acuminés constituent la plus fréquente des Infections Sexuellement Transmissibles.Si un abus sexuel est fortement suspecté chez notre patient, il n'en demeure pas moins que ces lésions peuvent être également manu portées ou de contamination per partum. Les condylomes d'origine sexuelle sont habituellement retrouvés chez les enfants de sexe féminin et à un âge plus avancé que celui de notre patient qui est de sexe masculin

Skin cancers at the National University Hospital of Cotonou from 1985 to 2004.

BACKGROUND: Skin cancer is the most common form of cancer occurring in adults in Europe and the USA. A low incidence has been reported in the black American population and in Africa, however. This study investigates the incidence of melanoma and epidermoid and basocellular carcinoma at Cotonou in Benin. METHODS: Over 20 years, 19 patient records were collected, 16 of which were the subject of a retrospective epidemiologic study. RESULTS: The main characteristic of skin cancer in the Department of Dermatology, Cotonou, Benin was its extreme rarity. The frequency was 0.00066%, with a male to female ratio of 1.28 and a mean age of 54.81 years. The mean ages at diagnosis for epidermoid carcinoma, melanoma, and basocellular carcinoma were 61.66, 59.40, and 54.56 years, respectively. The mean duration of epidermoid carcinoma was 6-10 times longer than that of melanoma and basocellular carcinoma. Of the 16 patients included in the study, five were albinos. In this group, the frequency was 31.25%. DISCUSSION: The extreme rarity of skin cancers in our series cannot be the result of recruitment bias alone. It reflects the actual situation. All of our cases of melanoma were in a plantar location. This inconsistency with other studies is probably a result of the size of our series. The duration of disease in our cases of carcinoma was comparable with the results obtained in a previous study in Dakar, Senegal. In our study, oculocutaneous albinism was the main preneoplastic factor. CONCLUSION: This study confirms the low incidence of skin cancer in the black population, the fact that basocellular carcinoma affects a relatively young population, and the predilection of melanoma for acral locations in black individuals.

Keloid acne of the neck: epidemiological studies over 10 years.

BACKGROUND Acne keloidalis nuchae is a chronic condition affecting young adult males of African origin. The frequency of the condition is low but its occurrence has a significant impact on the patient's quality of life. PATIENTS AND METHODS We performed a retrospective study on data collected over a period of 10 years in the Department of Dermatology and Venereology at the Centre National Hospitalier et Universitaire (CNHU) in Cotonou, Benin. We examined 90 files covering the period from 1993 to 2002 in terms of the epidemiologic, clinical and therapeutic features and course of the disease. RESULTS The frequency of acne keloidalis nuchae in patients attending the department for consultations over this period was 0.7%. All patients were male, and their mean age was 29 years. The mean period between disease onset and initial consultation in the department was 29 months. Of the patients diagnosed, 82.22% were seen at the stage when the keloid lesions were small. Lesion size did not appear to depend on the duration of the disease. The mean duration of follow up for the 34 patients reviewed was 22 weeks. In nine cases the lesions had spread and in five cases they had resolved. The treatment proposed depended on the type of lesion, but no effective therapeutic guidelines exist. CONCLUSIONS The study has demonstrated that, once the clinical stage of purely inflammatory lesions has passed, delay in consultation has a negligible effect on the course of the disease, which remains chronic and recurrent. A preventive approach using Information Education Communication (IEC) would be preferable.