Tetanus is an infection caused by Clostridium tetani. The disease has been described from the earliest medical literature. Despite this old knowledge, the existence of a vaccine, and the progress made in pathophysiolo...Tetanus is an infection caused by Clostridium tetani. The disease has been described from the earliest medical literature. Despite this old knowledge, the existence of a vaccine, and the progress made in pathophysiology and treatment, tetanus remains a real public health problem, particularly in developing countries. Tetanus in children and adults is still a frequent cause of hospitalization in the Infectious and Tropical Diseases Department (SMIT) of the Fann National University Hospital (CHNU). We conducted this study with the main objective of carrying out a situational analysis of tetanus at SMIT from 2010 to 2017. We recorded 706 cases of tetanus in a total of 8123 hospitalized patients. The median age of the patients was 23 years [1 - 90 years]. The sex ratio (M/F) was 4/1. More than half (58.78%) came from suburban areas. The population was most frequently made up of students (24%) or manual workers (22.1%). At least one comorbidity was present in 107 patients (15.15%). The absence of a vaccination record was found in 99.56%. The main portal of entry was integumentary (83.3%), post-circumcision (5.7%) and otogenous (4%). Tetanus was generalized in 93.9% of cases. The main signs of tetanus found were trismus and dysphagia. Patients were most frequently classified as stage II (78.7%). Antibiotic therapy was based on metronidazole (51.41%). Anti-tetanus serotherapy was carried out by sub-occipital administration in 97.6%. Tracheostomy was performed in 48 patients. Complications occurred in 226 patients (32.01%). The main complications were respiratory (53.98%), infectious (45.13%) and cardiovascular (41.59%). The average delay in hospitalization was 3.6 ± 3.4 days. The mean length of hospital stay was 11.9 ± 8.2 days. The hospital case-lethality rate was 18.98%. Despite the decline in cases over the years in our country, tetanus remains a public health problem because of its prevalence, severity, and lethality.展开更多
Background: Ovarian tuberculosis is a rare form of tuberculosis. Its clinical presentation mimics an ovarian tumor, leading to misdiagnosis. Proper treatment with anti-tuberculosis drugs can lead to a cure for the dis...Background: Ovarian tuberculosis is a rare form of tuberculosis. Its clinical presentation mimics an ovarian tumor, leading to misdiagnosis. Proper treatment with anti-tuberculosis drugs can lead to a cure for the disease but can sometimes cause adverse effects that compromise therapeutic management. Observation: We report a 71-year-old female Senegalese patient who presented with a chronic abdominopelvic mass with an elevated Cancer Antigen 125 (CA125) level, raising the suspicion of an ovarian tumor. She underwent an exploratory laparotomy and the anatomopathological study confirmed the diagnosis of ovarian and peritoneal tuberculosis. After starting treatment with anti-tuberculosis drugs, she developed toxidermia in the form of generalized urticaria. Discontinuation of the four-drug therapy and separate reintroduction of anti-tuberculosis drugs led to the incrimination of rifampicin. Progress was then favorable on Isoniazid (H) pyrazinamide (Z) and Ethambutol (E). Conclusion: Ovarian tuberculosis should be suspected in the presence of an abdominopelvic mass in a woman living in an endemic area. The occurrence of adverse reactions to anti-tuberculosis treatment is not uncommon, hence the importance of regular monitoring.展开更多
Background: Among patients treated for tuberculosis, 2% to 5% have a Central Nervous System (CNS) lesion, and its frequency rises to 10% in HIV-infected patients. Neuro-meningeal tuberculosis (NMT) is responsible for ...Background: Among patients treated for tuberculosis, 2% to 5% have a Central Nervous System (CNS) lesion, and its frequency rises to 10% in HIV-infected patients. Neuro-meningeal tuberculosis (NMT) is responsible for death and severe permanent neurological damage. This poor prognosis requires early diagnosis and rapid initiation of specific treatment. Unfortunately, the great clinical polymorphism and the lack of specificity of radiological and biological signs are frequently responsible for a delay in diagnosis and management. Senegal is one of the African countries where tuberculosis has remained a concern until now. And there are no studies carried out on this subject. Objective: The objective of this study was to describe the profile and outcome of Neuro-meningeal tuberculosis (NMT) cases diagnosed at the infectious diseases department (SMIT) of Fann University Hospital in Dakar, (referral service for management of tuberculosis). Methods: We carried out a retrospective, descriptive and analytical study, reviewing medical records of adults diagnosed with NMT at the SMIT of Fann Hospital from January 2015 to December 2020. Results: We collected 55 cases of NMT. The median age was 38 years [range 16 - 77 years]. The sex ratio (M/F) was 3.23. HIV patients represented 41.82% of cases. A history of tuberculosis was found in 25.5% of cases. The delay in consultation was greater than one month in 60% of patients. Headaches were the most constant reason for consultation (94.55%). Meningeal signs were present in 94.55% of patients, and consciousness disorders and intracranial hypertension were present in 63.64% and 56.36% respectively. Nerve palsy was found in 38.18%. CSF was clear in 81.64%. GeneXpert MTB/RIF in CSF was performed in 33 patients and was positive in 4 patients. Brain CT was abnormal in 72.09% of cases. Tuberculoma, hydrocephalus and meningeal contrast enhancement were the main lesions. The neuro-meningeal localization was associated with a pulmonary form in 32.7%. The lethality rate was 21.8%;higher in women (46.2% vs 14.3%;p = 0.01), in patients with a delay in consultation > 1 month (p = 0.03), and in patients who presented with consciousness disorders (p = 0.007). Conclusion: Despite the availability of the GeneXpert MTB/RIF, diagnosis of NMT remains difficult. Because of its variable clinical expression and the low sensitivity of the GeneXpert MTB/rif in the CSF, it exposes patients to serious complications. Among the factors associated with death, we found consciousness disorders, a long delay in diagnosis.展开更多
First described in 1907 by James Ramsay Hunt, Ramsay Hunt syndrome is a recurrence (reactivation) of varicella-zoster virus (VZV) affecting the geniculate ganglion, secondary to a decrease in cell-mediated immunity. T...First described in 1907 by James Ramsay Hunt, Ramsay Hunt syndrome is a recurrence (reactivation) of varicella-zoster virus (VZV) affecting the geniculate ganglion, secondary to a decrease in cell-mediated immunity. The strict definition of Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by erythematous vesicular rash on the ear. We report a 57-year-old female immunocompetent patient complaining of otalgia, small vesicles on the Ramsey Hunt Zone. She does not complain fever, hearing loss, nausea, vomiting or dizziness. There was no peripheral facial nerve palsy, no reduction of taste sensation, no ataxia or nystagmus, Romberg sign was negative. Our patient targets two of the three criteria needed for the diagnosis of Ramsay Hunt syndrome. She began to take Acyclovir-Steroid (AS) therapy very early with good outcome. This suggests that prompt diagnosis and management improve outcome and prevent occurrence of nerve palsy in Ramsay Hunt syndrome.展开更多
Laryngeal tuberculosis is a rare form of extrapulmonary tuberculosis, often complicating pulmonary tuberculosis that may be unrecognized. Its clinical presentation is nonspecific, often pointing to cancer. We report t...Laryngeal tuberculosis is a rare form of extrapulmonary tuberculosis, often complicating pulmonary tuberculosis that may be unrecognized. Its clinical presentation is nonspecific, often pointing to cancer. We report the case of a 77-year-old woman, with no reported pathological history. She also has no alcohol or tobacco intoxication, who presented with chronic dysphonia evolving for 2 months, associated with an altered general condition. The examination of the larynx by direct laryngoscopy and anatomical pathology study of the biopsies led to the diagnosis of laryngeal tuberculosis. A search for secondary sites revealed a concomitant pulmonary infection. The evolution was favorable under standard anti-tuberculosis treatment, with complete voice recovery and improved performance status. Laryngeal tuberculosis should be suspected in patients living in endemic areas and suffering from chronic dysphonia, even if they are not alcoholics or smokers.展开更多
Introduction: Tetanus portals of entry are numerous. Amongst these, the carerelated portals of entry are rarely reported. The aim of the study was to describe the epidemiological, clinical and outcome aspects and iden...Introduction: Tetanus portals of entry are numerous. Amongst these, the carerelated portals of entry are rarely reported. The aim of the study was to describe the epidemiological, clinical and outcome aspects and identify the factors associated with death from care-related tetanus. Patients and Methods: This is a retrospective study of descriptive and analytical purposes. Data were collected from the medical records of patients admitted to the Infectious and Tropical Diseases Department of the National University Hospital Center (CHNU) of Fann in Dakar for care-related tetanus during the period ranging from 1 January 2009 to 31 December 2016. Care-related tetanus was defined as any case of tetanus occurring after a surgical procedure, including circumcisions performed even outside a health facility. Results: In eight years, 50 cases of care-related tetanus were recorded. Care-related tetanus accounted for 6.7% of hospitalized tetanus cases. The mean age of patients was 21 ± 22 years, with a male predominance (sex ratio: 6.14). The procedure had been performed in most cases, either in a health facility in 22 patients (44%) or at home in 16 patients (32%), and occurred after circumcision. In 62% of cases the portal of entry was urological, followed by orthopedic surgery (14%) and visceral surgery (10%). The procedures performed were dominated by circumcision (31 cases), limb amputation (3 cases) and inguinal hernia repair (2 cases). Tetanus was immediately generalized on admission in all patients. Eighty-four percent (84%) of patients were admitted with Mollaret stage II. Cardiovascular (11 cases), infectious (10 cases) and respiratory (9 cases) complications were the most frequent. The hospital case fatality rate was 24%. Factors associated with death were female gender (p = 0.03), age between 15 - 60 years (p = 0.02), incubation time Conclusion: Care-related tetanus remains a concern in poor income countries, particularly in Senegal. The drop of these cases will require better immunization coverage of the population. It is also appropriate to raise the awareness of health care providers and surgeons and to promote capacity building for better prevention of cases through sero-immunization of patients at risk before the procedure and rigorous asepsis.展开更多
Introduction: The peripheral artery disease (PAD) is one of the chronic and frightening vascular complications of the diabetes whose tracking can be done by the Ankle-Brachial Index (ABI) measurement. We conducted in ...Introduction: The peripheral artery disease (PAD) is one of the chronic and frightening vascular complications of the diabetes whose tracking can be done by the Ankle-Brachial Index (ABI) measurement. We conducted in this context a study which consisted in measuring the ABI among hospitalized diabetic patients at Teaching Hospital of Pikine in Dakar, over 18 months’ duration. The aim was to determine the prevalence and evaluate factors correlated to the presence of the PAD. Patients and Method: This cross-sectional descriptive study interested the whole of diabetic patients hospitalized in Internal Medicine/Endocrinology Department, from January 2013 to June 2014. We carried out a complete clinical examination associated with ABI measurement by a Doppler probe for each included patient after having collected the clinical and paraclinical data. Results: Our population of study comprised 209 diabetic patients with a female predominance (126, 60.3%). The sex-ratio man/woman was 0.6. The median age of the population of study was 54 ± 2 years. In our series, 157 (75.1%) patients discovered their diabetes with the waning of an affection while the 52 (24.9%) other patients discovered their diabetes at the time of a systematic assessment. The PAD appeared by an intermittent claudication among 38 patients (18.2%). The ABI was normal for 126 patients (60.3%). The ABI was low for 51 patients (24.4%), unilateral in 3.8% of cases and bilateral in 20.6% of cases. The ABI was high among 32 patients (15.3%), unilateral in 7.2% of cases and bilateral in 8.1% of cases. The ABI extremes values were 0.11 and 2. In the population of study, 46 patients (22%) had a well-compensated PAD. The PAD was low compensated for 3 patients (1.4%) and severe for 2 patients (1%). The ABI was more frequent and significantly among women than men, with 32 cases (25.4%) against 19 (22.9%) cases (p = 0.021). The proportion of low ABI was more important among patients whose diabetes had evolved for more than 5 years (42.3% of cases) with a peak of frequency in the duration of 6 - 10 years (47.7% of cases). Conclusion: The PAD global prevalence among hospitalized diabetic patients appeared high with 24.4% patients presenting low ABI. Its early diagnosis among subjects at risk as for our study population allowed identifying asymptomatic subjects having another cardiovascular damage. Thus, the screening of obstructive arteriopathy of lower limb PAD by the measurement of ABI should be applied to all diabetic patients for a better assessment of atherosclerotic complication.展开更多
Introduction: De Quervain’s subacute thyroiditis is an inflammatory granulomatosis with clinical presentation some time atypical leading eventually to misdiagnosis or inadequate treatment. In our area, physician shou...Introduction: De Quervain’s subacute thyroiditis is an inflammatory granulomatosis with clinical presentation some time atypical leading eventually to misdiagnosis or inadequate treatment. In our area, physician should be aware of this possible etiology in presence of recent and acute features of thyrotoxicosis with or without painful firm goiter. We illustrate this fact with two new observations from Sub-Saharan Africa. Observations: Our first patient is a 70-year-old Guinean woman presenting a painful nodular and hard goiter at palpation. Her history was recent in a context of deterioration of the general state with a sub clinical thyrotoxicosis syndrome. The diagnosis of probable malignant thyroid tumor was evoked initially and a thyroidectomy considered. She presented an important biological inflammatory syndrome and biological peripheral hyperthyroidism. Neck ultrasound examination showed heterogeneous patchy decreased echogenicity. The diagnosis of subacute De Quervain’s thyroiditis was set up. A corticosteroid therapy at a rate of 20 mg/day of prednisone was begun with a fast degression of dose. After 3 weeks of treatment, we noticed total clinical recovery normalization of biological parameters. The second observation was about a 52-year-old Senegalese women living in Bamako. She presented cervical pains evolving for 2 months in a context of flu-like syndrome associated with thyrotoxicosis and marked biological inflammatory syndrome. The thyroid ultrasound showed global heterogeneity with characteristic aspect of “geography map” leading to the diagnosis of subacute thyroiditis. A combination therapy with low dose of prednisone, ß-blockers and tranquillizers. We noticed fast disappearance of clinical and biological signs. At 5 mg per day of prednisone, there were moderate signs of relapse with rapid favorable evolution after few days under increased dose of prednisone up to 10 mg/day. Conclusion: De Quervain’s thyroiditis can appear under misleading features opening out to make wandering diagnosis. A good clinical evaluation coupled with hormonal and ultrasound thyroid examination may help for right management. The use of low dose of corticosteroid had enabled us to obtain a fast control of main clinical and biological abnormalities.展开更多
Introduction: Management of pheochromocytoma faces different challenges leading to misdiagnosis and therapeutic delay in developing countries. The aim of our study was to evaluate the diagnostic and therapeutic featur...Introduction: Management of pheochromocytoma faces different challenges leading to misdiagnosis and therapeutic delay in developing countries. The aim of our study was to evaluate the diagnostic and therapeutic features as well as the evolution of our management strategies in hospital setting in recent years in Dakar. Patients and Method: We carried out a retrospective study over 12 years (January 2005 to June 2017), in 4 hospitals in Dakar. We only included patients with established diagnosis of pheochromocytoma upon clinical, biological, radiological and histological arguments. Results: During this period, 16 observations have been collected and were all about female patients. The mean age at the time of diagnosis was 36.81 years. The clinical signs were dominated by hypertension found for 14 patients. At biological examination, hypersecretion catecholamine was found in 13 patients, high urinary metanephrines in 7 patients, high plasmatic metanephrines in 2 patients and raised urinary Vanyl Mandelic Acid (VMA) in 4 patients. Dosage of chromogranin A showed high level for one patient. Abdominal CT scan allowed making the adrenal origin of tumors precise. One patient presented bilateral pheochromocytoma. Before being treated surgically, all patients had had medical preparation. The surgical treatment by median laparotomy consisted of an enucleation of the tumor in 2 patients, and adrenal resection in 11patients.The evolution after surgery was favorable in 12 patients out of 13. One patient died 2 days after surgery by hemodynamic instability. In 2 patients who presented metastases, multidrug therapy with cyclophosphamide, vincristine and dacarbazine was decided after a multidisciplinary meeting, but they died before treatment. Conclusion: Management of pheochromocytomas in developing countries is obviously improving, but the mortality rate remains high. Early diagnosis and perioperative care are to be targeted for better outcome and prognosis of this rare tumor in our areas.展开更多
Introduction: The Adult Onset Still’s Disease (ASD) is a systemic auto-inflammatory affection of unknown cause seldom described in sub-Saharan Africa. We report 3 observations of ASD illustrating the diagnostic and t...Introduction: The Adult Onset Still’s Disease (ASD) is a systemic auto-inflammatory affection of unknown cause seldom described in sub-Saharan Africa. We report 3 observations of ASD illustrating the diagnostic and therapeutic difficulties of this affection in our areas. Observation 1: Our first patient is a 56 years old schoolteacher presenting an ASD in its chronic articular form. She had been followed for an inflammatory arthralgia for 10 years and of the pharyngal pains without exact diagnosis. She presented ASD’s criteria of Yamaguchi and of Fautrel. The prednisone was begun at the dose of 0.8 mg/kg/day with fast appearance of a progressive muscular weakness. Use of methotrexate at a rate of 15 mg per week, associated with low dose of prednisone was effective in long-term without any flare of the disease so far. Observation 2: Our second patient is a 30 years old dressmaker presenting an ASD in its complicated systemic form of lymphohistiocytic activation syndrome. She validated the criteria of Yamaguchi and Fautrel for ASD. She also presented resistance to corticosteroid therapy. The evolution was marked by a hospital-acquired septicemia and a multi-organ failure leading to death. The diagnosis was retrospectively confirmed after that, with the low level of the glycosylated ferritin serum value. Observation 3: The third patient is a 22 years old Guinean student who presented prolonged fever and inflammatory polyarthralgia without articular deformation. He had been misdiagnosed for ASD with diagnostic wandering of several months. He was treated successfully with prednisone after set up of ASD diagnosis according common criteria. Corticosteroid therapy was stopped after 8 months without any relapse noted so far. Conclusion: Caring for ASD is difficult in our context mainly because of high cost of several explorations needed to set up its exact diagnosis while making differential one. Evolution under corticosteroid therapy is usually favorable but diagnostic delay may lead to severe complications and death.展开更多
The prevention of diabetic foot goes through a systematic podiatric assessment of diabetic patients permitting to identify the foot at risk. Then, we realized a study in the Internal Medicine Department at Pikine Teac...The prevention of diabetic foot goes through a systematic podiatric assessment of diabetic patients permitting to identify the foot at risk. Then, we realized a study in the Internal Medicine Department at Pikine Teaching Hospital in Dakar with the assessment of foot risk on admitted diabetic patients as our main objective. Methods: It was about a prospective cross-sectional, descriptive and analytic study done on 18 months period. Results: Overall, 142 patients were gathered. The average age was 56.22 years and the sex-ratio was 0.67. 87.2% of the patients were running type 2 diabetes. The capillary blood glucose and glycated hemoglobin were respectively around 3.24 g/L and 9%. High Blood Pressure was found in 62% of cases. The type of footwear most used by our patients was sandals (96.3%). Also, 30.6% of patients walked barefoot. Prior ulceration and/or amputation were noted in 30% of cases. During the foot examination, a lesion was found in 15.5% of patients. Loss of monofilament sensitivity was about 66.7%. The Ankle-Brachial Index (ABI) less than 0.9 was recorded in 34% of patients and at least a quarter of patients were posteriorly tibial pulselessness. The gradation of the foot risk according to the International Working Group of the Diabetic Foot (IWGDF) was established as follow: grade 0 (58%), grade 1 (9.8%), grade 2 (14.3%), grade 3 (17.3%). The presence of neuropathy (OR 12. 162 [3.368 - 43.923];p = 0.000), plantar keratosis (OR 2.87 [1.119 - 7.399];p = 0.024) and the absence of pulse perception (OR 9.00 [3.205 - 25.414];p = 0.000) were significant associated factors of foot injury occurrence on our patients. Conclusion: The prevention of diabetic foot in emerging countries is accessible by a systematic clinical examination of all diabetic feet and the awareness of adapted footwear.展开更多
文摘Tetanus is an infection caused by Clostridium tetani. The disease has been described from the earliest medical literature. Despite this old knowledge, the existence of a vaccine, and the progress made in pathophysiology and treatment, tetanus remains a real public health problem, particularly in developing countries. Tetanus in children and adults is still a frequent cause of hospitalization in the Infectious and Tropical Diseases Department (SMIT) of the Fann National University Hospital (CHNU). We conducted this study with the main objective of carrying out a situational analysis of tetanus at SMIT from 2010 to 2017. We recorded 706 cases of tetanus in a total of 8123 hospitalized patients. The median age of the patients was 23 years [1 - 90 years]. The sex ratio (M/F) was 4/1. More than half (58.78%) came from suburban areas. The population was most frequently made up of students (24%) or manual workers (22.1%). At least one comorbidity was present in 107 patients (15.15%). The absence of a vaccination record was found in 99.56%. The main portal of entry was integumentary (83.3%), post-circumcision (5.7%) and otogenous (4%). Tetanus was generalized in 93.9% of cases. The main signs of tetanus found were trismus and dysphagia. Patients were most frequently classified as stage II (78.7%). Antibiotic therapy was based on metronidazole (51.41%). Anti-tetanus serotherapy was carried out by sub-occipital administration in 97.6%. Tracheostomy was performed in 48 patients. Complications occurred in 226 patients (32.01%). The main complications were respiratory (53.98%), infectious (45.13%) and cardiovascular (41.59%). The average delay in hospitalization was 3.6 ± 3.4 days. The mean length of hospital stay was 11.9 ± 8.2 days. The hospital case-lethality rate was 18.98%. Despite the decline in cases over the years in our country, tetanus remains a public health problem because of its prevalence, severity, and lethality.
文摘Background: Ovarian tuberculosis is a rare form of tuberculosis. Its clinical presentation mimics an ovarian tumor, leading to misdiagnosis. Proper treatment with anti-tuberculosis drugs can lead to a cure for the disease but can sometimes cause adverse effects that compromise therapeutic management. Observation: We report a 71-year-old female Senegalese patient who presented with a chronic abdominopelvic mass with an elevated Cancer Antigen 125 (CA125) level, raising the suspicion of an ovarian tumor. She underwent an exploratory laparotomy and the anatomopathological study confirmed the diagnosis of ovarian and peritoneal tuberculosis. After starting treatment with anti-tuberculosis drugs, she developed toxidermia in the form of generalized urticaria. Discontinuation of the four-drug therapy and separate reintroduction of anti-tuberculosis drugs led to the incrimination of rifampicin. Progress was then favorable on Isoniazid (H) pyrazinamide (Z) and Ethambutol (E). Conclusion: Ovarian tuberculosis should be suspected in the presence of an abdominopelvic mass in a woman living in an endemic area. The occurrence of adverse reactions to anti-tuberculosis treatment is not uncommon, hence the importance of regular monitoring.
文摘Background: Among patients treated for tuberculosis, 2% to 5% have a Central Nervous System (CNS) lesion, and its frequency rises to 10% in HIV-infected patients. Neuro-meningeal tuberculosis (NMT) is responsible for death and severe permanent neurological damage. This poor prognosis requires early diagnosis and rapid initiation of specific treatment. Unfortunately, the great clinical polymorphism and the lack of specificity of radiological and biological signs are frequently responsible for a delay in diagnosis and management. Senegal is one of the African countries where tuberculosis has remained a concern until now. And there are no studies carried out on this subject. Objective: The objective of this study was to describe the profile and outcome of Neuro-meningeal tuberculosis (NMT) cases diagnosed at the infectious diseases department (SMIT) of Fann University Hospital in Dakar, (referral service for management of tuberculosis). Methods: We carried out a retrospective, descriptive and analytical study, reviewing medical records of adults diagnosed with NMT at the SMIT of Fann Hospital from January 2015 to December 2020. Results: We collected 55 cases of NMT. The median age was 38 years [range 16 - 77 years]. The sex ratio (M/F) was 3.23. HIV patients represented 41.82% of cases. A history of tuberculosis was found in 25.5% of cases. The delay in consultation was greater than one month in 60% of patients. Headaches were the most constant reason for consultation (94.55%). Meningeal signs were present in 94.55% of patients, and consciousness disorders and intracranial hypertension were present in 63.64% and 56.36% respectively. Nerve palsy was found in 38.18%. CSF was clear in 81.64%. GeneXpert MTB/RIF in CSF was performed in 33 patients and was positive in 4 patients. Brain CT was abnormal in 72.09% of cases. Tuberculoma, hydrocephalus and meningeal contrast enhancement were the main lesions. The neuro-meningeal localization was associated with a pulmonary form in 32.7%. The lethality rate was 21.8%;higher in women (46.2% vs 14.3%;p = 0.01), in patients with a delay in consultation > 1 month (p = 0.03), and in patients who presented with consciousness disorders (p = 0.007). Conclusion: Despite the availability of the GeneXpert MTB/RIF, diagnosis of NMT remains difficult. Because of its variable clinical expression and the low sensitivity of the GeneXpert MTB/rif in the CSF, it exposes patients to serious complications. Among the factors associated with death, we found consciousness disorders, a long delay in diagnosis.
文摘First described in 1907 by James Ramsay Hunt, Ramsay Hunt syndrome is a recurrence (reactivation) of varicella-zoster virus (VZV) affecting the geniculate ganglion, secondary to a decrease in cell-mediated immunity. The strict definition of Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by erythematous vesicular rash on the ear. We report a 57-year-old female immunocompetent patient complaining of otalgia, small vesicles on the Ramsey Hunt Zone. She does not complain fever, hearing loss, nausea, vomiting or dizziness. There was no peripheral facial nerve palsy, no reduction of taste sensation, no ataxia or nystagmus, Romberg sign was negative. Our patient targets two of the three criteria needed for the diagnosis of Ramsay Hunt syndrome. She began to take Acyclovir-Steroid (AS) therapy very early with good outcome. This suggests that prompt diagnosis and management improve outcome and prevent occurrence of nerve palsy in Ramsay Hunt syndrome.
文摘Laryngeal tuberculosis is a rare form of extrapulmonary tuberculosis, often complicating pulmonary tuberculosis that may be unrecognized. Its clinical presentation is nonspecific, often pointing to cancer. We report the case of a 77-year-old woman, with no reported pathological history. She also has no alcohol or tobacco intoxication, who presented with chronic dysphonia evolving for 2 months, associated with an altered general condition. The examination of the larynx by direct laryngoscopy and anatomical pathology study of the biopsies led to the diagnosis of laryngeal tuberculosis. A search for secondary sites revealed a concomitant pulmonary infection. The evolution was favorable under standard anti-tuberculosis treatment, with complete voice recovery and improved performance status. Laryngeal tuberculosis should be suspected in patients living in endemic areas and suffering from chronic dysphonia, even if they are not alcoholics or smokers.
文摘Introduction: Tetanus portals of entry are numerous. Amongst these, the carerelated portals of entry are rarely reported. The aim of the study was to describe the epidemiological, clinical and outcome aspects and identify the factors associated with death from care-related tetanus. Patients and Methods: This is a retrospective study of descriptive and analytical purposes. Data were collected from the medical records of patients admitted to the Infectious and Tropical Diseases Department of the National University Hospital Center (CHNU) of Fann in Dakar for care-related tetanus during the period ranging from 1 January 2009 to 31 December 2016. Care-related tetanus was defined as any case of tetanus occurring after a surgical procedure, including circumcisions performed even outside a health facility. Results: In eight years, 50 cases of care-related tetanus were recorded. Care-related tetanus accounted for 6.7% of hospitalized tetanus cases. The mean age of patients was 21 ± 22 years, with a male predominance (sex ratio: 6.14). The procedure had been performed in most cases, either in a health facility in 22 patients (44%) or at home in 16 patients (32%), and occurred after circumcision. In 62% of cases the portal of entry was urological, followed by orthopedic surgery (14%) and visceral surgery (10%). The procedures performed were dominated by circumcision (31 cases), limb amputation (3 cases) and inguinal hernia repair (2 cases). Tetanus was immediately generalized on admission in all patients. Eighty-four percent (84%) of patients were admitted with Mollaret stage II. Cardiovascular (11 cases), infectious (10 cases) and respiratory (9 cases) complications were the most frequent. The hospital case fatality rate was 24%. Factors associated with death were female gender (p = 0.03), age between 15 - 60 years (p = 0.02), incubation time Conclusion: Care-related tetanus remains a concern in poor income countries, particularly in Senegal. The drop of these cases will require better immunization coverage of the population. It is also appropriate to raise the awareness of health care providers and surgeons and to promote capacity building for better prevention of cases through sero-immunization of patients at risk before the procedure and rigorous asepsis.
文摘Introduction: The peripheral artery disease (PAD) is one of the chronic and frightening vascular complications of the diabetes whose tracking can be done by the Ankle-Brachial Index (ABI) measurement. We conducted in this context a study which consisted in measuring the ABI among hospitalized diabetic patients at Teaching Hospital of Pikine in Dakar, over 18 months’ duration. The aim was to determine the prevalence and evaluate factors correlated to the presence of the PAD. Patients and Method: This cross-sectional descriptive study interested the whole of diabetic patients hospitalized in Internal Medicine/Endocrinology Department, from January 2013 to June 2014. We carried out a complete clinical examination associated with ABI measurement by a Doppler probe for each included patient after having collected the clinical and paraclinical data. Results: Our population of study comprised 209 diabetic patients with a female predominance (126, 60.3%). The sex-ratio man/woman was 0.6. The median age of the population of study was 54 ± 2 years. In our series, 157 (75.1%) patients discovered their diabetes with the waning of an affection while the 52 (24.9%) other patients discovered their diabetes at the time of a systematic assessment. The PAD appeared by an intermittent claudication among 38 patients (18.2%). The ABI was normal for 126 patients (60.3%). The ABI was low for 51 patients (24.4%), unilateral in 3.8% of cases and bilateral in 20.6% of cases. The ABI was high among 32 patients (15.3%), unilateral in 7.2% of cases and bilateral in 8.1% of cases. The ABI extremes values were 0.11 and 2. In the population of study, 46 patients (22%) had a well-compensated PAD. The PAD was low compensated for 3 patients (1.4%) and severe for 2 patients (1%). The ABI was more frequent and significantly among women than men, with 32 cases (25.4%) against 19 (22.9%) cases (p = 0.021). The proportion of low ABI was more important among patients whose diabetes had evolved for more than 5 years (42.3% of cases) with a peak of frequency in the duration of 6 - 10 years (47.7% of cases). Conclusion: The PAD global prevalence among hospitalized diabetic patients appeared high with 24.4% patients presenting low ABI. Its early diagnosis among subjects at risk as for our study population allowed identifying asymptomatic subjects having another cardiovascular damage. Thus, the screening of obstructive arteriopathy of lower limb PAD by the measurement of ABI should be applied to all diabetic patients for a better assessment of atherosclerotic complication.
文摘Introduction: De Quervain’s subacute thyroiditis is an inflammatory granulomatosis with clinical presentation some time atypical leading eventually to misdiagnosis or inadequate treatment. In our area, physician should be aware of this possible etiology in presence of recent and acute features of thyrotoxicosis with or without painful firm goiter. We illustrate this fact with two new observations from Sub-Saharan Africa. Observations: Our first patient is a 70-year-old Guinean woman presenting a painful nodular and hard goiter at palpation. Her history was recent in a context of deterioration of the general state with a sub clinical thyrotoxicosis syndrome. The diagnosis of probable malignant thyroid tumor was evoked initially and a thyroidectomy considered. She presented an important biological inflammatory syndrome and biological peripheral hyperthyroidism. Neck ultrasound examination showed heterogeneous patchy decreased echogenicity. The diagnosis of subacute De Quervain’s thyroiditis was set up. A corticosteroid therapy at a rate of 20 mg/day of prednisone was begun with a fast degression of dose. After 3 weeks of treatment, we noticed total clinical recovery normalization of biological parameters. The second observation was about a 52-year-old Senegalese women living in Bamako. She presented cervical pains evolving for 2 months in a context of flu-like syndrome associated with thyrotoxicosis and marked biological inflammatory syndrome. The thyroid ultrasound showed global heterogeneity with characteristic aspect of “geography map” leading to the diagnosis of subacute thyroiditis. A combination therapy with low dose of prednisone, ß-blockers and tranquillizers. We noticed fast disappearance of clinical and biological signs. At 5 mg per day of prednisone, there were moderate signs of relapse with rapid favorable evolution after few days under increased dose of prednisone up to 10 mg/day. Conclusion: De Quervain’s thyroiditis can appear under misleading features opening out to make wandering diagnosis. A good clinical evaluation coupled with hormonal and ultrasound thyroid examination may help for right management. The use of low dose of corticosteroid had enabled us to obtain a fast control of main clinical and biological abnormalities.
文摘Introduction: Management of pheochromocytoma faces different challenges leading to misdiagnosis and therapeutic delay in developing countries. The aim of our study was to evaluate the diagnostic and therapeutic features as well as the evolution of our management strategies in hospital setting in recent years in Dakar. Patients and Method: We carried out a retrospective study over 12 years (January 2005 to June 2017), in 4 hospitals in Dakar. We only included patients with established diagnosis of pheochromocytoma upon clinical, biological, radiological and histological arguments. Results: During this period, 16 observations have been collected and were all about female patients. The mean age at the time of diagnosis was 36.81 years. The clinical signs were dominated by hypertension found for 14 patients. At biological examination, hypersecretion catecholamine was found in 13 patients, high urinary metanephrines in 7 patients, high plasmatic metanephrines in 2 patients and raised urinary Vanyl Mandelic Acid (VMA) in 4 patients. Dosage of chromogranin A showed high level for one patient. Abdominal CT scan allowed making the adrenal origin of tumors precise. One patient presented bilateral pheochromocytoma. Before being treated surgically, all patients had had medical preparation. The surgical treatment by median laparotomy consisted of an enucleation of the tumor in 2 patients, and adrenal resection in 11patients.The evolution after surgery was favorable in 12 patients out of 13. One patient died 2 days after surgery by hemodynamic instability. In 2 patients who presented metastases, multidrug therapy with cyclophosphamide, vincristine and dacarbazine was decided after a multidisciplinary meeting, but they died before treatment. Conclusion: Management of pheochromocytomas in developing countries is obviously improving, but the mortality rate remains high. Early diagnosis and perioperative care are to be targeted for better outcome and prognosis of this rare tumor in our areas.
文摘Introduction: The Adult Onset Still’s Disease (ASD) is a systemic auto-inflammatory affection of unknown cause seldom described in sub-Saharan Africa. We report 3 observations of ASD illustrating the diagnostic and therapeutic difficulties of this affection in our areas. Observation 1: Our first patient is a 56 years old schoolteacher presenting an ASD in its chronic articular form. She had been followed for an inflammatory arthralgia for 10 years and of the pharyngal pains without exact diagnosis. She presented ASD’s criteria of Yamaguchi and of Fautrel. The prednisone was begun at the dose of 0.8 mg/kg/day with fast appearance of a progressive muscular weakness. Use of methotrexate at a rate of 15 mg per week, associated with low dose of prednisone was effective in long-term without any flare of the disease so far. Observation 2: Our second patient is a 30 years old dressmaker presenting an ASD in its complicated systemic form of lymphohistiocytic activation syndrome. She validated the criteria of Yamaguchi and Fautrel for ASD. She also presented resistance to corticosteroid therapy. The evolution was marked by a hospital-acquired septicemia and a multi-organ failure leading to death. The diagnosis was retrospectively confirmed after that, with the low level of the glycosylated ferritin serum value. Observation 3: The third patient is a 22 years old Guinean student who presented prolonged fever and inflammatory polyarthralgia without articular deformation. He had been misdiagnosed for ASD with diagnostic wandering of several months. He was treated successfully with prednisone after set up of ASD diagnosis according common criteria. Corticosteroid therapy was stopped after 8 months without any relapse noted so far. Conclusion: Caring for ASD is difficult in our context mainly because of high cost of several explorations needed to set up its exact diagnosis while making differential one. Evolution under corticosteroid therapy is usually favorable but diagnostic delay may lead to severe complications and death.
文摘The prevention of diabetic foot goes through a systematic podiatric assessment of diabetic patients permitting to identify the foot at risk. Then, we realized a study in the Internal Medicine Department at Pikine Teaching Hospital in Dakar with the assessment of foot risk on admitted diabetic patients as our main objective. Methods: It was about a prospective cross-sectional, descriptive and analytic study done on 18 months period. Results: Overall, 142 patients were gathered. The average age was 56.22 years and the sex-ratio was 0.67. 87.2% of the patients were running type 2 diabetes. The capillary blood glucose and glycated hemoglobin were respectively around 3.24 g/L and 9%. High Blood Pressure was found in 62% of cases. The type of footwear most used by our patients was sandals (96.3%). Also, 30.6% of patients walked barefoot. Prior ulceration and/or amputation were noted in 30% of cases. During the foot examination, a lesion was found in 15.5% of patients. Loss of monofilament sensitivity was about 66.7%. The Ankle-Brachial Index (ABI) less than 0.9 was recorded in 34% of patients and at least a quarter of patients were posteriorly tibial pulselessness. The gradation of the foot risk according to the International Working Group of the Diabetic Foot (IWGDF) was established as follow: grade 0 (58%), grade 1 (9.8%), grade 2 (14.3%), grade 3 (17.3%). The presence of neuropathy (OR 12. 162 [3.368 - 43.923];p = 0.000), plantar keratosis (OR 2.87 [1.119 - 7.399];p = 0.024) and the absence of pulse perception (OR 9.00 [3.205 - 25.414];p = 0.000) were significant associated factors of foot injury occurrence on our patients. Conclusion: The prevention of diabetic foot in emerging countries is accessible by a systematic clinical examination of all diabetic feet and the awareness of adapted footwear.
