Onychomycosis in Diabetics: Prevalence, Clinical Features and Spectrum of Causative Fungi in South-Eastern Nigeria.

INTRODUCTION: Onychomycosis is a fungal infection of the nail unit and one of the common nail diseases that occurs commonly in diabetic patients. It poses a threat of diabetic foot complications to diabetics and negatively affects the quality of life of the patients. OBJECTIVES: The overall aim of the study was to determine the prevalence and clinical features of onychomycosis in diabetics, as well as the spectrum of causative fungi in Nigeria as compared with age and sex-matched controls. METHODOLOGY: This was a hospital-based, comparative cross-sectional study. One hundred and fifty consecutive adult diabetics and 150 healthy controls (accompanied persons and staff) matched for age and sex were recruited from the Diabetic Clinics and the Dermatology Clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. The participants were interviewed using a pre-tested structured questionnaire, nail scrapings were collected for fungal studies, and clippings for nail histopathology using Periodic Acid Schiff. RESULTS: The prevalence of onychomycosis among DM subjects was 45.3% vs. 35.3% in controls, which was not statistically significant (P value 0.078). Distal-lateral subungual onychomycosis was the most common clinical type in both study groups and presented mainly with nail discolouration, onycholysis, and subungual hyperkeratosis. The most common fungi isolated were dermatophytes (Trichophyton soudanense), non-dermatophytes (Aspergillus spp.), and Candida species (Candida albicans). CONCLUSION: Onychomycosis in diabetics is a very common nail disorder in the South-Eastern part of Nigeria with a high prevalence. The presence of foot ulcers was associated with onychomycosis in diabetics, and they were more likely to have non-dermatophytic onychomycosis.

INTRODUCTION: L'onychomycose est une infection fongique de l'unité de l'ongle et l'une des maladies des ongles les plus courantes chez les patients diabétiques. Elle pose une menace de complications du pied diabétique et affecte négativement la qualité de vie des patients. OBJECTIFS: L'objectif général de l'étude était de déterminer la prévalence et les caractéristiques cliniques de l'onychomycose chez les diabétiques, ainsi que le spectre des champignons causaux au Nigeria par rapport à un groupe témoin apparié selon l'âge et le sexe. MÉTHODOLOGIE: Il s'agissait d'une étude transversale comparative réalisée en milieu hospitalier. Cent cinquante diabétiques adultes consécutifs et 150 témoins sains (personnes accompagnatrices et personnel) appariés selon l'âge et le sexe ont été recrutés dans les cliniques de diabète et la clinique de dermatologie de l'Hôpital Universitaire du Nigeria à Ituku-Ozalla. Les participants ont été interrogés à l'aide d'un questionnaire structuré pré-testé, des échantillons de grattage d'ongles ont été prélevés pour des études fongiques, et des échantillons pour l'histopathologie des ongles utilisant l'acide périodique de Schiff. RÉSULTATS: La prévalence de l'onychomycose chez les sujets atteints de diabète était de 45,3 % contre 35,3 % chez les témoins, ce qui n'était pas statistiquement significatif (valeur de p 0,078). L'onychomycose sousunguéale distale-latérale était le type clinique le plus courant dans les deux groupes d'étude et se manifestait principalement par une décoloration des ongles, une onycholyse et une hyperkératose sousunguéale. Les champignons les plus couramment isolés étaient les dermatophytes (Trichophyton soudanense), les non-dermatophytes (Aspergillus spp.) et les espèces de Candida (Candida albicans). CONCLUSION: L'onychomycose chez les diabétiques est un trouble des ongles très courant dans le sud-est du Nigeria avec une prévalence élevée. La présence d'ulcères du pied était associée à l'onychomycose chez les diabétiques, et ils étaient plus susceptibles de présenter une onychomycose non-dermatophytique. MOTS - CLÉS: Onychomycose, Diabète sucré, Prévalence, Champignons, Nigeria.

Epidemiology of skin diseases in University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State.

Background: Several studies have been carried out to determine the patterns of skin diseases across Nigeria and results have shown changing patterns with the trend reflecting a higher tendency for allergic dermatoses in a majority of these studies. This study was carried out to evaluate the current clinical picture of patients presenting to our clinic. Materials and Methods: A prospective study of new patients seen in the skin clinic of University of Nigeria Teaching Hospital (UNTH), Ituku- Ozalla, between November 2013 and August 2014 was carried out. A total of 387 patients' data was analysed. Data collected on patients' sociodemographic status and diagnosis were entered into SPSS Version 17 and analyzed. Diagnosis was based on clinical findings, laboratory diagnosis including biopsy and histopathology were requested when necessary to make a diagnosis. Results: There were more females 245 (63%) than males 142 (37%). Most of the patients (81.9%) were aged above 16years and the commonest skin disease was infections (29.5%) followed by allergic skin diseases (13.6%). There was a significant difference in levels of income of study participants across gender and females who were engaged in unskilled labour were more likely to earn lower than males. Conclusion: Comparing the study findings with an earlier one from the same center, there is a change in pattern with infections being the most common skin disease. These are largely preventable; public enlightenment campaigns and policies to discourage over the counter purchase of prescription strength corticosteroid creams are highly desirable.

Factors influencing herpes simplex virus type 2 infection among females in Enugu, Enugu State, Nigeria.

BACKGROUND: Herpes Simplex Virus infection is a chronic infection of the sensory ganglia with variable levels of epithelial expression. An important feature of HSV infection is the recurrence of disease as a result of periodic or sporadic activation of viral replication. In addition, asymptomatic shedding of herpes viruses may play a significant role in transmission from person to person. This infection being lifelong manifests only in a small proportion of those infected. It has presented public health concern because of its progressively increasing prevalence which some reports say is of epidemic proportion in developing countries and also for its synergistic effect with HIV infection. OBJECTIVES: Determination of antibody prevalence to HSV-2/co-infection with HIV among females attending skin and ANC clinics in UNTH and ESUTH. MATERIALS AND METHODS: One hundred and eighty suitably qualified subjects were appropriately recruited over a period of six months into this study. Essential information was collected using a questionnaire. Venous blood was also obtained for HSV 2 serology, HIV screening, and confirmation, if positive. RESULTS: The antibody prevalence of HSV 2 was found to be 77.8% (n = 137) and 14.6% (n = 20) had clinical diagnosis. The HIV and HSV-2 co-infection rate was 5.11% (n = 9). The risk factors for groups 1 [HSV2 Infection] and 2 [HSV2 & HIV co-infection] were similar with few differences, thus buttressing the fact that their modes of transmission are similar. CONCLUSION: Factors influencing Herpes simplex virus type 2 infection among females in Enugu included among other things older age and increasing number of lifetime sexual partners.

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.

Hansen's disease: the need for increased healthcare provider awareness and re-training.

CONTEXT: Leprosy continues to be a challenge worldwide. In 2009, the World Health Organisation (WHO) reported 244,796 new cases worldwide. Of this, South East Asia, South Americas and Africa have the highest number of new cases. OBJECTIVE: To highlight misdiagnosis of Hansen's disease as a drawback to eradication of leprosy. MATERIALS: A retrospective study of cases of Hansen's disease misdiagnosed by clinicians who were seen in the skin clinics of two tertiary institutions in South-East Nigeria over a one year period. RESULTS: Of the nine misdiagnosed cases, three were females while six were males. Apart from one child of six years old, the rest of the patients were adults. Referring diagnoses included chronic osteomyelitis, acromegaly, dermatitis and depression. One of the patients presented with a reversal reaction (erythema nodosum leprosum) following treatment in a peripheral health facility. Confirmation of the diagnosis was based on slit skin smears for Acid Fast Bacilli carried out in the side laboratory of skin clinic UNTH, Ituku-Ozalla, Enugu state (four patients) and mile four hospital, Abakaliki, Ebonyi State( three patients). All the smears were positive. Patients were commenced on multi drug therapy and all showed marked clinical improvement following drug therapy. CONCLUSION: Eradication of leprosy may not be feasible if health care providers are ignorant of the different presentations of the disease. A high index of suspicion for leprosy is needed among health care workers in endemic areas. Development of tools for early diagnosis and detection of infection, improvement in existing tools for data collection, provision of guidelines and training materials on vital information for leprosy control will all contribute to the continued success of the National Tuberculosis and Leprosy Control Programme in Nigeria.

The African Programme for Onchocerciasis Control: impact on onchocercal skin disease.

OBJECTIVES: To assess the long-term impact of the African Programme for Onchocerciasis Control on itching and onchocercal skin disease (OSD). METHODS: Seven study sites in Cameroon, Sudan, Nigeria and Uganda participated. Two cross-sectional surveys were conducted of communities meso- and hyper-endemic for onchocerciasis before and after 5 or 6 years of community-directed treatment with ivermectin (CDTI). Individuals were asked about any general health symptoms including itching and underwent full cutaneous examinations. Onchocercal skin lesions were documented according to a standard classification. RESULTS: Five thousand one hundred and ninety three people were examined in phase I and 5,180 people in phase II. The presence of onchocercal nodules was a strongly significant (P < 0·001) risk factor for all forms of onchocercal skin disease: APOD (OR 1·66); CPOD (OR 2·84); LOD (OR 2·68); reactive skin lesions (OR 2·38) and depigmentation (OR 3·36). The effect of community-directed treatment with ivermectin was profound. At phase II, there were significant (P < 0·001) reductions in the odds of itching (OR 0·32), APOD (OR 0·28); CPOD (OR 0·34); reactive skin lesions (OR 0·33); depigmentation (OR 0·31) and nodules (OR 0·37). Reduction in the odds of LOD was also significant (OR 0.54, P < 0.03). CONCLUSIONS: This first multi-country report of the long-term impact of CDTI reveals a substantial reduction in itching and OSD. APOC operations are having a major effect in improving skin health in poor rural populations in Africa.