RESUMO
Since 1996, there have been reports of cases of cutaneous leishmaniasis in the town of Ouagadougou. The incidence has been on the rise but precise figures are not known. The object of the present study has been, first, to record cases of cutaneous leishmaniasis having occurred in private and public health centres in Ouagadougou from 1996 to 1998 and, second, to determine the progression of the disease in space and time. We wished also to confirm clinical cases in 1998 by parasitological examination, identify different clinical forms of the disease and map out cases in the town. We carried out a retrospective study from 1996 to 1998 and a prospective study in 1998. All cases recorded in this period in visited health centres were included. A total of 1845 cases of cutaneous leishmaniasis was identified, 50.3% of whom concerned women. The age of patients varied between 1 and 79 years for 356 patients, with a mean age of 26.7 years. Cases increased between 1996 and 1998 (1996 = 61 cases, 1997 = 552 cases, 1998 = 1218 cases). The months of highest incidence were August (13%), September (15%) and October (17%). Peripheral districts (28, 30, 29, 16, 15) in south-eastern areas of the town were the worst touched with 87% of cases. On average, patients seek care after 2 months of progression of the disease. The ulcero-crusted form (68.2%) was the most frequent clinical form observed for 327 patients, but almost half of the cases had more than one site of infection, (43.5%). Over half of the patients presented fewer than 10 lesions with an average of 6. The most common locations were on uncovered parts of the body, notably the superior (53%) and inferior limbs (49%). The parasite could be tested for by smear on 52 patients only in 1998 and 53.8% of cases tested were positive. Leishmania major, which is very prevalent in West Africa was identified in one patient. The vectors and main reservoirs of the parasite were not studied. Case management was generally incomplete; the most commonly prescribed drugs were antibiotics (70% of patients), but self-medication was frequent. Our recommendations after this preliminary study are: undertake multidisciplinary studies on cutaneous leishmaniasis in Ouagadougou in order to understand the local aetiology (vectors responsible for transmission, rodent and domestic animals involved in the epidemiological chain, parasite species); identify all other areas in the country where the disease is highly prevalent provide health care staff with a decisional algorithm and protocol therapy carry out and active control programme for cutaneous leishmaniasis in Burkina Faso.
