Immunoglobulin E in Nigerian onchocerciasis.

Total serum IgE was measured by radioimmunoassay in 58 adult Nigerian patients with untreated onchocerciasis. Levels in excess of 244.9 IU/ml, the mean level of the healthy Nigerian control subjects tested, were found in 86% of the patients. The levels were comparable to IgE levels found in 15 atopic Nigerian patients from the same residential area (mean = 1,028.7 IU/ml). The findings suggest that onchocerciasis, like allergy, is one of the causes of elevated total serum IgE, though normal levels may occur in this disease.

Calciphylaxis: case report and literature review.

Tissue calcification is a well-recognized common metabolic disease, but calciphylaxis still remains an enigmatic rarity. The latter may be induced experimentally and acquired naturally in human diseases. Although many chronic azotemic or end stage renal disease patients (ESRD) with hyperparathyroidism (HPT) are at risk of calciphylaxis not all of them do develop the disease, even non-renal, patients may also develop this disease. Out of a total of about 2000 hemodialysis, 15,000 dermatology and 26,000 medical patients seen over a three year period in a busy Saudi Arabian tertiary medical centre, we report a sentinel nephrology patient with sudden excruciatingly painful cutaneous calciphylaxis that necessitated acute dermatology emergency consultation, and present a review of the medical literature. In order to institute appropriate total quality management of this life-threatening, rare disease, it is advisable that a high index of suspicion should be entertained by dermatologists, general physicians, nephrologists, and pulmonologists in an appropriate clinical scenario.

Cutaneous malignant melanoma: Tabuk experience.

Cutaneous melanoma (CM) has a rising morbidity and mortality in the western world but is rare in certain geographical areas including the Middle East. The aim of this study is to define the pattern of CM in this environment over a period of about two decades. A review of associated histological reports, dermatology, plastic general surgical admissions and outpatient census statistic of the North West Military Hospital (N.W.A.F.H.) were carried out from January 1978 to June 1996. The clinico-therapeutic information from both the review case and newly discovered CM was then studied. The result shows that CM is probably rare in the Tabuk military environment and possibly has a low mortality among the affected individuals. The presence of only 2 cases of CM among 73,955 patients over about 20 years suggests that this neoplasm is rare in N.W.A.F.H. Surgery, with localised expert reconstruction, probably offers the best cure for uncomplicated CM in this area. It is suggested that the geographical environment, genetic attributes, custom, attitude, presence of white, painted, sun-reflecting buildings, traditional dress-code and behaviour of the indigenes probably contribute to the suppression of and protection against CM in Tabuk. It is recommended that regular, antimlanoma education awareness programmes among the indigenes and avoidance of sunbathing attitude of the expatriate community should be encouraged in order to maintain this suggested natural selection protection.

Erythema nodosum leprosum in Nigeria.

The occurrence of erythema nodosum leprosum among leprosy patients treated with diamino diphenyl sulfone in an endemic area is not rare, unlike in the leprosy patients treated at Lagos University Teaching Hospital. Two Nigerian patients with this disease are described, in whom this rarity was seen. Recurrent monthly fever with painful skin swellings in lepromatous patients from an edemic area is highly suggestive of erythema nodosum leprosum. The occurrence of this reaction in lepromatous leprosy gives a relatively poor prognosis.

The secular changes of skin and venereal diseases in Nigeria.

A retrospective review of the changing phase of the incidence of dermatological and venereal diseases, as seen in University Teaching Hospital practice in Lagos, Nigeria is presented. About 8,849 new patients were seen over a 5-year-period. An analysis of the dermatological conditions encountered is made, while brief reports of few common skin conditions are also given. The clinical pattern was similar to those of Western countries, but with addition of a great number of dermatoses. This similarity has been modified by epidemiological factors. A national program for improvement of the environmental health including control of industrial and communicable diseases will ameliorate the increasing morbidity of tropical dermatology.

Sexually transmitted diseases in clinic patients in Lagos.

In a study of patients attending an STD referral clinic in Lagos, Nigeria, the age distribution was similar to that seen on other parts of the world and the male-to-female ratio was 1.3:1. Non-specific genital infection was diagnosed in about 59% of patients and gonorrhoea in 19%. Most strains of Neisseria gonorrhoeae were sensitive to penicillin (1 unit) and the six relatively penicillin-resistant strains did not produce penicillinase. Candidosis and trichomoniasis were each diagnosed in about 10% of patients and latent syphilis in 1.4% (four cases). Genital warts were also uncommon; venereophobia and other conditions accounted for 1% and 2.2% of cases respectively.

PIP: The study population comprised 276 patients who were either referred to a sexually transmitted diseases clinic or invited to attend through contact-tracing between October 1976 and December 1977. 156 (57%) were men and 120 (43%) women. 43% (119) of the patients were aged between 16 and 29 years. Urethral specimens were collected from all men who presented with urethral discharge using a sterile cotton-wool swab passed into the anterior urethra; the swab was plated directly on to plates of Thayer-Martin (Oxoid) and chocolate agar medium. In women, specimens were obtained with a swab from the cervical os and vaginal vault under direct vision with a Cusco's speculum and processed as above. A wet preparation of the genital discharge was examined for Trichomonas vaginalis, Candida albicans, and parasites, and specimens showing yeast cells were plated on Sabouraud's agar; C albicans was identified by the germ-tube test. Serum from each patient was tested by the Venereal Disease Research Laboratory test and Reiter protein complement fixation test. The most common diagnosis was non-specific genital infection, in 164 (59.4%) of the 276 patients. Gonorrhea was diagnosed in 53 (19.2%) patients and candidosis and trichomoniasis each in 29 (10.5%). Antitreponemal antibodies were detected in 1.4% of patients; all were cases of latent syphilis. Venereophobia, lymphogranuloma venereum, genital warts, and a miscellaneous group of conditions accounted for the remainder of cases. More than one diagnosis was confirmed in 6.5% of patients. Analysis of the source of infection showed that 34.1% of all patients contracted infection through casual partners whom the patients had met only once and could not name or trace; regular partners and prostitutes were the source of infection in 11.6% and 19.2%, respectively. Four strains of N gonorrhea had a minimum inhibitory concentration (MIC) of 0.075-0.3 mcg/ml and two strains an MIC of or= 0.6 mcg/ml. None of the six strains that were relatively resistant to penicillin produced beta-lactamase.

A new immunodiagnostic test in onchocerciasis.

The radioallergosorbent (RAST) technique was used as a diagnostic test for onchocerciasis. IgE antibodies for Dirofilaria immitis antigen were found in thirty-one of fifty-seven (54%) affected patients.