[Thyroid cancers in Madagascar]. / Les cancers de la thyroïde à Madagascar.

This is a retrospective study, conducted on thyroid cancer observed for 13 months (from June 1(st) 2004 to June 30(th) 2005). Data were collected from four main surgical pathology laboratories in Antananarivo, Madagascar. Among 6,036 surgical samples, 179 were of thyroid gland, a rate that is near 3% of the total. Among them were found 40 cases of thyroid cancer, which is 0.66% of all screened samples, and 22.32% of all examined thyroid samples. In the studied population was observed a female preponderance (82%) with a mean age of 43.9 years when diagnosis was confirmed. It was evidenced a 50 % of papillary carcinoma and 45% of follicular carcinoma, with a rate of 2.5% respectively for the medullar and anaplastic carcinoma. Metastases were seen in 20%, originated from papillary type for the lymph node involvement and from the follicular type for the bone involvement. In Antananarivo, thyroid cancer is seen mainly in people from the surrounding Highlands, supposed to be sites of endemic goiter related to iodine deficiency. Despite its limits, this study may be used as reference about thyroid cancer in Madagascar. Further studies are required to find out other factors involved in the development of this disease.

Coexistence of urogenital schistosomiasis and sexually transmitted infection in women and men living in an area where Schistosoma haematobium is endemic.

BACKGROUND: In settings in which adequate laboratory service is lacking, the coexistence of urogenital schistosomiasis and sexually transmitted infections (STIs) poses a diagnostic challenge for health care providers in the management of patients with urogenital complaints. METHODS: Symptoms were recorded with use of a semistructured questionnaire at baseline and in follow-up surveys after STI and Schistosoma haematobium infection had been assessed and systematically treated as part of a community-based study of 253 women and 236 men, aged 15-49 years, living in an area of Madagascar where S. haematobium is endemic. RESULTS: Of those infected with S. haematobium, 35% of the women had concordant STI (e.g., infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and/or Trichomonas vaginalis), compared with 17% of the men. Both S. haematobium infection and STI were significantly more common among younger individuals, aged 15-24 years, than among older individuals. A broad spectrum of urogenital symptoms was reported. However, one-half of the women and men who had positive test results for an STI or for S. haematobium infection were asymptomatic. Gross hematuria and dysuria were, in multivariate analysis, associated with S. haematobium infection, as were genitopelvic discomfort in women and ejaculation pain in men. The association became stronger with higher intensity of infection. In bivariate analysis but not in the multiregression model, STI was associated with vaginal discharge and genitopelvic discomfort in women and was associated with urethral discharge in men. CONCLUSIONS: The rationale for empirical antischistosoma treatment of adolescents and younger adults in areas where S. haematobium is endemic, with praziquantel alone or in combination with existing anti-STI regimens, is discussed.

Validity of intradermal tuberculin testing for the screening of bovine tuberculosis in Madagascar.

A sample survey with the objective of determining the prevalence of bovine tuberculosis by means of an intradermal tuberculin test was conducted in Madagascar and it was found that the prevalence rate varied from 0-30% by veterinary district. In order to estimate the true prevalence, the validity of the test was investigated by assessing its sensitivity and specificity in two groups of animals from two different regions, which were destined for slaughter. In the first group where the probability of non-infected animals should have been the highest, sensitivity was estimated at 0.52 (n = 21) and specificity at 0.99 (n = 79). In the second group selected on the basis of apparent ill health of the animals in a high-prevalence bovine tuberculosis area, sensitivity was estimated at 0.8 (n = 10) and specificity at 1 (n = 12). The results obtained from both groups of cattle were not combined for statistical purposes because the sensitivity of the skin test seemed to fluctuate in relation to the chronicity of the disease. These fluctuations are discussed. However, since the first group of zebu cattle was more representative of the cattle population across the country as a whole, its results were retained as operational parameters for further screening.

[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.

Clinical findings in female genital schistosomiasis in Madagascar.

To assess the morbidity of S. haematobium infection in women of reproductive age (15-49 years) in the western part of Madagascar, the village of Betalatala with a prevalence of urinary schistosomiasis in women of 75.6% (95% confidence limit 69.3 to 81.9%) was compared with a neighbouring village with similar socio-economic characteristics and a prevalence of 5.0% (95% confidence limit 0 to 11.75%). The women were questioned in Malagasy about obstetrical history and urogynecological symptoms. They were examined gynaecologically, parasitologically and by ultrasonography. Important STDs were excluded by appropriate diagnostics. In Betalatala significantly more women reported a history of spontaneous abortion (P < 0.01), complaints of irregular menstruation (P < 0.001), pelvic pain (<0.05), vaginal discharge (P < 0.0001), dysuria (P < 0.05) and haematuria (P < 0.01) than in the control village. Biopsies were obtained from the cervix of 36 women with macroscopical lesions, and in 12 cases S. haematobium eggs were found by histological sectioning (33.3%). In the control village no eggs were detected in the histological sections of biopsies taken from 14 women. (P < 0.05). Infections with Candida albicans, Trichomonas vaginalis, Gardnerella vaginalis and Treponema pallidum were found in similar frequencies in both villages. In 9.8% of the women in Betalatala abnormalities of the upper reproductive tract were revealed by ultrasonography versus none in the women from the control village (P < 0.05). Echographic abnormalities of the urinary tract were present in 24% and 3% of the women in the study village and in the control village, respectively (P < 0.0001). These findings were accompanied by an elevated frequency of haematuria (55% versus 20%) and proteinuria (70.4% versus 25%) in the study population (P < 0.0001). Our study indicates that S. haematobium infection in women may not only cause symptoms in the urinary tract, but also frequently in the lower and upper reproductive tract.

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.

[Natural history of chromoblastomycosis in Madagascar and the Indian Ocean] [Natural history of chromoblastomycosis in Madagascar and the [Natural history of chromoblastomycosis in Madagascar and the Indian Ocean]. / Histoire naturelle des chromoblastomycoses à Madagascar et dans l'Océan indien.

The natural history of chromoblastomycosis was studied in Madagascar by analysing the characteristics of 1323 confirmed cases observed since 1955, including 45 patients receiving a new antifungic drug (terbinafine) during a multicentric study organized in 1995. The surveys data, conserved by the histopathology laboratory in the Institut Pasteur of Madagascar during 40 years, permit this retrospective analysis. The description of two ecosystems, one in the North with Fonsecaea pedrosoi evolving in the tropical rainforest and one in the South with Cladophialophora carrionii (41% of the whole sample) isolated in the spiny desert, demonstrates that the deforestation, in order to product charcoal and to build houses, is the primary factor associated with this disease. The epidemiologic (87% of patients are male and 96% are more than 16 years old, with more than 74% of the lesions located on feet and legs), mycologic (62% of the isolated strains belong to the F. pedrosoi species) and therapeutic (low efficiency of thiabendazole in long-term lesions, high efficiency of terbinafine especially on recent lesions and on Cladophialophora-infected patients) aspects of the natural history of chromomycosis confirmed that Madagascar is the most important focus in the world (global prevalence of about 1 for 8500 inhabitants), with few sporadic cases in the other islands of the Indian Ocean (La Reunion, Comoro islands and Mayotte). In the difficult context of Madagascar, the need for a non-specialized laboratory-applicable diagnostic technique that provides infection and species identification led the Institut Pasteur de Madagascar to develop an ELISA-based technique. A large-scale control throughout the country, with the assessment of effective oral chemotherapy with terbinafine, is seen as possible by the authors with the help of the manufacturer.

[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.

[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.

[Entomophthoromycoses in Madagascar (three cases)]. / Les entomophthoromycoses à Madagascar (à propos de trois cas malgaches).

The authors present three new cases of Entomophthoromycosis observed in Madagascar: Two cases of subcutaneous entomophthoromycosis without isolation of germ. An immunofluorescence technique showed the Basidiobolus ranarum to be the real cause. One case of rhinoentomophthoromycosis with isolation of Conidiobolus coronatus (first isolation in Madagascar).