[Bacterial dermohypodermitis and necrotizing fascitis: 104-case series from Togo]

The purpose of this retrospective study was to obtain data on the epidemiology, clinical features, and outcome of bacterial dermohypodermitis (BDH) observed in a hospital setting hospital in Lomé, Togo. Cases of BDH treated in dermatology and internal medicine of the Lomé university hospital center from January 1999 to December 2009 were reviewed. A total of 104 patients were hospitalized for BDH during the study period. Mean patient age was 42.9 +/- 16.1 years and sex ratio (M/F) was 0.89. Infection by HIV was detected in 10 of 37 patients in whom serology was performed. The site of erysipelas was located on the legs and feet in 93 cases (89.4%), entire lower limb in 4 (3.9%), upper limbs in 4 (3.9%), thighs in 2 (1.9%), and buttock in 1 (0.9%). The main local and systemic risk factors were existence of an entry site in 89 cases, use of depigmenting drugs in 11, HIV infection in 10, previous history of erysipelas in 9 cases, and lymphoedema in 8. First-line treatment used penicillin G in 90 cases. Seven patients presented necrotizing fasciitis. Necrotizing fasciitis was associated with HIV infection in 2 cases, use of non-steroidal anti-inflammatory drugs (NSAID) in 2, and use of depigmenting drugs in one. Two deaths were recorded in the necrotizing fasciitis group including one HIV-infected patient. Recurrence was observed in 8 patients and secondary complications such as lower limb elephantiasis occurred in 7 patients.