Epidemiology and Risk Factors of Bacterial Dermohypodermatitis in Conakry (Guinea): A Series of 136 Cases

Yombouno Emmanuel^1*, Touré Mariama Saliou¹, Touré Almiyassata¹, Savané Moussa^1,2, Kanté Mamadou Diouldél^1,2, Camara Issiaga¹, Diané Boh Fanta^1,2, Kéita Fatimata^1,2, Barry Abdoulaye¹, Soumah Mohamed Maciré^1,2, Tounkara Thierno Mamadou^1,2, Kéita Moussa^1,2, Cissé Mohamed^1,2

¹Department of Dermatology and Venereology of National Hospital Donka, Conakry, Guinea
²Faculty of Health Sciences and Techniques, Conakry, Guinea

*Correspondence author: Yombouno Emmanuel, Department of Dermatology and Venereology of National Hospital Donka, Conakry, Guinea; Email: [email protected]

Published Date: 30-04-2024

Copyright© 2024 by Emmanuel Y, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Bacterial Dermohypodermatitis (DHB) brings together three entities of pathologies with an acute and decidedly serious course in the event of a delay in diagnosis. The prognosis depends on the location and appearance of the local lesion. The objective of our study was to describe the epidemiological aspects and identify the risk factors for bacterial dermohypodermatitis in the dermatology-venereology department of the Donka national hospital (Guinea).

Patients and methods: Retrospective descriptive study covering the files of hospitalized patients over a period of 2 years (2019-2021) with at least one associated risk factor.

Results: We identified 535 cases of bacterial dermohypodermitis, 136 of which had at least one associated risk factor, i.e. 25.4% of cases. A female predominance was noted at 51.5%. The average age of the patients was 49.4±15.2 years. The main risk factors found were the existence of a portal of entry 87,5%, followed by artificial depigmentation 39%, diabetes 27.9%, lymphedema 19.9%, venous insufficiency 7.3%, history of erysipelas 6.6% and obesity with 5.9%. The diagnoses found were necrotizing fasciitis 41.9% followed by erysipelas 39% and necrotizing bacterial dermohypodermatitis 19.1% of cases.

Conclusion: The study showed a female predominance of bacterial dermohypodermatitis. The main risk factors were a portal of entry and artificial depigmentation. It remains a potentially serious pathology favored by the underlying terrain and necrotizing forms.

Keywords: Dermohypodermatitis; Risk Factors; Dermatology-Venereology; Guinea

Introduction

Bacterial Dermohypodermatitis (BDH) are acute bacterial infections, necrotizing or not, of skin tissues due either to group A β-hemolytic streptococcus (erysipelas) or to polymicrobial germs (necrotizing bacterial dermohypodermatitis and necrotizing fasciitis) [1]. Classically, three clinical entities make up DHB: erysipelas (non-necrotizing bacterial dermohypodermitis), necrotizing bacterial dermohypodermitis and necrotizing fasciitis [2]. Their incidence is increasing in the general population [3]. Several factors can favor their progression towards serious forms, notably the abusive use of depigmenting cosmetic products, the taking of non-steroidal anti-inflammatories, obesity, the existence of a portal of entry, diabetes, advanced age and the advent of HIV infection [4]. The data available in the West and sub-Saharan Africa argue in favor of an increase in cases of DHB, led by erysipelas which constitutes the first reason for hospitalization in certain countries [5-7].

Patients and Methods

This was a retrospective descriptive study carried out over a period of 2 years (2019-2021) covering the files of patients hospitalized in the dermatology-venerology department of Donka hospital, in Conakry. All patients with a diagnosis of bacterial dermohypodermatitis regardless of age, sex, occupation with at least one associated risk factor were included. The diagnosis of erysipelas was made in the face of an acute, warm and painful erythematous swelling, having been preceded by general signs: flu-like syndrome, nausea and/or vomiting, anorexia and marked physical asthenia. Bacterial dermohypodermatitis was recognized in the presence of inflammatory swelling, superficial necrosis, a zone of fluctuation accompanied by general signs and necrotizing fasciitis was diagnosed on the basis of an ulcero-necrotic lesion affecting the aponeurosis, snowy crepitus, odor characteristic and signs of shock. The data were collected with the KoBoCollect software and the data analysis was carried out by Epi info version 7.2.2.

Results

We identified 535 DHB files, 136 of which had at least one associated risk factor, i.e. 25.4% of cases. We noted a female predominance in 51.5%. The average age of the patients was 49.4±15.2 years with extremes of 18 and 87 years. The lower limbs, particularly the legs, were the most common locations (98.2%). The main risk factors found were the existence of an entry point (excoriation, intertrigo-inter toe, cracks, chronic ulceration, microtrauma) i.e. 87.5% of cases, followed by artificial depigmentation 39%, diabetes 27.9%, lymphedema 19.9%, venous insufficiency 7.3%, history of erysipelas 6.6% and obesity with 5.9%, use of poultices 2.9% (Table 1). The diagnoses found were necrotizing fasciitis 41.9% followed by erysipelas 39% and necrotizing bacterial dermohypodermatitis 19.1% of cases (Fig. 1-4).

Table 1: Main risk factors for the occurrence of DHB.

Figure 1: Distribution of patients according to the diagnoses found.

Figure 2: Necrotizing fascicitis of the left lower limb and fissured plantar keratoderma in type 2 diabetes.

Figure 3: Bullous erysipelas of the right leg due to obesity.

Figure 4: Necrotizing bacterial hypodermatitis of the left leg on artificial depigmentation site.

Discussion

Our study, which only took into account hospitalized patients, has limitations and biases due to its retrospective nature (non-digitalization of records making it difficult to use certain parameters, unavailability of additional examinations) and the period of study (advent of the COVID-19 pandemic). The prevalence of risk factors reported in previous studies [8,9]. This state of affairs can be explained by the socio-economic living conditions of populations in sub-Saharan Africa. The female predominance in our work is linked to the excessive use of artificial depigmentation which leads to skin atrophy and the increasing rate of cases of obesity which is perceived as a state of comfort in our context. The majority of women in Africa practice depigmenting cosmetics [10]. The risk factors found in our study have been reported by several African authors including Cissé, et al., Monica, et al., Pitché, et al., Saka B, et al., on the other hand Yii, et al., had implicated alcoholism as the main contributing factor [6-9,11]. The diagnoses found were dominated by necrotizing fasciitis, followed by erysipelas and necrotizing bacterial dermohypodermatitis. The available data speak in favor of erysipelas, which represents the primary reason for hospitalization in dermatology [12,13]. The high prevalence of fasciitis cases in our study could be explained by the fact that during the period of our study, the COVID-19 pandemic was raging throughout the world and the majority of patients were followed on an outpatient basis except in cases of complications.

Conclusion

Our study showed a female predominance of bacterial dermohypodermatitis. The main risk factors were a portal of entry and depigmentation. It remains a potentially serious pathology favored by the underlying terrain and necrotizing forms.

Conflict of Interests

The authors declare that there is no conflict of interest for this paper.

References

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Article Type

Case Report

Publication History

Received Date: 08-04-2024
Accepted Date: 23-04-2024
Published Date: 30-04-2024

Copyright© 2024 by Emmanuel Y, et al.  All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation: Emmanuel Y, et al. Epidemiology and Risk Factors of Bacterial Dermohypodermatitis in Conakry (Guinea): A Series of 136 Cases. J Dermatol Res. 2024;5(1):1-5.

Figure 1: Distribution of patients according to the diagnoses found.

Figure 2: Necrotizing fascicitis of the left lower limb and fissured plantar keratoderma in type 2 diabetes.

Figure 3: Bullous erysipelas of the right leg due to obesity.

Figure 4: Necrotizing bacterial hypodermatitis of the left leg on artificial depigmentation site.

Table 1: Main risk factors for the occurrence of DHB.