Aspects épidémiologiques et cliniques de la limboconjonctivite endémique des tropiques en milieu scolaire à Yaoundé

Cédric Ferla TSINDA KENNE (kenferla@yahoo.fr)
Ophtalmologie, Université de Yaoundé I
June, 2014
 
TSINDA KENNE Cédric Ferla est de nationalité camerounaise et d'ethnie Bamiléké. Il est médecin généraliste diplôme de la Faculté de Médecine et ses Sciences Biomédicales de l'Université de Yaoundé I.
 

Abstract

Since Diallo’s description in 1976, the tropical endemic limboconjunctivitis (TELC) is a term proposed to designate an allergic keratoconjunctivitis or vernal catarrh in tropical areas given the particular form of the disease. It is very common in children aged 0 to 15 years old. The disease is characterized by chronic ocular itching, tearing, mucus discharge, photophobia, foreign body sensation in the eye and a brownish coloration of the area of the palpebral fissure. Its onset is very early or during the first months of life for some children, either during the first years for others. Untreated early and properly, it can evolve to complications. Several studies were devoted to the study of TELC in Africa. In Cameroon, the hospital prevalence varies from north to south with minimal prevalence in south according to studies and relatively high prevalence in the north from the study of Koki and al. in 2011.

The overall objective was to determine the epidemiological and clinical profile of TELC in children aged 3 to 15 years enrolled in thirty primary and nursery schools in the Yaounde city. More specifically, the objective was to study the demographic characteristics of TELC and to present the clinical profile of TELC in schools in Yaounde.

We conducted a cross-sectional descriptive study over a period of two months from January 2014 to March 2014. Random cluster sampling was carried out in thirty nursery and primary (private and public) schools in Mfoundi division that allowed us to select 420 pupils to examine. An assessment of far visual acuity without correction and a slit-lamp biomicroscopy were performed at the Yaounde Central Hospital in pupils with limbic and/or palpebral, unilateral or bilateral conjunctival lesions, symptomatology or clinical course reminiscent of a TELC.
Data analysis was done using CSPro software version 4.0 in French, IBM SPSS 20, STATA 9 and comparison tests used were those of Chi2 and Student-Fisher with the limit of 95% confidence.

Of a total of 420 pupils included in this study, 12 withheld consent and 55 could not be traced. Therefore 353 pupils were recruited for this study with a participation rate among potentially eligible pupils of 84%. Of the 353 pupils, 129 were referred and examined at the Yaounde Central Hospital. Twenty three point two percent (23.2%) were diagnosed TELC. The average age of patients with TELC was 8.24 +/- 0.6 years (range: 3 to 15 years). The pupils of the age group of 6 to 10 years were the most affected with a statistically significant P value between the age groups concerned. Males predominated with a sex-ratio of 1.34 and a significant P value (P=0.0236). Ocular itching was the most common symptom encountered in 98% of patients followed by tearing (75%). Ocular involvement was bilateral. In all cases, symptoms were recurrent in dry season (93% of cases) with aggravating factors dominated by dust (60%) and exposure to sun light (52%). Far visual acuity without correction was at least 3/10 in 98%. The presence of conjunctival papillae, lid laxity and brownish pigmentation of the bulbar conjunctiva accounted for the majority of clinical signs with respectively 93%, 80%, and 63% followed by conjunctival hyperemia (49%). Palpebral form was observed in 65% of patients with TELC followed by mixed form in 28% of patients.

The prevalence of TELC in schools in Yaounde is 23.2%. The TELC is a common condition among children aged 6 to 10 years. Male children are the most affected. Palpebral form was the most frequent, contrary to observations made elsewhere in Africa.


********************************************************************************************