Herpes simplex virus type 2 infection among females in Enugu, Enugu State.

BACKGROUND: Herpes simplex virus type 2 infecion is life long with manifestation in a small proportion of those infected. It has presented public health concern because of its progressively increasing prevalence which some authorities say is of epidemic proportion in developing countries. Herpes simplex virus type 2 has recently been found to have synergistic effect with human immunodeficiency virus (HIV) and co-infection of the two presents more severe burden to the immunity of the victim. This leads to much morbidity and mortality with negative economic impact. In this study, we set out to determine antibody prevalence of HSV-2 in women attending skin and ante natal care [ANC] clinics in University of Nigeria Teaching Hospital [UNTH] and Enugu State University Teaching Hospital [ESUTH]. MATERIALS AND METHODS: 180 female patients/clients attending skin and ANC clinics in UNTH and ESUTH were enrolled in this descriptive study. Sociodemographic data and medical history were collected using a questionnaire. They were also examined for signs of HSV 2 manifestation, other STIs and WHO staging if HIV positive. Samples were also taken for serology, Gram staining and CD4 T-lymphocyte count. RESULTS: The prevalence of HSV 2 was found to be 77.8% (n=137) and 14.6% (n=20) had clinical diagnosis of HSV-2.The HIV and HSV-2 co-infection rate was 5.11% (n=9) and out of 11 that were HIV positive, 9 (81.82%) were HSV-2 antibody positive. The HIV prevalence in this study was 6.3%. CONCLUSION: Herpes simplex virus type 2 infection is common among females in Enugu, Enugu State and is commoner among those with HIV infection.

Pyoderma gangrenosum: a clinical observation in an adult Nigerian

Case Definition: Pyoderma gangrenosum (PG) is a destructive; necrotizing non-infective ulceration of the skin of unknown aetiology and rarely reported amongst Nigerians. It is believed to be a reactive inflammatory dermatosis and partly a spectrum of neutrophilic dermatoses. PG usually starts as a painful nodule or pustule that gradually becomes turgid and breaks down to form a progressively enlarging ulcer; with raised tender; undermined violeacous borders. These ulcers may occur singly or in multiples; usually with a prediliction for the lower limbs but may occur elsewhere. It is associated with several medical disorders but can also occur spontaneously in 10-30of cases.1 PG is a diagnosis of exclusion2.Objective: The atypical presentation of Pyoderma gangrenosum in our patient from a typical hot humid tropical climate where other causes of cutaneous ulceration may simulate or mimic PG and must be excluded was the reason for revisiting this topic. A case of idiopathic pyoderma gangrenosum in a 29 years-old Nigerian male is herein discussed alongside important differentials of tropical cutaneous ulcerations that could mimic it

Skin diseases in south-east Nigeria: a current perspective.

BACKGROUND AND OBJECTIVE: The incidence of skin diseases in south-east Nigeria during the present decade was analyzed and compared with results from other parts of Nigeria, particularly those in the same zone, obtained more than 30 years ago. This study was carried out to update the recent clinical picture of skin diseases in our environment in view of the rapid development, urbanization and advances in the region. PATIENTS AND METHODS: Consecutive new patients seen at the dermatology clinic of the University of Nigeria, Teaching Hospital, Enugu, Nigeria, from February 1999 to March 2001 were included in this prospective study. Only cases seen and examined by the author were included in this study to ensure uniformity of diagnosis. RESULTS: A total of 2871 patients were observed within the study period. Adults accounted for 69.7% and were aged between 18 and 73 years, while the male:female ratio was 1.3:1. Allergic skin diseases (24.9%) were the commonest skin disorders identified, as opposed to infestations which accounted for an extremely high result of 33.7% (for the same region between 1968 and 1971). In second place was infections/infestations (19.1%). A reversal of picture was thus observed. Within the allergic disorders; eczemas/dermatitis were found to be the most prevalent followed by follicular (13.7%) and pigmentary disorders (11.1%). Sexually transmitted diseases and HIV/AIDs have increased significantly and accounted for 5.4%. Blistering diseases (1.1%) and malignancies (0.5%) occurred less frequently, similar to results found in recent decades for the same region. CONCLUSION: The current picture of skin diseases in south-east Nigeria has changed significantly from mere infections to allergic skin, follicular and pigmentary disorders. Cutaneous lesions secondary to STDs and HIV/AIDs have also increased. Skin lesions related to malnutrition, kwashiorkor and starvation were not observed nor were cutaneous tuberculosis, yaws or pediculosis, while blistering disorders and malignancies remained almost the same. The current picture is similar to that in other developing and Afro-Caribbean countries. Primary-care physicians and health-care providers in Nigeria/Africa need to be aware of the globally changing pattern of skin diseases in the region to enable the allocation of necessary resources (financial, material and human) to manage these skin diseases.

Evaluation of syphilis in patients with HIV infection in Nigeria.

OBJECTIVE: To document the manifestations of syphilis among patients with concurrent HIV infection over a 12-month period. METHOD: Descriptive, cross-sectional, hospital-based study of all adult patients with syphilis and HIV infection who attended the skin clinic of the University of Nigeria, Teaching Hospital, Enugu, between July 2000 and June 2001. A standardized questionnaire was used to record age, sex, marital status, occupation and risk factor for HIV infection; initial site of onset of rash/ulcers, duration of the illness, any concomitant affection of mucosa, hair and nails as well as treatments received by each patient prior to presentation. Morphological distribution of lesions, mucosal surface (conjuctival, vulval and rectal) examinations and documentation of concomitant disorders with HIV were noted by the examining dermatologist. Lesional biopsy and dark-field microscopy were undertaken to confirm diagnosis where serologic (non-treponemal and treponemal specific) tests for syphilis were inconsistent with clinical suspicion. Each patient had a routine chest x-ray, mantoux and purified protein derivative (PPD) status taken. RESULTS: Thirty-one patients (21 males) with concurrent syphilis and HIV were seen during the study period. Primary syphilis was diagnosed in nine (29%), secondary syphilis in 20 (64.5%) and latent syphilis in two (6.5%). Neurosyphilis was not observed. Prevalence of syphilis for these patients with concurrent HIV was 2.1%. Mean duration of syphilis was 3.9 months +/- 1.4 and lesions of greatest concern occurred mainly on the genitalia. The glans penis was affected in 10 (32.3%) cases, the penile shaft in seven (22.6%), the oral cavity in five (16.1%), the rectum in six (19.4%) and the vulva in three (0.9%) cases. Nine (29.1%) patients had a history of primary syphilitic chancre, 19 (61.3%) had a past history of sexually transmitted disease (STD)--particularly genital ulcers--while three (9.7%) could not recall any past history of STD. Eighteen (59.3%) had a history of unprotected sex, 16 (51.7%) had multiple sexual partners, four (13.3%) had had oral sex, and one anal sex (3.3%); none admitted to being bisexual. Other relevant risk factors for HIV transmission were blood transfusion within 5 years for three (9.7%) and intravenous drug use in two (6.5%). Some patients had more than one condition as a potential source of exposure. Serological tests were weakly reactive in 17 (48.4%), strongly reactive in nine (29%) and non-reactive in five (16.1%) patients. Three patients exhibited prozone phenomenon. Treatment comprised the syndromic approach, which currently is advocated for use in primary healthcare centres without facilities for aetiological diagnosis of sexually transmitted infections. CONCLUSION: Our cases with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to treatment more slowly and died sooner than cases described in Western literature due to generally lower levels of health.

Successful treatment of scabies with oral ivermectin in Nigeria.

Currently, several topical scabicides are available but there is yet no oral or parenteral drug which has been established for the treatment of scabies in Nigeria. Ivermectin which is a modified avermectin, known to be an ectoparasiticidal agent in animals, has been used in adults for systemic parasitosis. In Nigeria, 25% benzyl benzoate is being extensively used for the treatment of scabies in adults. It is effective and readily available. The present study was carried out to evaluate the efficacy and safety of ivermectin in the treatment of patients with scabies at the skin clinic of the University of Nigeria Teaching Hospital, Enugu. Fifty-eight patients with scabies were recruited for the study; 13 (22.4%) were children aged between 5-14 years. Oral ivermectin was given in a single dose of 200 [microg/kg body weight to 29 patients. The remaining 29 patients had to apply 25% benzyl benzoate emulsion. All patients received a full physical and dermatological examination prior to onset of treatment and weekly for 4 weeks. Skin scrapings were taken to confirm the diagnosis of scabies. There was a 93% resolution of pruritus with ivermectin and 48% with benzyl benzoate. No side effects were observed with ivermectin. Our results show that oral ivermectin is a promising, effective and safe alternative in both children and adults of Nigeria when compared to 25% benzyl benzoate topical application.