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Background: Buruli ulcer is an infection caused by Mycobacterium ulcerans occurring in tropical areas. In West Africa, it is an emerging threat mainly affecting children aged under 15years. This chronic disease is complicated by dystrophic scars in which squamous cell carcinoma can occur in the long term., Patients and Methods: This is a retrospective study of squamous cell carcinomas in Buruli ulcer scars seen at the Treichville University Hospital (Abidjan, Ivory Coast) over a five-year period., Results: During the study period, 8cases were observed and concerned young adults presenting Buruli ulcer in their childhood. Tumours were restricted to the limbs, with loco-regional invasion. Treatment was primarily surgical. Four of the patients died., Discussion: The risk of recurrence of cancer in these scars remains poorly evaluated, highlighting the importance of long-term monitoring strategies for human patients in order to ensure rapid identification of any changes in Buruli ulcer scars., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Melanoma is a malignant tumor rarely being described in sub-Saharan Africa. We reported an unusual and atypical clinical presentation. It was a 59-year-old patient who was hospitalized for a monomelic black tumor evolving for 10 years. Histopathological examination confirmed the melanocytic origin of this tumor. Paraclinical assessment did not find any visceral metastasis. A partial resection of the tumor was performed. The patient left the hospital against medical consent due to lack of technical facilities. The delay in the consultation and the lack of knowledge of melanoma by doctors and patients might contribute to the severity and the difficulties of its management.

Background: Melanoma is responsible for 75% of all skin cancer-related deaths. Lentigo maligna (LM), the most prevalent melanoma in situ (MIS), accounts for 79-83% of all MIS. Its location in the head and neck area requires that tissue be spared in the course of clearing the tumor., Methods: We conducted a therapeutic study based on our practice experience with the so-called "collarette" skin biopsy technique used in the management of LM., Results: Thirty-one patients were diagnosed with LM in the head and neck area. These included 16 women and 15 men with a mean ± standard deviation (SD) age of 64.4 ± 13.6 years (range: 33-88 years). The majority (36%) of lesions were located on the cheek. To clear the tumor, surgery was performed using margins of >10 mm in 71% of cases. The average surface area of the surgical defect was 5.8 cm(2) (range: 1.1-15.5 cm(2) ). Reconstructive skin grafts were performed in the majority (68%) of cases. After the removal of the central tumor, 16 cases of MIS and 15 cases of invasive melanoma were identified. Only one patient experienced recurrence over a mean ± SD follow-up of 31 ± 16 months., Conclusions: The so-called "collarette" or "spaghetti" skin excision and biopsy technique is an advantageous and efficient way to achieve tumor clearance and represents an equally effective alternative to Mohs micrographic surgery in the treatment of LM in the head and neck area., (© 2013 The International Society of Dermatology.)

Background: Buruli ulcer (BU) denotes a cutaneous infection by Mycobacterium ulcerans endemic in certain tropical and subtropical regions. Treatment may be either medical and surgical or else purely medical for early lesions. The literature contains reports of several cases of transient aggravation of BU following initiation of medical treatment. We report a case observed in the Ivory Coast, one of the areas with the highest prevalence of BU worldwide. The distinguishing features of our case are the early onset of this paradoxical reaction and the multiple cephalic site of lesions., Patients and Methods: A 4-year-old child with no prior medical history was referred for two painless ulcerative cutaneous nodules. Incubation of samples from the edges of these lesions revealed the presence of acid-alcohol resistant bacilli (AARB), which were shown by PCR to be M. ulcerans, the causative agent in BU. Treatment consisted of levofloxacin (100mg/d) and rifampicin (150mg/d) for 8weeks. After 7days of medical treatment, seven painless nodules appeared on the patient's scalp. Further PCR for these lesions confirmed the presence of M. ulcerans. The same medical therapy was maintained and after 54days of treatment, all lesions had been healed., Discussion: The originality of this case rests on two features: the bifocal aspect of the lesions, which is uncommon, and the early development of cephalic predominance that occurred after the start of drug treatment. While cases of lesions secondary to initiation of medical therapy have already been described, such lesions generally occurred after at least 2months of treatment and did not involve the head., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Necrotizing fasciitis is a severe soft tissue infection caused by flesh-eating bacteria. It usually occurs on the lower limbs. The purpose of this report is to describe a case involving Streptococcus pyogenes on the breast of a 22-year-old African woman with HIV.

Buruli Ulcer, a common tropical disease, is endemic in West Africa in particular in Cote d'Ivoire, where it represents the second mycobacterial disease after Tuberculosis. The late diagnosis and treatment as well as, the lack of surveillance, lead to large skin ulcerations, local or multifocal osteomylitis and some time it may lead to neoplasia which contribute to worse the prognosis of the patient. We presented a case report in a girl of 16 years old, who died from an aggressive squamous cell carcinoma of the upper limb secondary to Buruli Ulcer. This case report showed the importance of early detection and treatment, a specific surveillance for Buruli Ulcer infected patients, a need for them to be vigilant and to report any suspected skin lesions even after healing, and the need for a good prevention strategy in Buruli Ulcer endemic areas.

Histoplasmosis is a subcutaneous mycosis caused by dimorphic fungus which is to be found in two types: the capsulatum and duboisii types. The capsulatum type has had an increasing incidence with the HIV-AIDS epidemics but it is not demonstrated that the duboisii one has had the same upward incidence. Signs in children and immunocompetent patient are rarely described during this disease. The diagnosis is often late in the child as it looks like Molluscum contagiosum lesions. We report a case of skin histoplasmosis of duboisii type non associated with HIV infection in a child. Diagnosis has been confirmed by a histopathological test of a nodule biopsy. Medical treatment was successfully based on itraconazol.

Pyoderma gangrenosum is an uncommon chronic ulcerative dermatosis with unknown aetiology and with a pathology which is still obscure. In 15-45% of cases, it is related to intestinal chronic inflammatory disease (MICI), to a systemic disease that it can sometimes reveals or to an immunodeficiency This disease starts whether with a pustule, a bubble or a nodule which leads during its evolvement to a superficial ulceration with clear edges. Its diagnosis is easy and is mainly clinical. It is a disease which is localized preferably in lower limbs. Treatment is mainly based on oral route corticotherapy. We report a case of gangrenosum pyoderma localized on the penis in a 43-year-old HIV infected patient. It is an uncommon localization, misleading and delicate. We have treated successfully this patient by oral corticotherapy combined with local antiseptic treatments for 6 months.

Buruli ulcer is still a public health problem in Côte d'Ivoire. Its physiopathology is poorly described and suggests a new clinical form. We report a clinical case in a 18-year-old patient who had a cold abscess on the right elbow. The histopathology test revealed a Mycobacterium ulcerans infection. The treatment consisted in antimycobacterial therapy and surgical care. The clinical healing was observed during 4 months of hospitalization. This form of Mycobacterium ulcerans with cold abscess, the first case described so far, requires great vigilance in clinical detection of cases and underlines the importance to intensify microbiological research mainly in endemic areas.

Context: Cheloid scars are common in black African. Treatment is not adequately codified and chronicity of these cheloid scars is responsible for frequent recurrences., Objective: To assess treatment of cheloid scars for their codification., Material and Methods: This study has been conducted in the dermatology unit. It is a therapeutic and prognostic study over one year. All the patients bearing cheloid scars and who agree to take part in this study were included., Results: Average age was 28 without any sex predominance. The most used treatment was the combination of surgery and corticoid injections in 66% of cases. We had achieved a rate of 94.5% of good results when combining injections, surgery and pressotherapy., Conclusion: Therapeutic method combining injection of corticoid to surgery and to other therapeutic means provide good outcomes. It should be done in accordance with the clinical features of the cheloid scar.

Infection due to Mycobacterium ulcerans or Buruli ulcer usually occurs on the limbs (70%) or trunk (20%). Involvement of the head and neck region is less frequent but can lead to serious sequels. The purpose of this report is to describe 8 patients including 7 children who were treated for Buruli ulcers on the head in the dermatology department of the University Hospital Center in Abidjan, Cote d'Ivoire. Eye lesions and visual impairment were the most frequent sequels.

Histoplasmosis is a deep mycosis whose capsulatum variety is recognized as being an AIDS-defining infection. However AIDS associated with Histoplasma capsulatum var. duboisii is rarely reported. We report a case of cutaneous duboisii histoplasmosis associated with AIDS which has been mistaken for molluscum contagiosum for many months. The diagnosis has been confirmed by means of a biopsy of a nodule followed by an anatomo-pathological examination. The medical treatment was successfully based on combination Triomune (stavudine + lamividine + nevirapine) and itraconazole.

Mycobacterium ulcerans infection or Buruli ulcer begins by a papule, nodule, blotch or oedema and develops into ulceration with complications which can lead to disabilities. Its prevalence is high in West Africa and in Côte d'Ivoire particularly. Until recently, only ulcerated forms were mostly observed, whereas nodular ones were unnoticed or did not draw patients' attention. From 1999 to 2002 we conducted a before-after survey in the endemic area of Zoukougbeu located in Daloa region, the central west part of Côte d'Ivoire in order to assess the potential impact of a screening and treatment strategy for nodular forms of Buruli ulcer on ulceration rate decrease. The survey used clinical criteria necessary to identify Buruli ulcer nodule which were defined according to a former study carried out in the same area in 1998. As result of our survey 781 Buruli ulcer cases were reported of which 34.7% were ulcerative forms, 61.1% were nodules and 4.2% were other forms (blotch and oedema). By comparing the data of 1999, when the prevention program started, to those of 2002, we observed a drop of 47.6% in the ulcerative lesions and an increase of 57.4% in nodule ones. These changes were statistically significant (p < 10-5). Annual trend, from 1999 to 2002, showed a decrease in the detection rate of the respective forms under study. It ranged from 25.8/10000 to 7.3/10000 for ulcerative lesions and from 23/10000 to 19.7/10000 for nodules. In spite of possible defects in the methodology of a before/after survey the incidence decrease of both ulcerative and nodular forms that coincided with the prevention program probably reflects the efficacy of the secondary prevention program that promotes early diagnosis and treatment of nodular forms of Mycobacterium ulcerans infection.

Caused by Mycobacterium ulcerans, Buruli ulcer is an infectious disease which leads to large cutaneous ulceration and is responsible for huge socio-economic consequences. Since 1997 the World Health Organization has started a global Buruli ulcer initiative in which African endemic countries are committed. After an epidemiological background of the disease in Côte-d'Ivoire and a description of the different clinical aspects, we report the main disease management actions carried out in the country by the National Program for Buruli ulcer control from 1998 to 2003. It seems that surgical team missions carried out in health center to treat cases, early detection and treatment of cases together with the implementation of a specific poly-chemotherapy lead to an effective control of the disease.

Mycobacterium ulcerans infection (Mu) is an emerging public health problem. The cumulative number of cases in Ivory Coast was 10,382 in 1997. One of the key points of the Yamoussoukro "global initiative" in December 1997 involved detection and treatment of cases at the early-disease stage. The threefold purpose of this transversal study was to determine the frequency of nodular-stage Mu infection, to describe the features of the nodules, and to identify nodular features suitable for early screening use. Of the 93 nodules removed, 58.1% were due to Mu, indicating that the prevalence of nodular-stage Mu in Zoukougbeu, Ivory Coast was 9 per 1000 inhabitants. All Mu nodules were recent, caused pruritus, and displayed oedematous edges. The mean duration of disease was 23 months. In endemic areas, Mu infection should be suspected for any lesion that is of recent onset (< 5 year), shows visible elevation, has a diameter of 3 cm or more, or is mobile under the skin. Cold nodules that are adherent to the superficial skin layer and located on the limbs or firm cold nodules should also be considered as suspect. Excision of cold nodules caused by Mu is recommended. The wound heals within 4 weeks and no recurrences have been reported after 6-month follow-up.

Current treatment of Buruli ulcer is mainly surgical. However, surgical management is difficult due to occurrence of more and more recurrent cases after treatment. This cross section study has been carried out from records of 346 Buruli ulcer patients who have received surgical treatment in three health centers in Cote d'Ivoire. Its purposes consisted in assessing the recurrence rate, in describing its aspects and in identifying its causes. Results showed that recurrent cases during Buruli ulcer were relatively frequent after surgery with a rate of 17.1%. They occurred early during hospitalization in an average of 5 months after surgery. They appeared mostly in ulceration form and were located on the previous lesion site. After statistical analysis, the following risk factors are associated with Buruli ulcer recurrent cases: patient under 30 years old, previous contact with a watercourse, duration of the disease exceeding 75 days before hospitalization, secondary infection before or after surgery disability, treatment by excision and skin graft, ongoing healing of operated wound. Recurrent cases after surgical treatment should not be neglected during Mycobacterium ulcerans infection. Surgeon must consider their prevention during patients treatment.

Objective: Buruli ulcer disease (BU), caused by Mycobacterium ulcerans, is endemic in many regions of Africa and causes substantial physical disability. Surgical resection, currently the mainstay of clinical management of BU, is impractical in many endemic areas. Therefore, the study was undertaken to evaluate an antibiotic regimen for medical management of BU., Methods: A randomized, placebo-controlled pilot study of dapsone plus rifampin versus placebo was conducted., Results: Forty-one participants were recruited in a BU-endemic zone of Côte d'Ivoire. Thirty persons completed the 2-month trial: 15 were treated with placebo and 15 with dapsone and rifampin. On blinded evaluation of photographs of the ulcers, clinicians with experience examining BU judged that 82% of ulcers in the treatment group improved compared with 75% in the placebo group (P=0.51). The median change in ulcer size was a decrease of 14.0 cm2 in the treatment group and a decrease of 2.5 cm2 in the placebo group (P=0.02), but initial ulcer sizes were larger in the treatment group (median 26.2 cm2) compared with the placebo group (median 4.8 cm2) (P=0.04)., Conclusions: Results of this study indicate that larger studies of antimycobacterial therapy of BU are warranted and can be successfully undertaken.

Ulcer caused by Mycobacterium ulcerans and called Buruli ulcer is characterised by large cutaneous ulceration which often leads to debilitating sequelae. The disease occurs in swampy and stagnant water areas in intertropical regions of Asia, the Indian Ocean, Latin America and Africa. West Africa has been affected for two decades with a significant increase in the last ten years. In Côte d'Ivoire, from 1991 to 1994, 2,246 cases have been detected. In 1995, the cumulative number was 5000 cases distributed throughout the forested and marshy areas of the southern part of the country. In order to assess the magnitude and severity of the disease in Côte d'Ivoire and to collect data necessary for developing a control plan, the National Programme of Buruli Ulcer Control (PNUM) conducted an extensive cross-sectional nation-wide survey. The results provide a total cumulative number of 10,382 cases distributed throughout almost all regions. The number of active cases was 4,642 which was equivalent to a prevalence of 0.32 per 1000. Buruli ulcer is the second most prevalent mycobacteriose in Côte d'Ivoire after tuberculosis and before leprosy. From 1996, the average annual incidence exceeded 2,000 cases. Moreover, the main identified risk factor was the presence of a watering point used by people nearby. Children were affected at a rate of 57%, with male predominance, while in adult cases, the female rate was higher. Children and women enjoyed higher recovery rates. Ulcerated cases represented 89.5% of active ones against 6.5% for oedematous forms and 4% in nodule cases. Definitive sequelae were more frequently observed in children with no difference of sex. We conclude that Buruli ulcer has been endemic in Côte d'Ivoire and is characterised by the severity of the lesions.

Medical treatment of Buruli ulcer is mostly disappointing even if Mycobacterium ulcerans is susceptible to many antibacterial drugs. The inefficiency in vivo of the drugs may be due to the tissue vascularisation disorders caused by the toxin that Mycobacterium ulcerans produces. This toxin causes an endarteritis followed by a thrombosis of the dermal vessels responsible for an ischemia which prevents the antibacterial drugs from reaching the infected area. Removal or prevention of that thrombosis should allow the drugs to be more effective. To verify this assumption, we used a combined therapy with two gold standard medicines in an oedematous form of Buruli ulcer on the face which could not be surgically treated: heparin for its activity on thrombosis and rifampin for its bactericidal activity on Mycobacterium ulcerans. Rifampin was administered at 300 mg dose per day. Based on the management of envenomisation cases due to viper bites, we used standard heparin at 500 Ul dose per kg repeatedly administered by an electrical syringe releasing 1 cc per hour in the tubulure of isotonic glucose infusion. The results were encouraging. The dreadful oedema of the face started to reduce on the 15th day and disappeared on the 30th day. A small area at the temple dried. But we were obliged to stop the use of standard heparin due to an occurrence of Klebsiella oxytoca septicaemia from permanent vein route. Rifampin was still administered at the same dose. The face oedema reappeared quickly, followed by a full closure of the eyelids and an ulceration at the right temple level. The standard heparin was therefore substituted by low weight molecular heparin, enoxaparin, administered at 40 mg twice per day by subcutaneous route. 45 days later the oedema reduced and ulceration did not develop. After 90 days of treatment, usual signs of mycobacterial infection progression disappeared. We stopped therefore the use of enoxaparin but continued with rifampin until healing of the ulceration which occurred after 12 months of treatment. We observed no recurrence over a period of 16 months after complete healing. We can conclude that heparin combined with antimycobacterial drugs--which are active in vitro on Mycobacterium ulcerans--could provide an effective medical treatment for Buruli ulcer.

Genital ulcers are common manifestations of infectious disease. The incidence of genital ulcers featuring a chronic course has increased since the beginning of the AIDS epidemic. The purpose of this 18-month cross-sectional study was to determine the main infectious causes of chronic genital ulcers (CGU) and their correlation with HIV infection. A total of 29 patients with CGU defined as an ulcer showing no sign of healing after more than one month were studied. Mean age ranged from 24 to 54 years. The male-to-female sex ratio was 1:5. The etiology was herpes in 19 cases (65.5 p. 100), chancroid in 6 cases (20.6 p. 100), streptococcal infection in 2 cases (6.8 p. 100), Pseudomonas aeruginosa infection in 1 case (3.4 p. 100) and cutaneous amibiasis in 1 case (3.4 p. 100). Twenty-two patients (75.8 p. 100) presented HIV infection including 16 with HIV1 and 6 with HIV1 and HIV2. All patients with herpes were HIV-positive. Eighteen of these patients were in stage C3 of HIV infection. Genital herpes was the main etiology of UGC in patients with HIV infection (p < 0.001). Conversely chancroid was the main etiology in patients without HIV infection (p < 0.05). This finding suggests that herpetic CGU is highly suggestive of AIDS whereas chancroid CGU is not. Although syphilis is widespread in Africa, it was not a cause of CGU in this study. Search for herpes simplex virus or Haemophilus ducreyi in patients with CGU is an important criteria for presumptive diagnosis of AIDS in Africa.

The incidence of cutaneous atypical mycobacterial infections is increasing. Their clinical presentation is variable. The atypical mycobacteria are difficult to culture and thus diagnosis can be difficult to establish. PCR (Polymerase Chain Reaction) and mycolic acid analysis have recently been used for mycobacterial species identification, but are not routinely used. Risk factors for cutaneous atypical mycobacterial infection include (1) immunodepression due to HIV infection, lymphoma, leukemia or immunosuppressive therapy. Immunodepression is responsible for the emergence of cutaneous infections by a large variety of atypical mycobacterial species, particularly in industrialized countries. (2) The natural environment is directly responsible for the emergence of cutaneous infections but a small number of atypical mycobacterial species including M. marinum in Europe and North America, and M. ulcerans in the tropics. (3) The medical environment when sterilization is inadequate is also not uncommonly responsible. Clinical features are rarely specific for mycobacterial species, and thus analysis of factors relevant to treatment is more important than species classification. We describe environmental forms (Buruli ulcer caused by M. ulcerans is endemic in the tropics, and swimming pool granuloma which is the aquatic form of M. marinum infection), opportunist forms caused by various species in immunodepressed hosts and iatrogenic and accidental forms mostly due to M. fortiutum and M. chelonei. We review the literature and update the clinical characteristics and risk factors for these diseases.

Paired sera and cervicovaginal secretions (CVS) from 11 HIV-1- and 11 HIV-2-infected women, all clinically asymptomatic (CDC A1 and A2 categories), were analyzed for total IgG, IgA, albumin (HSA), IgG, and IgA antibodies to env-encoded surface glycoproteins of HIV-1 (gp160) and of HIV-2 (gp105), by comparison to 15 age-matched healthy controls. Secretion rates of IgG and IgA into CVS were evaluated by calculation of their relative coefficients of excretion (RCE) by reference to HSA. Cervicovaginal production of anti-HIV antibodies was evaluated by comparison between specific antibody activities of IgG and of IgA to HIV in CVS were, respectively, 6- and 4-fold increased, whereas the secretion rate of total IgG was 2.1-fold increased and that of total IgA was 2.5-fold reduced. In contrast, total IgG and IgA as well as their secretion rates were normal in HIV-2-infected women. In HIV-1- but not in HIV-2-infected women, HSA levels in cervicovaginal washings were twofold increased, demonstrating alteration of the mucosal barrier in HIV-1 infection. In HIV-1-infected patients, IgG and IgA to gp160 were detected in all sera and CVS. In HIV-2-infected patients, IgG to gp105 was detected in all sera and CVS, whereas IgA to gp105 could be detected in only half of sera and one-third of CVS. Cross-reactivity by IgG and/or IgA to HIV-1 or HIV-2 against the surface glycoprotein of the other HIV type was observed in sera as well as in CVS, and more frequently in HIV-2- than in HIV-1-infected women. Finally, the mean specific activities of IgG and of IgA to gp160 or gp105 were higher in CVS than in sera, evidencing a possible local synthesis of both isotypes in HIV-1 as well as in HIV-2 infections. As early as the asymptomatic stages, HIV-1 affects the cervicovaginal mucosa more than HIV-2 does, suggesting higher viral replication within the female genital tract in HIV-1 infection than in HIV-2 infection.

Paired sera and cervicovaginal secretions (CVS) from 30 women infected with human immunodeficiency virus (HIV) type 1 (before AIDS) were analyzed for IgG and IgA antibodies to HIV and for IgG, IgA, and human serum albumin. Subjects were compared with 30 aged-matched healthy controls. In HIV-infected women, cervicovaginal immunoglobulins were markedly increased, and IgG predominated. An increased immunoglobulin transudation was implicated, since cervicovaginal albumin levels were 2.3-fold above those of normal controls. Furthermore, IgG excretion by reference to albumin was increased 1.9-fold, whereas the IgA secretion tended to decrease, suggesting a possible enhanced local IgG synthesis. Mean IgG and IgA anti-HIV antibody titers were, respectively, 30- and 12-fold higher in serum than in CVS, but their mean specific activities were higher in CVS than in serum, suggesting a local synthesis of both isotypes. The IgA antibody response to HIV remained poor compared with the strong IgG response.

Recent reports have suggested increases in Buruli ulcer (BU), an infection caused by Mycobacterium ulcerans in west Africa. In 1991, we conducted surveillance for BU in a rural area of Cote d'Ivoire and identified 312 cases of active or healed ulceration. A case-control study was then performed to investigate risk factors for this infection. The rate of illness did not appear to differ between males and females (5.2% versus 7.5%; P = 0.11). The highest rate of illness was seen in the 10-14-year-old age group (143 cases per 1,000 population). New cases increased more than three-fold between 1987 and 1991, and local prevalence of BU was as high as 16.3%. Twenty-six percent of persons with healed ulcers had chronic functional disability. Participation in farming activities near the main river in the region was identified in the case-control study as a risk factor for infection (odds ratio [OR] for each 10-min decrease in walking distance between the fields and the river = 1.52, 95% confidence interval [CI] 1.01, 2.28, P = 0.046). Wearing long pants was protective (OR 0.20, 95% CI 0.06, 0.62, P < 0.005). We conclude that the incidence of BU is increasing rapidly in Cote d'Ivoire. Specific causes of this increase were not identified, but wearing protective clothing appeared to decrease the risk of disease.

Objective: To assess the frequency of CD4+ T-lymphocyte depletion in selected populations in West Africa and to determine whether an association exists between AIDS-like illnesses and CD4+ T-lymphocytopenia in HIV-negative individuals., Design: Retrospective review of databases and prospective case-control study., Setting: Project RETRO-CI, an AIDS research project in Abidjan, Côte d'Ivoire, a University Hospital and tuberculosis treatment and maternal and child health centres in Abidjan., Methods: We conducted a retrospective review of CD4+ T-lymphocyte counts performed between 1991 and 1992 on hospitalized medical patients, outpatients with tuberculosis, and women participating in a study of HIV-1 and HIV-2 mother-to-child transmission. A prospective case-control study was conducted in 1992 to examine the relationship between HIV-negative CD4+ T-lymphocyte depletion and wasting syndrome (wasting and chronic diarrhoea and/or chronic fever)., Results: In the retrospective data review, CD4+ T-lymphocyte counts < 300 x 10(6)/l were found in 9.6% of 115 HIV-negative hospitalized patients, in 4.2% of 312 ambulatory tuberculosis patients, and in 0.4% of 263 healthy women after delivery. In the case-control study, no association was found between CD4+ T-lymphocyte depletion in HIV-negative individuals and the presence of wasting syndrome. Increased mortality in HIV-negative individuals was associated with wasting but not with reduced CD4+ T-lymphocyte counts. In contrast, a trend existed for increased mortality with increasingly severe CD4+ T-lymphocyte depletion in HIV-positive patients. Tuberculosis was the most frequently proven or suspected diagnosis in HIV-negative individuals with wasting and CD4+ T-lymphocytopenia., Conclusions: In the absence of HIV infection, CD4+ T-lymphocytopenia is uncommon (< 1%) in West African asymptomatic individuals but is more frequent in those with tuberculosis (4%) and hospitalized patients (10%). CD4+ T-lymphocytopenia in HIV-negative individuals was not associated with wasting syndrome or increased mortality. There was no evidence for frequent, clinically relevant immune deficiency other than that associated with HIV infection.

We studied the efficacy and safety of cefetamet pivoxil (CAT), an oral aminothiazolyl cephalosporin, in a series of open, comparative multicenter studies in 207 women (four study centers) with uncomplicated gonorrhea, and summarized and pooled the results with those of earlier open dose-finding trials (360 men; six study centers). We compared single-dose treatment regimen of CAT--over the range of 400-1500 mg--with spectinomycin, thiamphenicol, ampicillin, or amoxicillin plus probenecid. The overall cure rates were 100% in 88 women treated with 1500 mg CAT and in 137 men treated with 1200 or 1500 mg CAT, 98% (114 of 116 men) in those treated with 800 or 1000 mg CAT, and 93% (42 of 45 men) in those treated with 400 or 500 mg CAT; the composite cure rate of the comparators was 97%. The tolerability of CAT (n = 428) compared favorably (1.8% adverse events) with that of the standard drugs (n = 139) (4.3% adverse events). Single-dose treatment with 1500 mg CAT is effective and safe in adults with uncomplicated gonorrhea.

Objective: (1) To determine the prevalence of HIV-1 and HIV-2 infections and associated risk factors in men attending Abidjan's three sexually transmitted disease (STD) clinics; (2) to examine the use of such sites for epidemiological surveillance., Design: Cross-sectional study., Setting: Abidjan's two main STD clinics (Clinics A and T), and the University Hospital Dermatology outpatients clinic., Patients: Consecutive patients with genitourinary symptoms., Main Outcome Measures: Prevalence of reactivity to HIV-1, HIV-2, and both viruses; descriptive characteristics of clinic attenders; clinical diagnoses of STD; risk factors associated with HIV-1 and HIV-2 positivity., Results: The overall prevalence of HIV (HIV-1 and/or HIV-2) infection was 21% (250 out of 1169; 16% HIV-1, 2% HIV-2, 3% dual reactivity). Overall prevalence varied by clinic: University Hospital Dermatology outpatients clinic, 39%; Clinic T, 19%; Clinic A, 10%. Men with STD had an overall prevalence of 31% (155 out of 506), compared with 14% in men without physical signs of STD (odds ratio 2.6, 95% confidence interval 2.0-3.6). The highest prevalence, 46%, was in men with genital ulcer disease. Risk factors associated with HIV-1 as well as with HIV-2 infection after multivariate analysis were a history of sex with prostitutes, lack of circumcision, being unskilled, and a history of prior genital ulcer. Current genital ulcer, current STD and positive Treponema pallidum haemagluttination assay were associated with HIV-1 and dual reactivity., Conclusions: Risk factors for HIV-2 infection in men attending Abidjan STD clinics were broadly similar to those for HIV-1 infection. HIV-1 infection was more strongly associated with current STD. Important differences between the three clinics were observed in STD prevalence and type, and HIV seroprevalence. Such differences should be taken into account in the planning of HIV serosurveillance in STD clinics.

The cardiac volume in decubitus was measured by Rohrer radiological method in 229 subjects, of which 150 were children of both sexes, aged 4 to 16 and 79 were adult males, 17 to 50 years old. Anthropometric parameters and maximum O2 consumption were also measured. Considering that the size of thorax in Ivory Coast natives is significantly smaller than that of a Caucasian, an eventual influence over the cardiac volume was looked for. Results showed that: -- in the child, the cardiac, volume increased linearly with age: 162 ml at 4 and 680 ml at 16; -- significant positive correlations were found between the cardiac volume, the body-weight andusrface, and the measurements of the thorax; -- when compared to data found in the literature, the cardiac volumes of children and adults of the Ivory Coast in relation with the body weight or surface are lower than the values found in Caucasians; -- children who have been swimming for two years and adults from the national swimming team have a cardiac volume significantly superior to that of Ivory controls; for these subjects, results are equivalent to those of Caucasians; -- there is a highly significant positive correlation between the cardiac volume and the maximum oxygen consumption. To compare values of cardiac volume in different populations, it is necessary that the groups of subjects be very homogeneous and have a comparable level of activity.