ABSTRACT
INTRODUCTION: Chromoblastomycosis (CBM) is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. CBM lesions are recalcitrant and extremely difficult to eradicate. We report three cases of CBM with difficulties in therapeutic management. OBSERVATION: Three men aged 36, 50 and 67 years, all farmers, presented for between three and ten years with hyperkeratotic, scaly plaques with black dots on the right thigh and left leg, respectively. For all patients, mycological examination showed fumagoid cells, all of which were pathognomonic for CBM. PCR identified Fonsecaeanubica in one patient and Cladophialophoracarrionii in two patients. All patients received itraconazole 200mg/day for over 18 months. Two patients required combined therapy with terbinafine for seven months, which improved lesions; however, relapse occurred in one patient during the 5th month of this combined therapy and five months after the end of this treatment in the other. The patient on monotherapy (itraconazole) also presented recurrence of lesions five months after the end of treatment. DISCUSSION: Itraconazole is the standard therapy for CBM, with cure rates ranging from 15 to 80%. Success with itraconazole after eight to twelve months was reported by several authors. Fonsecaea and Cladophialophora are the most common species found in Madagascar, and while these organisms are susceptible to triazoles in vitro, clinical response is not so clear-cut. CONCLUSION: Although unavailable in Madagascar, posaconazole and isavoconazole appear to be effective in treating chromoblastomycosis.
Subject(s)
Ascomycota , Chromoblastomycosis , Fonsecaea , Adult , Aged , Chromoblastomycosis/diagnosis , Chromoblastomycosis/drug therapy , Health Resources , Humans , Madagascar , Male , Middle AgedABSTRACT
BACKGROUND: Little is known about the epidemiology and associated factors of childhood AD in the markedly different, low-income, tropical environment like Madagascar. METHODS: We aim to assess the epidemiology and associated factors of AD in individuals fewer than 15 years of age in Antananarivo Madagascar. It was a retrospective and descriptive study over a period of 7 years (2010 to 2016) in children 6 months to 14 years in the Department of Dermatology, Joseph Raseta Befelatanana Antananarivo Madagascar. The diagnosis of AD was based on clinical data. RESULTS: The prevalence of AD was 5.6% in children aged 6 months to 14 years. The details of 151 cases of atopic dermatitis were analyzed. The mean age of patients was 4 years. There was a female preponderance (sex ratio: 0.7). A family history of AD was noted in 56 cases (37%). No association between breast-feeding and AD was found. The age of onset of AD was before the age of 3 months in 7.5% and between 6 months to 5 years in 70%. Children born in March (dry season) had the highest risk of AD. Consultations for AD increased during the winter (from July to October; p = 0.005). However, the prevalence of AD was similar in urban and rural areas. CONCLUSION: Weather may have an impact on the prevalence of atopic dermatitis in Madagascar. No significant correlation was found between the duration of breastfeeding and AD, as well as urbanization.
ABSTRACT
Introduction : L'urgence dermatologique constitue une face cachée de la dermatologie. Elle constitue une partie non négligeable en urgence médi-cale car sa méconnaissance entraînerait des conséquences désastreuses. Notre objectif était de décrire le profil épidémio-clinique et évolutif des situations d'urgences en dermatologie. Matériels et Méthodes : Une étude rétrospective, descriptive était menée dans les deux services de Dermato-logie du Centre Hospitalier Universitaire Joseph Raseta de Befelatanana, Antananarivo, de 2015 à 2017. Etaient inclus tous les patients hospitalisés présentant une urgence dermatologique vraie ou relative de tout âge. Résultats : Sur 634 patients hospitalisés, 113 patients présentaient une urgence dermatologique, soit 17,82%. Les pathologies observées étaient : les toxidermies (37%), les dermatoses infectieuses (20%), les maladies systé¬miques compliquées (11,7%), les dermatoses bulleuses auto-immunes (8%) et les réactions lépreuses (8%). Le taux de mortalité était de 7,8%. Con¬clusion : La toxidermie est la première pathologie grave en Dermatologie. La connaissance de ces principales urgences dermatologiques serait une aide précieuse pour les praticiens travaillant loin des centres hospitaliers de Dermatologie
