Necrotizing Fasciitis (LRINEC): Epidemiology, Clinical Profiles, and Value of the Laboratory Risk Indicator in a Third-World Setting.

Acute bacterial dermohypodermites (ABDH) are frequent soft tissue infections. When left untreated, they can lead to severe regional or general complications. Our study evaluated the role of Laboratory Risk Indicator for Necrotizing (LRINEC) in ABDH global care by early detection of patients associated with risk of complication. From January 1, 2006 to December 31, 2015, 221 patients were included. The prevalence of ABDH was 1.02%. Women were the most observed (115/221), with a sex ratio of 0.92. The mean age was 49.8 years, and the majority was between 45 and 59 years old (34.39%). Farmers (30.32%), laborers (25.34%), and traders (18.10%) were the most observed professional categories. The main risk factors reported were anti-inflammatory drugs use (23.98%), alcohol (22.62%), obesity (15.84), medical history of ABDH (14.48%), diabetes mellitus (13.12%), smoking (11.31%), cardiovascular diseases (9.95%), HIV infection (9.90%), and skin blanching (7.6%). Infectious gateway was reported in 62% of cases. The most frequent infection site was the legs (90.05%). Fever was reported in 71.04% of cases. The LRINEC score was above 6 in 23% of cases. Complications occurred in 22.63% of cases, and comparing the two groups according to the LRINEC score, in group with the LRINEC score ≥ 6, we observed 64% of complications. The LRINEC score is an easily available, accessible, and user-friendly tool. It should be disseminated and used by all practitioners to predict complications in patient hospitalized for ABDH in a third-world setting.

Mycobacterium ulcerans Disease with Unusual Sites Not to Be Ignored.

Objective. The usual preferential site of BU is in the limbs. In our experience, we noticed atypical and often misleading sites which pose serious issues for the diagnosis and often for the treatment. Methods. This is a retrospective study conducted over a period of ten years of BU treatment at the Department of Dermatology of the University Teaching Hospital of Treichville (Abidjan, Côte d'Ivoire). We included in this study all BU cases with atypical site diagnosed clinically and confirmed either by the histology, by smear, or by PCR. Results. Epidemiologically, the age of patients ranged from 3 to 72 years with a median age of 14.2 years. Children aged less than 15 years were affected in almost 80% of case. The clinical table was dominated by ulcerated forms in 82.1% of cases. The unusual topography mostly observed was that of the torso (thorax, back, and abdomen) in 76.8% of cases. Conclusion. BU is an endemic disease in Côte d'Ivoire where it constitutes a serious public health issue. Several years following its first cases, BU still is little known. This dermatosis may present atypical misleading clinical aspects which must be ignored.

Multifocal Buruli Ulcer Associated with Secondary Infection in HIV Positive Patient.

Buruli ulcer is a chronic and infectious skin disease, caused by Mycobacterium ulcerans. It leads to large skin ulceration and sometimes bone infection which is responsible for deformities. Here, we report a case of multifocal form of Buruli ulcer associated with secondary infection in a 46-year-old human immunodeficiency virus (HIV) positive woman. The antimycobacterial drugs combined to surgery allowed curing this multifocal case and rose up two relevant issues: the susceptibility of immune reconstitution inflammatory syndrome (IRIS) occurrence and Mycobacterium dissemination. The deep immune depression, the underline biological, and clinical disorders of the patient might contribute to IRIS occurrence and Buruli ulcer dissemination. Future investigations have to be conducted on the mechanism of IRIS on set and on Mycobacterium ulcerans dissemination after ARV drugs initiation and the patient related underline clinical or biological disorders.