Reliability assessment and validation of the post-acne hyperpigmentation index (PAHPI) in a population from Sub-Saharan Africa in Senegal.

BACKGROUND: A post-acne hyperpigmentation index (PAHPI) has been developed in the United States to better compare therapeutic modalities. Our aim in this study was to validate the PAHPI score in patients with skin type VI from sub-Saharan Africa. PATIENTS AND METHODS: The study was conducted in Dakar, Senegal. Twenty-one patients with Fitzpatrick skin type VI, aged 17 to 55 years, presenting hyperpigmentation secondary to acne were included. Ongoing use of skin bleaching products or acne treatments was allowed. Four trained dermatologists rated the patients using the PAHPI. A narrow-band reflectance spectrophotometer (Mexameter MX-18, Cologne, Germany) was used to measure the degree of pigmentation of involved and adjacent skin on 6 representative facial lesions. RESULTS: The average inter-rater reliability (weighted Kappa) showed substantial agreement for intensity (0.67), moderate agreement for number (0.53) and fair agreement for lesion size (0.28). Inter-rater reliability for the total PAHPI was excellent for both day 1 and day 2 (interclass correlation coefficient of 0.87 and 0.85, respectively; P<0.0001). Intra-rater reliability for total PAHPI ranged from 0.83 to 0.93 (P<0.0001). PAHPI scoring thus demonstrated excellent reliability both between and within raters. The association was moderate to substantial for all raters on both days (range for rho on day 1: 0.531 to 0.815; range for rho on day 2: 0.448 0.762). The correlations between the Mexameter (Courage and Khazaka) measurements and PAHPI scores showed moderate to substantial agreement. CONCLUSION: Although tested primarily in African American women to date, PAHPI is also valid for patients from sub-Saharan Africa.

Unusual extra-podal fungal mycetoma with black grains in a Senegalese child.

Mycetoma remains endemic in the tropical and subtropical regions of the "mycetoma belt" including Senegal. It affects more commonly young men in the age group of 20 to 40 years. The foot represents the most commonly affected site. The most common extra-podal localizations are leg, knee, buttocks, hand and arm. We report an exceptional case of cervical fungal mycetoma that occurred in a 13-year-old Senegalese child. He consulted for a cervico-submandibular tumefaction with multiple sinuses and black grains discharge evolving since 6 years, associated to laryngeal dyspnoea. Mycological examination with culture isolated Madurella mycetomatis. Cervical CT Scan showed bone and soft tissue invasion. Terbinafine alone was administered. During the evolution, tracheotomy was performed following the aggravation of the laryngeal disorders. Death from severe sepsis occurred after 8 months of evolution. The particularities of our case are the occurrence of fungal mycetoma in a child, the cervical localization and the difficulties of therapeutic management largely due to the diagnostic delay.

Genetic diversity and distribution of Bradyrhizobium and Azorhizobium strains associated with the herb legume Zornia glochidiata sampled from across Senegal.

Herb legumes have great potential for rehabilitation of semi-arid degraded soils in Sahelian ecosystems as they establish mutualistic symbiosis with N(2)-fixing rhizobia. A phylogenetic analysis was performed for 78 root nodule bacteria associated with the common Sahelian herb legume Zornia glochidiata Reichb ex DC in Senegal. Based on ITS (rDNA16S-23S) and recA sequences, these strains were shown to belong to the two genera Bradyrhizobium and Azorhizobium. Strains of this latter, although frequent, formed small and ineffective nodules and suggested a parasitism rather than a symbiotic association. A potential negative effect of Azorhizobium on Zornia growth was tested for when inoculated alone or in association with a Bradyrhizobium strain. Bradyrhizobium isolates were distributed in four groups. Groups A and B were two sister clades in a larger monophyletic group also including Bradyrhizobium liaoningense, Bradyrhizobium yuanmingense, and Bradyrhizobium japonicum. Strains of cluster D fell in a sister clade of the photosynthetic Bradyrhizobium sp. group, including ORS278, whereas group C appeared to be divergent from all known Bradyrhizobium clusters. Amplified fragment length polymorphism (AFLP) clustering was congruent with ITS and recA phylogenies, but displayed much more variability. However, within the main Bradyrhizobium clades, no obvious relationship could be detected between clustering and geographical origin of the strains. Each sub-cluster included strains sampled from different locations. Conversely, Azorhizobium strains showed a tendency in the phylogeny to group together according to the site of sampling. The predominance of ineffective Azorhizobium strains in the nodules of Zornia roots, the large Bradyrhizobium genetic diversity and the geographical genetic diversity pattern are explored.

Phenotypic and genotypic diversity of Genista saharae microsymbionts from the infra-arid region of Tunisia.

AIMS: Genista saharae, indigenous of Sahara, is a spontaneous shrub that plays an important ecological role for the preservation and fertility of poor and eroded soils. This legume has not been examined for its root nodule bacteria. The taxonomic diversity of bacteria from root nodules of G. saharae growing in the infra-arid region of Tunisia was investigated. METHODS AND RESULTS: A total of 28 bacterial strains isolated from root nodules of G. saharae grown in Tunisian soil were characterized using a polyphasic approach including phenotypic characteristics, PCR-RFLP of 16S rDNA and 16S rRNA gene sequencing. It was found that new isolates are diverse and affiliated to Ensifer (75%), Rhizobium (10%) and Phyllobacterium (15%). The Phyllobacterium isolates lacked the capacity for nodule formation on this plant. CONCLUSIONS: Genista saharae formed nodules with diverse rhizobia in Tunisian soils. Furthermore, our results support the presence of non-nodulating commensal strains (Phyllobacterium) in legumes nodule. SIGNIFICANCE AND IMPACT OF THE STUDY: This study is the first report on the characterization of G. saharae microsymbionts in Tunisia.