Publications by authors named "H Asse"

8 Publications

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Reconstructive surgery for sequellae of Mycobacterium ulcerans infection (Buruli ulcer) of the upper limb.

J Plast Surg Hand Surg 2021 Mar 1:1-6. Epub 2021 Mar 1.

Institut de Chirurgie Reconstructive, Abidjan, Côte d'Ivoire.

Introduction: Infection by Mycobacterium ulcerans constitutes a neglected tropical disease whose prevalence seems to have overrun those of cutaneous tuberculosis and leprosy. Its aggressivity depends on a mycolactone toxin. Lesions may involve skin, tendon and bone with a large spectrum of manifestations: non-ulcerative (papules, nodules, plaques), ulcerative and oedematous presentations as well as osteomyelitis with muscular contraction and ankylosis. Upper limbs account for more than two thirds of the infection sites. Surgical treatment may involve tendon transpositions, partial and total skin grafts. Amputation is relegated to extreme cases.

Material And Methods: Selected iconography from patients during the last 15 years is presented. At least 1500 cases had partial skin grafts (anterior thigh). Total skin grafts (inguinal region) were used in about 200 cases. Complex lesions involved 9 ilioinguinal flaps (5 boys, 4 girls, mean age 11.2 years, range 2-16 years), 5 tendon transfers (4 boys, one girl, mean age 15.4 years, range 12-19 years) and 3 resections of the first carpal row (2 girls, 1 boy, mean age 8 years, range 4-15 years).

Results And Discussion: Out of 9 ilioinguinal flaps mild, marginal necrosis was the only complication in 2 patients without flap loss. Mean hospital stay was 26.44 days (range, 18-41 days), with return to full weight-bearing after a mean of 12 weeks (range 9-25 weeks) after discharge. Functional thumb opposition to allow pencil prehension was achieved in all three cases of resection of first carpal row resection without postoperative complications.
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http://dx.doi.org/10.1080/2000656X.2021.1884083DOI Listing
March 2021

Integrated approach in the control and management of skin neglected tropical diseases in three health districts of Côte d'Ivoire.

BMC Public Health 2020 Apr 17;20(1):517. Epub 2020 Apr 17.

Programme National de Lutte contre l'Ulcère de Buruli, Abidjan, Côte d'Ivoire.

Background: Neglected tropical diseases (NTDs) comprise 20 communicable diseases that are prevalent in rural poor and remote communities with less access to the health system. For effective and efficient control, the WHO recommends that affected countries implement integrated control interventions that take into account the different co-endemic NTDs in the same community. However, implementing these integrated interventions involving several diseases with different etiologies, requiring different control approaches and driven by different vertical programs, remains a challenge. We report here the results and lessons learned from a pilot test of this integrated approach based on integrated screening of skin diseases in three co-endemic health districts of Côte d'Ivoire, a West African country endemic for Buruli ulcer, leprosy and yaw.

Method: This cross-sectional study took place from April 2016 to March 2017 in 3 districts of Côte d'Ivoire co-endemic for BU, leprosy and yaws. The study was carried out in 6 stages: identification of potentially co-endemic communities; stakeholder training; social mobilization; mobile medical consultations; case detection and management; and a review meeting.

Results: We included in the study all patients with skin signs and symptoms at the screening stage who voluntarily accepted screening. In total, 2310 persons screened had skin lesions at the screening stage. Among them, 07 cases were diagnosed with Buruli ulcer. There were 30 leprosy cases and 15 yaws detected. Other types of ulcerations and skin conditions have been identified and represent the majority of cases detected. We learned from this pilot experience that integration can be successfully implemented in co-endemic communities in Côte d'Ivoire. Health workers are motivated and available to implement integrated interventions instead of interventions focused on a single disease. However, it is essential to provide capacity building, a minimum of drugs and consumables for the care of the patients identified, as well as follow-up of identified patients, including those with other skin conditions.

Conclusions: The results of this study show that the integration of activities can be successfully implemented in co-endemic communities under the condition of staff capacity building and minimal care of identified patients.
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http://dx.doi.org/10.1186/s12889-020-08632-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164353PMC
April 2020

[Detection of the IS2404 insertion sequence and ketoreductase produced by Mycobacterium ulcerans in the aquatic Heteroptera in the health districts of Dabou and Tiassalé in Côte d'Ivoire].

Med Sante Trop 2015 Jan-Mar;25(1):44-51

Université de Nantes, Nantes, France.

Buruli ulcer (BU) disease, caused by Mycobacterium ulcerans, is a major public health problem in Côte d'Ivoire. Until now, the mode of BU transmission was unknown, but recent studies implicate aquatic Heteroptera in the chain of transmission. This study was launched in Côte d'Ivoire to search for specific genetic markers for M. ulcerans in these bugs, including the insertion sequence IS2404 and ketoreductase (Kr), both involved in the synthesis of mycolactone, a toxin produced by these mycobacteria. Samples of aquatic Heteroptera were collected monthly with deep nets from ponds near villages in the health districts of Dabou and Tiassalé. After identification and enumeration of the bugs, batches of the same taxon underwent real-time PCR to search for the IS2404 target and Kr. Saliva of 69 specimens of Diplonychus sp randomly selected in the samples was also analyzed by PCR. In all, 283 single-taxon batches were created. Thus, PCR identified 26 batches belonging to the families of Belostomatidae, Naucoridae, Corixidae, Ranatridae, and Nepidae as positive for both targets. The IS2404 insertion sequence and Kr were present in 6 of the 69 samples analyzed in the saliva of Diplonychus sp. These aquatic Heteroptera suspected of infection by M. ulcerans might release it into the environment because of their ability to fly. They might thus be the source of human contamination.
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http://dx.doi.org/10.1684/mst.2014.0363DOI Listing
February 2016

Landscape diversity related to Buruli ulcer disease in Côte d'Ivoire.

PLoS Negl Trop Dis 2008 Jul 30;2(7):e271. Epub 2008 Jul 30.

Université d'Artois, Faculté d'Histoire-Géographie, Arras, France.

Background: Buruli ulcer disease (BU), due to the bacteria Mycobacterium ulcerans, represents an important and emerging public health problem, especially in many African countries. Few elements are known nowadays about the routes of transmission of this environmental bacterium to the human population.

Methodology/principal Findings: In this study, we have investigated the relationships between the incidence of BU in Côte d'Ivoire, western Africa, and a group of environmental variables. These environmental variables concern vegetation, crops (rice and banana), dams, and lakes. Using a geographical information system and multivariate analyses, we show a link between cases of BU and different environmental factors for the first time on a country-wide scale. As a result, irrigated rice field cultures areas, and, to a lesser extent, banana fields as well as areas in the vicinity of dams used for irrigation and aquaculture purposes, represent high-risk zones for the human population to contract BU in Côte d'Ivoire. This is much more relevant in the central part of the country.

Conclusions/significance: As already suspected by several case-control studies in different African countries, we strengthen in this work the identification of high-risk areas of BU on a national spatial scale. This first study should now be followed by many others in other countries and at a multi-year temporal scale. This goal implies a strong improvement in data collection and sharing in order to achieve to a global picture of the environmental conditions that drive BU emergence and persistence in human populations.
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http://dx.doi.org/10.1371/journal.pntd.0000271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474700PMC
July 2008

[Genital sites of Buruli ulcer (BU): clinical and therapeutic aspects].

Prog Urol 2005 Sep;15(4):736-8

Service de Chirurgie réparatrice, Institut Raoul Follereau d'Adopzé, Côte d'Ivoire, France.

BU of the penis and scrotum is a rare disease that can potentially induce extensive lesions. The authors describe the clinical characteristics and treatment in the light of two cases. BU induces irreversible necrotic lesions and despite the knowledge of the micro-organism responsible (Mycobacterium ulcerans), no medical treatment is currently effective. Excision of wounds and skin grafts remain the treatment of choice, and give excellent results.
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September 2005

[Treatment of Buruli ulcer desease by excision and skin graft].

Ann Chir Plast Esthet 2004 Feb;49(1):11-6

Service de chirurgie maxillofaciale et plastique, centre hospitalier intercommunal de Villeneuve-Saint-Georges, 40, allée de la Source, 94195 Villeneuve-Saint-Georges cedex, France.

Introduction: Buruli ulcer is the most common mycobacteria disease after leprosy and tuberculosis. The purpose of our study is to make our contribution to the surgical treatment of Buruli ulcer and to asses our results.

Method: One hundred eighteen patients presenting progressive Buruli ulcers were operated on. The surgical procedure included excisions for necrotic lesions and grafts for clean wounds. The results were estimated on the time of hospitalization and appearance of complications.

Results: Seventy-three patients (62%) were subjected to excision followed by thin skin grafts and 35 patients (30%) were subjected to grafts only. The number of excision times varies from 1 to 7 per patient and from 1 to 4 for the skin grafts. All our patients heal within a period of 120 days with extremes going from 14 to 265 days. We deplored 26 complications (22%): eight new focus, seven infectious complications, six recurrences, five stiffnesses and ankyloses.

Conclusion: The treatment of Buruli ulcer by excision and grafts is efficient but does not prevent recurrences and new focus from happening and for their prevention, it is necessary to discover pharmaceutical molecules that are efficient on Mycobacterium ulcerans.
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http://dx.doi.org/10.1016/j.anplas.2003.04.001DOI Listing
February 2004

[Plastic surgery treatment of Buruli ulcer sequelaes. A retrospective study of 16 patients].

Ann Chir Plast Esthet 2003 Feb;48(1):13-9

Service de chirurgie maxillo-faciale et chirurgie plastique et reconstructrice, centre hospitalier intercommunal de Villeneuve-Saint-Georges, 40, allée de la Source, 94195 cedex, Villeneuve-Saint-Georges, France.

Introduction: Thirteen percents of the patients suffering from Buruli ulcer in Ivory Coast show sequels at a result of their spontaneous healing. The purpose of our study is to report and estimate the first series of the sequel treatment of Buruli ulcer, with standard reconstructive procedures used in plastic surgery.

Method: Sixteen patients totalizing 18 sequels were classified into 2 groups:13 patients showed functional sequels in connection with cicaticial retractions about level with joints;3 patients showed aesthetic sequels with no repercussion on the functional aspect. The surgical treatment included for the functional sequels, the excision of the retractile scar, the restoration of the underlying structures followed by the coverage of the defect with skin grafts or muscle or musculo cutaneous flaps and for aesthetic sequels, the excision of the scar tissues and the coverage with full-thickness skin grafts.

Results: The results were considered good because the patients found an acceptable physical activity again that enable some of them to resume a professional activity and others a school activity. Motherless, a certain number of complications are to be deplored:1 case of distal necrosis of a skin flap autonomized which required excision and conducted healing but without repercussions on the functional result;1 residual edema about level with the fingers at the time of the covering of a hand with a groin flap;1 haematoma at the donar site of a full-thickness skin graft.

Conclusion: Distance flaps are more advisable for hand sequels in Buruli ulcer considering the regional character of the disease and the necessity to preserve the main vascular axes about level with the hand. On the lower limb, autonomized skin flaps enable provide important tissue and preserve the major vascular axes of the lower limb.
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http://dx.doi.org/10.1016/s0294-1260(02)00177-2DOI Listing
February 2003

[Survey of leprosy disabilities in patients treated with multiple drug therapy in Ivory Coast].

Acta Leprol 1997 ;10(3):151-8

Unité Epidémiologie-Formation, Institut Marchoux, Bamako, Mali.

Between 1990 and 1995, twenty thousand cases of leprosy were treated with WHO recommended multiple drug therapy (MDT) in Ivory Coast. A disability survey was conducted in April 1996 with a half-randomized sample of five hundred patients. This survey showed that 28.73% of the patients had got grade two disabilities in WHO scale. 12.9% of the non disabled patients at detection had developed leprosy impairments during or after treatment. Plantar ulcers (12.2% of the patients) appeared very frequent comparatively to the findings of a similar survey in Burkina Faso in 1995 (0.9% of plantar ulcers). With these results, the authors estimated the needs for disabilities care to enable the reinforcement of the prevention of disabilities and physical rehabilitation (POD and PR) in Ivory Coast.
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September 1997