[Care of covid-19 patients at the dermatology hospital of Bamako]. / Prise en charge des patients covid-19 a l'hopital de dermatologie de Bamako.

AIM: To assess the COVID-19 patients' treatment duration according to the place of treatment at the Dermatology Hospital of Bamako (DHB). METHODS: This was a cross-sectional study comparing the management of COVID-19 PCR-positive patients in the hospital to that of those managed at home from March 2020 to April 2021 until two consecutive negative PCR 48 hours apart. RESULTS: Among the 1109 patients, 369 were hospitalized, 497 followed at home. As of April 31, 2021, 81.2% (900/1109) of the patients recovered, 1.3% (14/1109) were transferred to another health structure, and 2.5% (28/1109) died. No statistically significant difference was observed between the mean duration of the treatment for patients treated at home (10 days) in (95% CI, 9.69-10.3) and those managed at hospital (10 days95% CI, 9.76-10.23) (Mantel-Cox test, p= 0.060). CONCLUSION: These results suggest that the place of treatment do not influence the time to recovery. This is particularly important given the current burden of COVID-19 management on the health workforce.

OBJECTIF: Evaluer la durée du traitement des patients COVID-19 selon le lieu de pris en charge à l'Hôpital de Dermatologie de Bamako (HDB). MÉTHODOLOGIE: Il s'agissait d'une étude transversale comparant la prise en charge des patients COVID-19 PCR-positifs à l'hôpital à celle à domicile de mars 2020 à avril 2021 jusqu'à l'obtention de deux tests PCR négatifs consécutifs à 48 heures d'intervalle. RÉSULTATS: Parmi les 1109 patients, 369 ont été hospitalisés, 497 suivis à domicile. Au 31 avril 2021, 81,2% (900/1109) des patients se sont rétablis, 1,3% (14/1109) ont été transférés dans une autre structure de santé et 2,5% (28/1109) sont décédés. Aucune différence statistiquement significative n'a été observée entre la durée moyenne du traitement pour les patients traités à domicile (10 jours) en (IC 95 %, 9,69-10,3) et ceux pris en charge à l'hôpital (10 jours IC 95 %, 9,76-10,23) (test de Mantel-Cox, p= 0,060). CONCLUSION: Ces résultats suggèrent que le lieu de traitement n'influence pas le temps de récupération. Ceci est particulièrement important étant donné la charge actuelle de la gestion des COVID-19 sur le personnel de santé.

A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa).

In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert's response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.

Impact of insecticide-treated bednets and indoor residual spraying in controlling populations of Phlebotomus duboscqi, the vector of Leishmania major in Central Mali.

BACKGROUND: Cutaneous leishmaniasis (CL) is an endemic neglected tropical disease prevalent in several areas where seasonal malaria transmission is active. We assessed the effect of indoor residual spraying (IRS) and the mass distribution of long-lasting insecticide-treated bednets (LLINs) for malaria control on sand fly population diversity and abundance, and its impact on the risk of Leishmania transmission in the district of Baroueli, endemic for CL in Mali. METHODS: Kemena and Sougoula, two villages in the district of Baroueli, were selected for entomology surveys from March to September 2016 to evaluate sand fly species composition and density, and Leishmania infection rates in the vector Phlebotomus duboscqi. The surveys followed an annual indoor residual spraying and mass distribution of long-lasting insecticide-treated bednets (IRS/LLINs) that began in 2011 for malaria vector control. We also carried out a leishmanin skin test (LST) survey in the two villages to determine the incidence of Leishmania infection in humans living in the endemic area. RESULTS: A total of 2936 sand fly specimens, 1013 males and 1923 females, were collected and identified from the two villages throughout the study period. Fourteen species, 2 belonging to the genus Phlebotomus and 12 to the genus Sergentomyia, were documented. The genus Sergentomyia constituted 91% of collected sand flies versus 9% for the genus Phlebotomus (P. duboscqi and P. rodhaini). Of those, P. duboscqi was the most abundant, representing 99.6% of the collected Phlebotomus species. In both villages, P. duboscqi was most abundant during the end of dry season (June). The prevalence of Leishmania infection in individual females of P. duboscqi by PCR was 3.5%. After 5 years of the IRS/LLINs, the incidence of Leishmania infection in the human population as measured by LST was 4.2%. CONCLUSIONS: Compared to historical data collected from 2005-2008, a considerable reduction was observed in both sand fly density and prevalence of human Leishmania infection in the villages of Kemena and Sougoula, Baroueli District, following IRS/LLINs. This suggests that IRS/LLINs used for mosquito control also impacts sand fly vectors reducing the incidence of leishmaniasis. TRIAL REGISTRATION: NCT00344084 . Registered: 23 June 2006.

[Cutaneous tuberculosis in Bamako, Mali]. / Tuberculose cutanée à Bamako, Mali.

INTRODUCTION: Tuberculosis is the most common mycobacteriosis in sub-Saharan Africa. Cutaneous tuberculosis is rare and underdiagnosed due to its clinical polymorphism and to the smallness of technical equipment. This study aims to describe the epidemiological, clinical, histopathological aspects of cutaneous tuberculosis in Bamako (Mali). METHODS: We conducted a cross-sectional descriptive study from January 1991 to December 2008. The study was performed in the Department of Dermatology at the National Center for Disease Control and in the Department of Pneumophtisiology at the Hospital of Point G. The patients with tuberculosis confirmed by histological and/or biological examination were included in the study. RESULTS: Out of 4269 patients? medical records, 61 cases of cutaneous tuberculosis were identified (1.43%). Men accounted for 59% of the cases (36 patients) and women 41% (25 cases); sex-ratio was 1.44. The age of the patients ranged from 3 months to 61 years, with an average age of 27.56 ± 36 years. The average length of follow-up was 10.9 ± 10 months. The identified clinical forms were scrofuloderma (41 cases), ulcerative form (13 cases), verrucous form (4 cases), and tuberculous Lupus (3 cases). Tuberculosis was associated with HIV in 7 cases, with leprosy in 3 cases. CONCLUSION: Cutaneous tuberculosis is underdiagnosed in Mali. Efforts are needed to improve the accessibility and the technical equipment available in the Departments, in order to conduct an extensive interdisciplinary study on this pathology.

Correction: Prevalence of Cutaneous Leishmaniasis in Districts of High and Low Endemicity in Mali.

[This corrects the article DOI: 10.1371/journal.pntd.0005141.].

Prevalence of Cutaneous Leishmaniasis in Districts of High and Low Endemicity in Mali.

Historically the western sahelian dry regions of Mali are known to be highly endemic for cutaneous leishmaniasis (CL) caused by Leishmania major, while cases are rarely reported from the Southern savanna forest of the country. Here, we report baseline prevalence of CL infection in 3 ecologically distinct districts of Mali (dry sahelian, north savanna and southern savanna forest areas). We screened 195 to 250 subjects from 50 to 60 randomly selected households in each of the 6 villages (four from the western sahelian district of Diema in Kayes region, one from the central district of Kolokani and one from the southern savanna district of Kolodieba, region of Sikasso). The screening consisted of: 1] A Leishmanin Skin Test (LST) for detection of exposure to Leishmania parasites; 2] clinical examination of suspected lesions, followed by validation with PCR and 3] finger prick blood sample to determine antibody levels to sand fly saliva. LST positivity was higher in the western district of Diema (49.9%) than in Kolokani (24.9%) and was much lower in Kolondieba (2.6%). LST positivity increased with age rising from 13.8% to 88% in Diema for age groups 2-5 years and 41-65 years, respectively. All eight PCR-confirmed L. major CL cases were diagnosed in subjects below 18 years of age and all were residents of the district of Diema. Exposure to sand fly bites, measured by anti-saliva antibody titers, was comparable in individuals living in all three districts. However, antibody titers were significantly higher in LST positive individuals (P<0.0001). In conclusion, CL transmission remains active in the western region of Mali where lesions were mainly prevalent among children under 18 years old. LST positivity correlated to higher levels of antibodies to sand fly salivary proteins, suggesting their potential as a risk marker for CL acquisition in Mali.

[Geriatric dermatoses in patients hospitalized in the Department of Dermatology in Bamako (Mali)]. / Dermatoses gériatriques en hospitalisation dermatologique à Bamako (Mali).

INTRODUCTION: Skin diseases in the aging population vary and are a key concern for clinicians in terms of diagnosis, management and follow-up. This study aims to describe the epidemiological and clinical aspects of skin diseases among geriatric patients hospitalized in the Department of Dermatology at the National Center In Support Of Disease, Bamako. METHODS: We conducted a cross-sectional case study of patients with geriatric dermatoses hospitalized in the Department of Dermatology at the National Center In Support Of Disease from 1 January 2010 to 31 December 2014. Out of 398 patients hospitalized, 76 patients aged 60 years and over were included in the study. Data entry was accomplished using Epidata 3.1 software, while data analysis was performed using stata 14 software. RESULTS: The prevalence of skin diseases among hospitalized geriatric patients was 19.10%. The age of the patients varied from 60 to 95 years, with an average age of 68.85 years. We enrolled 29 men and 47 women, with a sex-ratio of 0,60. The main diseases reported were dermohypodermitis (44.74%), autoimmune bullous dermatitis (13.16%), toxidermia (10.53%), venous ulcers (6.58%), arterial ulcers (3.95%), malignant tumors (5.27%), diabetic wounds (3.95%). Four patients died (5,26%). CONCLUSION: This study has assessed a high prevalence of subjects aged 60 and over hospitalized in the Department of Dermatology in Bamako. Moreover, it has confirmed that dermohypodermitis are the most frequent skin diseases among geriatric patients hospitalized in Mali.

[Epidemio-clinical profile of dermatoses in children receiving dermatological consultation in the Department of Dermatology at the National Center for Disease Control in Bamako (Mali)]. / Profil épidémio-clinique des dermatoses chez les enfants vus en consultation dermatologique dans le service de dermatologie du centre national d'appui à la lutte contre la maladie à Bamako (Mali).

INTRODUCTION: Skin diseases are a major public health problem in developing countries. In common practice, children represent the most affected segment of the population. This study aims to describe the epidemiological and clinical aspects of skin diseases in children aged 0-15 years receiving dermatological consultation in the Department of Dermatology at the National Center for Disease Control in Bamako (Mali). METHODS: We conducted a cross-sectional study in the Department of Dermatology and Venereology at the National Center for Disease Control from 1 January 2009 to 31 December 2009.Out of a total of 16339 patients who had undergone a dermatological consultation 5149 children were included in the study. RESULTS: Dermatitis-frequency in hospital attending children was 31.51%. We enrolled 2838 boys (55,10%) and 2311 girls (44.90%), with a sex-ratio of 1,22. Patient age ranged from 03 days to 15 years with an average age of 8 ± 5.7 years. Infectious dermatoses accounted for 55.10% of all dermatoses, immuno-allergic dermatoses (32.5%), inflammatory dermatoses (11.85%). CONCLUSION: Our study highlights the severity of infectious and immuno-allergic pathologies and the necessity to promote simple preventive measures such as hygiene, buying a clipper for each child.

Dermatitis of the folds in black Africans in Bamako, Mali.

Dermatitis of the folds (intertrigo) is a frequent reason for attending consultations, particularly in Africa, where the hot and humid climate constitute an aggravating factor. It is a complex pathology with multiple and intricate etiologies. The aim of this study was to describe epidemiological and etiological aspects of dermatitis of the folds in black-skinned subjects in Bamako (Mali). We conducted a transversal descriptive survey of cases of localized dermatitis of the folds of the skin in dermatology clinics in Bamako. In total, 141 cases of intertrigo were identified: 96 female subjects (68%) and 45 male subjects. The average age of patients was 30 ± 18 years (2-80 years). The majority of patients were seen between March and June; 52% of patients had already received treatment before the consultation. The lesions affected skin folds of the groin area and/or area between the buttocks in 95 patients (57.4%), and folds of the armpits and area under the breasts were affected in 46 cases (42.6%). Eczema, erythrasma, and fungal disease were the most frequently observed pathologies. Of interest to this study is the topographical approach that a dermatologist must adopt when diagnosing certain forms of dermatitis. In populations with specific cultural practices, apart from a thorough knowledge of these specific factors, treatment of these conditions requires certain harmful attitudes and behaviors to be abandoned.

Pruritus in dermatological hospital in Bamako, Mali.

Pruritus is a symptom frequently encountered in dermatology consultations. For practitioners working in a tropical environment, particularly in Africa, the diagnosis of pruritus remains a constant problem. The aim of this study was to describe the epidemioclinical aspects and the etiologies of pruritus encountered at the dermatological hospital in Bamako. We conducted a prospective survey on a cohort of patients attending the Department of Dermatology at the Centre National d'Appui (CNAM-Ex Institut Marchoux) in the Fight against Disease over a 1-year period (June 1, 2009-May 31, 2010). Consequently, the study included every patient, whatever their age and gender, that agreed to take part in the survey and whose main reason for attending for a consultation was "pruritus." The clinical and biological data were entered and analyzed using Epi Info software, version 6.04 fr. A total of 232 patients (163 women, 69 men) attended because of pruritus out of 1761 overall patients (i.e., a prevalence of 13.17%). The mean age of the patients was 33 ± 19 years. Dermatological causes represented 95% of the etiologies. This work allowed us to observe the systemic causes of pruritus in the dermatological environment in Mali and greater likelihood of black women to attend because of pruritus.

[Etiology of acquired hypochromic patches in dermatological area in Mali]. / Etiologies Des Hypochromies Acquises En Milieu Dermatologique.

INTRODUCTION: In dark skin patients, hypopigmentation is the most disfiguring condition. Very few studies on hypochromic disorders have been conducted in specialized health centers. The present study is aimed to describe the etiologies of hypochromic patches in dermatological area, in Bamako. METHODS: We carried out a cross sectional study in the Dermatology Clinic of the "Centre National d'Appui à la lutte contre la Maladie (CNAM, Ex Institut Marchoux)". All acquired hypochromic patches (HP) were selected. HP was defined as a "skin patch lighter in pigmentation than normal surrounding skin with a diameter of at least 1 cm". The diagnosis was mainly based on clinical findings. RESULTS: The prevalence of HP was 3.42% and the main causes were seborrheic dermatitis (23.3%), pytiriasis alba (20.15%), vitiligo (18.9%), pityriasis versicolore (18.5%) and leprosy (12.6%). CONCLUSION: There are many causes of HP including leprosy, a disease though rare to date, but still prevalent in dermatological area.