[Epidemiology of otomycoses at the University Hospital of Yopougon (Abidjan-Ivory Coast)]. / Épidémiologie des otomycoses au centre hospitalier et universitaire de Yopougon (Abidjan-Côte d'Ivoire).

OBJECTIVE: Otomycosis is a fungal infection, which leads to a damage of the external auditory meatus. The disease is worldwide in distribution but is said to be more common in tropical countries. Though otomycosis presumably occurs frequently in Africa, reports on its incidence and etiology are rare from Côte d'Ivoire. The objective of this study was to evaluate the prevalence of the disease and to identify aetiological agents as well as the risk factors. MATERIAL AND METHODS: A cross-sectional study was carried out in the Otorhinolaryngology Department of the University Teaching Hospital of Yopougon from September 2007 to February 2008. For laboratory investigation, specimens were collected by means of a sterile swab. Samples were inoculated on Sabouraud's Dextrose Agar with and without antibiotics and incubated at 30°C for a period of 1 to 2 weeks. Identification was performed by direct microscopic examination on Cotton Blue Mount preparation and slide culture examination was used for differentiation of morphology. Biotyping was performed using Carbohydrate Fermentation tests, Carbohydrate Assimilation Tests (galerie Api 20 CAux TM - Sanofi Pasteur), Germ tube Test, detection of chlamydospore formation on corn meal agar. RESULTS: A total of 110 patients (sex-ratio=1.2) with suspected cases of otomycosis were investigated. Itching, otalgia, and hypoacusis were the symptoms reported by the patients and the apparent signs were debris in the ear, scabs and inflammation of the external auditory meatus. Of these, 88 cases (80%) were confirmed specifically of mycotic etiology on the basis of positive culture with 92 isolates consisting of yeasts (65.2%) and moulds (34.8%). The predominant etiological agents were Aspergillus flavus (28.4%), Candida guilliermondii (19.3%) and Candida parapsilosis (18.2%). The predisposing factors included previous otological pathology (P=0.010), frequent scratching of the external ear canal and use of ear drops (RR=3.47; IC 95%=1.3-9.27). CONCLUSION: This study revealed the great prevalence of otomycosis in Abidjan, some predisposing factors and the aetiological agents. Management of otomycosis must include mycological examination for diagnosis and information for changing behaviour patterns leading to infection.

[Intestinal parasites in children in Biankouma, Ivory Coast (mountaineous western region): efficacy and safety of praziquantel and albendazole]. / Parasitoses intestinales infantiles à Biankouma, région des 18 Montagnes (ouest de la Côte d'Ivoire): étude de l'efficacité et de la tolérance du praziquantel et de l'albendazole.

Schistosomiasis and soil-transmitted helminthiasis are a global public health problem, especially among schoolchildren. The purpose of this study was to determine the overall and specific prevalences of intestinal helminth infection and to assess the clinical efficacy, tolerance, and safety of praziquantel and albendazole for treating it. A descriptive cross-sectional study based on random sampling with one degree of freedom was conducted from November 2006 to March 2007 in the primary schools of Biankouma, Côte d'Ivoire. Stool samples were collected from 386 children aged from 4 to 15 years and analyzed by direct examination, with both the simplified Ritchie and Kato techniques. Children infected by schistosomiasis and soil-transmitted helminthiasis eggs were treated with praziquantel (40 mg/kg in a single dose), albendazole (400 mg/kg in a single dose) or both, as deemed necessary. The prevalence rate of intestinal parasite infection was 55.2%, including overall 15.4% with more than one parasite: two in 14.2% and three in 1.2%. Infection was correlated with male gender and older age. The most frequent helminths were Schistosoma mansoni (35.5%) and Necator americanus (25.9%). The efficacy rate for praziquantel, defined as parasite-free stools, was 57.7% on day 14 and 80.9% on day 90. The efficacy rate for albendazole on day 7 was 96.1% for Ascaris lumbricoides, 93% for Necator americanus and 81.3% for Trichuris trichiura. Adverse effects were common (40.8%) but minor (abdominal pain, headache, and itching) within 2 to 4 hours after intake of praziquantel.

[A new focus of human paragonimosis discovered in Côte d'Ivoire (West Africa): the case of the Lauzoua Island]. / Un nouveau foyer de paragonimose humaine découvert en Côte d'Ivoire (Afrique de l'ouest): le cas de l'île de Lauzoua.

Fifteen cases of human paragonimosis were detected in Ivory Coast from 1974 to 1999. Since no further cases have been reported, an epidemiological survey was carried out in local health centers. The purpose of this paper is to described a new focus of paragonimosis discovered on Lauzoua Island. Clinical and parasitological examinations were performed on 17 patients presenting chronic cough, haemoptysis and/or epilepsy. Stools belonging to cats, dogs and pigs as well as river crustaceans were also examined to identify parasite eggs and metacercariae respectively. Paragonimus eggs were found in stools and/or sputum of five patients. Measurements of these eggs after fixation in formalin allowed division into three groups. Stools from cats, dogs and pigs were negative. Small Paragonimus metacercariae (mean: 277 to 323 microm) were found in three Callinectes marginatus crabs (out of 15 caught near the island). No metacercariae were found in local prawns. The presence of these three Paragonimus egg groups as well as of infected crabs near the island will require further study to identify the species and determine the prevalence of each in human infection.

Un nouveau foyer de paragonimose humaine découvert en Côte d'Ivoire (Afrique de l'Ouest): le cas de l'île de Lauzoua

Quinze cas de paragonimose humaine ont été détectés en Côte d'Ivoire de 1974 à 1999. Comme aucun autre cas n'a été trouvé depuis cette dernière date, une étude épidémiologique a été réalisée dans les centres locaux de santé. La présente note rapporte un nouveau foyer de paragonimose dans l'île de Lauzoua. Des examens cliniques et parasitologiques ont été effectués chez 17 patients souffrant de toux chronique, d'hémoptysie ou d'épilepsie. Des fèces de chats, de chiens et de porcs de même que des crustacés de rivière ont été également examinés pour y trouver les oeufs du parasite ou des métacercaires respectivement.Des oeufs de Paragonimus ont été trouvés dans les selles ou les expectorations de cinq patients. Les dimensions des oeufs (fixés dans du formol)permettent de caractériser trois groupes. L'examen des fèces provenant des chats, des chiens et des porcs s'est révélé négatif.Desmétacercaires de Paragonimus,de petite taille (de 277 à 323 µm en moyenne), ont été trouvées dans trois crabes (sur les 15 Callinectes marginatus capturés autour de l'île) tandis que l'examen des crevettes locales était négatif. La présence de trois types d'oeufs pour Paragonimus et celle des crabes parasités autour de l'île nécessitent d'autres études pour déterminer les espèces de ces parasites et la prévalence de l'infestation humaine pour chaque espèce

[Symptomatic and asymptomatic Plasmodium falciparum infection in children from 6 months to 6 years old in the Abobo general hospital (Abidjan, Côte d'Ivoire)]. / Portage symptomatique et asymptomatique de Plasmodium falciparum chez les enfants de 6 mois a 6 ans a l'hôpital général d'Abobo (Abidjan, Côte d'Ivoire).

It is commonly admitted that people living in malarial zone are carrying asymptomatic Plasmodium. Côte d'Ivoire is one of these zones. The studies carried out on malaria in these areas have focused mainly on the clinical forms of the disease and effectiveness of the antimalarial drugs. The purpose of this study was to determine the prevalence of the symptomatic and asymptomatic carriage of Plasmodium falciparum in children of 6 months to 180 months old in the Abidjan area. Over a period of twelve months, 902 feverish subjects and 681 non-feverish subjects were selected among the 7,017 people admitted in the paediatrics service of the Abobo general hospital for detection of malaria parasite. Among 1,583 selected subjects, 358 were carrying Plasmodium falciparum implying a total prevalence rate of 22.6%. The prevalence rate was 13.5% and 29.5% respectively in the asymptomatic subjects and symptomatic subjects. The highest proportions of positive thick smears were observed during the long rainy and dry seasons but, parasitaemia was the highest during the short dry season. In 31.5% of the cases, the asymptomatic carriers had a parasitic density higher or equal to 10,000 trophozoites/microl of blood and fever was not related to parasitic load. The prevalence rates of Plasmodium carriage and malaria were higher during the long rainy season. This study highlighted a considerable proportion of asymptomatic Plasmodium falciparum carriers. Improving environmental conditions should help to reduce this rate of carriage.

[Persistence of a paragonimosis focus in the department of Lakota, Côte d'Ivoire (West Africa)]. / Persistance d'un foyer de paragonimose dans le département de Lakota, Côte d'Ivoire (Afrique de l'Ouest).

A field survey was carried out from March to August 2006 in three villages around the town of Lakota (Côte d'Ivoire) to verify the presence of paragonimosis in local people, wild vertebrates, and crabs. Out of the 92 patients who were recruited because of their chronic cough, haemoptysis and/or epilepsy, 3 had Paragonimus eggs in their stools and/or sputa. Examination of stools belonging to 24 wild mammals and a reptile revealed the presence of eggs in three civets (Viverra civetta) and a mongoose (Crossarchus obscurus). Six local crabs (out of the 30 Liberonautes latidactylus dissected) harboured Paragonimus metacercariae having low diameters (299 to 315 pm). The presence of several paragonimid species (at least 2) in the district of Lakota was hypothesized. However, the existence of quantitative variations in metacercarial diameters for the same species of Paragonimus cannot be excluded.

[Epidemiological profile of the schistosomiasis in school children in the Agneby Region (south-east of Côte-d'Ivoire)]. / Profil epidémiologique des schistosomoses chez les enfants d'age scolaire dans la région de l'Agnéby (sud-est de la Cote-d'Ivoire).

A parasitological survey was conducted in the Agnéby region (south-east Côte-d'Ivoire) from November 2000 to February 2001 in order to establish the epidemiological profile of schistosomiasis in school children in this region. Stools and urines of 724 school children were examined. Faeces were examined by direct analysis completed by Kato and Ritchie methods. Analysis of urine samples was made through the technique of centrifugation (2.000 g for 10 minutes). This survey revealed the importance of schistosomiasis. 20.6% of the subjects were found carriers of Schistosoma mansoni eggs, 12.6% carriers of Schistosoma haematobium eggs and 3.2% were found carriers of eggs of two Schistosoma species. Prevalence was higher in Adzope than in Agboville and Schistosoma mansoni was globally prevalent. Males were significantly more infected than females and older children were more infected than young children. The prevalence distribution among people could be explained by behaviour and occupations.

[Revaluation of chloroquine therapeutic efficacy on children with uncomplicated Plasmodium falciparum malaria in eastern Ivory Coast (1999-2002)]. / Efficacité thérapeutique de la chloroquine dans le traitement du paludisme simple à Plasmodium falciparum de l'enfant dans l'est de la Côte-d'Ivoire (1999-2002).

OBJECTIVE: A prospective study was made from November 1999 to May 2002 in order to revaluate the therapeutic efficacy of chloroquine in pediatric Plamodium falciparum malaria in Ivory Coast. DESIGN: This study was included in the national Plasmodium falciparum-susceptibility supervision program. Two hundred and fifty-six out of 594 patients from six to 59 months of age were included. Chloroquine was administered in accordance with the standard 14 day WHO protocol; i.e. administered dose of 25 mg/kg, in split doses, over three days. RESULTS: Two hundred and forty-seven patients completed the treatment. Among these, 217 presented with adequate clinical response (87.8%). The percentage of therapeutic failure was 12.2% with 12 early cases of therapeutic failure and 18 late cases of therapeutic failure. Chloroquine was more efficacious in Agnibilékrou (11.3% of therapeutic failure), Bondoukou (10.4%), and Tanda (10%), than in Abengourou (16.4%). Parasitic reduction on patients with resistant Plasmodium was superior to 90%, from day 0 to day 3. The risk of therapeutic failure was significantly linked to patient age. CONCLUSION: Considering these results, the authors suggest that the first-line treatment with chloroquine must be continued for uncomplicated malaria in humans.

[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.

[Serological survey of acquired toxoplasmosis in women of child-bearing age in Yopougon (Abidjan, Côte d'Ivoire)]. / Dépistage sérologique de la toxoplasmose acquise chez les femmes en âge de procréer dans la commune de Yopougon (Abidjan, Côte d'Ivoire).

The seroprevalence of toxoplasmosis was assessed from August 2000 to March 2001 on 1025 women in child-bearing age while consulting in the preventive health center (PHC) of Yopougon (Abidjan). Indirect immunofluorescent test was used for detection of IgG and Remington test for detection of IgM. Among the women under investigation, 60% were found to be IG seropositive, including 0.4% IgM seropositive. Soil and food were sources of contamination. When compared to previous studies conducted in the same region for several years, these results give evidence of a stability of the seroprevalence of toxoplasmosis, contributing to increase the risk of toxoplasmic encephalitis occurrence in AIDS patients.

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

[Therapeutic efficacy of chloroquine in the uncomplicated malaria due to Plasmodium falciparum in hospital patients in central Ivory Coast (1997-2000)]. / Efficacité thérapeutique de la chloroquine dans le traitement du paludisme simple dû à Plasmodium falciparum des consultants hospitaliers dans le centre de la Côte d'Ivoire (1997-2000).

A study in vivo of Plasmodium falciparum sensitivity to chloroquine was carried out from April 1997 to February 2000 at Yamoussoukro, Kossou and Bouaké in the central region of Côte d'Ivoire. This study was included in the national Plasmodium falciparum-sensitivity program. One hundred and sixteen subjects consulting for suspected malaria were included according to the WHO's standard of 14 days. Chloroquine was administered on a dosage of 25 mg/kg, spread over three days. Among 108 subjects who finished the treatment, 26.9% (29/108) had therapeutic failure to chloroquine (23 precocious therapeutic failure and 6 late therapeutic failure). Chloroquine was more efficacious in Yamoussoukro (87.5% of clinical appropriate response) and Bouaké (82.5%) than in Kossou (61.7%). Parasitic reduction on subjects with therapeutic failure was higher than 85%. The risk of therapeutic failure is not linked to age of patient. Before a revaluation of this situation, chloroquine should always be recommended as a first-line treatment for uncomplicated malaria for the local populations.

[Clinical trial of amodiaquine in the community of Attécoubé (Abidjan, Côte d'Ivoire)(May-December 1955)]. / Essai clinique de l'amodiaquine dans la commune d'Attécoubé (Abidjan, Côte d'Ivoire) (mai-décembre 1995).

A prospective study in the municipality of Attécoubé (Abidjan, Côte d'Ivoire) evaluated the sensitivity of P. falciparum to amodiaquine with a posology of 35 mg/kg over 3 days (1st day: 15 mg/kg; 2nd day: 10 mg/kg; 3rd day: 10 mg/kg) as well as its tolerance of this dosage. One hundred five WHO in vivo standard tests were performed over 7 days on subjects aged > 15 years from May to December 1995. The subjects were carriers of varying number of trophozoites: between 1000 to 34,000 trophozoites were recorded with a mean of 5193 trophozoites by microliter. We divided the subjects into two groups: group A with 43 patients to whom we administered medication and group B with 62 subjects who took their medication on their own. Clinical and parasitological verifications were made on D0, D2 and D7. Biological verification was conducted for 31 subjects of group A by mean of SGOT and SGPT quantity determination on D0 and D2. This survey revealed that 1.9% of P. falciparum malaria patients had precocious therapeutic failure to amodiaquine (35 mg/kg over 3 days) in this area. Clinical and biological tolerance was good and there was no difference between the two groups. We suggest that amodiaquine might be used for uncomplicated malaria at first intention in Abidjan.

Interêt de la chimioprophylaxie antipalustre chez l'enfant

Les auteurs ont evalue l'efficacite de la chimioprophylaxie a la chloroquine des enfants dans la region d'Abidjan. L'evaluation a ete realisee au cours du second trimestre de 1992 aux urgences pediatriques du CHU de Cocody chez 133 enfants ages de 3 mois a 6 ans hospitalises pour acces palustre. 36;84 pour cent des enfants ne pratiquaient pas de chimioprophylaxie; 41;35 pour cent des hospitalises pratiquaient une chimioprophylaxie irreguliere et 21;80 pour cent des malades pratiquaient une chimioprophylaxie reguliere. Cette etude montre que la chimioprophylaxie antipalustre n'empeche pas toujours la survenue d'acces palustre grave chez l'enfant en zone d'endemie

Etiologies fongique et parasitaire des vulvo-vaginites a Abidjan. [lettre]

Une etude retrospective d'une annee d'activite allant de janvier 1989 a decembre 1989 du laboratoire de parasitologie-mycologie de la Faculute de Medecine d'Abidjan; portant sur 124 prelevements vaginaux; a permis aux auteurs de trouver un taux de positivite globale de 56;45 pour cent. Par ordre de frequence; ils ont trouve Candida albicans a un taux de 38;70 pour cent; Candida tropicalis 5;64 pour cent; puis Candida guillermondii 0;80 pour cent. Au cours de cette meme etude; Trichomonas vaginalis a ete mis en evidence 17 fois par l'examen direct; soit une prevalence de 13;70 pour cent

[Chronic diarrhea and parasitoses in adults suspected of AIDS in the Ivory Coast]. / Diarrhées chroniques et parasitoses chez des adultes suspectés de SIDA en Côte-d'Ivoire.

148 adult patients with chronic diarrhoea and suspected to be HIV infected have had stool examinations. 46 are without any enteric parasite. Those detected in the others patients are Sporozoans: I. belli (16.2%) and Cryptosporidium sp. (6.7%) found alone or joint, together or with other parasites. Among those, all Flagellate species are identified, but T. intestinalis (6%) is predominant. Entamoeba coli (8.%) is the most frequent amebic species, however, E. histolytica histolytica have been found twice, once singly, the second associated with I. belli, Schistosoma mansoni and Candida albicans. Necator americanus (14%) and Strongyloides stercoralis (12%) are the predominant worm species. Among the yeasts, C. albicans (35.8%) is the most important species isolated, singly in 13.5% of the patients. In an intertropical and parasitical endemic area where many parasites are not considered uncommon, opportunist agents as I. belli, Cryptosporidium sp. and C. albicans appear in an non-negligible frequency in our study.