Between January 1993 and June 1997, 30 patients with crusted scabies were seen at the dermatological clinic in Dakar (Senegal). Seventeen of these patients were male and 13 were female. Six were children aged 5 to 15 years and 24 were adults aged 18 to 70 years. Diagnosis of crusted scabies was straightforward because this condition, which was rare in Dakar before 1990, has become much more common and is now familiar to Senegalese dermatologists. The infection presented as an extensive scaly or crusted eruption with symmetrical lesions affecting the hands, feet, knees, elbows and ears in particular. Scalp involvement was reported in 25 patients. Erythrodermia was present in 4 cases and pachyonychia in 4 cases. Twenty-seven of the 30 patients had moderate or severe pruritus, whereas an absence of pruritus is regarded as a classical characteristic of crusted scabies. Diagnosis was readily confirmed by examination of hyperkeratotic material under the microscope: numerous mites and eggs were present. The two most common etiological factors were auto-immune diseases (6 cases, 4 of whom were receiving no steroid or other immunosuppressive treatment at the time of onset of crusted scabies) and malnutrition (5 of the 6 children in the study). The other associated conditions identified were: physical debilitation (4 cases), HIV infection (3), mental disability-Down's syndrome (3) and long term use of topical steroids for artificial depigmentation (2). Two patients were immunocompetent and 5 patients died shortly after diagnosis, before any underlying conditions could be identified. Seven patients were cured with benzyl benzoate. Seven others, all adults, received a single oral dose of ivermectin (200 mg/kg) and topical kerolytic drugs. Ivermectin was ineffective in 1 case, and an improvement was observed in another case, although a complete cure was achieved only after a second dose. The other patients were all cured and showed no signs of scabies one month after ivermectin treatment. A recurrence was observed in 3 patients a few months later however, suggesting that these patients were reinfected. No side effects were reported in any of the patients treated with ivermectin.

Adolescent↗

PubMedDate not supplied

[Lepromatous leprosy with extensive ulcerations and cachexia. The Lucio phenomenon? Lazarine leprosy?].

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

[Leprosy tests: diagnostic problems (apropos of 2 cases)].

Two cases of reactional leprosy leading to wrong diagnosis are reported. The first one concerns a reversal reaction predominantly neuritic, initially taken for polyarthritis. The second one concerns an erythema nodosum leprosum with extensive cutaneous necrosis (Lucio's phenomenon or ulcerative lazarine leprosy). Main aspects and mechanisms of leprosy reactional states are reviewed. It is emphasized that errors or delays in diagnosis are often caused by failing to recognize cutaneous or neuritic symptoms.

Adult↗

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[Priority health care finances and joint control by the population and the state (Pikine - Senegal) 1975-1981].

Where the government cannot meet wide-ranging health needs of the population and when people are given the opportunity to manage their own affairs and to be involved in decision-making, they can become very efficient. This was demonstrated by an experiment in a senegalese town (450 000 inh.) between 1975 and 1981. A strategy for priority health care with the active participation of the local community was developed to provide a network of acceptable and accessible health services. This was with government support. --The government provides the basic structure of its health services to which the community contributes. It provides the medical staff, technical guidance and logistic support and helps the community volunteers to develop sound accounting procedures. --The community contributes financial and human resources to improve the coverage of the health units. Based on a self-financing system controlled by a health committee per each health unit, communities are in decision making concerning the utilization and management of the community's resources. Procedures to control the community's financial contribution are especially well detailed in the paper. In view of this successful experiment, the minister of public health with the agreement of the government, has recommended that community participation in financing health care services be extended to all regions of the country.

Community Participation↗

PubMedDate not supplied

[Red grain mycetomas (A. pelletieri). Apropos of 20 new cases in Dakar].

20 cases of mycetoma A. pelletieri coming from Sénégal are reported. This series confirms the peculiar localisation, extension and severity of this type of mycetoma: 14 cases located outside the foot (buttock, perineum, scrotum, inguinocrural area, abdominal and chest wall); frequency of lymph node involvement; importance of superficial extension; surgical possibilities overreached in more than 1/3 of the cases. Effectiveness of sulfa-methoxy-trimethoprime in the medical management is outlined.

Actinomycetales Infections↗

PubMedDate not supplied

[Mycetomas in Africa].

Mycetoma is the pathological process in which exogenous fungal or actinomycotic etiological agents generate grains. These agents belong to two groups: fungi and aerobic actinomycetes. Eumycetoma (caused by fungi) and actinomycetoma (caused by actinomycetes) must be distinguished as their treatments are different. These causative agents are introduced by traumas. Mycetomas are frequent in the northern tropical zones of America in Mexico and Venezuela, Africa in Senegal, Mauritania and Sudan and Asia in India, but can also be observed beyond these areas. In Africa, a high endemicity has been noted in a Sahelian band spanning from Senegal and Mauritania in the west to Somalia and the Republic of Djibouti in the east where there are long dry seasons and short rainy seasons. In this zone, M. mycetomatis (fungi) and S. somaliensis (actinomycetes) are predominant. A. pelletieri is common only in West Africa. Rainfall influences the distribution of these agents. S. somaliensis is more often found in desert areas, and A. pelletieri in more rainy areas. Mycetoma is more frequent in males and affects the age group between the second and fourth decades. Most of the patients are outdoor workers. In Africa, the foot is the most frequent localisation of the disease followed by the leg. Mycetoma is characterized by tumefaction, subcutaneous nodules and in most cases discharging sinuses that drain exudate containing grains. It gradually invades the tissues and bones causing a functional disability. Bone involvement depends on the duration of the disease, the site of the lesion and the causative agent. Invasion of lymph nodes is observed in rare cases, usually with actinomycetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗