A. Dicko

Prevalence of Cutaneous Leishmaniasis in Districts of High and Low Endemicity in Mali.

Historically the western sahelian dry regions of Mali are known to be highly endemic for cutaneous leishmaniasis (CL) caused by Leishmania major, while cases are rarely reported from the Southern savanna forest of the country. Here, we report baseline prevalence of CL infection in 3 ecologically distinct districts of Mali (dry sahelian, north savanna and southern savanna forest areas). We screened 195 to 250 subjects from 50 to 60 randomly selected households in each of the 6 villages (four from the western sahelian district of Diema in Kayes region, one from the central district of Kolokani and one from the southern savanna district of Kolodieba, region of Sikasso). The screening consisted of: 1] A Leishmanin Skin Test (LST) for detection of exposure to Leishmania parasites; 2] clinical examination of suspected lesions, followed by validation with PCR and 3] finger prick blood sample to determine antibody levels to sand fly saliva. LST positivity was higher in the western district of Diema (49.9%) than in Kolokani (24.9%) and was much lower in Kolondieba (2.6%). LST positivity increased with age rising from 13.8% to 88% in Diema for age groups 2–5 years and 41–65 years, respectively. All eight PCR-confirmed L. major CL cases were diagnosed in subjects below 18 years of age and all were residents of the district of Diema. Exposure to sand fly bites, measured by anti-saliva antibody titers, was comparable in individuals living in all three districts. However, antibody titers were significantly higher in LST positive individuals (P<0.0001). In conclusion, CL transmission remains active in the western region of Mali where lesions were mainly prevalent among children under 18 years old. LST positivity correlated to higher levels of antibodies to sand fly salivary proteins, suggesting their potential as a risk marker for CL acquisition in Mali.

A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa)

In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert’s response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.

Pruritus in dermatological hospital in Bamako, Mali

Pruritus is a symptom frequently encountered in dermatology consultations. For practitioners working in a tropical environment, particularly in Africa, the diagnosis of pruritus remains a constant problem. The aim of this study was to describe the epidemioclinical aspects and the etiologies of pruritus encountered at the dermatological hospital in Bamako. We conducted a prospective survey on a cohort of patients attending the Department of Dermatology at the Centre National d’Appui (CNAM‐Ex Institut Marchoux) in the Fight against Disease over a 1‐year period (June 1, 2009–May 31, 2010). Consequently, the study included every patient, whatever their age and gender, that agreed to take part in the survey and whose main reason for attending for a consultation was “pruritus.” The clinical and biological data were entered and analyzed using Epi Info software, version 6.04 fr. A total of 232 patients (163 women, 69 men) attended because of pruritus out of 1761 overall patients (i.e., a prevalence of 13.17%). The mean age of the patients was 33 ± 19 years. Dermatological causes represented 95% of the etiologies. This work allowed us to observe the systemic causes of pruritus in the dermatological environment in Mali and greater likelihood of black women to attend because of pruritus.

Dermatitis of the folds in black Africans in Bamako, Mali

Dermatitis of the folds (intertrigo) is a frequent reason for attending consultations, particularly in Africa, where the hot and humid climate constitute an aggravating factor. It is a complex pathology with multiple and intricate etiologies. The aim of this study was to describe epidemiological and etiological aspects of dermatitis of the folds in black‐skinned subjects in Bamako (Mali). We conducted a transversal descriptive survey of cases of localized dermatitis of the folds of the skin in dermatology clinics in Bamako. In total, 141 cases of intertrigo were identified: 96 female subjects (68%) and 45 male subjects. The average age of patients was 30 ± 18 years (2–80 years). The majority of patients were seen between March and June; 52% of patients had already received treatment before the consultation. The lesions affected skin folds of the groin area and/or area between the buttocks in 95 patients (57.4%), and folds of the armpits and area under the breasts were affected in 46 cases (42.6%). Eczema, erythrasma, and fungal disease were the most frequently observed pathologies. Of interest to this study is the topographical approach that a dermatologist must adopt when diagnosing certain forms of dermatitis. In populations with specific cultural practices, apart from a thorough knowledge of these specific factors, treatment of these conditions requires certain harmful attitudes and behaviors to be abandoned.

Impact of insecticide-treated bednets and indoor residual spraying in controlling populations of Phlebotomus duboscqi, the vector of Leishmania major in Central Mali

BackgroundCutaneous leishmaniasis (CL) is an endemic neglected tropical disease prevalent in several areas where seasonal malaria transmission is active. We assessed the effect of indoor residual spraying (IRS) and the mass distribution of long-lasting insecticide-treated bednets (LLINs) for malaria control on sand fly population diversity and abundance, and its impact on the risk of Leishmania transmission in the district of Baroueli, endemic for CL in Mali.MethodsKemena and Sougoula, two villages in the district of Baroueli, were selected for entomology surveys from March to September 2016 to evaluate sand fly species composition and density, and Leishmania infection rates in the vector Phlebotomus duboscqi. The surveys followed an annual indoor residual spraying and mass distribution of long-lasting insecticide-treated bednets (IRS/LLINs) that began in 2011 for malaria vector control. We also carried out a leishmanin skin test (LST) survey in the two villages to determine the incidence of Leishmania infection in humans living in the endemic area.ResultsA total of 2936 sand fly specimens, 1013 males and 1923 females, were collected and identified from the two villages throughout the study period. Fourteen species, 2 belonging to the genus Phlebotomus and 12 to the genus Sergentomyia, were documented. The genus Sergentomyia constituted 91% of collected sand flies versus 9% for the genus Phlebotomus (P. duboscqi and P. rodhaini). Of those, P. duboscqi was the most abundant, representing 99.6% of the collected Phlebotomus species. In both villages, P. duboscqi was most abundant during the end of dry season (June). The prevalence of Leishmania infection in individual females of P. duboscqi by PCR was 3.5%. After 5 years of the IRS/LLINs, the incidence of Leishmania infection in the human population as measured by LST was 4.2%.ConclusionsCompared to historical data collected from 2005–2008, a considerable reduction was observed in both sand fly density and prevalence of human Leishmania infection in the villages of Kemena and Sougoula, Baroueli District, following IRS/LLINs. This suggests that IRS/LLINs used for mosquito control also impacts sand fly vectors reducing the incidence of leishmaniasis.Trial registrationNCT00344084. Registered: 23 June 2006

Tuberculose cutanée à Bamako, Mali

INTRODUCTION Tuberculosis is the most common mycobacteriosis in sub-Saharan Africa. Cutaneous tuberculosis is rare and underdiagnosed due to its clinical polymorphism and to the smallness of technical equipment. This study aims to describe the epidemiological, clinical, histopathological aspects of cutaneous tuberculosis in Bamako (Mali). METHODS We conducted a cross-sectional descriptive study from January 1991 to December 2008. The study was performed in the Department of Dermatology at the National Center for Disease Control and in the Department of Pneumophtisiology at the Hospital of Point G. The patients with tuberculosis confirmed by histological and/or biological examination were included in the study. RESULTS Out of 4269 patients? medical records, 61 cases of cutaneous tuberculosis were identified (1.43%). Men accounted for 59% of the cases (36 patients) and women 41% (25 cases); sex-ratio was 1.44. The age of the patients ranged from 3 months to 61 years, with an average age of 27.56 ± 36 years. The average length of follow-up was 10.9 ± 10 months. The identified clinical forms were scrofuloderma (41 cases), ulcerative form (13 cases), verrucous form (4 cases), and tuberculous Lupus (3 cases). Tuberculosis was associated with HIV in 7 cases, with leprosy in 3 cases. CONCLUSION Cutaneous tuberculosis is underdiagnosed in Mali. Efforts are needed to improve the accessibility and the technical equipment available in the Departments, in order to conduct an extensive interdisciplinary study on this pathology.Introduction La tuberculose est la mycobactériose la plus fréquente en Afrique subsaharienne. La localisation cutanée est rare et sous diagnostiquée à cause de son polymorphisme clinique et la faiblesse du plateau technique. Le but de cette étude était de décrire les aspects épidémiologiques, cliniques, histopathologiques de la tuberculose cutanée à Bamako (Mali). Méthodes De janvier 1991 à décembre 2008 nous avons réalisé une étude transversale descriptive. L’étude s’est déroulée dans le service de Dermatologie du Centre National d’Appui à la lutte contre la Maladie et le service de Pneumo-phtisiologie au l’hôpital du Point G. Ont été inclus dans l’étude les cas de tuberculose confirmés par l’histologie et ou la biologie. Résultats Sur 4269 dossiers, 61 cas de tuberculose cutanée étaient recensées (1,43%). Les hommes représentaient 59% des cas (36 malades) et les femmes 41 % soit (25 cas); soit un sex-ratio de 1,44. L’âge des malades variait de 3 mois à 61 ans pour une moyenne de 27,56 ± 36 ans. La durée d’évolution était en moyenne de 10,9 ± 10 mois. Les formes cliniques recensées étaient le scrofuloderme (41 cas), la forme ulcéreuse (13 cas), la forme verruqueuse (4 cas), et le lupus tuberculeux (3 cas). La tuberculose était associée au VIH dans 7 cas, à la lèpre dans 3 cas. Conclusion La tuberculose cutanée est sous diagnostiquée au Mali. Des efforts sont nécessaires pour améliorer l’accessibilité et le plateau technique des services spécialisés, pour mener une étude approfondie interdisciplinaire sur cette pathologie.

Maladie de Kaposi profuse chez un enfant VIH positif, probablement contaminé par sa grand-mère

Kaposis disease in children with HIV is rarely reported in everyday practice. This is a case study of cutaneous Kaposis disease revealing HIV in a 5-year-old child with polymorphic eruption of papules and nodules on the face, trunk, back, and limbs. Histopathological examination confirmed the diagnosis of Kaposis disease. The childs HIV serology was positive with a CD4 count of 240/mm3, normochromic and normocytic anemia, and a hemoglobin level at 8.5 g/dl. It was found that the child, after early weaning from his HIV-negative mother, had repeatedly suckled his healthy grandmother, who had no skin lesions but was HIV1 positive. Both grandmother and child were referred for treatment in their locality. The case is noteworthy for the way in which the HIV1 virus infected the child during weaning and then being suckled by his grandmother. The child already had an initial dental flare that could have injured his grandmother. Thus, in our case, there is a contamination by HIV1 virus most likely from the grandmother and contamination by the HHV8 virus, source unidentified as a technical plateau was reached.

Dermatoses gériatriques en hospitalisation dermatologique à Bamako (Mali)

INTRODUCTION Skin diseases in the aging population vary and are a key concern for clinicians in terms of diagnosis, management and follow-up. This study aims to describe the epidemiological and clinical aspects of skin diseases among geriatric patients hospitalized in the Department of Dermatology at the National Center In Support Of Disease, Bamako. METHODS We conducted a cross-sectional case study of patients with geriatric dermatoses hospitalized in the Department of Dermatology at the National Center In Support Of Disease from 1 January 2010 to 31 December 2014. Out of 398 patients hospitalized, 76 patients aged 60 years and over were included in the study. Data entry was accomplished using Epidata 3.1 software, while data analysis was performed using stata 14 software. RESULTS The prevalence of skin diseases among hospitalized geriatric patients was 19.10%. The age of the patients varied from 60 to 95 years, with an average age of 68.85 years. We enrolled 29 men and 47 women, with a sex-ratio of 0,60. The main diseases reported were dermohypodermitis (44.74%), autoimmune bullous dermatitis (13.16%), toxidermia (10.53%), venous ulcers (6.58%), arterial ulcers (3.95%), malignant tumors (5.27%), diabetic wounds (3.95%). Four patients died (5,26%). CONCLUSION This study has assessed a high prevalence of subjects aged 60 and over hospitalized in the Department of Dermatology in Bamako. Moreover, it has confirmed that dermohypodermitis are the most frequent skin diseases among geriatric patients hospitalized in Mali.

Profil épidémio-clinique des dermatoses chez les enfants vus en consultation dermatologique dans le service de dermatologie du centre national d’appui à la lutte contre la maladie à Bamako (Mali)

INTRODUCTION Skin diseases are a major public health problem in developing countries. In common practice, children represent the most affected segment of the population. This study aims to describe the epidemiological and clinical aspects of skin diseases in children aged 0-15 years receiving dermatological consultation in the Department of Dermatology at the National Center for Disease Control in Bamako (Mali). METHODS We conducted a cross-sectional study in the Department of Dermatology and Venereology at the National Center for Disease Control from 1 January 2009 to 31 December 2009.Out of a total of 16339 patients who had undergone a dermatological consultation 5149 children were included in the study. RESULTS Dermatitis-frequency in hospital attending children was 31.51%. We enrolled 2838 boys (55,10%) and 2311 girls (44.90%), with a sex-ratio of 1,22. Patient age ranged from 03 days to 15 years with an average age of 8 ± 5.7 years. Infectious dermatoses accounted for 55.10% of all dermatoses, immuno-allergic dermatoses (32.5%), inflammatory dermatoses (11.85%). CONCLUSION Our study highlights the severity of infectious and immuno-allergic pathologies and the necessity to promote simple preventive measures such as hygiene, buying a clipper for each child.

P 19 : Erythème noueux révélant une lèpre lépromateuse

Introduction L’erytheme noueux est une complication observee au cours de la lepre lepromateuse. Sa survenue avant tout traitement anti bacillaire est possible, mais relativement rare en pratique. Nous rapportons un cas de lepre lepromateuse revelee par un erytheme noueux lepreux (ENL) Observations M. H., 34 ans agent comptable, a consulte pour une eruption cutanee diffuse, evoluant par poussee depuis un an. L’interrogatoire, a revele plusieurs poussees analogues durant les 8 dernier mois, calmees par la prise d’anti-inflammatoire et d’antalgiques. Devant la severite des poussees et leur rapprochement, il decide de consulter en dermatologie. A l’examen, on notait une febricule a 38°C, une eruption nodulaire localisee sur les faces d’extension des avants bras, les cuisses, jambes, le thorax et le dos douloureux a la palpation, parfois surmonte de pustules. La peau etait dyschromique dans son ensemble, et comportait par endroit quelques macules erythemateuses et/ou pigmentees. Le bilan biologique etait normal pas d’atteinte nerveuse, une biopsie cutanee a evoque une lepre lepromateuse. La bacilloscopie a confirme la presence de BAAR a 4+.Une polychimiotherapie associee a la thalidomide au debut a ete instaure pour une duree de douze mois. Apres 6 mois le malade n’a plus fait de poussees d’ENL. Conclusion Nous attirons l’attention des praticiens sur la necessite de rechercher une lepre devant tout cas d’erytheme noueux lepreux atypique chez des malades vivant en zone d’endemie lepreuse.