Position Statement on Atopic Dermatitis in Sub-Saharan Africa: current status and roadmap

BACKGROUND

The first International Society of Atopic Dermatitis (ISAD) global meeting dedicated to atopic dermatitis (AD) in Sub-Saharan Africa (SSA) was held in Geneva, Switzerland in April 2019. A total of 30 participants were present at the meeting, including those from 17 SSA countries, representatives of the World Health Organization (WHO), the International Foundation for Dermatology (IFD) (a committee of the International League of Dermatological Societies, ILDS www.ilds.org), the Fondation pour la Dermatite Atopique, as well as specialists in telemedicine, artificial intelligence and therapeutic patient education (TPE).

RESULTS

AD is one of the most prevalent chronic inflammatory skin diseases in SSA. Besides neglected tropical diseases (NTDs) with a dermatological presentation, AD requires closer attention from the WHO and national Departments of Health.

CONCLUSIONS

A roadmap has been defined with top priorities such as access to essential medicines and devices for AD care, in particular emollients, better education of primary healthcare workers for adequate triage (e.g. better educational materials for skin diseases in pigmented skin generally and AD in particular, especially targeted to Africa), involvement of traditional healers and to a certain extent also patient education, bearing in mind the barriers to effective healthcare faced in SSA countries such as travel distances to health facilities, limited resources and the lack of dermatological expertise. In addition, several initiatives concerning AD research in SSA were discussed and should be implemented in close collaboration with the WHO and assessed at follow-up meetings, in particular, at the next ISAD meeting in Seoul, South Korea and African Society of Dermatology and Venereology (ASDV) meeting in Nairobi, Kenya, both in 2020.

PRIMARY MALIGNANT AMELANOTIC MELANOMA ARISING FROM A VITILIGO PATCH OF AN AFRICAN TANZANIAN: CASE REPORT

Skin cancer is rare in people of African origin while vitiligo occurs worldwide. The occurrence of primary malignant melanoma and vitiligo together is very rare. We present a rare case of primary malignant amelanotic melanoma arising from a depigmented patch of a patient with vitiligo. It was completely excised and followed for one year. No recurrence or metastases was noted during the follow up period.

HIV - associated and non - HIV associated types of Kaposi's sarcoma in an African population in Tanzania. Status of immune suppression and HHV-8 seroprevalence

In this study 77 patients with histologically confirmed Kaposi's sarcoma (KS) were seen at the Regional Dermatology Training Centre (RDTC) in Moshi, Tanzania. Sixty six patients (85.7%) were HIV-seropositive KS-patients (40 males, 26 females; male: female ratio 1.5:1), whereas another 11 (14.3%) KS-patients, all males, were found HIV-seronegative, thus corresponding to the endemic African KS-type. In both groups the CD4+ cell counts were generally low, the CD8+ population increased and the CD4+/CD8+ ratio inverted. Immune suppression was, however, more prominent in the HIV-seropositive group.HHV-8 seroprevalence was high in patients with HIV-associated KS (94.6%), nevertheless, 3 (5.4%) patients in this group remained HHV-8 seronegative. All nine patients with the HIV-seronegative African type of KS were found positive for HHV-8. Of the entire group seen, males were more likely to be HHV-8 seropositive than females (OR = 3.348 95% CI, 0.96-11.65; p < 0.05). The relative risk to develop KS in individuals seropositive to both HIV and HHV-8 was high (OR = 10.6, 95% CI; 2.981-37.688; p < 0.001).Overall, HIV-associated KS differed from the non-HIV-associated by its widespread clinical dissemination on the trunk, the frequent involvement of the oral mucosa and the craniofacial region, and its more rapidly progressive course. No histological differences between the two KS-groups were seen, although spindle cell infiltrates were more often found in the HIV-associated KS-group.

Risk factors for bacterial vaginosis among bar and hotel workers in Northern Tanzania

OBJECTIVE

To determine risk factors for bacterial vaginosis (BV) among women working in the bars and hotels in Moshi, Northern Tanzania.

RESULTS

Severe disturbances of vaginal flora or BV were detected in 70/268 (26.1%) women (95% confidence interval (CI): 20.8%-31.4%). In multivariate analyses, religion was the only socio-demographic characteristic that remained significantly associated with BV. Other independent predictors of BV were Trichomonas vaginalis (adjusted odds ratio (OR)=2.7, 95% CI: 1.4-5.3), Chlamydia trachomatis (adjusted OR=3.5, 95% CI: 1.2-10.6), syphilis (adjusted OR=7.1, 95% CI: 41.1-4.7) and herpes simplex virus type 2 (HSV-2) infection (adjusted OR=1.8, 95% CI: 1.0-3.3).

CONCLUSION

Bacterial vaginosis (BV) was the common cause of genital symptoms in the study population. Since sexually transmitted diseases (STDs) were strongly associated with BV, control of STDs and BV should be given the highest priority in this population.

Asymptomatic gonorrhoea and chlamydial infection in a population-based and work-site based sample of men in Kilimanjaro, Tanzania

The aim of this study was to screen healthy rural and urban Tanzanian men for chlamydial infection and gonorrhoea, and determine the prevalence and the predictive value of urethral symptoms, signs and pyuria. In 2 cross-sectional surveys, 796 men were interviewed regarding symptoms and examined for signs of urethritis. Gonorrhoea was detected by culture/gram-stained smears, Chlamydia trachomatis by antigen immunoassay, and pyuria by leukocyte esterase dipstick test. The prevalence of chlamydial infection, gonorrhoea and pyuria among rural men was 9.6%, 0.4%, and 12.7%, and among urban bar workers 7.4%, 8.1% and 6.3% respectively. Among all, 0.6% had urethral discharge confirmed by examination, while 2.6% reported urethral discharge and 7.4% dysuria. Among chlamydia-infected men, 59 (89%) of the 66 cases did not have urethritis symptoms or signs. Similarly, 24 (88%) of 28 men with gonorrhoea were asymptomatic. Treatment based on the urethral discharge sign, would have detected only one out of 92 cases with gonorrhoea and/or chlamydia in these populations.

Teledermatology as a new tool in sub-saharan Africa: an experience from Tanzania

Large areas of sub-Saharan Africa suffer a substantial lack of skin care. Hence teledermatology, meaning the online visual exchange of clinical and histologic data, could develop into a powerful medical resource. We report the first established teledermatologic connection in this area: between the Regional Dermatology Training Centre (RDTC) in Moshi, Northern Tanzania, and the Department of Dermatology, University Hospital of Zürich, Switzerland. This report illustrates local difficulties as well as the considerable potential of teledermatology in such a setting.

Serological markers for treponemal infection in children in rural Kilimanjaro, Tanzania: evidence of syphilis or non-venereal treponematoses?

OBJECTIVE

To determine the seroprevalence of treponemal infection and possible risk factors among children aged 0-14 in the general population of a rural Tanzanian village.

METHODS

The survey was conducted as a part of a cross section study of a total village population on HIV and sexually transmitted disease. Among 1708 registered children aged 0-14, the 553 first attending were tested for treponemal infection with both rapid plasma reagin test (RPR) and Treponema pallidum Haemagglutination test (TPHA). These children belonged to a household cohort--also including their parents, siblings, and other household members--with 1339 members; 1224 (91.4% participated in the survey and 82.1% of these were tested for treponemal infection.

RESULTS

The overall prevalence for the TPHA test was 6.4% among girls and 1.1% among boys (odds ratio, OR = 6.5; 95% confidence interval, CI: 1.9-22.3). The sex difference was most pronounced in the age group 10-14; 11.1% among girls versus 1.0% among boys (OR = 12.8; CI: 1.6-101.9). Among the 20 children who were TPHA positive, we found two cases of active, congenital syphilis. There was a lack of association between positive serology in children and positive serology in their parents.

CONCLUSION

The highly significant predominance of girls testing positive for TPHA, and the concomitant lack of association between parents' and children's serostatus might point to sexual transmission as being the most common route of transmission of treponemal infection in girls during childhood in this village. The sources of infection for the seropositive girls are possibly found outside the family.

HIV and reproductive tract infections in a total village population in rural Kilimanjaro, Tanzania: women at increased risk

The aim of this study was to determine the prevalence of HIV infection, other sexually transmitted diseases (STDs), and biological risk factors associated with HIV infection in a rural population in Tanzania. A population-based study of a village population was carried out from July 1991 through January 1992. A total of 3,239 people (83.7%) participated in an HIV serosurvey. The total HIV prevalence was 0.7 and 1.9% among males and females, respectively (odds ratio, OR = 2.5; 95% confidence interval, CI: 1.2-5.1), and 4.3% in women and 1.6% in men in participants aged 15 to 44 (OR = 2.6; CI: 1.2-5.8). The same age group was interviewed and offered screening for STDs. Trichomonas vaginalis vaginitis (24.7%) was the most common reproductive tract infection (RTI); 10.3% of women were infertile and 10.6% suffered from pelvic inflammatory disease (PID). Comparing women and men, we found that 2.2 versus 20.4% had been treated for genital discharge (OR = 12.6; CI: 7.1-22.5); 2.6 versus 1.2% suffered from active syphilis (OR = 1.5; CI: 0.9-2.3); 6.9 versus 9.6% had chlamydial infection; and 46.9 versus 14.6% had an ongoing RTI/STD (OR = 5.0; CI: 3.6-6.9). A significant association was found between HIV infection and STD cases (in women) and between HIV infection and a history of STDs (in men). The heavy burden of untreated RTIs in females calls for a more gender-specific approach to HIV and STD prevention.