Unusual extra-podal fungal mycetoma with black grains in a Senegalese child.

Mycetoma remains endemic in the tropical and subtropical regions of the "mycetoma belt" including Senegal. It affects more commonly young men in the age group of 20 to 40 years. The foot represents the most commonly affected site. The most common extra-podal localizations are leg, knee, buttocks, hand and arm. We report an exceptional case of cervical fungal mycetoma that occurred in a 13-year-old Senegalese child. He consulted for a cervico-submandibular tumefaction with multiple sinuses and black grains discharge evolving since 6 years, associated to laryngeal dyspnoea. Mycological examination with culture isolated Madurella mycetomatis. Cervical CT Scan showed bone and soft tissue invasion. Terbinafine alone was administered. During the evolution, tracheotomy was performed following the aggravation of the laryngeal disorders. Death from severe sepsis occurred after 8 months of evolution. The particularities of our case are the occurrence of fungal mycetoma in a child, the cervical localization and the difficulties of therapeutic management largely due to the diagnostic delay.

[Epidemiological, clinical and etiological profile of tinea capitis in adult patients in Dakar, Senegal]. / Profil épidémio-clinique et étiologique des teignes du cuir chevelu chez l'adulte à Dakar (Sénégal).

OBJECTIVE: To determine the epidemiological and etiological profile of tinea capitis in adults in Dakar (Senegal). PATIENTS AND METHODS: A 9-month prospective, multicenter, descriptive and analytic study. Patients included were aged over 18 years. Mycological tests were used to confirm the diagnosis. RESULTS: 121 patients were included with a mean age of 36.1 years and a hospitalisation frequency of 0.8%. The age range of 64.4% of patients was between19 and 38 years. 51% of patients were housewives. A low socioeconomic level was found in 72.8% of cases. In 3.3% of patients, the disease began in childhood. 31.4% of patients had already consulted a traditional healer. Similar familial cases were noted in 60.3% of patients. Contact with a sheep was noted in 32.2% of cases, deliberate skin lightening in 64% of women, hair salon attendance in 46.7% of women, and immunosuppression in 17.3% of patients, while itching was present in 95.5%. Dermatologic examination showed scaled plaques and a diffuse form, with 92.6% and 64% (n=75) respectively. Wood's light examination was positive in 40.2% of patients. A positive culture test was found in 71%. The most frequently encountered species were: T. soudanense (65%), M. audouinii (21%), T. rubrum (4.7%), M. gypseum (3.5%), T. violaceum (2.3%), T. verrucosum (2.3%) and M. canis (1 case). The clinical course was favorable under treatment with griseofulvin or terbinafine. CONCLUSION: Tinea capitis in adults mainly affects young women. The diffuse form is the most common. The most frequently encountered species was T. soudanense.

Dermatological emergencies in tropical zones: 189 dermatology cases in Dakar.

to assess : the frequency of emergencies among patients admitted to dermatology departments in Dakar, their most common causes, mortality rate, and the most frequent dermatoses. This one-year prospective study took place in the two reference departments for the treatment of dermatological diseases in Dakar. We have included all patients with a dermatological emergency, regardless of age and gender, as determined by the doctor receiving the patient. The data were entered in Excel and analyzed with R software, version 3.1.2. the study included 189 patients, 40 % of all dermatology department admissions. The sex ratio was 0.89 (M/F) and the average age 49 years. The mean time from arrival to treatment was 30 minutes. Absolute emergencies accounted for 45.4 % of these emergencies, and relative emergencies 54.6 %. Absolute emergencies were dominated by severe drug eruptions (17 %) and relative emergencies by infectious dermatoses (38 %). Emergency measures were carried out in all cases, associated with etiological treatment. The mortality rate was 7 % (n=14), and 5 (36 %) of these deaths were due to severe drug eruptions. Infectious dermatoses and severe drug eruptions are the most frequent emergencies. The high mortality rate, related mostly to drug eruptions, indicates the need for early management and an adequate technical platform.

Rare cutaneous tuberculosis in Sub-Saharan Africa developed on discoid lupus erythematous lesion.

Lupus vulgaris is a common presentation of cutaneous tuberculosis (TB), but its ulcerative or vegetating form also called vorax is rare.We report a case of lupus vulgaris in its vorax form, which occurred in a patient with discoid lupus erythematous. A 42-year-old patient monitored for chronic lupus erythematosus consulted again for a facial tumor and fever. Physical examination revealed painful ulcerative and crusted lesions on an old discoid lupus lesion and covered the entire upper lip. Similar lesions were noted on cheeks. Moreover, there were cervical lymphadenopathy, a bilateral pulmonary condensation syndrome, and dysphonia. Cutaneous histopathology had revealed a tuberculoid granuloma without caseating, and nucleic acid amplification tests (GeneXpert®) performed on sputum were positive. Thus, the diagnosis of multifocal TB with skin involvement of vorax type was confirmed. The outcome was favorable following TB treatment. Our observation is distinctive as it is a granulomatosis and ulcerative form of lupus vulgaris, which occurred on a discoid lupus erythematous lesion. This is a rare form of lupus vulgaris. This scarcity can be explained by diagnostic difficulties as there are numerous differential diagnoses and histopathology is not often helpful.

[Cutaneous leishmaniasis due to Leishmania infantum associated with HIV]. / Leishmaniose cutanée à Leishmania infantum associée à une infection par le VIH.

BACKGROUND: In Senegal, reported cases of cutaneous leishmaniasis are often due to Leishmania major. Immunosuppression related to HIV infection contributes to the emergence of leishmaniasis in humans and to cutaneous localization of viscerotropic species. We report the first observed case in Senegal of opportunistic cutaneous leishmaniasis due to Leishmania infantum associated with HIV. PATIENTS AND METHODS: A 5-year-old boy presented crusted ulcerative lesions of the scalp and left forearm, together with axillary and cervical lymphadenopathy present for two months. Direct parasitological examination of the scalp and arm lesions, coupled with liquid aspiration of lymph nodes and bone marrow, enabled identification of amastigote forms of Leishmania. Polymerase chain reaction performed on skin, lymph node and bone marrow biopsy samples allowed identification of L. infantum. The child was positive for HIV1. Treatment of HIV infection and leishmaniasis resulted in clinical improvement. DISCUSSION: Co-infection with cutaneous leishmaniasis due to L. infantum and HIV is a complex combination in terms of the related therapeutic issues. The clinical and laboratory outcomes depend on restoration of immunity and on the efficacy, safety and availability of anti-leishmaniasis drugs.

[Multifocal histoplasmosis due to Histoplasma capsulatum var. duboisii in a 22 year-old Senegalese patient without proven immunodepression]. / Histoplasmose multifocale à Histoplasma capsulatum var. duboisii chez un Sénégalais de 22ans sans immunodépression prouvée.

The authors report a case of multifocal African histoplasmosis with polymorphic skin involvement occuring in a patient without proven immunosuppression. He was a young 22-year-old patient from eastern Senegal - but born in Ouganda - who presented with polymorphic skin lesions: ombilicated papulo-nodules, gums and ulcerative and budding lesions. He showed lymphadenopathies without clinical inflammation and with a cheesy appearance of the biopsy but without tuberculosis and also hepatosplenic and bone involvement. Mycological samples of the skin and lymph nodes biopsies revealed yeasts of Histoplasma capsulatum var. duboisii with a positive culture on Sabouraud medium. HIV serology, HTLV1et 2, the serum proteins electrophoresis were unremarkable. Treatment with amphotericin B was irregular because of its inaccessibility in the national territory and its cost. The patient died of sepsis together with the aggravation of his disease.

Experience in control of avian influenza in Africa.

The first outbreak of H5N1 highly pathogenic avian influenza (HPAI) in Africa was confirmed at Kaduna, Nigeria, on 8 February 2006. Within three months, seven other countries on the continent, Burkina Faso, Cameroon, Côte d'Ivoire, Djibouti, Egypt, Niger and Sudan, were infected. More recently Ghana and Togo became infected. The origin of the introduction of the disease to Nigeria and the other infected countries is still unknown, owing to lack of adequate tracing of the movements of poultry and poultry products and lack of reliable epidemiological data from the affected countries. The preventive measures adopted in countries free from H5N1 HPAI include selective or total bans on the importation of poultry and poultry products from infected countries. All the infected countries have implemented more or less the same internationally recommended disease control measures including quarantine, stamping-out and active surveillance, while poultry vaccination was carried out in Côte d'Ivoire and Egypt. These control measures, adopted and implemented by weak veterinary services, cannot explain the apparent 'epidemiological silence' of H5N1 HPAI in Africa, and further studies are needed to explain the different behaviour of the H5N1 HPAI virus in Africa and Asia.

[Development of African children: influence of the home environment]. / Développement de l'enfant Africain: influence du milieu de vie.

The purpose of this report was to show how special features of the African home environment affect child development. Special emphasis was placed on the traditional social structure and the roles of various players. The different stages of development are described in relation to the major social events in African families and communities. Psychomotor development in African children presents several particularities in relation to children in the industrialized world but differences tend to decrease as a result of ongoing social upheaval. Modernization or globalization has had a profound effect on family organization and child care. These changes must be taken into account by officials in charge of child-psychiatry services. Preventive initiatives should taken into account and, insofar as possible, preserve traditional familial resources.

[Hysteria in children: Briquet's syndrome (a case report)]. / Hystérie de l'enfant: le syndrome de Briquet (à propos d'une observation).

In this case report, the authors studied the difficulties to set up the diagnosis of hysteria in the Briquet's Syndrome. The description presented here is about an eleven years old girl patient without any particular family background and who, after her tonsils have been out against her will, presented a hysteria in the form of Briquet's Syndrome. All the explorations showed no abnormalities. It is the questioning, and the analysis of facts from informations by the patient and her family which allowed to conclude the diagnosis of hysteria. She received a chemotherapy, associated with a psychotherapy and a family guidance. The course was favourable after two months. The authors compare these findings with some data of the literature and underline the diagnostic and therapeutic difficulties they faced. How physicians should approach such form of hysteria to set up the diagnosis is to proceed by elimination because the disease can simulate all sorts of medical or psychiatrical affections.

Xerovac: an ultra rapid method for the dehydration and preservation of live attenuated Rinderpest and Peste des Petits ruminants vaccines.

The accepted procedure for the long-term preservation of live viruses and bacteria in vaccines has been lyophilisation. We show that thermolabile viruses can be dehydrated in vitro, within 18 h, in an excipient containing trehalose. We further demonstrate that in the resulting dehydrated state, where the viruses are captive in a metastable glass composed of trehalose, they are capable of resisting 45 degrees C for a period of 14 days with minimal loss of potency. The degree of thermotolerance achieved matches that of current 'thermostable' lyophilised vaccines, but with the distinct advantage of a shorter, cheaper and simpler process. The development and utilisation of this process can make significant improvements in current live virus vaccine production. It presents a further step away from dependence on mandatory low temperature refrigerated storage and could lead to greater confidence in vaccine stability, potency and efficacy.

[Naawtal or the psychopathological aspects of a particular migration]. / Le Naawtal ou les aspects psychopathologiques d'une migration particulière.

This study deals with some psycopathological features of naawtal. Naawtal is a Wolof word designating a social practice based on black magic that consists in ostracizing someone to prevent him from competing for a common goal or approaching a loved one. This traditional practice leads to involuntary migration from one place to another in the country. The survival of this practice in the socio-economic context of modern Senegal and indeed its extension to social classes not previously involved, reflects individual suffering, collective malaise, and ongoing social adjustments. Analysis of the practice of naawtal not only distinguishes motives, author, means of casting the spell (involving birds and wind), and the way to break the spell but also underlies the essential place of sexual identity with the notion of greater female vulnerability. To illustrate this article, the case of a woman persecuted by auditory hallucinations is analyzed in the light of the syndrome of mental and motor automatism characteristic of the diagnosis of chronic hallucinatory psychosis. The basic notion of internal exile and drifting contained in this traditional representation of mental illness is called on to explain the psychopathologic features. The authors emphasize the value of the reference to naawtal in the therapeutic relationship in helping to achieve acceptance of psychiatry in Africa.

[Epidemiology of bovine brucellosis in Mali: serologic investigation and initial isolation of strains of Brucella abortus]. / Epidémiologie de la brucellose bovine au Mali: enquête sérologique et isolement des premières souches de Brucella abortus.

The authors report the results of an epidemiological survey of bovine brucellosis in Mali, based on a relatively representative sample of 1,000 serum samples from 236 herds. The prevalence of infection in the herds, established by indirect enzyme-linked immunosorbent assay (ELISA) was 53% +/- 6.4. The proportion of animals infected was 23.3% +/- 2.5, falling to 22% when compared with the basic serum pool of 9,466 samples. This rate was relatively high in stationary herds in the semi-arid, sub-humid and arid zones. Four strains of Brucella abortus were isolated from cattle bearing hygromas.

[Traditional medicine and psychiatry: apropos of 3 experiences in Senegal, New Caledonia and Nepal]. / Médecines traditionnelles et psychiatrie: a propos de trois expériences, au Sénégal, en Nouvelle-Calédonie et au Népal.

The authors describe by turns their experience about indigenous medicine in Senegal, in New-Caledonia and in Nepal. They show that these indigenous medicines have common fundamental characteristics, although these various cultures are not linked together by their history. They compare these ways of thinking with occidental scientific medicine, and with the way of thinking of psychoanalysis.

[Attitude and behavior of the youth of Senegal toward drugs]. / Attitude et comportement des jeunes du Sénégal face aux drogues.

Formerly known as a dreadful calamity for industrialized countries, drug abuse now seems to have spread all over the world. In Senegal, it has been very difficult to gather reliable statistics on its extensiveness. To better define the problem in Senegal, UNESCO has launched an epidemiological study on young people drug abuse and alcoholism in schools and elsewhere. The authors analyse the results of this study and draw the following conclusions: all types of drug use are linked to religious practice, drug use by young people is due to curiosity or their ignorance of drug drawbacks and their lack of education, school, family, religious education and social repression play an important role in the fight against drug use.

Considerations generales sur l'enuresie au Senegal

L'etude retrospective a porte sur une periode de cinq annees; de janvier 1987 a decembre 1991. elle a recense 199 enuretiques sur 1009 consultants a la clinique pedopsychiatrique. L'enuresie represente 20 pour cent de cette consultation. La majorite des cas viennent a Ker Xaleyi vers l'age de 12 ans qui correspond au pic. L'affection est relativement plus frequente chez les patients feminins 23 pour cent que masculins 17;33 pour cent

Financing urban primary health services. Balancing community and government financial responsibilities, Pikine, Senegal, 1975-81.

It is difficult to prejudge a community's capacity to satisfy its basic human needs, because no satisfactory method has been developed to predict the potential resources of a poor community. To improve their health conditions, all people, even poor, have some resources available. When they can manage themselves and be involved in decision making, they can become very efficient and contribute many material and human resources needed to organize health facilities in situations where the government fails to provide for wide-ranging needs, especially in the new cities. This was demonstrated by our experiment in Senegal between 1975 and 1981. This paper discusses the respective roles and responsibilities of the communities and the government in terms of: the process of setting up and carrying out the project in Pikine and the stages of community participation; and the pre-conditions for successful co-management in a primary care organization financed in a large part by the community.

[Various sociocultural findings concerning sexual impotence in Senegal]. / Quelques données socio-culturelles dans l'impuissance sexuelle au Sénégal.

This study emphasizes the role of the socio-cultural status and consequently of psychologic factors in sexual impotence of the black African in Senegal: --role of age, related to the perception of a dual status; --role of the ethnic group giving or not preeminence to sex; --rank in the brotherhood which may raise a conflict with ancestor; --matrimonial situation having significance of an acceptance of the cultural code about sex; --somatizations expressing the sexual potentialities; --non structured neurosis as expression of psychic and sexual inhibition; --religious behaviour with opportunities of conflicts with the religious authorities.