Bacterial dermohypodermitis: A retrospective single-center study of 244 cases in Guinea

Background. Dermo-hypodermal bacterial infections (erysipelas, cellulitis and necrotizing fasciitis) are frequent and may be life-threatening. Patients and methods. A retrospective study of a period of 4 years and 6 months (1 June 1999 to 31 December 2003) was carried out at the Donka University Hospital centre (Conakry-Guinea) in order to analyze the epidemiological, clinical and therapeutic characteristics of bacterial dermohypodermitis in a hospital environment. Results. Two hundred and forty-four patients (188 women and 56 men) were hospitalized for bacterial dermohypodermitis. Mean age was 38 years. The site of dermohypodermitis comprised the entire lower limbs in 4 cases (2%), legs and feet in 200 cases (82%), thighs in 12 cases (4%), buttocks in 4 cases (2%) and upper limbs in 24 cases (10%). A previous history of dermohypodermitis, chronic alcoholism, use of non-steroidal anti inflammatory drugs, obesity and lymphoedema was identified. Necrotizing bacterial dermohypodermitis and necrotizing fasciitis were the main complications and were seen in 31 patients. These conditions were generally associated with use of non-steroidal anti inflammatory drugs (90% vs. 25%) (OR = 27, CI 95 = 8-94), delayed initiation of suitable treatment and use of traditional medicine. Conclusion. Our study shows female predominance of bacterial dermohypodermitis. This is explained by cutaneous atrophy in women resulting from use of depigmenting drugs that facilitate skin breaks, thus allowing ingress of bacteria. NSAID intake, while frequent in our series, was far higher in the fasciitis group, suggesting a potentially aggravating role of these drugs.