Julienne Noude Teclessou

Systemic complications during voluntary cosmetic depigmentation among women in Togo: A case-control study.

OBJECTIVE The aim of our study was to document the systemic complications of skin bleaching among women in Togo. METHODS This was a case-control study conducted between December 2009 and December 2013. Cases comprised of women using skin-bleaching products for at least 6 months and age-matched with non-users (±3 years). RESULTS We recruited a total of 150 women using skin-bleaching and matched them with 300 controls. Univariate analysis revealed a correlation between systolic hypertension (OR=2.56; 95% CI: 1.68-3.92), diastolic hypertension (OR=1.89; 95% CI: 1.17-3.05), hyperglycaemia (OR=1.5; 95% CI: 1.2-9, 65) and obesity (OR=1.68; 95% CI: 1.08-2.62) with the use of skin-bleaching products. Multivariate analysis revealed a correlation between skin bleaching and both systolic hypertension (OR=3.94; 95% CI: 1.59-3.75) and obesity (OR=2.88; 95% CI: 1.23-5.69). CONCLUSION The results of our study show the existence of a correlation between voluntary cosmetic depigmentation, hypertension and obesity in Togo.

Basidiobolomycosis Simulating a Mycobacterium ulcerans Infection in a Togolese Rural Child

Background Basidiobolomycosis is a deep mycosis which preferentially affects rural young people in tropical countries. We report an atypical case, with multiple ulcers, simulating a Buruli ulcer. Case Report A 5-year-old boy, living in a rural area, was seen for ulcers on the buttocks and at the back and right flank that had been in progress for 4 months. On examination, we found an infiltrated plaque with sharp edges, little painful, located on the buttocks, back, and the right flank. On this plaque, there were multiple ulcers with polycyclic contours and fibrinous bottom. There were inguinal inflammatory lymph nodes. The patient had an altered general condition. Examination of other organs was normal. The diagnosis of Buruli ulcer was evoked first; the search for Mycobacterium ulcerans by polymerase chain reaction was negative. Histology test performed revealed hypodermic granulomatous inflammation with predominant macrophage and eosinophils. The mycological culture was not done. The child was treated successfully with ketoconazole (10 mg/kg/day) during eight weeks. Discussion Our observation shows great clinical and epidemiological similarities between basidiobolomycosis and Buruli ulcer. It confirms the efficacy of ketoconazole in severe basidiobolomycosis infection with alteration of general condition. Histopathology is very important for differential diagnosis between these two diseases.

Les connectivites en milieu hospitalier à Lomé: étude rétrospective de 231 cas

This study aimed to highlight the epidemiological , clinical, therapeutic and evolutionary profile of connective tissue diseases in the hospitals setting in Lomé. We conducted a retrospective and descriptive study from January 1, 1993 to December 30, 2012. We focused on the medical records of patients with connective tissue diseases hospitalized in five Departments of Dermatology and Rheumatology at the Hospitals in Lomé. During the study period, we identified 231 cases of connective tissue diseases in the five study centers, corresponding to a frequency of 0.19% of consultations. The average age of patients was 36,96±15 years, the sex-ratio was 0,2. Major connective tissue diseases included lupus disease (50.22%), sclerodermas (21,64%) and rheumatoid polyarthritis (20.35%). Clinically, the main clinical manifestations of connective tissue diseases included discoid lupus lesions (87.50%) and photosensitivity (82.50%) in patients with systemic lupus erythematosus, skin sclerosis (90.48%) in patients with systemic scleroderma and distal joint involvement (100%) in patients with rheumatoid arthritis. Treatment in patients with systemic lupus erythematosus (92.5%) and rheumatoid arthritis (73.47%) was based on systemic corticosteroids. Connective tissue diseases are rare in people living in Lomé, with a predominance of lupus disease. They are more frequent in young women. Treatment is based on systemic corticosteroids.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)-induced Stevens-Johnson syndrome and gynecomastia in an HIV-infected child: A case report

BACKGROUND Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are antiretroviral drugs often used in the first-line treatment regimen of HIV1 infection worldwide. We report a case of successive gynecomastia and Stevens-Johnson syndrome (SJS) respectively induced by efavirenz and nevirapine in a single patient. CASE REPORT A 16-year-old boy, HIV1-infected since birth, was started on antiretroviral treatment (ART) in August 2015 and was taking a regimen comprising abacavir, lamivudine and efavirenz. In April 2016, when his weight reached 35kg, abacavir was replaced with tenofovir. Bilateral breast enlargement, previously hidden by the patient, was diagnosed two years after the start of ART. History-taking, physical examination and laboratory tests ruled out known causes of gynecomastia, and efavirenz was thus considered the most likely cause. This drug was then withdrawn and replaced with nevirapine in July 2017. Thirty-three days after the patient started nevirapine treatment, a skin rash appeared. Physical examination revealed erythematous macules and flaccid bullae with estimated skin detachment of 10%. There were also conjunctival, buccal and genital lesions. A diagnosis was made of SJS induced by nevirapine. Three months after withdrawal of efavirenz, breast size decreased by 3cm on the left breast and 2cm on the right breast; two months after the SJS, cutaneous sequelae alone persisted, such as diffuse hyperchromic macules. DISCUSSION Recognition of gynecomastia as a side-effect of efavirenz is important to allow the condition to be treated while it is still potentially reversible. Moreover, when efavirenz is replaced, a protease inhibitor should be preferred to nevirapine.

Facteurs de risque associés à la sévérité de l’atteinte oculaire au stade aigu du syndrome de Stevens-Johnson et de la nécrolyse épidermique toxique en Afrique subsaharienne

AIM The purpose of this study was to identify risk factors associated with the severity of acute ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) in sub-Saharan Africa. PATIENTS AND METHOD A retrospective study was carried out at the dermatology department in collaboration with the ophthalmology department for SJS/TEN patients between January 2000 and December 2016 in Lomé (Togo). The severity of acute ocular involvement was evaluated using the Power classification, and the drug eruption score was assessed using de Bastuji-Garin classification. RESULTS A total of 107 cases of SJS/TEN (84 cases of SJS, 20 cases of TEN and 3 cases of overlap syndrome) were analyzed. There were 71 women and 36 men, with an average age of 32.3±12.5 years (range: 5 to 75 years). Sulfonamides (37.4%) were the most commonly used drugs followed by nevirapine (22.4%). HIV serology was positive in 46 (58.2%) of the 79 patients tested. A total of 54 (50.5%) patients had acute ocular involvement, which was mild in 29.9% of patients, moderate in 13.1% and severe in 7.5%. In multivariate analysis, exposure to sulfadoxine was the sole factor associated with moderate or severe acute ocular involvement in SJS/TEN (adjusted odds ratio=3.3; 95% CI=[1.1; 10.2]). CONCLUSION Exposure to sulfadoxine was identified in our study as a risk factor associated with the severity of acute ocular involvement in SJS/TEN. Multicenter studies should be conducted in sub-Saharan Africa to confirm this associated risk factor.

Evolution of HIV prevalence and behavioral factors among MSM in Togo between 2011 and 2015

Introduction The aim of this study was to assess sexual behavior and measure HIV prevalence among MSM in 2015, in Togo. Methods We conducted a cross-sectional study from February to March 2015 in nine major cities of Togo. The respondent-driven sampling method was used to recruit MSM. Behavioral data were collected by interviewer-administered questionnaires. The blood tests were then carried out among MSM to assess their HIV status. Data were inputted into an Epidata database and exported to STATA® 9.0 for analysis. Qualitative variables were compared using the chi-2. Results A total of 496 MSM were involved in this study, with 43.35% in the capital, Lome. Over the past 12 months, 88.9% of MSM had had sexual intercourse with men and 24.1% of them had had sex with women. The last sexual intercourse was with a casual partner among 52.9% of MSM. During the last 30 days preceding the survey, 68.5% of MSM had regularly used a condom during active anal intercourse and 71.9% had used it during passive anal intercourse. The national prevalence rate of HIV among MSM was 13.0%. The factors associated with HIV infection were age of MSM OR = 5.30 [1.85-15.1], HIV testing history OR = 2.63 [1.18-5.87] and the city of residence of MSM OR = 5.56 [2.90-10.64]. Conclusion This study confirms that HIV prevalence among MSM is five times higher than in the general population (13% vs 2.5%). Thus, the need to rethink HIV sensitization and prevention strategies targeting hidden and stigmatized populations such as MSM.

HIV prevalence and behavioral studies among female sex workers in Togo in 2015

The purpose of this study is to determine the seroprevalence of HIVamong female sex workers (FSWs) and to document the behavior in this target population four years after the last study and possibly readjust these interventions. We conducted from March 27 to April 4, 2015 a crosssectional study of 1197 FSWs. Behavior data were collected by interviewer-administered questionnaires. The FSWs were then subjected to blood tests to measure the prevalence of HIV. The average age of respondents FSWs was 28 years and 20% had their first sexual intercourse before 15 years old. Overall, 48% of the FSWs received between 1 and 7 customers per working day. The majority of FSWs (90%) had consistently used condoms during their last week of work. HIV seroprevalence was 11.7% for FSWs. HIV prevalence was higher in FSWs living in Lomé, the capital city, (13.4%) than those living in the Kara region, in the North of the country (2%), P < 0.0001. The results of this study show the positive behavioral change in FSWs with a stabilization of HIV prevalence in this group after four years.

Prevalence and Factors Associated with Self-Medication in Dermatology in Togo

Objective This study aimed to determine the prevalence of and factors associated with self-medication in dermatology in Lomé, Togo. Methods We conducted an analytical cross-sectional study from February to April 2016 in 2 dermatology departments in Lomé. Univariate and multivariate logistic regression models were carried out to identify possible factors associated with self-medication. Results A total of 711 patients were included in the study. The mean age (±SD) of the patients was 26.6 ± 6.9 years and the sex ratio (male/female) was 0.6. The main dermatologic diseases recorded were immunoallergic dermatoses (39.7%) and infectious skin diseases (22.6%). Two-thirds (481/711; 66.7%) of the patients had practiced self-medication before consultation in dermatology units. In multivariate analysis, factors associated with self-medication were female sex (aOR = 1.44; 95% CI = [1.01, 2.05]), duration of dermatologic disease more than one year (aOR = 1.79; IC = [1.19, 2.68]), adnexal dermatoses (aOR = 2.31; 95% IC = [1.03–5.21]), keratinization disorders (aOR = 4.23; 95% CI = [1.36–13.13]), and fungal skin infections (aOR = 5.43; 95% CI = [2.20, 13.38]). Conclusion Our study confirms that self-medication practice is very common among patients with dermatologic diseases in Lomé and has identified associated factors.

Enquête comportementale et de séroprévalence du VIH chez les professionnelles du sexe au Togo en 2015

The purpose of this study is to determine the seroprevalence of HIVamong female sex workers (FSWs) and to document the behavior in this target population four years after the last study and possibly readjust these interventions. We conducted from March 27 to April 4, 2015 a crosssectional study of 1197 FSWs. Behavior data were collected by interviewer-administered questionnaires. The FSWs were then subjected to blood tests to measure the prevalence of HIV. The average age of respondents FSWs was 28 years and 20% had their first sexual intercourse before 15 years old. Overall, 48% of the FSWs received between 1 and 7 customers per working day. The majority of FSWs (90%) had consistently used condoms during their last week of work. HIV seroprevalence was 11.7% for FSWs. HIV prevalence was higher in FSWs living in Lomé, the capital city, (13.4%) than those living in the Kara region, in the North of the country (2%), P < 0.0001. The results of this study show the positive behavioral change in FSWs with a stabilization of HIV prevalence in this group after four years.

P 44 : Les connectivites en milieu hospitalier à Lomé

Objectif documenter le profil epidemiologique, clinique, therapeutique et evolutif des connectâtes en milieu hospitalier a Lome. Materiel et methode s Il s’agissait d’une etude retrospective descriptive menee de janvier 1993 a decembre 2012 et portant sur les dossiers de malades ayant souffert d’une connectivite dans les services de dermatologie et de rhumatologie de cinq centres hospitaliers de Lome. Resultats Nous avons recense 231 cas de connectivites, soit une frequence de 0,19% des consultations. L’âge moyen des patients etait de 36,96 ± 15 ans (extremes : 4 ans et 81 ans), la sex-ratio 0,2. Les principales connectivites etaient la maladie lupique (50,22%), les sclerodermies (21,64%) la polyarthrite rhumatoide (20,35%). Les manifestations cliniques de ces connectivites etaient le lupus discoide (87,5%) et la photosensibilite (82,5%) chez les patients ayant un lupus erythemateux systemique, la sclerose cutanee (90,48%) chez les patients ayant une sclerodermie systemique et une atteinte articulaire distale (100%) avec raideur matinale de plus d’une heure (36,1%) chez les patients ayant une polyarthrite rhumatoide. Deux patients ayant une dermatomyosite avaient des antecedents de tumeur de la gorge et de tumeur de la hanche operee. La corticotherapie etait le traitement de base des patients ayant un lupus erythemateux systemique (92,5%), une sclerodermie systemique (61,90%) et une polyarthrite rhumatoide (73,47%). Les complications survenues au cours du traitement etaient infectieuses chez 40% des patients ayant un lupus erythemateux systemique et 6,67% des patients ayant une polyarthrite rhumatoide. L’evolution etait favorable sous traitement chez 35,5% ; 5,2% etaient decedes et 58% etaient perdus de vue apres une duree moyenne de survie de 132,89 jours. Conclusion Cette etude confirme l’extreme rarete des connectivites en milieu hospitalier a Lome. Des difficultes techniques et financieres quant a la realisation des bilans paracliniques pour le diagnostic et le suivi des patients expliquent le nombre important des perdus de vues.