Recurrent vulvo-vaginal candidiasis in Abidjan (Côte d'Ivoire): Aetiology and associated factors.

Recurrent vulvovaginal candidiasis (RVVC) is a major health problem for sexually active women because of its severe effect on their quality of life. A thorough knowledge of their epidemiology leads to their efficient management. Therefore, a cross-sectional study was conducted in 2014 in women with leucorrhoea associated or not with other clinical signs. Recurrence was based on the occurrence of at least four annual episodes of Candida vulvo-vaginitis. An individual interview based on a questionnaire was conducted to identify the socio-demographic parameters that could be associated with the RVVC. Vaginal samples were collected at the obstetrical gynaecology department of the University Hospital of Cocody and at the Pasteur Institute of Côte d'Ivoire. On each sample, a direct examination and culture on Sabouraud-chloramphenicol medium with or without actidione were performed. Yeast identification was performed using chromogenic media (CandiSelect®4 [Bio-Rad]) and the study of sugar assimilation using the Auxacolor® 2 gallery (Bio-Rad). A total of 400 patients were included. The average age was 29.2 years (SD=7.2 years). Of these, 94 had recurrent vulvovaginal candidiasis, with a prevalence of 23.5% (CI95%: 19.49-28.02). Five species of the genus Candida have been identified: Candida albicans (59.6%), Candida glabrata (19.1%), Candida tropicalis (16%), Candida krusei (4.2%) and Candida inconspicua (1.1%). Some factors such as education level, history of sexually transmitted infection, type of underwear used, frequency of personal hygiene and type of product used for these hygiene have been associated with the occurrence of RVVCs. The occurrence of RVVCs is relatively high in our study population. Non-albicansCandida species occupy a significant place in this disease epidemiology. By addressing the factors associated with the occurrence and/or persistence of RVVCs, it will be possible to reduce their incidence in sexually active women.

Oropharyngeal candidiasis prevalence among HIV-infected patients at the teaching hospital of Treichville (Abidjan, Côte d'Ivoire).

AIM OF THE STUDY: The aim of this study was to determine the mycological profile of oropharyngeal candidiasis among HIV-infected patients from Internal Medicine, Infectious and Tropical Diseases, and Pneumo-Phthisiology Diseases departments of the Teaching Hospital of Treichville in Abidjan, Côte d'Ivoire. PATIENTS AND METHODS: This was a cross-sectional study carried out on patients with lesions suggestive of oropharyngeal candidiasis from October 2010 to April 2011. Oral swabs were cultured, and Candida species were identified using a germ tube test, a chlamydospore formation assay, and the API 20C system. RESULTS: A total of 286 patients were included, among whom 99.1% were infected with HIV. The prevalence of oropharyngeal candidiasis was 79.4% (CI95%=74.4-83.8). Five different species of Candida were identified, with the predominant species being Candida albicans (95.2%). Most affected patients were female (54.6%, P<0.0001) between the ages of 30 and 45 (78.4%, P<0.0001). The most lesion types observed were thrush (87.8%). Patients infected with HIV1 (95.6%), with a primary school level of education (52.8%), under antiretroviral therapy (88.5%) and with tuberculosis as an associated pathology (62.5%) were the most commonly affected. Patients were mostly under ART first line treatment (86.4%) and at the beginning of the treatment (86.4%). CONCLUSION: Oropharyngeal candidiasis is frequent among HIV-infected patients. Better and early management of this vulnerable population should allow for a reduction in the high prevalence observed.

[Mycological profile of hand onychomycosis amongs "Garba" sellers in Abidjan (Côte d'Ivoire)]. / Profil mycologique des onychomycoses des mains chez les vendeurs de « Garba ¼ à Abidjan (Côte d'Ivoire).

OBJECTIVE: The aim of this study is to determine the prevalence and the fungi involved in onychomycosis located on fingers in Abidjan. MATERIAL AND METHODS: This study includes the sellers of cooked cassava semolina served with fried tuna fish called "garba". Fines squames specimen was processed with 30% KOH for a direct microscope examination. Serous collection were done in physiological serum. Part of the original sample was cultured on Sabouraud medium with antibiotics (chloramphénicol, actidione). Species distribution and antifungal susceptibility by the technique on agar were noted. RESULTS: A total of 205 male sellers were involved. The Onychomycosis prevalence was 6.3%; (95% CI : 3.6-10.3). Five species of yeasts were identified. Candida spp were the most frequent (84.6%) and Candida albicans represented 30.8% of isolated yeasts. Trichosporon cutaneum were isolated in two case (15.4%). Susceptibility for amphotericin-B was 92.3% contrary to 5-fluorocytosine 30.8%. The subjects aged between 15 to 24 (69.2%), with a higher seniority (84.6%) and illiterate (69.2%) were the most affected. The main risk factors of fungal infections were the presence of previous fingernail onychomycosis (P<0.0001) and the frequent fingernail cutting (P=0.0009). CONCLUSION: Onychomycosis caused by yeast is infrequent among "garba" sellers in Abidjan. The main fungi involved in fingernail onychomycosis were Candida species. It is nevertheless necessary to implement sensitization for them on contributing factors.

[Fungal aetiologies and contributing factors of interdigital tinea pedis among policemen in Abidjan (Ivory Coast)]. / Étiologies fongiques et facteurs favorisant les intertrigos inter-orteils chez les gendarmes à Abidjan (Côte d'Ivoire).

AIM OF THE STUDY: Fungal interdigital tinea pedis are poorly documented in Ivory Coast. This study aimed to determine the distribution of fungal species and contributing factors of the disease among policemen in Abidjan. PATIENTS AND METHODS: Our cross-sectional study was carried out at the police school in Abidjan. Our patients consisted of symptomatic or non-symptomatic police students. Samples of scales or serosities taken from inter-toes spaces were examinated with KOH mount and cultured on Sabouraud-chloramphenicol and Sabouraud-chloramphenicol-actidione media. The method of identification depended on the observed fungus. RESULTS: Among the 303 police students with clinical lesions of the inter-toe folds, 233 (76.9%; IC 95%=71.9-81.4) had a positive diagnosis after mycological examination. Lesions were predominantly located in the 3rd and 4th interdigital plantar spaces, with desquamation (100%) followed by maceration (82.5%) as the predominant functional sign. Dermatophytes accounted for 86.3% of the strains isolated with as majority species : Trichophyton interdigitale (40.3%), Microsporum langeronii (30.0%) and Trichophyton rubrum (15.5%). Yeasts accounted for 13.7% of the strains with Candida albicans (7.7%) as the most found species. The duration at the police school (P=0.004) and the practice of sports activities (P=0.0001) were statistically associated with the occurrence of the disease. CONCLUSION: A good hygiene of feet would reduce the incidence of the disease among the defense and security forces. Also, investigations for the influence of the seasons in the occurrence of interdigital tinea pedis will allow a better understand of epidemiology of this dermatomycosis.

Aetiologies and contributing factors of vulvovaginal candidiasis in Abidjan (Cote d'Ivoire).

AIM OF THE STUDY: In order to update the data and contribute to optimizing the management of vulvovaginal candidiasis, we conducted this study to determine their etiology (and hence the sensitivity of the isolated fungal organisms) and the factors contributing to their occurrence in Abidjan (Cote d'Ivoire). PATIENTS AND METHODS: This cross-sectional survey involving 400 women with clinically vulvovaginitis was conducted from May to July 2011. It was carried out at the health centre for venereal diseases located at the National Institute of Public Hygiene in Abidjan. After a swab collecting, direct examination and culture on Sabouraud Chloramphenicol and Sabouraud Chloramphenicol Actidione media were implemented to research yeasts. After identifying yeast species through blastesis tests and auxanogram, its in vitro susceptibility to amphotericin B, 5-fluorocytosine, clotrimazole, miconazole, econazole and ketoconazole was assessed. RESULTS: As a whole, 172 patients suffered from vulvovaginal candidiasis i.e. an overall prevalence of 43%. Candida albicans was most frequently isolated (82.5%) followed by C. glabrata (10.5%). C. albicans and C. tropicalis were resistant to the 5-fluorocytosine (respectively 24.65 and 33.33%). Other molecules have shown excellent activity on all yeasts isolated. Type of housing, type of underwear and patients personal history were statistically associated with the presence of vulvovaginal candidiasis (respectively P=0.003; 0.010; 0.022). CONCLUSION: Vulvovaginal candidiasis is relatively frequent in Abidjan and antifungal compounds are in general still effective for treatment. Being knowledgeable of risk factors for this vulvovaginitis will ensure better prevention of their occurrence.

[Herpetological data and management of ophidian envenomation at university hospitals in Abidjan, Côte d'Ivoire]. / Données herpétologiques et prise en charge des envenimations ophidiennes dans les CHU d'Abidjan (Côte d'Ivoire).

This study was carried in the intensive care units of Abidjan university hospitals and in the herpetology department of Pasteur Institute between January 2001 and April 2003. The purpose was to identify ophidian species that were dangerous for man and to document cases of snakebite in Abidjan. The study was carried out in two phases, i.e., collection and identification of snake species followed by review of case records involving snake envenomation at Cocody and Treichville university hospitals. A total of 5 snake families, 14 genera and 17 species including some that were dangerous for man were identified. All species except Naja nigricollis live in forest areas. Most snakebites led to simple clinical signs that regressed within 72 hours with only symptomatic treatment. However, a few cases required immunotherapy. Traditional methods of snakebite treatment were used for first line treatment in 50% of cases.

[Evaluation of the therapeutic efficacy of amodiaquine versus chloroquine in the treatment of uncomplicated malaria in Abie, Côte-d'Ivoire]. / Evaluation de l'efficacité thérapeutique de la chloro- quine versus amodiaquine dans le traitement du palu- disme simple a Abié, Côte-d'Ivoire.

The WHO 14-days' test and an in vitro survey were carried out to study the efficacy of amodiaquine versus chloroquine in Abie, a hyperendemic village in the southern forest area of Côte-d'Ivoire. One hundred and nineteen children less than 15 years old suffering from uncomplicated malaria were randomised. Among these, 62 were given amodiaquine treatment and 57 chloroquine treatment. both 4-aminoquinoleines were administered at the same dose of 30 mg/kg spread over three days by 10 mg/kg/day. Before the drug was administered, parasites were taken from some patients of each group and were evaluated in vitro to both drugs. In vivo, the amodiaquine treatment shows 95% of clinical success, 2% of early clinical failures and 3% of late clinical failures. For the chloroquine treatment, the rates are respectively. 79%, 7% and 14%. However, some patients still had a level of parasitaemia for both treatments but were asymptomatic. These parasites were found to be resistant in vitro. The authors recommend that the treatment to be used in Abie must be firstly amodiaquine followed by sulfadoxine-pyrimethamine in cases where there is persistent asymptomatic parasitemia.

Prevalence et facteurs favorisants des otomycoses traitees en milieu hospitalier a Abidjan (Cote d'Ivoire)

Otomycosis is fre q u e n t ly encountered in tropical and subtropical zones. In Ivory Coast diagnosis of this disease is often based solely on the clinical symptoms. The objectives of this study were to determine the prevalence; predisposing factors; and etiologic agents associated with otomycosis at the Treichville University Hospital Center in Abidjan; Ivory Coast. M y c o l ogical examinations we re perfo rmed on specimens obtained from 115 patients presenting with external otitis at the d'Oto-Rhino-Laryngology Department. Fungi-positive cultures were obtained in 49 patients for an overall otomycosis prevalence of 42.6 (95Confidence Interval (CI); 34.4-52.2). Univa ri ate analysis showed that the predisposing fa c t o rs for otomycosis we re frequent swimming in natural or artificial pools (Relative Risk (RR) 3.7; CI 1.7-8.1); daily ear cleaning (RR 3.5; CI 1.8-6.8) and excessive use of eardrops containing antibiotics and corticoids (RR = 9.3; IC95= 4.3-20.1). The most common etiologic agents were Aspergillus fl avus (20.4); Candida albicans (16.3); Candida parapsilosis (14.3); and A s p e rgillus niger (12.2). A combination of two agents was found in five cases. These data show that otomycosis is endemic in Ivo ry Coast. Manage m e n t of otomycosis must include mycological examination for diagnosis as well as changing behavior patterns leading to infection

[In vivo sensitivity of Plasmodium falciparum to amino-4-quinolines and sulfadoxine pyrimethamine in Agou (Ivory Coast)]. / Sensibilité in vivo de Plasmodium falciparum aux amino-4 quinoléines et à la sulfadoxine pyriméthamine à Agou (Côte d'Ivoire).

A comparative study of the in vivo sensitivity of Plasmodium falciparum to amodiaquine versus chloroquine has been made among children in Agou (south Côte d'Ivoire). In case of resistance to these drugs, the association of sulfadoxine-pyrimethamine was administered and followed by a J14 checking. We have noticed: (1) 8.47% of amodiaquine resistance versus 36.96% of chloroquine resistance (all these resistances are from type II), (2) a good clinical efficiency of the 4 amino quinolines. Only 1.69% of the subjects having resistant stocks to amodiaquine have gone feverish down to J7 whereas 10.47% of subjects have clinically resisted to chloroquine, (3) a good tolerance of drugs and an excellent clinical and parasitological efficiency of the second intention treatment. These data are in favour of using first the 4 amino quinolines (particularly the amodiaquine) in the treatment of simple bout of malaria to Plasmodium falciparum in this region. In case of resistance to these drugs, we recommend the combination sulfadoxine-pyrimethamine.

[Comparative study of four malaria diagnostic techniques used in Ivory Coast]. / Etude comparative de quatre techniques de diagnostic biologique du paludisme utilisées en Côte d'Ivoire.

The biological diagnosis of malaria plays an important part in the patients' treatment for malaria. Thus, many techniques have been developed to reach this purpose. We have compared four of them concerning 196 patients from October, 1996 to January, 1997 in Abidjan. Thick blood film has been chosen as the technique for reference. It has come out that the plasmodic index was 18.3%. The Plasmodium falciparum has been the only encountered species. The different sensitivities of the QBC test and of the Parasight F test reached 100% against 83.3% in the case of the thin blood film. The QBC test and the thin blood film had each a specificity of 100% against 88.1% for the Parasight F test. Unlike the QBC test, the thick blood film and the thin blood film have remained the most difficult to be realised. Therefore, the analysis of parameters of credibility (sensitivity, specificity), predictable values and the time involved will allow in a given situation to use the appropriate biological diagnosis technique.

Bilan des examens parasitologiques du sang pour la recherche du paludisme a l'Institut Pasteur de Cote d'Ivoire (I.P.C.I.) en 1992: impact de la chimiotherapie sur les resultats de laboratoire

Au cours de l'annee 1992; le service de parasitologie de l'I.P.C.I. a effectue 1435 examens pour la recherche du paludisme. 269 resultats positifs ont ete obtenus; soit 18;74 pour cent de paludisme confirme contre 1166 resultats negatifs. 429 sujets; soit 29;89 pour cent ont recu un traitement antipaludique avant l'examen; 645 sujets; soit 44;94 pour cent n'ont recu aucun traitement prealable et pour 361 sujets; soit 25;15 pour cent aucune indication n'est donnee sur la prise du medicament. Parmi les patients qui ont consomme des medicaments; 17;01 pour cent avaient encore une goutte epaisse positive et chez les malades non traites 20;15 pour cent sont positifs. Lorsqu'on considere les produits consommes; sept specialites viennent largement en tete avec un pour centage d'utilisation de 84;71 pour cent. Par odre decroissant; ce sont: la Nivaquine; La Flavoquine; l'Halfan; l'Arsiquinoforme; le Quinimax; le Quiniforme et le Fansidar. Dans la presque totalite des cas de resultats positifs apres la prise de medicaments (89;88 pour cent) les doses sont infracuratives. 10 malades (2;73 pour cent); bien qu'ayant suivi le protocole therapeutique conseille pour le medicament choisi ont une goutte epaisse positive. Les auteurs ont conclu que l'inadaptation des doses etait le fait de la forte proportion d'automedication. L'echec therapeutique chez les 10 malades pourrait s'expliquer par l'existence de la chimioresistance dont celle a la chloroquine est deja reconnue