[Herpes zoster and human imunodeficiency virus in the medical centers of Ouagadougou]. / Le zona dans les formations sanitaires de Ouagadougou dans le contexte de la pandemie du VIH/SIDA.

Herpes zoster is an acute posterior ganglio-radiculitis related to the reactivation of the chicken pox-herpes zoster virus remained quiescent in the neurons of the nerve-knots. It usually occurs at the subject after 60 years old. For young patient, it is closely related to the infection by the HIV. Our exploratory descriptive and analytical study was carried out from 1 October 2002 to 30 September 2003, in order to describe the epidemiological, clinical aspects of the herpes zoster in the medical formations of the town of Ouagadougou (Burkina Faso) and to determine the prevalence of the infection by the HIV in the patients. We have collected 118 patients who have a herpes zoster through 6500 consultants. There were 79 women and 39 men. The average age was 34.4 years. The age bracket from 20 to 40 years was the most touched. The blistered eruption was the first reason for consultation; the light with type of burn, intermittent pain prevailed. The lesions healed in one month but there were 28 ulcerated necrotic cases. Post zoster pains have been observed in 33 cases. The localizations were the members in 44 cases (37.29%), the head in 35 cases (29.66%) and the trunk in 40 cases (33.90%). We have observed a case with double localization of herpes zoster. On 65 patients tested for the HIV, 58 (89.2%) were infected. The age bracket from 20 to 40 was the most concerned. A case of corneal necrosis isolated, with blindness and another with an opposed, spasmodic and total hemi paresis were notified. Fourteen patients having an antecedent of herpes zoster were all infected by HIV. Since the pandemic infection by the HIV, the incidence of the herpes zoster increases within the young population. The high frequency of HIV infection among our patients (89.2%) showed that the herpes zoster is closely related to this disease.

[Epidermodysplasia verruciformis: clinicaland epidemiological features of 45 cases in the Department of Dermatology at the University Hospital Center of Yalgado Ouedraogo, Ouagadougou]. / Epidermodysplasie verruciforme: aspects epidémiologiques et cliniques de 45 cas dans le service de Dermatologie du Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou.

INTRODUCTION: The epidermodysplasia verruciformis is a rare, autosomic, recessive, genodermatose characterized by a chronic, disseminated, cutaneous infection with human papillomavirus. The majority of these patients have a genetic or acquired immunodeficiency. PATIENTS AND METHODS: This retrospective study was conducted on the records of all patients who presented in our dermatology department with an epidermodysplasia verruciformis in a 13 years and 6 months period, from January 1st, 1992 to June 30th, 2005. RESULTS: We have collected 45 cases of epidermodysplasia verruciformis. They were aged from 3 to 57 years, with a mean of 24.6 years. The most concerned age bracket was that from zero to 9 years. They were 29 women (64.4%) and 16 men (35.6%). The eruption presented as papules of 2 to 3 mm size, associated with hypochromic, finely squamous macules with the same size. We noted three cases of itching. We found 37.7% of family cases. We observed 14 cases of HIV positive patients and one case of cancer. CONCLUSION: This study confirmed that the epidermodysplasia verruciformis was rare. Genetic factors or immunodeficiency would support the appearance of the disease.

Epidermodysplasie verruciforme : aspects epidemiologiques et cliniques de 45 cas dans le service de dermatologie du centre universitaire Yalgado Ouedraogo; Ouagadougou

Introduction : L'epidermodysplasie verruciforme est une genodermatose rare; autosomique recessive caracterisee par une infection cutanee a papillomavirus humains; disseminee; d'evolution chronique. La plupart de ces malades ont un deficit immunitaire. Patients et Methodes : Il s'agissait d'une etude retrospective a partir des dossiers des malades ayant consulte pour une epidermodysplasie verruciforme dans le service; du 1er janvier 1992 au 30 juin 2005; soit une periode de 13 ans et six mois. Resultats : Nous avons collige 45 cas d'epidermodysplasie verruciforme. L'age moyen etait de 24;6 ans avec des extremes de 3 a 57 ans. La tranche d'age la plus touchee etait celle de zero a 9 ans. Il s'agissait de 29 femmes (64;4) et de 16 hommes (35;6). L'eruption etait faite de papules de 2 a 3 mm associee a des macules identiques; hypochromiques; rosees; finement squameuses. Nous avons note trois cas de prurit. Nous avons retrouve 37;7de cas familiaux. Dans le cadre du deficit immunitaire acquis; nous avons observe un cas de cancer du sein et quatorze patients etaient seropositifs pour le VIH. Conclusion : Cette etude a confirme la rarete de cette affection et a montre que l'immunodepression cellulaire genetique ou acquise favoriserait l'apparition de la maladie

[Lupus tuberculosis: a cause of medio-facial mutilation not to be ignored]. / Le lupus tuberculeux: une cause de mutilation centrofaciale à ne pas méconnaître.

Medio-facial mutilations are a real problem from a diagnosis and prognosis point of view. Various etiologies may be in question, namely bacterial, parasitic, mycotic, viral infections or yet predisposing factors such as denutrition or a immunodepression. Among these etiologies, the lupus tuberculosis remains a major concern to be taken into account in poor socio-economic background. We report two cases of lupus tuberculosis in teen-agers whose diagnosis difficulty induced sequellae although limited by a further appropriate care management. The clinical spectrum of the cutaneous tuberculosis and the place of this affection featuring ahead of other medio-facial mutilations etiologies remain important in tropical area.

[Cutaneous leishmania in HIV patient in Ouagadougou: clinical and therapeutic aspects]. / Leishmaniose cutanée chez les malades infectés par le VIH. Aspects cliniques et thérapeutiques.

BACKGROUND: Immune suppression cause by HIV infection is a risk factor in the progression of leishmania diseases. In Burkina Faso atypical clinical presentations of leishmaniases have been observed among people living with HIV. The goal of this study was to describe clinical and evolutionary aspects of cutaneous leishmania and HIV co-infection among patients followed at Ouagadougou University Hospital. PATIENTS AND METHODS: This 16-month prospective study was carried out from January 2003 to April 2004 among HIV-seropositive patients with a diagnosed cutaneous leishmania infection. At baseline, infection and lesions were classified. Clinical diagnosis of cutaneous leishmania depended on finding parasites by microscopy in smears or tissue biopsies. Histological examinations were done if clinical and parasitological diagnosis were not concordant. Treatment consisted of three 21-day rounds of pentavalent antimonial, (Glucantime(R)). Clinical evolution was monitored at the end of each treatment round. RESULTS: Thirty-two HIV-1 positive patients (16 women and 16 men) were included. Mean age was 35.5 (10-67 years old). Leishmania lesions had been evolving, on average, for 12 weeks. Eleven patients were taking HAART and 21 patients were taking cotrimoxazole prophylaxis against opportunistic infections. Cutaneous lesions were found: in the face (15 cases), torso (18 cases), upperlimbs (26 cases) and lower-limbs (28 cases). Observed clinical forms were: papulo-nodular (9 cases), ulcerative (14 cases), infiltrative (12 cases), lepromatous and diffuse (15 cases), psoriasis-like (5 cases), cheloid, histioid or kaposi-like (1 case each). Some patients presented more than one clinical form. Prognosis was satisfactory in 24 patients after the first treatment. Twelve patients relapsed after the first treatment, among those 10 were only taking cotrimoxazole. At the end of the third treatment, 24 patients were cured, 3 died and 5 were lost to follow-up. CONCLUSION: Clinical polymorphism of cutaneous leishmania has been observed in HIV-patients, thereby increasing the risk of differential diagnosis.

Trachoma, flies and environmental factors in Burkina Faso.

The presence of flies is one of the earliest risk factors for trachoma and it has been suggested that flies could act as vectors for transmission of chlamydiae. A national trachoma survey was conducted in 1997 in Burkina Faso to (i) study the relationship between trachoma occurrence, flies, dirty faces and some environmental factors, and (ii) investigate the role of flies in the presence of trachoma. The country was stratified into eight groups of provinces and a random sample of 30 clusters was selected in each group. All children aged < 10 years were examined for the diagnosis of active trachoma (trachomatous inflammation which was follicular and/or intense) and the dirtiness of the face and the presence of flies on the face were recorded. The children's carers were questioned about the number of baths given and daily face-washing. Household heads were asked about ownership of cattle and small ruminants. The presence of latrines, a stable, and garbage collection inside the yard was noted. Among 16,514 children examined, 27.0% had active trachoma and 3.3% intense inflammatory trachoma. Flies were present on 11.2% of children's faces and 82.4% and 19.7% of these children had active and intense inflammatory trachoma, respectively. Among the 30.2% of children with dirty faces, 70.2% had active and 10.2% intense inflammatory trachoma. In multivariate analysis, at least one daily bath showed a protective effect on both active and intense inflammatory trachoma. Face-washing twice daily was found to be significantly protective for active trachoma in some regions. A strong association was demonstrated between the presence of flies and dirty faces (odds ratio = 334, 95% confidence interval 202-546). The presence of flies on children's faces, dirty faces and trachoma appeared to be strongly associated. Although the presence of flies may be a marker of socio-economic status and is probably linked with other trachoma risk factors, our data indicated that interventions targeting fly control should be an important issue in controlling trachoma.