Sepsis and Macrophage Activation Syndrome: Two Successive Complications of Staphylococcus aureus Infection

The macrophage activation syndrome (MAS) and the sepsis are both a condition of hyperinflammation. The differential diagnosis can be difficult. The two pathologies can succeed with each other. The purpose of this literature review is to illustrate these diagnostic and therapeutic difficulties through a reported case of a macrophage activation syndrome secondary to infection (MASI). It was a 42- year- old diabetic man, hospitalized for an acute myositis due to an infection of Staphylococcus aureus. These germs caused a septic shock requiring antibiotic therapy. After an initial clinical improvement, the diagnosis of MASI post-Staphylococcus aureus was retained with a persistence of the inflammatory syndrome and appearance of fever with splenomegaly associated with hepatic cytolysis a 30% decrease in prothrombin time, a mild regenerative anemia without hemophagocytosis. An inflammatory syndrome may have several completely opposite etiologies and pathophysiology. Our case fulfilled both of the criteria of sepsis and MAS. Several signs were common for the two pathologies, but a detailed analysis of the clinical and biological elements lead to the diagnostic orientation

Rosai-Dorfman Disease Involving Multiple Organs: An Unusual Case with Poor Prognosis

Rosai-Dorfman disease is a rare, benign histiocytic proliferative disorder that usually affects the lymph nodes. Although extranodal involvement has been reported in diverse sites, manifestation in the cardiovascular system is extremely rare. Specifically, cardiac involvement in Rosai-Dorfman disease is an extraordinarily infrequent event. We describe a case of a 36-year-old female who presented Rosai-Dorfman disease of multiple organs including the heart, with poor prognosis

Cutaneous Manifestations of Lupus Erythematosus in Antananarivo (Madagascar)

Introduction: Lupus erythematosus is a serious autoimmune inflammatory disease. Mucocutaneous manifestations are themain clinical manifestations, so our aim is to determine the different cutaneous manifestations of lupus erythematosus in Antananarivo.Methods: A retrospective study was conducted over a period of 5 years from January 2007 to December 2011 in the medical derpartment of Joseph Raseta Befelatanana University Hospital.. All patients who presented lupus erythematosus were included.Results: Among 57,509 patients seen in Joseph Raseta Befelatanana University Hospital, sixty seven cases of lupus erythematosus were included. The mean age was 35.08 years [minimum: 9; maximum: 69 years]. The sex ratio was 0.06. Among these 67 patients, forty six presented cutaneous manifestations (68, 65%). As specific lesions in lupus, chronic cutaneous lupus was observed in 47.82%, acute cutaneous lupus in 30.43% and subacute cutaneous lupus in 06.52% of patients. The other dermatological manifestations found were alopecia in 52.17%, photosensitivity in 43.47%, Raynaud's phenomenon in 17.39% and bullous lesions in 06.52% of patients.Conclusion: A little difference was found in epidemiological, clinical and paraclinical aspects in lupus Malagasy patients and Africans. Lupus erythematosus is still a under-diagnosed disease in Madagascar. A deeper understanding of the cutaneous manifestations of SLE is essential for diagnosis and prognosi

Motifs d’Hospitalisation des Patients en Dermatologie à Antananarivo, Madagascar

Introduction: The Dermatology Department of the University Hospital Center of Befelatanana in Antananarivo deals with both outpatient and inpatient dermatoses. Two outpatient studies were conducted in 2001 and in 2006. But, this will be the first for Madagascar regarding hospitalization. So our aim is to determine the epidemiological-clinical profile of dermatoses seen in hospitalization.Patients and methods: This descriptive retrospective study was conducted from 1 February 2006 to 28 February 2012 in Dermatology department at the University Hospital Befelatanana. The register of hospital consultants and files were used to fill out data collection form.Results : We collected 286 patients seen in the Dermatology department. The mean age was 37.70 years (5- 98 years) with a sex ratio 0.49. Our study showed the importance of autoimmune diseases (33.3%) that are dominated by systemic lupus erythematosus (n = 51). It is a serious chronic pathology evolving by push. The management of severe toxidermia (25,1%) is done in hospital as in any other country. The mean duration of hospitalization was 34 days. The mortality rate was 3.49%.Conclusion: The serious forms of dermatological pathologies require management in hospital.

Observance Thérapeutique Au Cours Des Dermatoses Chroniques A Madagascar

Introduction: Therapeutic compliance is the adequacy of the patient's behavior regarding medical recommendations. In Madagascar, No survey has not yet been published in that regard. Thus, our purposes are to determine the compliancy rate of patients with chronic diseases in dermatology and to identify the factors affecting their therapeutic compliance.Methods: Monocentric descriptive and retrospective study performed in the dermatology department of Joseph Raseta Befelatanana University Hospital center, On a 6 months duration, among patients with chronic dermatoses.Results: We counted 133 patients with a compliancy rate of 35.34%. Several parameters particularly age, gender, educational level, salary, understanding of pathology and treatment, duration of follow-up, were considered and correlated with the rate of compliance to assess factors of good and bad compliance.Conclusion: In order to improve the therapeutic observance in care unit, It is necessary to intervene on the standard of living of the patients suffering from chronic dermatoses and to promote the therapeutic education accompanied by psychological support to make them understand their pathology as well as the appropriate treatment

Quality of Life in Patients with Psoriasis Seen in the Department of Dermatology, Antananarivo, Madagascar

Background. Psoriasis is a chronic, inflammatory, and multifactorial dermatosis that impairs quality of life (QoL). Health-related QoL has become an important element in medical decision-making along with the effectiveness and the harmlessness of the treatments. Objective. To assess the impact of psoriasis in the QoL of patients with psoriasis by using the DLQI scales. Methods. A cross-sectional study from January to June 2018 was conducted in the Department of Dermatology of the University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar, including patients more than 18 years old with mild to severe psoriasis. The severity of psoriasis was assessed using the “Psoriasis Area and Severity Index (PASI)”. QoL of patients with psoriasis was evaluated by using the DLQI scales. Results. 80 patients were included, their mean age was 36.5 years, and the male to female was 1.5 : 1. The mean DLQI score was 13.8. Symptoms, feelings, and psychic were the most altered dimensions. QoL was impaired in young patients, single, having medium level education. Even though patients with disease duration more than 5 years had higher DLQI score than other patients, the difference was not statistically significant (p=0.36). Furthermore, the clinical presentation of psoriasis did not influence the patient’s QoL (p=0.73). Patients with nail involvement had QoL impaired but the difference with another localization was not statistically significant (p=0.2). The quality of life was influenced by body area involved. The higher the body surface area involved, the more QoL is impaired (p=0.002). Furthermore, the higher the PASI, the more QoL is altered (p=0.002). Conclusion. Psoriasis has a negative impact in the quality of life in Malagasy patients with psoriasis, especially in younger and single patients. Worse quality of life is correlated to severity of psoriasis

Clinical aspects of previously treated chromoblastomycosis: A case series from Madagascar

International audienc

Atopic dermatitis in adults: A cross-sectional study in the department of dermatology, Antananarivo, MadagascarCapsule Summary

Background: Although atopic dermatitis (AD) is becoming a pressing public health concern in the world, Madagascar is underrepresented in the AD literature. Objective: We aimed to study the demographic and clinical pattern of AD in adult dermatology outpatients. Methods: A cross-sectional study was conducted in the Department of Dermatology, University Hospital, Antananarivo, Madagascar. Patients >15 years old with a registered diagnosis of AD, from January 2010 to February 2019, were included. AD was diagnosed by a dermatologist according to Hanifin and Rajka criteria. The severity of AD was assessed using scoring atopic dermatitis (SCORAD). Results: Forty-two cases of AD were included. The prevalence was 0.5%. The median patient age was 37 years. The age of onset of AD was before the age of 15 years in 38% of the patients and after the age of 15 years in 61.9% of the patients. There was a female preponderance (female to male ratio, 2:1), but no correlation was found between sex and the severity of AD. People living in urban areas were the most affected. According to SCORAD, 37 cases presented moderate AD and 2 cases presented severe AD. Conclusion: The prevalence of AD in adult dermatology outpatients is still low, and moderate AD is the most frequent form, according to SCORAD