First report of cryptococcosis due to Cryptococcus gattii sensu stricto VGI in an Ivorian HIV negative patient.

INTRODUCTION: Cryptococcus gattii species complex is endemic to tropical and subtropical regions and is described as a causative agent of cryptococcosis in immunocompetent individuals. CASE PRESENTATION: We describe the first case of cryptococcosis in a HIV-negative patient from Ivory Coast infected by Cryptococcus gattii sensu stricto VGI. Isolates were recovered from cerebrospinal fluid (CSF) prior to systemic antifungal treatment up to 42 days after detection of the presence of yeasts in the CSF. Eighteen isolates were recovered, genetic diversity and antifungal susceptibility analyses were performed. All the isolates belonged to the Cryptococcus gattii sensu stricto (B;VGI) and were identified as a new sequence type (ST) 553 by Multilocus Sequence Typing (MLST) analyses. Susceptibility testing showed that all the strains had a wild-type phenotype for fluconazole, amphotericin B and flucytosine. Treatment with fluconazole (1200mg/day) was initiated with success. CONCLUSION: This is the first case report of the presence of C. gattii sensu stricto VGI in a HIV-negative ivorian patient and the second report of the presence of species from the C. gattii complex species in this country.

Pediculosis capitis in Abidjan, Côte d'Ivoire: Epidemiological profile and associated risk factors.

Pediculosis capitis (PC) is a parasitic infestation, common in children's communities caused by Pediculus humanus capitis. Various factors including infestation-related stigma, treatment cost and health risks make this infestation deserves special attention. This study aims to determine epidemiological profile of pediculosis capitis twenty years after the last study in Abidjan, Côte d'Ivoire. An epidemiological cross-sectional survey was carried out from April to June 2018 across 40 public primary schools in the ten districts of Abidjan. Data from schoolchildren and parents and/or guardians were collected using a pretested questionnaire after agreement and signature of the informed consent form. Head lice were identified visually with a magnifying glass, and then collected using fine combs and hairbrushes. The positive diagnosis was made by the detection of living lice in the hair. Of the 4, 805 included participants, 28 (0.58%) were hosting living lice in hair. Analysis of associated factors showed that gender related-status was associated with PC. In this case, girls were more affected than boys (p=0.018). Plateau, Treichville and Port Bouët municipalities were the most affected (p=0.018). The length hair was associated with the occurrence of PC (p<0,001). Schoolchildren from families with low monthly income was most infected by PC (p=0.023). Some parameters such as promiscuity and collective use of washing facilities and bedding, were not found to be associated to head lice infestation. This study shows a drastic decrease of PC prevalence in Abidjan corresponding to 97%. This could be due to the improvement in the quality of life and education of the population of Abidjan. The establishment of hygiene committees and the teaching of basic hygiene practices from the first school years have contributed to these achievements. Maintaining these measures will contribute to the sustainable elimination of CP among children in Abidjan.

[Clinical and mycological characteristics of onychomycosis due to Candida at Institut Pasteur of Côte d'Ivoire]. / Caractéristiques cliniques et mycologiques des onychomycoses à Candida à l'Institut Pasteur de Côte d'Ivoire.

OBJECTIVE: This study aims to study the clinical and mycological characteristics of onychomycosis due to Candida in mycology unit of Institut Pasteur of Côte d'Ivoire. PATIENTS AND METHODS: This is a retrospective study which was carried out on patients from 1990 to 2016 for mycological diagnosis of onychomycosis and which socio-demographic characteristics, direct examination and culture results were recorded. RESULTS: In this study, 1898 patient files were selected. The average age of the patients was 31.69 years (standard deviation=15.11) with a sex ratio of 0.87. The frequency of Candida onychomycosis from patients received was 61.7%. Finger nails (67.7%) were more affected by this condition, followed by those of the toes (25.3%). Ninety cases of double localization of the nails of the hands and toes have been found. Candida albicans was the most frequent species accounting for 79.1% of isolated yeasts. Among the non-albicans, C. parapsilosis and C. tropicalis were isolated at the level of the toenails with frequencies rate of 11.2 and 9.6%. CONCLUSION: Onychomycosis due to Candida are relatively common in Abidjan and are dominated by C. albicans. The mycological confirmation of the fungal etiology in onychopathy and a good hygiene of the nails will allow a better management.

[Mycological profile of hand onychomycosis amongs "Garba" sellers in Abidjan (Côte d'Ivoire)]. / Profil mycologique des onychomycoses des mains chez les vendeurs de « Garba ¼ à Abidjan (Côte d'Ivoire).

OBJECTIVE: The aim of this study is to determine the prevalence and the fungi involved in onychomycosis located on fingers in Abidjan. MATERIAL AND METHODS: This study includes the sellers of cooked cassava semolina served with fried tuna fish called "garba". Fines squames specimen was processed with 30% KOH for a direct microscope examination. Serous collection were done in physiological serum. Part of the original sample was cultured on Sabouraud medium with antibiotics (chloramphénicol, actidione). Species distribution and antifungal susceptibility by the technique on agar were noted. RESULTS: A total of 205 male sellers were involved. The Onychomycosis prevalence was 6.3%; (95% CI : 3.6-10.3). Five species of yeasts were identified. Candida spp were the most frequent (84.6%) and Candida albicans represented 30.8% of isolated yeasts. Trichosporon cutaneum were isolated in two case (15.4%). Susceptibility for amphotericin-B was 92.3% contrary to 5-fluorocytosine 30.8%. The subjects aged between 15 to 24 (69.2%), with a higher seniority (84.6%) and illiterate (69.2%) were the most affected. The main risk factors of fungal infections were the presence of previous fingernail onychomycosis (P<0.0001) and the frequent fingernail cutting (P=0.0009). CONCLUSION: Onychomycosis caused by yeast is infrequent among "garba" sellers in Abidjan. The main fungi involved in fingernail onychomycosis were Candida species. It is nevertheless necessary to implement sensitization for them on contributing factors.

[Fungal aetiologies and contributing factors of interdigital tinea pedis among policemen in Abidjan (Ivory Coast)]. / Étiologies fongiques et facteurs favorisant les intertrigos inter-orteils chez les gendarmes à Abidjan (Côte d'Ivoire).

AIM OF THE STUDY: Fungal interdigital tinea pedis are poorly documented in Ivory Coast. This study aimed to determine the distribution of fungal species and contributing factors of the disease among policemen in Abidjan. PATIENTS AND METHODS: Our cross-sectional study was carried out at the police school in Abidjan. Our patients consisted of symptomatic or non-symptomatic police students. Samples of scales or serosities taken from inter-toes spaces were examinated with KOH mount and cultured on Sabouraud-chloramphenicol and Sabouraud-chloramphenicol-actidione media. The method of identification depended on the observed fungus. RESULTS: Among the 303 police students with clinical lesions of the inter-toe folds, 233 (76.9%; IC 95%=71.9-81.4) had a positive diagnosis after mycological examination. Lesions were predominantly located in the 3rd and 4th interdigital plantar spaces, with desquamation (100%) followed by maceration (82.5%) as the predominant functional sign. Dermatophytes accounted for 86.3% of the strains isolated with as majority species : Trichophyton interdigitale (40.3%), Microsporum langeronii (30.0%) and Trichophyton rubrum (15.5%). Yeasts accounted for 13.7% of the strains with Candida albicans (7.7%) as the most found species. The duration at the police school (P=0.004) and the practice of sports activities (P=0.0001) were statistically associated with the occurrence of the disease. CONCLUSION: A good hygiene of feet would reduce the incidence of the disease among the defense and security forces. Also, investigations for the influence of the seasons in the occurrence of interdigital tinea pedis will allow a better understand of epidemiology of this dermatomycosis.

[Fluconazole 1200mg or 800mg for cryptococcal meningitis treatment in Ivory Coast]. / Fluconazole 1200mg ou 800mg dans le traitement de la cryptococcose neuroméningée en Côte d'Ivoire.

OBJECTIVE: Assessing the use of high-dose fluconazol monotherapy (1200mg or 800mg) in the treatment and prognosis of HIV-associated cryptococcal meningitis in Ivory Coast. PATIENTS AND METHODS: A retrospective study carried out from August 2008 to August 2011 based on patients charts suffering from CM in the Abidjan Tropicals and Infectious Disease Unit. Mortality rate and associated factors were analyzed. RESULTS: Forty-six cases of cryptococcal meningitis (2.5% of hospitalizations) were included. The sex-ratio was of 1.2. The median age was 40.5 [35-47] years. The symptomatology was subacute (93.5%). The main clinical symptoms were syndrome of pure meningeal irritation (65%), fever (100%); 35% of patients had encephalomeningits. Twenty-one (45.7%) was ART-naïve patients. Fluconazole 1200mg was prescribed to 29 (63%) patients. Therapeutic lumbar punctures were performed in 42 (91.3) patients. The mortality rate was 50%. Significant predictors of mortality were encephalomeningitis and therapeutic lumbar puncture. CONCLUSION: Cryptococcal meningitis associated mortality remains high despite the use of high-dose fluconazole monotherapy. Therapeutic lumbar punctures help to improving the prognosis.

Aetiologies and contributing factors of vulvovaginal candidiasis in Abidjan (Cote d'Ivoire).

AIM OF THE STUDY: In order to update the data and contribute to optimizing the management of vulvovaginal candidiasis, we conducted this study to determine their etiology (and hence the sensitivity of the isolated fungal organisms) and the factors contributing to their occurrence in Abidjan (Cote d'Ivoire). PATIENTS AND METHODS: This cross-sectional survey involving 400 women with clinically vulvovaginitis was conducted from May to July 2011. It was carried out at the health centre for venereal diseases located at the National Institute of Public Hygiene in Abidjan. After a swab collecting, direct examination and culture on Sabouraud Chloramphenicol and Sabouraud Chloramphenicol Actidione media were implemented to research yeasts. After identifying yeast species through blastesis tests and auxanogram, its in vitro susceptibility to amphotericin B, 5-fluorocytosine, clotrimazole, miconazole, econazole and ketoconazole was assessed. RESULTS: As a whole, 172 patients suffered from vulvovaginal candidiasis i.e. an overall prevalence of 43%. Candida albicans was most frequently isolated (82.5%) followed by C. glabrata (10.5%). C. albicans and C. tropicalis were resistant to the 5-fluorocytosine (respectively 24.65 and 33.33%). Other molecules have shown excellent activity on all yeasts isolated. Type of housing, type of underwear and patients personal history were statistically associated with the presence of vulvovaginal candidiasis (respectively P=0.003; 0.010; 0.022). CONCLUSION: Vulvovaginal candidiasis is relatively frequent in Abidjan and antifungal compounds are in general still effective for treatment. Being knowledgeable of risk factors for this vulvovaginitis will ensure better prevention of their occurrence.

[In vitro susceptibility of vaginal Candida albicans to antifungal drugs in Abidjan (Ivory Coast)]. / Sensibilité in vitro des souches de Candida albicans d'origine vaginale aux antifongiques à Abidjan (Côte d'Ivoire).

OBJECTIVE: The aim of this study was to evaluate in vitro susceptibility of vaginal Candida albicans to common antifungal drugs in Abidjan, Ivory Coast. PATIENTS AND METHODS: From January to September 2008, 150 women with leucorrhoea were sampled for vaginal mycosis at the Pasteur Institute (Ivory Coast). Samples were analyzed by direct examination, Sabouraud-chloramphenicol and Sabouraud-chloramphenicol-actidione culture. C. albicans was identified after blastesis, chlamydosporulation and auxanogram tests. The susceptibility of this fungus to amphotericine B, 5-fluorocytosine, fluconazole, itraconazole and voriconazole was evaluated by a semi-solid medium microdilution technique: ATB(®) Fungus 3. RESULTS: Among 62 yeasts strains isolated, C. albicans represented 45 cases or 72.6%. Vaginal itching (P=0.04) and urinary burning (P=0.002) was statistically correlated with vaginal candidosis. We observed a range of susceptibility of C. albicans strains to antifungals: 100% to amphotericine B (CMI90=0.5µg/mL); 98% to 5-fluorocytosine (CMI90=4µg/mL); 86.7% to voriconazole (CMI50=0.06µg/mL) and 80% to fluconazole (CMI50=2µg/mL and CMI90=32µg/mL). However, only 46.7% of C. albicans strains were sensitive to itraconazole (CMI50=0.125µg/mL). CONCLUSION: These results show that vaginal C. albicans remain sensitive to the most commonly antifungal drugs used in Abidjan. However, this susceptibility should be regularly monitored.