Cutaneous basidiobolomycosis: Seven cases in southern Benin.

BACKGROUND: Cutaneous basidiobolomycosis is the most common form of entomophthoramycosis. Herein we report seven cases of cutaneous basidiobolomycosis. PATIENTS AND METHODS: A retrospective observational study was conducted at the Buruli ulcer treatment centre in Pobè and at the national teaching hospital in Cotonou from 2010 to 2015. RESULTS: Seven cases of cutaneous basidiobolomycosis were diagnosed. The mean patient age was 9.53 years. There were 4 female and 3 male patients, all from southeast Benin. Clinically, the disease presented in all cases as a hard, well-defined, subcutaneous plaque with little inflammation, and which could easily be lifted from the deep structures but remained attached to the surface structures. The overlying skin was hyperpigmented. Plaques were localized to the buttocks or thighs. All patients had inflammatory anaemia with an accelerated erythrocyte sedimentation rate (30 to 70mm over the first hour), and a low haemoglobin count (8.7 to 11.4g/dL). Blood hypereosinophilia (650 to 3784elements/mm3) was present in six of the seven subjects. Histopathology (performed for 5 of the 7 subjects) showed granulomatous lesions with foreign-body giant cells, and inflammatory cells, with occasional eosinophils surrounding fungal hyphae (Splendore-Hoeppli phenomenon). Mycological analysis revealed Basidiobolus ranarum in three cases. The patients were treated with ketoconazole (5/7) and itraconazole (2/7), with good outcomes after 10 to 24 weeks of therapy. DISCUSSION: Cutaneous basidiobolomycosis is uncommon in southern Benin, with only seven cases being diagnosed over 6 years. The diagnosis of cutaneous basidiobolomycosis is a challenge in the field in Benin due to the non-specific clinical presentation, the lack of technical resources, and the existence of numerous differential diagnoses. CONCLUSION: Cutaneous basidiobolomycosis is an uncommon fungal infection in southern Benin chiefly affecting children.

Early growth and neurodevelopmental outcome in very preterm infants: impact of gender.

BACKGROUND AND OBJECTIVE: Nutrition in the neonatal unit may impact the neurological outcome of very preterm infants, and male preterms are more likely to suffer neonatal morbidity and adverse neurological outcomes. We hypothesised that growth during hospitalisation would impact neurological outcome differently, depending on infant gender. METHODS: Surviving infants born between 1 January 2003 and 31 December 2009 with a gestational age <33 weeks, and enrolled in Loire Infant Follow-up Team, a regional cohort in western France, qualified for the study. Growth during neonatal hospitalisation was assessed by the change in weight z-score between birth and discharge, and infants where ranked into 5 classes, depending on their change in z-score (<-2, -2 to -1.01, -1 to -0.51, -0.50 to 0.01 and ≥0), the last class being the reference. The main outcome criterion was neurodevelopmental outcome at 2 years of corrected age. For each class of changes in weight z-score, crude or adjusted OR for non-optimal outcome was calculated for each gender, and compared between genders. RESULTS: 1221 boys and 1056 girls were included. Gender and early growth interact, (p=0.02). Moreover when change in weight z-score varied from <-2 to (-0.50 to -0.01), adjusted OR for non-optimal outcome varied from 3.2 (1.5-6.8) to 2.2 (1.2-4.1) in boys versus 1.8 (0.7-4.2) to 0.95 (0.4-1.9) in girls. For each class, the OR was significantly higher in boys. CONCLUSIONS: In very preterm infants, male neurodevelopment appears to be much more sensitive than female to poor postnatal growth.

[Rhinofacial conidiobolomycosis associated with cervical, thoracic and brachial localizations: one clinical case in Nigeria]. / Conidiobolomycose rhinofaciale avec localisations cervicales, thoraciques et brachiales: à propos d'un cas nigérian.

We report here the clinical case of a Nigerian adult patient who received medical care during October 2010, at the Center for Diagnosis and Treatment of Buruli ulcer in Pobè (Benin). He presented a massive facial tumor associated with several subcutaneous (cervical, thoracic and upper limbs) nodules, evolving since several years. Tissue samples collected at Pobè medical center were addressed to the mycology and histology laboratories of Angers University Hospital (France), according to the medical exchange agreement between the two institutions about the diagnosis and treatment of Buruli ulcer disease. Histological examination showed a Splendore-Hoeppli phenomenon, consisting of a granulomatous reaction made of eosinophilic polynuclear cells surrounding rare, large and irregular, non-septate hyphae. A filamentous fungus was isolated by cultivation of the clinical samples, which was identified as Conidiobolus coronatus. The patient was treated orally with daily doses of ketoconazole (400 mg per day). After 4 months of treatment, a marked regression of the facial lesion was obtained. A first constructive facial surgery was achieved, but the patient did not attend the second step. This case report allows us to remind the mycological diagnosis of this exotic mycosis, but also to emphasize the main difficulties encountered in medical management in the developing countries.

[Detection of Mycobacterium ulcerans DNA in water bugs collected outside the aquatic environment in Benin]. / Détection des signatures moléculaires de Mycobacterium ulcerans chez des punaises aquatiques capturées au Bénin en dehors de leur environnement aquatique.

Hosting of Mycobacterium ulcerans by water bugs is now well established and their vectoring role has been demonstrated experimentally. These findings were recently corroborated by detection of viable bacilli in the saliva of wild water bugs. However, the extent of water bug involvement in M. ulcerans ecology remains unclear and difficult to evaluate due to lack of understanding about water bug biology. The purpose of this study is to describe the first detection of M. ulcerans DNA in the tissue of water bugs captured outside the aquatic environment. This finding supports the hypothesis that water bug migratory behavior contributes not only to the spread of M. ulcerans but also to transmission outside the aquatic environment.

[Determinants of diphemanil methylsulfate (Prantal) utilization: a survey of practice in the French neonatal and intensive care units]. / Enquête française sur l'utilisation du diphémanil méthylsulfate (Prantal) dans les unités de néonatologie.

UNLABELLED: Diphemanil methylsulfate (Prantal) is a quaternary ammonium with parasympathicolytic properties. It is used in premature and term neonates with bradycardias related to vagal hyper reflectivity (HRV). OBJECTIVES: To assess the use of Prantal in the French neonatal and intensive care units: its indications, its modalities of use, its side effects and the number of patients treated during 1 year (2004) in France. METHODS: A questionnaire was electronically sent to all neonatology units and all neonatal intensive care units in France. RESULTS: Among 202 units, 121 (60%) answered the questionnaire. Prantal was reported to be used in 51 (42.1%) units. Among them, 38 (31.4%) actually treated 169 patients in 2004 with a mean number of patients treated by unit of 4. The diagnostic of HRV was supported by: a history of malaise (84.3%), bradycardia (94.1%), oculocardiac reflex (74.5%), cardiac Holter (76.4%), cardiorespirographic recording (19.6%), esophageal pHmetry (35.2%) and esophageal fibroscopy (21.5%). The mean starting dosing was 4.7 mg/kg/d, the mean maximal dosing was 9 mg/kg/d and the mean daily intakes were initially 2.3 and secondary 2.9. Prantal dosing was adjusted to weight in 54.9%, every month in 85.7%. Treatment was stopped at the mean post-natal age of 6 months, mostly in a progressive manner and without monitoring help. CONCLUSION: Prantal was seldom used in 2004 in France for different reasons: HRV is an uncertain entity, the efficacy of Prantal has not been validated and atropinic side effects can be encountered.

[Discovery of a neuroblastoma producing cardiogenic shock in a 2-month-old child]. / Découverte d'un neuroblastome lors d'un choc cardiogénique chez un enfant de deux mois.

CASE REPORT: A two-month-old male child presented a severe heart failure associated with a malignant hypertension. Abdominal ultrasound revealed a mass connected to the left adrenal gland. CT scan showed a tumor of 7 x 6 x 8 cm, forcing back both the left kidney and the aorta. A biopsy allowed the diagnosis of neuroblastoma without MYCN oncogene amplification. Intensive care stabilized the hemodynamic situation. Under chemotherapy the tumor volume decreased significantly and complete surgical excision became possible. Three years after diagnosis, the patient remained in complete remission. CONCLUSION: Clinical presentation of this neuroblastoma was extremely uncommon. The catecholamines produced by the tumoral cells could induce an increase of the myocardiac work following the left ventricule post charge increase. Theses mechanisms could be synergistic for a myocardial exhaustion.

[Hypocalcemia in malaria. Study of correlations with other parameters]. / L'hypocalcémie palustre. Etudes des corrélations avec d'autres paramètres.

In a privileged observation of severe malaria contracted after laboratory contamination, we noticed a deep hypocalcemia 67 mg/l = 1.67 mmol/l. Since then we found again that hypocalcemia, connected with hypoalbuminemia, in ten other patients showing severe forms of malaria Plasmodium falciparum. The main biological datas of those four cases are summarized below. We made a systematic study of malaria cases, whatever may have been the intensity of parasitemia and clinical symptoms, and whatever the plasmodial species. For 26 non african paludisms , we found an average level of calcemia of 85 mg/l and an average hypoalbuminemia of 37 g/l = 536 mumol/l. For 30 african paludisms we found an average calcemia of 87.5 mg/l. That reduced value is statistically significant comparatively with the average value of 30 african people with no malaria 91.5 mg/l. The problem is to know if this hypocalcemia is connected only with hypoalbuminemia and if it may involve clinical or therapeutical effects.