Efficacité du Dakin Cooper Stabilisé® dans la prise en charge des plaies drépanocytaires

Objectif : Apprécier l'efficacité et la tolérance du Dakin Cooper Stabilisé® dans le traitement des plaies drépanocytaires.Patients et méthodes : Il s'agit d'une étude prospective descriptive sur 35 patients, ayant des plaies drépanocytaires, recrutés au centre de Dermatologie de Treichville (Abidjan, Côte d'Ivoire) de janvier 2010 à déceRésultat : La douleur a disparu chez 91,4% des patients, une semaine après le début du traitement. La guérison est survenue chez 80% des patients après six semaines.Conclusion : Le Dakin Cooper Stabilisé® est efficace en six semaines dans le traitement des plaies drépanocytaires et est bien toléré

[Bifocal Buruli ulcer: multiple cephalic lesions after initiation of medical treatment]. / Ulcère de Buruli à début bifocal: multiples lésions céphaliques après instauration du traitement médical.

BACKGROUND: Buruli ulcer (BU) denotes a cutaneous infection by Mycobacterium ulcerans endemic in certain tropical and subtropical regions. Treatment may be either medical and surgical or else purely medical for early lesions. The literature contains reports of several cases of transient aggravation of BU following initiation of medical treatment. We report a case observed in the Ivory Coast, one of the areas with the highest prevalence of BU worldwide. The distinguishing features of our case are the early onset of this paradoxical reaction and the multiple cephalic site of lesions. PATIENTS AND METHODS: A 4-year-old child with no prior medical history was referred for two painless ulcerative cutaneous nodules. Incubation of samples from the edges of these lesions revealed the presence of acid-alcohol resistant bacilli (AARB), which were shown by PCR to be M. ulcerans, the causative agent in BU. Treatment consisted of levofloxacin (100mg/d) and rifampicin (150mg/d) for 8weeks. After 7days of medical treatment, seven painless nodules appeared on the patient's scalp. Further PCR for these lesions confirmed the presence of M. ulcerans. The same medical therapy was maintained and after 54days of treatment, all lesions had been healed. DISCUSSION: The originality of this case rests on two features: the bifocal aspect of the lesions, which is uncommon, and the early development of cephalic predominance that occurred after the start of drug treatment. While cases of lesions secondary to initiation of medical therapy have already been described, such lesions generally occurred after at least 2months of treatment and did not involve the head.

[Epidemiology of tinea capitis in Abidjan, Cote d'Ivoire]. / Epidémiologie des teignes a Abidjan (Côte d'Ivoire).

Tinea capitis is a dermatosis of the scalp due to dermatophytes that can cause hair loss. It remains a significant endemic problem mainly in school children in tropical regions. The purpose of this case-control study carried out in the Dermatology Center of Treichville Hospital was to identify risk factors for tinea capitis in Abidjan, Cote d'Ivoire. A total of 80 cases were recruited on the basis of clinical findings showing one or several plaques showing desquamation or parakeratosis suggestive of tinea capitis. Diagnosis was confirmed by mycology using samples seeded on Sabouraud-chloramphenicol glucose agar and incubated at 27 degrees C for a mean period of 15 days. Species identification was based on growth rate, macroscopic aspect of isolates, production and potential diffusion of pigment, and microscopic examination. Controls were the next patient of the same age and sex with no evidence of mycosis. All subjects were questioned about previous history of mycosis, duration of tinea capitis lesions, functional signs, grooming habits, and pet-keeping. Size of selection was calculated by epi info 6.04 fr according to following estimations: percentage of exposed subjects in control group: 30%; percentage of exposed subjects in case group: 50%; probability threshold of 5% to find a difference between case and control groups even though there was no difference; and probability threshold of 20% to find no difference between cases and controls even though there was a difference. Study findings demonstrated a 3 times higher incidence of tinea capitis in boys than in girls and a peak during childhood especially between the of 5 to 9. The most frequent etiologic agents were Trichophyton soudanense and Microsporum langeroniise. Subjects at highest risk lived in dwellings having less than 4 rooms, used soap to wash the hair, cut their hair with a blade, and had low income.

Epidémiologie des teignes à Abidjan (Côte d'Ivoire)

Due à des dermatophytes, la teigne est une dermatose du cuir ch evelu pouvant entraîner la chute des ch eveux. Elle reste un problème d'actualité car elle sévit à l'état endémique touchant surtout les enfants d'âge scolaire. Notre étude avait pour objectif de rechercher les facteurs de risque de teigne à Abidjan. Nous avons réalisé une enquête cas-témoins au Centre de Dermatologie du CHU de Treichville. Quatre-vingt (80) cas ont été recrutés sur la base de symptômes cliniques et confirmés après un prélèvement mycologique ensemencé sur milieu gélosé de Sabouraud-chloramphénicol et sur milieu gélosé de Sabouraud- chloramphénicol- cycloheximide, incubé à 27°C pendant 15 jours en moye n n e. Au terme de cette étude, nous avons noté : la prédominance masculine de l'affection avec un sex ratio de 3 ; la prédominance de l'atteinte dans l'enfance avec un pic entre 5 et 9 ans ; que Trichophyton soudanense et Microsporum langeronii partagent les étiologies de façon équivalente ; que les sujets les plus exposés à la teigne habitent dans un logement de moins de 4 pièces, utilisent le savon pour le lavage des cheveux, se font couper les cheveux avec une lame et ont de faibles ressources économiques

[Chronic genital ulcerations and HIV infection: 29 cases]. / Ulcérations génitales chroniques et infection à VIH: a propos de 29 cas.

Genital ulcers are common manifestations of infectious disease. The incidence of genital ulcers featuring a chronic course has increased since the beginning of the AIDS epidemic. The purpose of this 18-month cross-sectional study was to determine the main infectious causes of chronic genital ulcers (CGU) and their correlation with HIV infection. A total of 29 patients with CGU defined as an ulcer showing no sign of healing after more than one month were studied. Mean age ranged from 24 to 54 years. The male-to-female sex ratio was 1:5. The etiology was herpes in 19 cases (65.5 p. 100), chancroid in 6 cases (20.6 p. 100), streptococcal infection in 2 cases (6.8 p. 100), Pseudomonas aeruginosa infection in 1 case (3.4 p. 100) and cutaneous amibiasis in 1 case (3.4 p. 100). Twenty-two patients (75.8 p. 100) presented HIV infection including 16 with HIV1 and 6 with HIV1 and HIV2. All patients with herpes were HIV-positive. Eighteen of these patients were in stage C3 of HIV infection. Genital herpes was the main etiology of UGC in patients with HIV infection (p < 0.001). Conversely chancroid was the main etiology in patients without HIV infection (p < 0.05). This finding suggests that herpetic CGU is highly suggestive of AIDS whereas chancroid CGU is not. Although syphilis is widespread in Africa, it was not a cause of CGU in this study. Search for herpes simplex virus or Haemophilus ducreyi in patients with CGU is an important criteria for presumptive diagnosis of AIDS in Africa.

[Radiographic aspects osteoarticular complications in Buruli ulcers]. / Aspects radiographiques des complications ostéo-articulaires dans l'ulcère de Buruli.

The authors examine radiographic aspects of osteo-articular and soft tissue lesions on the basis of 30 files of in-patients suffering from Buruli ulcers. They specify the chronology and precociousness of certain signs: soft tissue lesions, bone demineralization, periostal apposition two months after the beginning of signs, and later osteolysis and joint complications. These lesions are not specific and occur contiguously to soft tissue lesions. The authors specify the part of secondary-infection germs in the appearance of bone lesions.