ADVANTAGES AND DIFFICULTIES OF PATHOLOGICAL EXAMINATION IN

Transcription

1 ADVANTAGES AND DIFFICULTIES OF PATHOLOGICAL EXAMINATION IN BURULI ULCER ULCER - PARTNERSHIP WITH AN NGO IN BENIN Dr Chemaly Ph(1), Dr Wann AR(2), Pr. Akpo MT(3), Dr Ballé MC(4) 1. Association PCD 2. St Vincent de Paul hospital-paris, Association PCD 3. CHU, Cotonou, Benin 4. Centre Padre Pio, Cotonou, Benin

2 Pathology in BU: reminder In incipient and fully developed forms, the wholly distinctive histological picture, directly reflects the action of mycolactone, a necrotising and immunosuppressive toxin secreted by Mycobacterium ulcerans: Necrosis of the dermis Necrosis of the hypodermis Discrete nature of the inflammatory reaction + AFB often very numerous

3 NECROSIS OF THE DERMIS

4 NECROSIS OF THE HYPODERMIS

5 VERY NUMEROUS BACILLI, OCCASIONALLY VISIBLE UNDER HE (left and top right) ZIEHL BOTTOM Bacilli visible under haematoxylin eosin min. infl. reaction

6 COUNTLES BACCILLI, ZIEHL, SAME CASE

7 ANOTHER CASE: THERE ARE OCCASIONALLY FEW OR EVEN NO BACILLI

8 In fairly recent, healing and recurrent lesions less necrosis less numerous or even no bacilli more marked inflammatory reaction with epithelioid and giant-cell granuloma The image is compatible with BU in this context

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10 Necrosis, granuloma, blood vessel disorder

11 The histological images have been kindly provided by Dr Michel Huerre, pathologist at the Institut Pasteur in Paris

12 Advantages of pathology in diagnosing BU Pathological examination ( PE ) has its place at every stage and for all clinical forms of BU sensitivity of from 63 to 82 % it allows differential diagnosis, which is often necessary and may thus avert the need for pointless and costly examinations results are rapidly available, in 4 to 5 days it can be performed by any normally equipped laboratory by the country's own physicians its importance will increase as a result of improvements in early case detection of non-ulcerative forms, for which swabs cannot be taken

13 However, availability of PE is poor in countries where BU is widespread Evaluation mission in Benin from 1 to 10/12/2005, in collaboration with our fellow pathologists : 1. Contacts with BU control officials at PNLUB and in CDTUB in the presence of Beninese pathologists A favourable and enthusiastic response

14 Evaluation mission (contd.) 2. Evaluation at Cotonou CHU av. level of activity with no specific recruitment of BU patients equipment often antiquated or incomplete occasional stock shortages of consumables detailed list of needs drawn up 3. Same evaluation carried out at the Padre Pio centre in Cotonou list of needs also drawn up 4. Visit to the CDTUB in Allada: telemedicine project at a very advanced stage with satellite transmission of digital histological sections or alternatively of still photographs as e attachments 5. Visit to the Gbemonten Centre in Zagnanado

15 Difficulties identified: 1. Breakdown of an automatic tissue processor frequently brings the work of the laboratory to a halt 2. missing reagents have to be sought in neighbouring countries; if this fails, it is impossible to carry out some stains 3. Consumables are five times more expensive in Africa than in Europe (pure alcohol, xylene, paraffin ) 4. both the material and the automats are expensive. For example vacuum infiltration processors (Pathcentre) 30000, good quality microscope at least 5000, microtome 5 to 8000.

16 Despite the cost of the material and consumables, path examination is cheaper than PCR or culture: In France the cost is 37, whereas the other two procedures cost 63 each

17 Role of the association Pathologie Cytologie Développement ( PCD ) An NGO formed by pathologists and path technicians which has been working for some twelve years to promote pathology In French-speaking Africa In some countries of the former USSR and in South-East Asia

18 Provision of various types of equipment (various automats, microscopes, microtome ) Material collected from public or private laboratories It is overhauled, repaired Delivered free of charge On average, one delivery every 4 to 5 years per medical school - 1m 3 weighing 500kg Whenever possible, we deliver the same machines as those in place e for spare parts Difficulties: transport costs: 60/m 1 /d/m 3 60/m 3 of of 250kg+port charges of 10 to 30 + forwarding agent's storage charges of requently complex customs formalities delay delivery and increase transport cost

19 Provision of various items of equipment Automatic tissue sampler microscopes microtomes

20 Provision of various items of equipment Parcels ready for dispatch

21 Parcels ready for dispatch

22 Provision of emergency kits kits of reagents and stains allowing a large number of stains to be performed Supply of books and journals on pathology Assistance to enable our foreign colleagues to attend training courses in France Participation in screening for cervical cancer through transmission of images of difficult cases from three countries ( Cambodia, Algeria, Mali )

23 Organization on the spot in Africa of training modules for path lab technicians.

24 2004 MODULE IN YAOUNDE Organization of modules

25 Organization of modules YAOUNDE 2004

26 Report on the most recent module in Yaoundé November 2005 (introduction to the report) Organization of the third further-training training module for path lab technicians, at Yaoundé from 14 to 26 November 2005 Tissue technologists project Project module, histology science faculty Introduction: Two further training modules were planned as soon as the project was prepared in In 2005, two modules were organized. S Six path lab technicians from outside Cameroon participated in the second. These two modules were mainly funded thanks to a grant provided by the Hauts-de de-seine Department Council in December 2004 and a contribution from the Franco-African paediatric oncology group in 2005.

27 We have links with most university teaching hospitals (CHU) in French-speaking Africa Where BU control in particular is concerned, a second mission has just taken place to DRC; a report will be produced later.

28 Conclusion The project to promote pathological diagnosis of BU met with an enthusiastic reception among colleagues responsible for BU control, who assured us of their support. There is a strong demand from pathologists BU is remarkably managed by the PNLUB by means of: collection of +++samples and transfer to Cotonou which considerably facilitates the task Excellent performance of the CDTUB, two of which we visited: Allada and Zagnanado

29 Conclusion ( contd.) Thanks to the different aspects of its activity and its strong presence in Africa, our NGO is capable of overcoming the difficulties identified and is prepared to hep strengthen existing pathology services through partnership. We have the equipment, and dedicated and skilled volunteers Even though all the members of our association are volunteers, we need financial support to enable us to continue our work on account of the heavy cost of transport, management and storage