[Cervical cancers diagnosed at the Pasteur Institute of Madagascar from 1992 to 2002]. / Bilan des cancers du col utérin diagnostiqués à l'Institut Pasteur de Madagascar de 1992 à 2002.

In Madagascar, the epidemiological data actualized concerning the cancer of the collus of uterus are not available because of the absence of register of cancer. The objective of this study is to achieve a first assessment of the problem, to complete the epidemiological knowledge, to point out the tool of precoce detection of the precancerous lesions, to propose the measures aiming to improve the management of the patients and to contribute to the institution of a register of cancer. This is a retrospective survey on the frequency of the cancer of the cervix observed from 1992 to 2002 about 23,908 withdrawals addressed to the Institut Pasteur de Madagascar for anatomopathological exam and 12,605 cervical smears for cytological exam. In pathological anatomy, 2,621 (63.4%) of 4,136 cases of diagnosed cancer, have been observed in women. 687 cases (26.2%) of them were localized in the collus. The 3/4 of the cancers of the cervix is invasive and the mean age is 48.2 years old at the time of diagnosis. The cytology detects only 74 cases of invasive cancer of which most don't have an histological confirmation. 274 pre-lesions of cervix cancer were diagnosed for this period, the majority lesions are cytological diagnosis. In spite of a non representative recruitment of the general population, and by the number of withdrawals considered, these results may represent indicators of the epidemiological situation and justify the institution of program to detect the precancerous lesions in a national scale.

[Squamous cell carcinoma arising from chromomycosis. Report of two cases]. / Carcinome épidermoïde développé sur des lésions de chromomycose. A propos de deux observations.

Madagascar is the principal area of endemic chromomycosis in the world with 1 400 cases registered from 1955 to 1996. Malignant transformation is rare and only 12 cases have been reported. We describe herein two new cases of squamous carcinoma arising from chronic lesions of chromomycosis. These carcinomas which develop slowly and are non invasive, are similar to those arising from burns, tropical phagedenic ulcers and chronic leprosy ulcers. Epidemiological aspects, histopathology and treatment are described.

[Cancer in Madagascar. Experience of the Institut Pasteur de Madagascar from September 1992 to June 1996]. / Le cancer à Madagascar. Expérience de l'Institut Pasteur de Madagascar de début septembre 1992 à fin juin 1996.

The Unit of the anatomo-pathology in the "Institut Pasteur de Madagascar" (IPM) examined in the period from September 1992 to June 1996 tissue specimens from 10,275 patients. Tumorous pathology presented 40% of the tissues and half of which were of malign etiology. 64% of the cancer diagnosed were in females. Cervical cancer was most frequently observed (17%), followed by breast cancer (16%). Cancer in the gastro-intestinal tract (15%) was most often located in the colon without sex difference. Stomach cancer occurring predominantly in males presented 25% of the total cases of cancer in the gastro-intestinal tract. Cancer of liver is rarely diagnosed despite the high prevalence of infection with hepatitis B virus. Skin cancer constituted 9% of the malign diagnosis and was mainly found in males. Children under 15 years old presented 7.4% of the total cases of malignancy with the haematopoietic tissues (30%) and the eyes (17%) as the most frequent topic locations. Due to a very low seroprevalence of the HIV in Madagascar, malign tumours associated to AIDS were only seen in a few rare cases. The review of cancer cases in the IPM may not be representative for the cancer epidemiology of Madagascar because of a general very low level of health care coverage, especially in the rural areas. Furthermore, a major part of the specimens originates from easily accessible organsystems, whereas other organs seem less investigated due to lack of appropriate available technique. Therefore, it is not feasible for the moment to establish a cancer register in Madagascar, although the Unit of Pathology in the IPM can offer a valid cancer diagnostical service.

Schistosoma haematobium induced lesions in the female genital tract in a village in Madagascar.

Female genital schistosomiasis, FGS, was investigated in a gynaecological study as part of an overall community based morbidity survey, including parasitological and ultrasonographical examination, of a Schistosoma haematobium endemic area in Madagascar. Women (103), of childbearing age (15-49 years), were included for a gynaecological examination and visible lesions of vagina and cervix were biopsied in order to determine the origin of the lesion. Furthermore all women were screened for the presence of schistosome ova using PAP smears from the vagina and the endo/exo cervix. In total 15 women showed schistosome ova in the vagina and/or cervix (median age 24 years and range 15-36 years). Of 36 women with cervical abnormalities, 12 eggs were detected by cervical biopsy (33%). In addition, two of the 12 presented vaginal induration, which contained eggs. Six women had eggs in their PAP smears of which three were egg negative by cervical biopsy. The prevalence of positive S. haematobium egg excretion in the urine among the 103 women was 69% and the geometric mean egg count of positive individuals was 51 eggs/10 ml of urine. Five of the 15 women with confirmed FGS had < or = 1 egg/10 ml of urine. Bladder lesions and congestive changes in the kidneys were demonstrated by ultrasonographic examination in 33 and 9% of the 103 women, respectively. None of the 15 women with confirmed FGS had renal congestion. Our study demonstrates that FGS is a common manifestation of the infection with S. haematobium, even in lightly infected individuals.

Forty years of chromoblastomycosis in Madagascar: a review.

Confirmed cases of chromoblastomycosis in Madagascar from 1955 through 1994 were studied retrospectively. The total number of cases reported was 1,343, of which 98.5% were confirmed by histopathology. Only 30.8% of the cases showed a positive cultivation on mycologic media, and Fonsecaea pedrosoi was identified from 61.8% of the fungal strains. Two distinct areas of endemic chromoblastomycosis, each with a characteristic ecosystem and a single species, are identified. Madagascar represents the most important focus of this fungal disease described to date in the world.

Treatment of chromomycosis with terbinafine: preliminary results of an open pilot study.

In an open trial, long courses (6-12 months) of terbinafine at a dosage of 500 mg/day were administered orally to 43 patients with a diagnosis of chromomycosis. Sixteen patients (37.2%) had previously relapsed after one or two courses of thiabendazole. A spectacular improvement in the lesions, including disappearance of bacterial superinfections and of associated oedema and elephantiasis, was observed as soon as 2-4 months after the beginning of treatment. The mean number of fungal cells in skin scrapings fell by about 70% in 4 months. Mycological cure, as judged by skin scrapings, was observed in 41.4, 74.1 and 82.5% of patients infected with Fonsecaea pedrosoi after 4, 8 and 12 months of therapy, respectively. For the first time with this disease, total cure was observed even in imidazole-refractory patients or chronic cases (47.2% with a lesion present for longer than 10 years). The efficacy of terbinafine in Cladosporium carrionii-infected patients seemed higher, as indicated by the examination at 4 months.

[Madagascar: esophagogastroduodenoscopy. Descriptive analysis of 12,000 examinations and problems encountered in the tropics]. / Madagascar : la fibroscopie oeso-gastro-duodénale. Analyse descriptive de 12000 examens et problèmes rencontrés sous les tropiques.

The experience of the Digestive Endoscopy Center of the Soavinandriana Hospital in Antananarivo provides insight into not only esogastroduodenal disease in Madagascar but also technical problems involved in performing esophago-gastro-duodenoscopy in tropical areas. From September 1990 to March 1995 a total of 12000 esophago-gastro-duodenoscopy procedures were performed without complication. The main finding was duodenal ulcer which observed in 3580 cases (29.8% of patients) followed by peptic esophagitis due to gastroesophageal reflux in 555 cases and gastric ulcer in 460 cases. Esophageal cancer was detected in 16 cases and malignant gastroduodenal tumor in 82 cases including 63 adenocarcinomas and 5 digestive lymphomas. Overall 4156 procedures (34.6%) were normal and 1130 procedures (9.4%) were performed to investigate digestive tract hemorrhage. These findings document the high incidence of duodenal ulcer in Madagascar where treatment of this condition is difficult due to the high cost. This study underlines the problems encountered in operating an endoscopy department in tropical areas especially with regard to desinfection of equipment and training of endoscopists.

[Prevalence of toxoplasmosis in Tananarive. Study conducted at the Pasteur Institute of Madagascar (PIM) on a sample of 2354 subjects]. / Approche de la prévalence de la toxoplasmose à Tananarive. Etude réalisée à l'Institut Pasteur de Madagascar (IPM) sur un échantillonnage de 2354 sujets.

The prevalence of Toxoplasma antibodies was studied in 2,354 individuals in Tananarive, at the Institut Pasteur of Madagascar. The seroprevalence among the malagasy population amounts to 52.1%. At the age of 10 years old, 36.3% of our sample have already acquired toxoplasma antibodies, proving an early infection. No differences have been observed between sexes. The toxoplasmosis prevalence among the female population coming from France, India and Pakistan and living in Tananarive seemed the same than in their home countries, whereas female population coming from China had shown a different seroprevalence compared to their home country.

[Seroprevalence of rubella in pregnant women at Antananarivo. Study of 853 sera at the Pasteur Institute in Madagascar]. / Séroprévalence de la rubéole chez la femme enceinte à Antananarivo. Etude effectuée à l'Institut Pasteur de Madagascar sur 853 sérums.

The authors reported the results of a seroepidemiological study of rubella in pregnancy in Antananarivo at the Institut Pasteur de Madagascar. A total of 853 sera were tested using hemagglutination inhibition as reference method. Rubella antibodies were present in 80.5% of the malagasy pregnant women. These results seem quite similar to those observed from other tropical african countries. The rubella prevalences among the pregnant woman's population coming from France, India and Pakistan and living in Antananarivo (respectively, 89.8% and 81.8%) seem the same than in their home countries.

[Etiology of hepatocellular carcinomas in Madagascar: results of a study in Antananarivo from October 1995 to October 1996]. / Etiologie des hépatocarcinomes à Madagascar: résultats d'une étude menée à Antananarivo d'Octobre 1995 à Octobre 1996.

Hepatocellular carcinoma (HCC) etiology and incidence in Madagascar are not well established. The work presented here is the first documented study on HCC in Madagascar. The study was undertaken at the Centre Hospitalier de Soavinandriana, Antananarivo, from October 1995 to October 1996. Hepatocellular carcinoma was reported in 19 out of 22 patients with liver tumor included in the study. In 6 cases, patients developed post alcoholic cirrhosis HCC. Hepatitis B virus markers were detected in 48% of cases (13/19). The HBs Ag was detected in 42% of cases (8/19) in association with HBe Ag in 16% of cases (3/19), and hepatitis C virus antibodies in 11% of cases (2/18). In 3 cases, the etiology remained unknown. Hepatocellular carcinoma appeared the most frequent liver cancer, mainly due to post-hepatitis B cirrhosis. The introduction of hepatitis B vaccine in EPI (Expanded Program of Immunization) is recommended in order to reduce the percentage of hepatitis B virus carriers in the malagasy population and furthermore the incidence of HCC.

[Evolution of the Mycobacteria Laboratory of the Pasteur Institute of Madagascar from 1991 to 1994]. / Evolution du Laboratoire des Mycobactéries de l'Institut Pasteur de Madagascar de 1991 à 1994.

In 1991, the Laboratory of Mycobacteria was a small laboratory, part of the Clinical Biology Centre (CBC) of the Institut Pasteur de Madagascar: 656 pathological samples have been analysed for the account of the CBC and the National Control Programme activities. Within 4 years, the number of samples tested increased by more than threefold and the technical ability has evolved in an important way, specially for the identification and the antibiotic sensitivity testing. The scientific equipment have been modernized and the rooms surface increased by fourfold. In 1995, this laboratory was officially designated as the National Reference Laboratory for the culture, the identification and antibiogramme for the account of the National Control programme and for the private clinicians. It also participates to the tuberculosis research programmes of Institut Pasteur de Madagascar. It is associated to the Laboratory of Mycobacteria in the Institut d'Hygiène Sociale of Antananarivo which is the National Reference Laboratory for the bacilloscopy, the teaching and the supervision of the peripheral laboratories.

[Extra-pulmonary tuberculosis in Antananarivo. Principal localizations and biological diagnosis]. / Les tuberculoses extra-pulmonaires á Antananarivo. Principales localisations et diagnostic biologique.

We describe the state of extrapulmonary tuberculosis in the capital of Antananarivo, a city of high endemicity for tuberculosis but very low endemicity for HIV infection. The Laboratory of Mycobacteria in the Institut Pasteur of Madagascar had examined from August 94 to April 95, 543 pathological samples issued from 295 patients clinically suspected of extrapulmonary tuberculosis (64% male and 36% female). The diagnosis of tuberculosis was confirmed for 47.7% of the patients (141/295), using either the culture technique or the histopathological method: 93% of them had an unique localization whereas 7% had a double localization. The most frequent form encountered was the pleural localization (77.8%), followed by the lymphadenopathic form (8,4%) and the abdominal form (6.9%). The confirmation rate on biopsies was 67% by histopathological method compared to 55% by the culture. On the fluid samples, the confirmation rate was 20.9% using the culture. The agreement between histology and culture was 70.3%. Of the 138 strains identified, 135 were M. tuberculosis, 1 M. bovis and 2 environmental mycobacteria.

[660 cases of histologic extra-pulmonary tuberculosis at the Pasteur Institute in Madagascar]. / A propos de 660 cas de tuberculoses histologiques extra-pulmonaires étudiés a l'Institute Pasteur de Madagascar.

A 33 months retrospective study (from September 1992 to May 1995) of 8525 patients indicated that the incidence of histologic extrapulmonary tuberculosis (EPT) was 7,7%. The 8341 malagasy native patients presented an incidence of 7.8%. Male are more frequently infected than female. Most samples came from Antananarivo, with a prevalence reaching 12,5% while it was only 2,9% in the provinces. Most pathologic EPT were pleural tuberculosis (55,6%) and ganglial tuberculosis (34%). Peritoneal tuberculosis were much less frequent. According to literature data in Madagascar, the incidence of histologic EPT is obviously increasing.

[Pericardial tuberculosis in Madagascar. 23 cases]. / Les péricardites tuberculeuses á Madagascar. A propos de 29 cas.

A 56 months retrospective study, from October 1990 to May 1995, at the Centre Hospitalier de Soavinandriana in Antananarivo pointed out 29 tuberculous pericarditis among the 97 pericardial effusions discovered by the echocardiography of 5600 patients. The sex-ratio was 0,81 and the mean age 38,6 years old (+/- 14,3). Hospitalization was justified by dyspnea (18 cases), thoracic pain (18 cases), lower limbs edema (6 cases) and ascitis (3 cases). Moreover, electrocardiography showed microvoltage in 18 cases and thoracic radiography showed one heart enlargement. Even if for 15 cases a pleural effusion was associated, only 2 patients had a pulmonary image suggestive of tuberculosis. Tuberculous pericarditis has been proved by the following examinations: pericardium puncture (21 cases), pericardium and pleural biopsy (respectively 11 and 13 cases), ganglionic biopsy and search of alcohol-acid-fast bacilli in sputum: 1 case. Histologic proof has been obtained 8 times out of 9 pericardial biopsies and 6 times out of 7 pleural biopsies. Bacteriological proof has been obtained 11 times by pathological samples cultivation: twice from fresh caseous material taken from the pericardium, once from 13 pleural fluids, 5 times from 6 pericardial biopsies, 3 times from 3 pleural biopsies. The patients have been put under antituberculous treatment associated with prednisone. 20 patients have been declared cured at the end of the treatment, 5 were dead and 4 were lost out of sight. Tuberculous pericarditis has become rare in developed countries but it is still challenging in Madagascar. In spite of the antituberculous treatment associated with corticoids, prognosis is severe (evolution towards pericardial constriction death.

[Peritoneal tuberculosis in Madagascar, 55 cases at the Soavinandriana Hospital Center in Antananaviro]. / La tuberculose péritoneale á Madagascar, á propos de 55 observations recueillies au Centre Hospitalier de Soavinandriana a Antananarivo.

This retrospective study conducted in Antananarivo for a 42 months period, from September 1991 to March 1994, allowed to record 55 peritoneal tuberculosis, all of them in malagasy patients. The sex ratio was 0,83 and the mean age 36 years old. Ascites puncture was done each time there was an effusion (44 cases). For all cases. For all cases, the diagnosis based on laparoscopy allowed an investigation of the liver and the peritoneum, and 10 peritoneum biopsies could be done. The tubercular bacillus has been isolated in 2 ascites fluids out of 8 incubations, and in 5 biopsies of peritoneal granulation out of 8. For 8 cases, another tubercular localization has been discovered: 5 pleurisis, 2 evolutive tuberculosis and 1 pericardial effusion. All the patients have been put under antitubercular treatment and have regained health. Peritoneal tuberculosis has become rare in the West but is still a frequent pathology mostly in young women, in Africa and up in Madagascar.

[Hepatic hydatidosis in Madagascar: a case of autochthonous origin]. / Hydatidose hépatique à Madagascar: a propos d'un cas d'origine autochtone.

Hydatid disease, due to the larval stage of Echinococcus granulosus, is described for the second time at liver level, in Madagascar. Even with a low level of endemic animal disease and an uncontrolled population of stray dogs, the human parasitosis is very rare in Madagascar. It is interesting to note that, since a hundred of years, the epidemiological status of this Zoonosis has not really changed in the great island.

[Study of 3985 female genital smears from the Clinical Biology Center of the Pasteur Institute in Madagascar]. / Etude de 3985 prélèvements génitaux féminins effectués au Centre de Biologie Clinique de l'Institut Pasteur de Madagascar.

A microbiological study of 3985 cervico-vaginal swabs has been carried out on patients from Pasteur Institute of Madagascar, most of them suffering from leucorrhea. This puts forward the predominance of non-specific vaginitis as well as cervicitis caused by mycoplasmas.