Open Access

Research

Lupus in Bamako, Mali

Cutaneous tuberculosis in Bamako, Mali

Adama Dicko 1.2, Ousmane Faye 1.2, Youssouf Fofana 1, and, Moussa Soumoutera 1 Siritio Berthé 1.2, Saidou Toure 3 Bekaye Traore 2 Binta

Guindo 2 Tall Koureissi 2 Alimata Keita 2 lassine Keita 2 Karim Coulibaly 2 somita Keita 1.2

1 Department of Dermatology, National Support Center for the Fight against Disease, Bamako, Mali, 2 Medicine Faculty of Dentistry,

Bamako, Mali, 3 Regional Hospital of Sikasso, Bamako, Mali

& Corresponding author: Youssouf Fofana, Dermatology, National Center of Support to the Fight against Disease, Bamako, Mali

Keywords: Lupus, scrofuloderma, Bamako, Mali

Received: 05.01.2017 - Accepted: 15/05/2017 - Published: 08/06/2017

summary

Introduction: Tuberculosis is the most common mycobacterial infection in sub-Saharan Africa. Cutaneous localization is rare and under

diagnosed because of its clinical polymorphism and the weakness of the technical platform. The purpose of this study was to describe aspects

Epidemiological, clinical, histopathological of cutaneous tuberculosis in Bamako (Mali). Methods: From January 1991 to December 2008 we

have performed a descriptive cross-sectional study. The study took place in the National Center of Dermatology Service of Support for the fight

against the disease and Pneumo-phthisiology service at the Point G Hospital were included in the study cases of tuberculosis confirmed

or histology and biology. Results: Of 4269 cases, 61 cases of cutaneous tuberculosis were identified (1.43%). Men accounted for

59% of cases (36 patients) and women 41% or (25 cases); or a sex ratio of 1.44. The age of patients ranged from 3 months to 61 years for

average of 27.56 ± 36 years. Disease duration averaged 10.9 ± 10 months. The clinical forms were identified scrofuloderma

(41 cases), ulcerative form (13 cases), wart form (4 cases), and lupus vulgaris (3 cases). Tuberculosis was associated with HIV in 7

case, leprosy in 3 cases. Conclusion: Cutaneous tuberculosis is diagnosed in Mali. Efforts are needed to improve

accessibility and technical platform specialized services to conduct an interdisciplinary comprehensive study of this pathology.

Pan African Medical Journal. 2017; 27: 102. doi: 10.11604 / pamj.2017.27.102.11577

This article is available online at: http://www.panafrican-med-journal.com/content/article/27/102/full/

© Adama Dicko et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), qui allowded
unrestricted use, distribution, and reproduction in Any medium, Provided the original work is Properly Cited.

Pan African Medical Journal - ISSN: 1937- 8688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology
Network (AFENET). (Www.afenet.net)

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Abstract

Introduction: Tuberculosis is The Most common mycobacteriosis in sub-Saharan Africa. Cutaneous tuberculosis is uncommon and underdiagnosed due

ict to clinical polymorphism and to the smallness of technical equipment. This study AIMS to describe the epidemiological, clinical, histopathological

aspects of cutaneous tuberculosis in Bamako (Mali). Methods: We Conducted a cross-sectional descriptive study from January 1991 to December

2008. The study Was Performed in the Department of Dermatology at the National Center for Disease Control in the Department of

Pneumophtisiology at the Hospital of Point G. The patients with tuberculosis confirmed by histological and / or biological examination Were included

in the study. results: Out of 4269 patients? medical records, 61 cases of cutaneous tuberculosis Were APPROBATION (1.43%). Men Accounted for 59%

of the cases (36 patients) and 41% women (25 cases); Was sex ratio 1.44. The age of the patients ranged from 3 months to 61 years, with year

average age of 27.56 ± 36 years. The average length of follow-up Was 10.9 ± 10 months. The clinical forms APPROBATION Were scrofuloderma (41

boxes), ulcerative form (13 boxes), verrucous form (4 cases), and tuberculous Lupus (3 boxes). Was tuberculosis associated with HIV in 7 cases,

with leprosy in 3 boxes. Conclusion: Cutaneous tuberculosis is underdiagnosed in Mali. Efforts are needed to Improve the accessibility and the

technical equipment available in the Departments, in order to conduct extensive an interdisciplinary study on this pathology.

Key words: Cutaneous tuberculosis scrofuloderma, Bamako, Mali

Introduction cutaneous tuberculosis was based on clinical, histological

and biology. Were not included all incomplete files. The

epidemiological data (sex, age, occupation, ethnicity, place of

Tuberculosis is a chronic infectious disease
residence), clinical (reasons for consultation, clinical character of
due to Mycobacterium. It is a health problem
injury, disease duration, the seat of lesions), biological (NFS
public in many developing countries, according to
pulmonary radio, HIV status IDR), the histology data
the World Health Organization (WHO) 9.6 million people
collected from clinical records. All data
have contracted tuberculosis in 2014 [1]. It is one of
were collected using a questionnaire and then entered
leading causes of death (1.5 million) worldwide, according to WHO
analyzed with SPSS 12.0 software.
[2]. In Africa, with the advent of HIV and AIDS certain locations

Extra pulmonary saw their numbers grow. [3] The skin

represented 2.1% of cases, this location is characteristic by

its polymorphism, the delay in diagnosis and attendance at

Results

treatment. The discovery of a cutaneous form may lead to

screening for latent pulmonary home. The purpose of this study was During the study period, over 4269 files, we identified

of to describe the aspects epidemiological, clinics 61 cases of cutaneous tuberculosis 1.43%. Men

histopathology of cutaneous tuberculosis in Bamako (Mali). 59% of cases (36 patients) and women is 41%

(25 cases); or a sex ratio of 1.44. The average age was 27 years

with extremes of 3 months and 61 years. Children (3 months-15 years)

accounted for 18% of cases (11/61). The most professions

Methods
were represented household with 13.11% tracking

Traders 9.84% and 6.56% students students. Among them

From January 1991 to December 2008 we conducted a study
65.6% from rural areas Koulikoro (22 cases), Kayes
descriptive cross on inpatient records seen for
(12 cases) and Mopti (12 cases). The main reasons for consultation
cutaneous tuberculosis. The study took place in the largest
were lymphadenopathy in 60.6% cases, a fistula in
central management of the capital tuberculosis. These are
(19.6%) cases, the duration of disease progression ranged from 1.5
Dermatology services of the National Support Center in the fight
months to 109.6 months with a mean of 10.9 ± 10 months. The
against the disease (CNAM) and pneumophtisiology service
signs of bacillary impregnation anorexia were found 35
University Hospital of Point G. From clinical records, reporting
times, 46 times weight loss and asthenia 38 times. Clinically the
of histophatologie we identified all cases. The diagnosis

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location of lesions was: cervical and supraclavicular in no immediate consultation: ignorance and illiteracy;

42.6% (26/61), axillary 9.8% (6/61), arms and back 8.2% (5/61) remoteness and the lack of funds limited

each (Table 1). The forms found were clinques accessibility of specialized centers. Some combination is

scrofuloderma in 67.2% or 41 cases (Figure 1, Figure 2), the also made severe clinical picture of our patients it is 7

ulcerative tuberculosis in 21.3% (13 cases), the form warty in cases associated with HIV 1 and 3 cases associated with multi bacillary leprosy.

6.6% (4 cases), and lupus tuberculosis in 4.9% or 3 cases HIV is known as aggravating the clinical picture and

(Figure 3). Tuberculosis was associated with HIV in 7 cases responsible for a progressive diminution of immunity, source

(11.48%), leprosy in 3 cases (4.92%). including opportunistic infections, tuberculosis is the most

frequent [2]. Leprosy also weakened the body and therefore makes it

more susceptible to Mycobacterium tuberculosis [7]. Among the clinical forms

Discussion scrofuloderma was the most noted form in our study is

(47.50%) unlike other forms also found

like lupus vulgaris. This is consistent with results

The purpose of this study was to describe the epidemiological,
Previous work in Dakar and Madagascar [5, 6]. The
Clinical and laboratory of cutaneous tuberculosis in two
cervical spine (37.70%) observed in our series had already
large specialized structures in its management: it is the
been reported to Dakar and Mali [5, 8]. If this elective localization
pulmonology department of the G and the Dermatology Service
Cervical is classic, others as anal fistulas are
CNAM. Our methodological requirements the diagnosis
rare. This is in general, drawling pus. examination
systematically excluded all probable ( "false positives
Histological of the piece of fistulec allowed us to lay the
") That could have been mistakenly viewed as tuberculosis
diagnostic. In our series, we have noted that 2 Breach
skin. Nevertheless, this study gives us insight on
Genital. This is a rare special form responsible
cutaneous tuberculosis in Bamako, Mali despite his character
sterility generally observed at the stage of complications.
collecting historical data. It represents 1.4% of our

study during this period. The patients were 36

men 25 women, with a sex ratio of 1.44. reaching

skin represents about 2% of extrapulmonary forms Conclusion

are estimated at 18% according to the relationship provided by the Program

National Lute against Tuberculosis (NTP) in Mali. [4] In Dakar, Cutaneous tuberculosis is diagnosed in Mali. Some efforts

it represented 4.7% of reasons for consultation [5]. sex are necessary to improve accessibility and the tray

Men were the most affected. The observed current trends Technical specialized services to conduct a study

generally showed no predominance of one sex interdisciplinary depth on this pathology.

relative to each other. Reaching young subjects in our study is

a classic of tuberculosis in Africa given [5, 6]. All the State of current knowledge on the subject

social and professional groups were represented. Most • public health problem in many countries in
affected were those from rural areas (65.6%) the world;

this is explained by the low socioeconomic level. Factors

• One of the main causes of death in the world;
classically risk identified at the present time are: the
• The skin represents 2.1% of the locations.
promiscuity, poverty, lack of hygiene, HIV infection and
Contribution of our study to knowledge
poor nutritional status of the subject.
• Hospital incidence of cutaneous tuberculosis in Mali;

• His association with leprosy in 3 cases.

The disease had advanced on average 10 months to 109 months

for some people. This partly explains the severity of the table

clinical observed in some patients. This long evolution

be explained by several factors: The predominance of adenitis

tuberculous and indolent nature of this form that motivates

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Conflicts of interest 3. Tigoulet F Fournier V Caumes E. Clinical forms of

cutaneous tuberculosis. Bull Soc Pathol Exot. 2003; 96 (5): 362-

367. Google Scholar

The authors declare no conflict of interest.

4. Lute National Program against Tuberculosis in Mali

(NTP) Annual Report. 2012; 18p. Google Scholar

Author Contributions

5. Kane A, SO Niang, Cissé million, TN Sy Diallo M Dieng MT, Ndiaye

All authors contributed to the design, analysis and B. Tuberculosis skin Dakar: about 151 cases. Mali

data interpretation, drafting the article or revising Med. 2010; Volume XXV 1: 14-17. Google Scholar

criticism for its intellectual content. All authors have read and

approved the final manuscript. 6. Ravolamanana Ralisata L Rabenjamina FR, Ralison A.

extrathoracic forms of tuberculosis hospital

Mahajanga (Madagascar). Arch Inst Pasteur Madagascar.

Tables and figures 2000; 66 (1 & 2): 13-17. Google Scholar

7. Andonaba JB Barro-Traoré F Kyelem CG Kafando C Diallo B

Table 1: Distribution by biopsy result
Niamba P Traore A. Comorbidity pulmonary tuberculosis
Figure 1: Scrofuloderma cervical spine and chest
Leprosy multi bacillary in adults in Bobo-Dioulasso (Burkina
Figure 2: Scrofuloderma breast and cervical spine
Faso). Bull of ALLF. 2012; 27: 15-17. PubMed | Google
Figure 3: Lupus facial tubercle
Scholar

8. Diombana ML AG Mohamed A Bayo S Bak Keita Penneau Mr.

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1. World Health Organization: Fact sheet N ° 104 March Mali): 50 biopsies. Afr Med Black. 1998; 45: 516-519. Google
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Table 1: Distribution by biopsy result

clinical form Frequency Percentage

Scrofuloderma / adenitis 41 67.2

lupus tuberculosis 3 4.9

warty tuberculosis 4 6.6

ulcerative tuberculosis 13 21.3

Total 61 100

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Figure 1: Scrofuloderma and cervical spine

chest

Figure 2: Scrofuloderma breast and cervical spine

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Figure 3: Lupus facial tubercle

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