[Pediatric orbital Rosai-Dorfman disease: An unusual case]. / Maladie de Rosai-Dorfman à localisation orbito-palpébrale de l'enfant : à propos d'une observation exceptionnelle.

INTRODUCTION: Rosai-Dorfman disease (RDD) is a sinus histiocytosis with massive lymphadenopathy. This rare condition is a benign disease of unknown etiology. Bilateral orbital localization of RDD is rare. OBSERVATION: The authors report the case of a 6-year-old child who presented with bilateral orbital-palpebral masses associated with chronic cervical lymphadenopathy. There were no laboratory signs of inflammation. Serological and tuberculosis screening tests were negative. Histopathological examination of a lymph node biopsy established a diagnosis of Rosai-Dorfman disease. The patient underwent surgical excision of the orbital lesions followed by long-term corticosteroid therapy. A favorable course was observed, with no sign of recurrence after one year of follow-up. CONCLUSION: Rosai-Dorfman disease is very rare in its bilateral orbital presentation. Histopathological diagnosis remains challenging. In Africa, the presence of chronic oculo-palpebral tumor associated with or without cervical lymphadenopathy must raise the suspicion of Rosai-Dorfman disease after ruling out tuberculosis and lymphoma.

Severe infectious keratitis in tropical environments: 118 cases collected over 10 years.

INTRODUCTION: The aim of our study was to evaluate the clinical, microbiological, and contributing factors of microbial keratitis in tropical environment. Materiel and methods: We performed a retrospective study of all patients admitted to the ophthalmology department of Principal Hospital in Dakar for infectious keratitis, over ten years from January 2006 to December 2015. Clinical, microbiological, and contributing factors as well as visual effects were studied. RESULTS: We collected data of 118 patients hospitalized for unilateral infectious keratitis in 10 years, for an average of 12 cases per year. The patients' mean age was 50 years. At least one local risk factor was found in 58.5% of cases. These were mainly ocular trauma (39%), followed by local treatment of glaucoma (16%), and recent eye surgery (14.5%). In 9 cases (8%), the only risk factor for abscess was an isolated general factor. This was diabetes in 7 cases. The clinical aspects described can be grouped according to topography, depth, and severity in pre-perforation state or perforation (45%), anterior chamber Tyndall effect greater than 1 cross, reaching a hypopyon stage (24%), stromal infiltrate larger than 2 mm (18%) and the abscess located within 3 mm of the corneal center (13%). The microbiological examination isolated a germ in 17% of cases, principally Pseudomonas aeruginosa (40%), followed by Staphylococcus aureus (20%). Prognosis was severe with visual acuity of less than 1/10 in 90% of cases and evisceration in 16% of cases. DISCUSSION: The most common risk factor was local ocular trauma by foreign bodies in the cornea. The poor prognostic factors were possible delay in consultation, low initial visual acuity, and low rate of positive microbiological examinations. CONCLUSION: Infectious keratitis is a potentially serious condition that can lead to blindness and eventually to loss of the ocular globe in tropical environments. Local risk factors are largely dominated by ocular trauma. Only early management based on the microbiological results improves the prognosis.

[Etiology and prognosis of the eye traumas by war weapons in the Senegalese army]. / Étiologies et pronostic des traumatismes oculaires par armes de guerre dans l'armée sénégalaise.

INTRODUCTION: The aim of this work is to identify the main weapons causing eye injuries during the campaigns of the Senegalese army in the south of the country, as well as the prognosis of these traumas. PATIENTS AND METHODS: This study is retrospective and concerns soldiers wounded by the weapons of war during the exercise of their mission within the Senegalese armed forces of 1991 in 2005. They are mainly soldiers affected in the south of the country during a war, clashes with the rebels or in Guinea-Bissau during operation Gabou in 1998. And they were evacuated to the ophthalmology department of the Principal Hospital in Dakar, which is a level 3. RESULTS: Thirty-seven military all male, with an average age of 30.5 years. Forty-six eyes including 9 bilateral cases. The trauma agent is a burst of RPG7 shells in 62% of cases, mine explosion in 13.5%, offensive grenade 10.8%, assault rifle 5.7% and flame lance-roquette anti-char (LRAC) accounts for 8%. We noted a phthisis of the globe for 14 eyes (30.43%) and for 15 eyes (32.60%) a functional loss of the affected globe. Inability to fight was decided by 29 wounded soldiers (78.37% of the cases), sedentary employment in 27 cases (72.97%) and 10 cases (27.03%) of reformed soldiers. DISCUSSION: In the conflict in southern Senegal, the RPG7 shell burst causes 62% of eye injuries. This RPG7 shell called "rebel weapon" is frequently used in conflicts in Africa. The prognosis of trauma with these types of weapons is severe. CONCLUSIONS: The combat goggles systematically integrated in the equipment of the Senegalese combatant, would be an invaluable contribution on the prevention of the traumatisms of the eye.

[Selective laser trabeculoplasty (SLT): our experience in African blacks]. / La trabéculoplastie au laser sélectif (TLS) : notre expérience chez le noir africain.

INTRODUCTION: The purpose of our study was to evaluate in the short and medium term, intraocular pressure results after selective laser trabeculoplasty in black patients with chronic open angle glaucoma or isolated ocular hypertension. MATERIALS AND METHODS: We conducted a retrospective study with a mean 12.5-month follow-up in black patients who underwent SLT. Inclusion criteria were: an open iridocorneal angle greater than or equal to Schaeffer grade 3, data recorded and available on trabecular pigmentation, data on SLT parameters available, and intraocular pressure by Goldmann applanation tonometry recorded.A positive result was defined as a post-laser IntraOcular Pressure (IOP) less than 21 mmHg after 1-month follow-up. The main motivation was the reduction of number of eye drops used. Performed first was a treatment of the inferior 180° (3:00-9:00), possibly supplemented by a second session at 15 days or 1 month if a pressure decrease was noted after the first session. IOP results were evaluated prior to SLT, immediately following SLT and then depending on the drop in pressure. Statistical analysis was performed using the EPI.info 7 software. RESULTS: A total of 69 eyes of 40 patients treated with SLT were identified. The mean IOP prior to SLT was 18.3 mmHg ± 4. Our results showed 90% of patients who positively responded to the treatment (10% failure) with a mean IOP decrease of 2.3 ± 1 mmHg, that is 13%, by the second week. The mean pressure decrease continued to 4.78 ± 1 mmHg for patients (30%) in the group treated for 360°, that is 27% in the same period of time. SLT permitted discontinuation of a prostaglandin in 60% (42 cases). Eyes on triple-drug therapy went from 23 before SLT to 5 following SLT (a 26% decline), eyes on two medications went from 32 to 16 (24% decline). In result association tests, only pigmentation of the angle and visual field stage had a statistically significant probability. DISCUSSION: In our experience, SLT is indicated in black patients to potentiate less effective treatments, to reduce the number of drops in order to limit side effects, but also to avoid or delay monotherapy treatment-naïve, hypertensive eyes. CONCLUSION: In the short and medium term, SLT brought about an IOP decrease in 90% of black patients, and discontinuation of a prostaglandin in 60% of our patients. In addition, the iridocorneal angle in blacks appears to be less pigmented than previously thought, and a protocol systematically treating 360° seems to provide better results.

[Orbital mycetoma: a case report]. / Mycétome orbitaire : à propos d'un cas.

INTRODUCTION: Mycetomas are pathological processes through which exogenous fungal or actinomycotic etiological agents produce grains. These etiological agents live in the soil and plants of endemic areas. They are introduced traumatically, primarily into the foot. The orbital location is rare. OBSERVATION: We report the case of a 17-year-old student admitted for progressive left proptosis over 2 years, following penetrating trauma by a fork in a rural setting. Examination revealed a heterogenous orbital mass with multiple fistulae, producing pus and black grains, and suggested, due to the color of the grains, a diagnosis of fungal mycetoma. MRI revealed a destructive process at the level of the lamina papracea of the ethmoid and the orbital floor. Anatomopathological examination confirmed the fungal nature of the infection, while culture in Sabouraud's medium was inconclusive. The outcome was favorable after exenteration and debridementof the ipsilateral maxillary sinus and nasal cavities, along with 4 months of ketoconazole. No recurrence has been observed for 14 months after surgery. DISCUSSION: Mycetomas are endemic to northwest Africa. Most frequently located in the foot, they are seldom seen in the orbit. The color of the grains provides a clue as to the etiology. Black-grain mycetomas are always fungal and are treated surgically--essentially like cancer--as the persistence of a single grain will cause a recurrence. CONCLUSION: The orbital location of a mycetoma is rare. In the present case report, the concept of port of entry, the clinical appearance, and the color of the grains guided the diagnosis. The histological examination of the surgical specimen confirmed the diagnosis.

Are the cellular immune responses of children and adults with Schistosoma mansoni infection intrinsically different? Cytokines produced ex vivo in response to antigens and mitogens.

In recently exposed communities, intensity of schistosomiasis infection increases as children age and then drops again in adulthood, indicating that host maturity is an important aspect of resistance to schistosomiasis. We investigated whether the cellular immune response to the parasite was correlated with age in subjects with similar daily patterns of exposure, current intensities of infection and number of years of exposure. The cellular immune response of subjects with either 'low' (under 200 eggs per gram (EPG)) or 'high' (over 400 EPG) intensities of infection was investigated, in a recently established focus where subjects had similar histories of exposure and number of years of experience with Schistosoma mansoni. Subject's whole blood was cultured with adult worm antigen (AWA), a mixture of phytohaemagglutinin (PHA) and lipopolysaccharide (LPS), or left unstimulated, and culture supernatants were tested for IL-4, IL-5, IL-10 and IFN-gamma. Children and adults tended to respond differently to schistosome antigen. The most statistically significant illustration of this was the negative correlation between age and IL-5 produced by samples from people with low intensities of infection cultured with AWA (P < 0.003, P < 0.05 after Bonferroni correction). IL-10 produced by samples cultured with PHA and LPS was also notably lower in children than in adults, although not formally significant after Bonferroni correction. This indicates that it is possible for age, independently of intensity of infection or experience with the parasite, to influence the immune response to schistosomiasis.

Human water contacts patterns in Schistosoma mansoni epidemic foci in northern Senegal change according to age, sex and place of residence, but are not related to intensity of infection.

In an epidemic focus in northern Senegal, adults had lower intensities of infection than adolescents, a phenomenon that could not be attributed to immunity acquired over the previous 10-15 years of exposure to the parasite because all age groups had had the same number of years' experience of the worm. This article considers whether this pattern could have been because of higher levels of exposure to the parasite in younger age groups. Personal contact with infected water was recorded using a questionnaire in Schistosoma mansoni foci not more than 3 years old and in another, 10-year-old focus. Many aspects of contact (e.g. frequency, duration or time of day of contact) may contribute to the number of encounters with infective cercariae (true exposure), so various assumptions regarding the relationship between water contact and true exposure were tested resulting in a range of exposure indices. People reported a mean of 4.4 separate contacts, and spent a median of 57 min per day in water. Patterns of water contact differed depending on the exposure index used, e.g. considering duration, males spent a longer time in water than females (P < 0.001). But using frequency, females had more contacts with water than males in most villages (P < 0.001). Generally, exposure levels dropped as people become aged (P < 0.001) and residents of the older focus were more exposed than residents of other foci (P < 0.002). Intensity of (re)infection was not related to exposure either alone or in models incorporating age, sex and/or village irrespective of the index used. There is therefore evidence that age, sex and place of residence determine exposure but none to suggest that exposure had an influence on the relationship between these factors and intensity of infection. We propose therefore that in this population other factors have principal importance in determining intensity of infection.

Specificity of circulating antigen detection for schistosomiasis mansoni in Senegal and Burundi.

The specificity of schistosome circulating antigen detection was determined in negative individuals from two S. mansoni- endemic countries, Senegal and Burundi, and compared with results from Dutch control individuals. A nearly absolute specificity was achieved for circulating anodic antigen (CAA) detection in serum, irrespective of the target population or sample pretreatment method. Circulating cathodic antigen (CCA) detection in serum and urine resulted in a lower specificity than serum CAA detection. Apparent large differences in specificity of CCA detection between countries were mainly due to pretreatment methods. Apparently, the alkaline/heating pretreatment method is not as effective as trichloroacetic acid (TCA)-pretreatment in removing (certain) interfering components, which may vary between populations. In view of the development of the urine CCA assay into a noninvasive screening test, a slightly lower specificity may still be acceptable. For precise epidemiological analyses the highly specific serum CAA assay remains the method of choice.

The contribution of host-related factors to low cure rates of praziquantel for the treatment of Schistosoma mansoni in Senegal.

Surprisingly low cure rates were repeatedly observed after treatment with a standard dosage of praziquantel in a recently established Schistosoma mansoni focus in northern Senegal. In 4 discrete cohorts from the same population, cure rates were 18-36% and egg count reduction rates were 77-88%. Data and material of 920 compliant subjects from all 4 cohorts were further analyzed to identify possible host-related factors associated with low cure rates. The lowest cure rates were found in the highest egg count groups. However, in low and moderate egg count groups, drug efficacy was also below normal values. Cure rates were similar in males and females, showed no seasonal variation, and were independent of previous praziquantel treatment. They were significantly higher in adults than in children, also after allowing for intensity of infection. Individual water contact behavior and specific humoral immune responses were examined in 2 extreme subgroups, either without significant egg count reduction or showing complete parasitologic cure. There was no significant difference in frequency and duration of water contact between those individuals with complete cure and those that showed little effect of praziquantel treatment. Levels of IgG, IgG1, IgG3, IgG4, IgM, and IgE against adult worm antigen were not different between the 2 subgroups. Thus, the abnormally frequent failure of treatment observed in this focus could not be associated with any host-related factor, other than age and pretreatment egg counts.