M.C. Seck

Acute kidney injury associated with Plasmodium malariae infection

According to current estimates, Plasmodium malariae is not very common in Senegal, as more than 98% of malaria cases are suspected to be due to Plasmodium falciparum. However, it is possible that other malarial species are being under-reported or misdiagnosed. This is a report of a case of P. malariae in a 30-year-old man previously hospitalized with acute kidney injury after treatment with quinine and re-hospitalized three months later. He was diagnosed with renal cortical necrosis post malaria treatment. Plasmodium malariae was identified with light microscope and confirmed using species-specific small-subunit rRNA (ssrRNA) amplification.The patient was treated for malaria with intravenous quinine for seven days, followed by three days of oral treatment; the bacterial infection was treated using ceftriaxone during the first hospitalization and ciprofloxacin associated with ceftriaxone the second time. He also had four rounds of dialysis after which he partially recovered the renal function. Given the complications that can be caused by P. malariae infection, it should be systematically looked for, even if the predominant species is P. falciparum in Senegal.

Article original/Original articleChampignons non dermatophytiques et non candidosiques isolés au CHU Le Dantec de Dakar en 2014 : étude épidémiologique, clinique et mycologiqueNondermatophytic and noncandidal fungi isolated in Le Dantec University hospital of Dakar in 2014: Epidemiological, clinical and mycological study

In recent years, the incidence of superficial fungal infections involving nondermatophytic and noncandidal fungi increased considerably. The objective of this work was to analyze the epidemiological, clinical and mycological fungal infections due to nondermatophytic and noncandidal fungi diagnosed in the laboratory of parasitology-mycology of Le Dantec hospital in Dakar. With a retrospective study of the various cases of nondermatophytic and noncandidal fungi isolated in the laboratory of parasitology-mycology during the period of November 2013 to December 2014, we collected 22 cases of infections in 11 men and 11 women; age ranging from 17 to 75 years with a mean of 45.3 years (sex ratio=1): eight cases of intertrigo, seven cases of onychomycosis, four cases of palmoplantar keratoderma (KPP), a case of onychomycosis associated with interdigital intertrigo, a case of infectious myositis and one case of African histoplasmosis. We have isolated and identified a total of 22 nondermatophytic and noncandidal fungi: ten Fusarium, five Trichosporon, two Chrysosporium, two Geotrichum, one Rhodotorula, one Neoscytalidium dimidiatum and one Histoplasma capsulatum var. duboisii. So we are seeing the emergence of nondermatophytic and noncandidal increasingly isolated from superficial and local lesions. These fungi, generally contaminants or commensal, cause a problem regarding their direct involvement in pathological processes in which they are isolated. So we should respect the recommendations proposed for their involvement in pathological processes and, by a collaboration between clinician and biologist, demonstrate their real involvement through effective, targeted treatment.

Champignons non dermatophytiques et non candidosiques isolés au CHU Le Dantec de Dakar en 2014 : étude épidémiologique, clinique et mycologique

In recent years, the incidence of superficial fungal infections involving nondermatophytic and noncandidal fungi increased considerably. The objective of this work was to analyze the epidemiological, clinical and mycological fungal infections due to nondermatophytic and noncandidal fungi diagnosed in the laboratory of parasitology-mycology of Le Dantec hospital in Dakar. With a retrospective study of the various cases of nondermatophytic and noncandidal fungi isolated in the laboratory of parasitology-mycology during the period of November 2013 to December 2014, we collected 22 cases of infections in 11 men and 11 women; age ranging from 17 to 75 years with a mean of 45.3 years (sex ratio=1): eight cases of intertrigo, seven cases of onychomycosis, four cases of palmoplantar keratoderma (KPP), a case of onychomycosis associated with interdigital intertrigo, a case of infectious myositis and one case of African histoplasmosis. We have isolated and identified a total of 22 nondermatophytic and noncandidal fungi: ten Fusarium, five Trichosporon, two Chrysosporium, two Geotrichum, one Rhodotorula, one Neoscytalidium dimidiatum and one Histoplasma capsulatum var. duboisii. So we are seeing the emergence of nondermatophytic and noncandidal increasingly isolated from superficial and local lesions. These fungi, generally contaminants or commensal, cause a problem regarding their direct involvement in pathological processes in which they are isolated. So we should respect the recommendations proposed for their involvement in pathological processes and, by a collaboration between clinician and biologist, demonstrate their real involvement through effective, targeted treatment.

Evaluation of PIMATM CD4 System for Decentralization of Immunological Monitoring of HIV-Infected Patients in Senegal.

Background HIV infection is a concern in the army troupes because of the risk behaviour of the military population. In order to allow regular access to CD4+ T cell enumeration of military personnel as well as their dependents and civilians living with HIV, the Senegalese Army AIDS program is implementing PIMATM Alere technology in urban and semi-urban military medical centres. Validation such device is therefore required prior their wide implementation. The purpose of this study was to compare CD4+ T cell count measurements between the PIMATM Alere to the BD FACSCountTM. Methodology We selected a total of 200 subjects including 50 patients with CD4+ T-cells below 200/mm3, 50 between 200 and 350/mm3, 50 between 351 and 500/mm3, and 50 above 500/mm3. CD4+ T-cell count was performed on venous blood using the BD FASCountTM as reference method and the PIMATM Point of Care technology. The mean biases and limits of agreement between the PIMATM Alere and BD FACSCountTM were assessed with the Bland-Altman analysis, the linear regression performed using the Passing-Bablok regression analysis, and the percent similarity calculated using the Scott method. Results Our data have shown a mean difference of 22.3 cells/mm3 [95%CI:9.1–35.5] between the BD FACSCountTM and PIMATM Alere CD4 measurements. However, the mean differences of the two methods was not significantly different to zero when CD4+ T-cell count was below 350/mm3 (P = 0.76). The Passing-Bablok regression in categorized CD4 counts has also showed concordance correlation coefficient of 0.89 for CD4+ T cell counts below 350/mm3 whilst it was 0.5 when CD4 was above 350/mm3. Conclusion Overall, our data have shown that for low CD4 counts, the results from the PIMATM Alere provided accurate CD4+ T cell counts with a good agreement compared to the FACSCountTM.

Distribution of erythrocyte binding antigen 175 (EBA-175) alleles and ABO blood groups in a hypoendemic area in Senegal

INTRODUCTION The study was conducted to determine for the first time the association between the erythrocyte binding antigen 175 (EBA-175) alleles and ABO blood groups in malaria patients living in Thies, a hypoendemic area in Senegal. METHODOLOGY In 2007, the EBA-175 alleles and blood group types were determined by nested PCR and the Simonin test respectively in blood samples obtained from uncomplicated Plasmodium falciparum malaria positive patients. RESULTS AND CONCLUSION In total, 129 patients were enrolled in the study. The EBA-175 genotyping showed a prevalence of 67.45% for the F-allele, 27.90% for the C-allele and 4.65% of mixed C+F infection. The distribution of the ABO blood group type showed 59.8% for the O group, 19.7% for the A group, 17.2% for the B group, and 3.3% for the AB group. No correlation was noted between the EBA-175 alleles and either the blood group type or parasitemia.

Tinea pedis due to Cylindrocarpon lichenicola beginning onycholysis.

A 33 year old woman presented with both feet, humid and white Tinea pedis at the second, third and fourth inter-toes areas associated with a beginning onycholysis of the nails lasting for 18 months. KOH mount of the samples was positive for fungal hyphae. The fungus was isolated on Sabouraud-chlorampphenicol agar and identified as Cylindrocarpon lichenicola. The patient was treated with an association of terbinafine tablet and terbinafine cream and presented clinical cure after three months.

Distribution of Parasites Detected in Stool Samples of Patients in Le Dantec University Hospital of Dakar, Senegal, from 2011 to 2015

To identify the parasites responsible for intestinal parasitic infections diagnosed at Le Dantec University Hospital of Dakar, distribution of parasites detected in stool samples of patients was studied. From 2011 to 2015, 2578 patients were included in the study. A direct examination and Ritchie technique were performed as parasite search techniques. In total, 408 samples were positive showing 440 intestinal parasites; this corresponds to prevalence of 15.8%. Parasites were detected in monoparasitism (85.7%) and multiparasitism (14.3%). The most common species found in monoparasitism were Entamoeba coli (38.9%), E. histolytica/dispar (12.7%), Giardia intestinalis (8%), and Ascaris lumbricoides (7.3%). The most common associations were A. lumbricoides-Trichuris trichiura (3.6%) and E. coli-G. intestinalis (2.7%). Nonhospitalized patients were significantly more affected with 65.4% compared to hospitalized counterparts; and also there were more men (50.7%) than women. With 67.4%, adults were the most affected age group, while the elderly were less affected with only 7% (p = 0.5). This study shows increasing prevalence of intestinal parasitic infections over the years. So health education should be promoted in addition to the already begun mass treatment program. This would help to limit or even halt the spread of these diseases.

Les intertrigos interorteils impliquant Fusarium spp. à Dakar (Sénégal)

INTRODUCTION Fungal interdigital tinea pedis (ITP) is a common pathology mainly due to dermatophytes and yeasts. Fusarium sp. is rarely incriminated in the genesis of intertrigo. In Dakar, a recent study conducted in 2016 on fungal ITP showed that Fusarium were more involved in the etiology of ITP than dermatophytes, coming just after yeasts dominated by Candida. Following this, we wanted to draw attention to the increasing incidence of ITP resulting from Fusarium spp., in Dakar, Senegal, and to analyze the epidemiological and mycological particularities of these ITP due to Fusarium spp. PATIENTS AND METHODS A retrospective study including all patients received at the laboratory for suspicion of ITP between January 1st, 2014 and June 30th, 2017 was conducted. Diagnosis was based on mycological examination, including direct examination and culture. Mycological analysis was considered positive when direct examination and culture were positive after at least one repeat. RESULTS Twenty-nine cases of Fusarium ITP accounting for 44.6% of all ITP in the study period were diagnosed in 15 men and 14 women. The mean age of the patients was 48.4 years. Fusarium ITP were diagnosed in immunocompetent patients except in two diabetics. The mean duration of the lesions was 6.83 years. The most frequent species isolated belonged to the Fusarium solani complex with 19 cases. CONCLUSION Fusarium ITP in a healthy subject requires regular monitoring because any subsequent decrease in immune defenses could lead to fatal hematogenous spread.

Onychomycosis Caused by Fusarium spp. in Dakar, Senegal: Epidemiological, Clinical, and Mycological Study

Fusarium spp. represent 9 to 44% of onychomycoses caused by fungi other than dermatophytes. This retrospective study describes 17 cases of Fusarium onychomycosis diagnosed at the Laboratory of Parasitology and Mycology of Le Dantec University Hospital in Dakar, Senegal, from 2014 to 2016. It included all patients received in the laboratory for suspicion of onychomycosis between January 1, 2014, and December 31, 2016. Diagnosis was based on mycological examination including direct examination and culture. Mycological analysis was considered positive when direct examination and culture were positive after at least one repeat. Seventeen Fusarium onychomycosis cases representing 12.9% of all onychomycoses reported were diagnosed. There were 5 cases on the fingernails and 12 on the toenails in 6 males and 11 females, and the mean age was 44 years (range: 26–64). Onychomycoses were diagnosed in immunocompetent patients except in a diabetic patient. The mean duration of lesions was 4.9 years (range: 1–15), and distal subungual onychomycosis was predominant. Almost all patients were from suburban areas of Dakar region. The most frequent species isolated belong to Fusarium solani complex. Because of the risk of disseminated infection in immunocompromised patients, realization of susceptibility tests is necessary to ensure better therapeutic management.

Le paludisme à Plasmodium ovale wallikeri et Plasmodium ovale curtisi au Sénégal en 2016

Recently in Senegal, a case of Plasmodium ovale malaria had led to a diagnostic difficulty due to the ignorance of this parasite and the neglect of it. The objective of this study was to actively investigate cases of P. ovale malaria that would be misdiagnosed in the health centre structures of Senegal. The study was conducted in three areas that reflect different epidemiological strata of malaria. Microscopy was performed by microscopy experts on suspected malaria patients. The results were validated by Rougemont real-time PCR. Positive P. ovale cases were genotyped by nested PCR targeting the potra gene. A total of 406 samples were taken. Microscopy of Giemsa stained thick and thin smears recorded 228 cases of Plasmodium falciparum (97%), 3 cases of Plasmodium malariae (1.3%), and 4 cases of P. ovale (1.7%). The cases of P. ovale observed at microscopy were confirmed by real-time PCR. Genotyping of P. ovale revealed 3 cases of P. ovale wallikeri and 1 case of P. ovale curtisi. The prevalence of P. ovale malaria remains low in Senegal. However, malaria microscopists should be trained to recognize non-falciparum species in order to avoid the diagnostic delays and unnecessary investigations. National malaria control program should consider those species for the better management of malaria control in the country. Simplified molecular methods like, loop-mediated isothermal amplification (LAMP) may be useful to better characterize the epidemiology of non-falciparum malaria.