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<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Could it be a myiasis (fly larvae infestation)??<o:p></o:p></span></p>
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<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><b><span
style='font-size:8.0pt;font-family:"Arial","sans-serif";color:#1F497D'>Dr Riadh
BEN-ISMAIL </span></b><span style='font-size:8.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><br>
</span><b><span style='font-size:8.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Regional Advisor/CTD/DCD </span></b><span style='font-size:8.0pt;
font-family:"Arial","sans-serif";color:#1F497D'><br>
</span><b><span style='font-size:8.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>World Health Organization. </span></b><span style='font-size:
8.0pt;font-family:"Arial","sans-serif";color:#1F497D'><br>
</span><b><span style='font-size:8.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Eastern Mediterranean Regional Office </span></b><span
style='font-size:8.0pt;font-family:"Arial","sans-serif";color:#1F497D'><br>
</span><b><span style='font-size:8.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>P.O. Box 7608 </span></b><span style='font-size:8.0pt;
font-family:"Arial","sans-serif";color:#1F497D'><br>
</span><b><span style='font-size:8.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Cairo 11371 EGYPT </span></b><span style='font-size:8.0pt;
font-family:"Arial","sans-serif";color:#1F497D'><br>
</span><b><span style='font-size:8.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Direct Tel:00 20 2 22765280 </span></b><span style='font-size:
8.0pt;font-family:"Arial","sans-serif";color:#1F497D'><br>
</span><b><span style='font-size:8.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>DCD Fax:00 20 2 22765414 </span></b><span
style='font-size:8.0pt;font-family:"Arial","sans-serif";color:#1F497D'><br>
</span><b><span style='font-size:8.0pt;font-family:"Arial","sans-serif";
color:green'>email: ismailr@emro.who.int </span></b><span style='font-size:
8.0pt;color:#1F497D'><o:p></o:p></span></p>
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<p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>
leish-l-bounces@lineu.icb.usp.br [mailto:leish-l-bounces@lineu.icb.usp.br] <b>On
Behalf Of </b>jeffrey shaw<br>
<b>Sent:</b> Wednesday, October 13, 2010 4:04 AM<br>
<b>To:</b> Leish-L<br>
<b>Subject:</b> [Leish-l] FW: PRO/EDR> Undiagnosed skin disease - Nigeria:
(SO)<o:p></o:p></span></p>
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<p class=MsoNormal style='margin-bottom:12.0pt'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'><br>
Subject: Fwd: PRO/EDR> Undiagnosed skin disease - Nigeria: (SO)<br>
From: marizashaw@gmail.com<br>
To: jayusp@hotmail.com<br>
<br>
<br>
<o:p></o:p></span></p>
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<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>----------
Forwarded message ----------<br>
From: <b>ProMED-mail</b> <<a href="mailto:promed@promed.isid.harvard.edu">promed@promed.isid.harvard.edu</a>><br>
Date: 2010/10/6<br>
Subject: PRO/EDR> Undiagnosed skin disease - Nigeria: (SO)<br>
To: <a href="mailto:promed-edr@promedmail.org">promed-edr@promedmail.org</a><br>
<br>
<br>
<br>
UNDIAGNOSED SKIN DISEASE - NIGERIA: (SOKOTO)<br>
********************************************<br>
A ProMED-mail post<br>
<<a href="http://www.promedmail.org" target="_blank">http://www.promedmail.org</a>><br>
ProMED-mail is a program of the<br>
International Society for Infectious Diseases<br>
<<a href="http://www.isid.org" target="_blank">http://www.isid.org</a>><br>
<br>
Date: Mon 4 Oct 2010<br>
Source: AllAfrica, Daily Trust report [edited]<br>
<<a href="http://allafrica.com/stories/201010041232.html" target="_blank">http://allafrica.com/stories/201010041232.html</a>>
[edited]<br>
<br>
<br>
A strange skin disease that eats deep into the human body has broken<br>
out in Sokoto, affecting a large number of the people. The disease<br>
which is defying medical solution, is nicknamed "Mallam Fatori",<br>
after a desert town in Borno State where it was said to have emanated from.<br>
<br>
Victims suffering from the disease, who spoke to Daily Trust, said<br>
they had been carrying the ailment for 5 to 9 months now and have<br>
visited several hospitals including the Usman Danfodio University<br>
Teaching Hospital, Sokoto (UDUTH), but could not get any solution.<br>
<br>
Speaking exclusively to Daily Trust in Sokoto, 2 victims, [a<br>
27-year-old man] and a woman, said in separate interviews that the<br>
ailment started with different parts of their body itching [? from]<br>
mosquito bites and developed rashes when they scratched the place<br>
which turns into deep wounds.<br>
<br>
The [man] said, "I noticed the ailment about 5 months ago. It is<br>
affecting 8 different parts of my body as you can see. Since then I<br>
have been to a leprosy hospital in Kaduna, the leprosy hospital in<br>
Amanawa near Sokoto, UDUTH, and many other hospitals, but they do not<br>
seem to know much about it and so could not offer any positive treatment.<br>
<br>
"I know about 50 people that are suffering from the sickness in<br>
Sokoto including women and children. Many of the patients watch<br>
helplessly as the disease eats into their bodies without medical<br>
solution. But at Amanawa hospital, the doctors said they were<br>
suspecting it was the result of [leishmaniasis]," he said.<br>
<br>
[The woman], who said she was infected with the disease in 2<br>
different places on her body, said she had been suffering from it for<br>
about 9 months now and was yet to find a cure after visiting 5<br>
hospitals including UDUTH.<br>
<br>
"My problem started with the affected parts itching me. When I<br>
scratched it, boils came out. The boils remained small on the<br>
surface, but inside my flesh, the wound had eaten deep. But the wound<br>
does not [hurt] at all even though it keeps expanding internally. You<br>
can see how small the boil is on the surface but this big, round<br>
black mark is evidence that the wound has expanded internally," she said.<br>
<br>
When Daily Trust visited UDUTH, the head of the medicine department<br>
of the hospital, Professor Isezua, said arrangements were being made<br>
to properly examine one of the patients suffering from the disease to<br>
enable him to understand it before commenting on it.<br>
<br>
The Sokoto State commissioner for information, Alhaji Dahiru<br>
Maishanu, said the state government did not know about the disease.<br>
But he said the state had mobile clinics that could be deployed to<br>
any part to handle the emergence of any type of sickness reported to<br>
government.<br>
<br>
[Byline: Shehu Abubakar]<br>
<br>
--<br>
Communicated by:<br>
ProMED-mail<br>
<<a href="mailto:promed@promedmail.org">promed@promedmail.org</a>><br>
<br>
[The text mentions leishmaniasis and cutaneous leishmaniasis is a<br>
possibility resulting in sores at the site of the bite by the<br>
sandfly. Cutaneous leishmaniasis is found in northern Nigeria, but it<br>
usually does not expand deep into the subcutaneous tissue. Diagnosis<br>
is based on microscopy of fluid expressed from the edge of the wound,<br>
which is supposed to be a well-known procedure in an endemic area.<br>
<br>
Another possibility is tropical ulcer caused by fusiform bacteria. It<br>
is surprising however, that this would spread as an epidemic, and it<br>
would be possible to treat with proper antibiotics. Infection with<br>
fusiform bacteria can spread through the subcutaneous tissue and<br>
deeper through fascia, but the slow course over months is surprising<br>
although it can develop into a chronic form.<br>
<br>
A 3rd possibility is Buruli ulcer, caused by _Mycobacterium<br>
ulcerans_, which causes a long standing chronic ulceration that can<br>
also expand through subcutaneous tissue and penetrate fascia. This is<br>
probably the most likely explanation for the described disease. (More<br>
information on Buruli ulcer can be found at<br>
<<a href="http://www.who.int/mediacentre/factsheets/fs199/en/"
target="_blank">http://www.who.int/mediacentre/factsheets/fs199/en/</a>>).<br>
<br>
The reservoir for _Mycobacterium ulcerans_ and the transmission route<br>
to humans are not known, but a recent study from Australia suggests<br>
that contact with mammals is a possibility (Fyfe JA et al: A major<br>
role for mammals in the ecology of _Mycobacterium ulcerans_. PLoS<br>
Negl Trop Dis. 2010 Aug 10; 4(8): e791; available at<br>
<<a
href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000791"
target="_blank">http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000791</a>>).<br>
- Mod.EP]<br>
<br>
[Sokoto state, in north western Nigeria, can be located on the maps at<br>
<<a href="http://www.un.org/Depts/Cartographic/map/profile/nigeria.pdf"
target="_blank">http://www.un.org/Depts/Cartographic/map/profile/nigeria.pdf</a>>
and<br>
<<a href="http://healthmap.org/r/0bXT" target="_blank">http://healthmap.org/r/0bXT</a>>.
- Sr.Tech.Ed.MJ]<br>
...................................ep/mj/dk<br>
<br>
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