Cryptococcus neoformans is an important fungal pathogen in immunocompromised patients. A retrospective study was conducted to investigate the occurrence of Cryptococcus neoformans infection in patients admitted to Bobo-Dioulasso Hospital over a 3 year-period. During this period, cryptococcal meningo-encephalitis was diagnosed in 36 individuals. The median age of the patients under study was 34.25 years. There was a male preponderance (24 males/12 females) in our report. Typical presentations were persistent headaches (27 cases/36), neck stiffness (16/36), altered consciousness (14/36), fever (12/36) and convulsions (9/36). Oral candidiasis coexisted with cryptococcal meningitis in 7 patients. HIV serology was positive in all patients. At diagnosis, lymphocytes counts were < 1500/mm3 in 66.66% patients. CSF examination with India ink helped to the diagnosis of cryptococcosis in all cases. Cryptococcus neoformans was associated with Streptococcus pneumoniae in 4 patients. 15/36 patients died within 1 to 29 days after admission. High mortality was related to delayed diagnosis. Cryptococcal meningitis highly contributes to mortality in HIV-infected patients in Burkina Faso and it may occur in patients not severely immunocompromised patients. A need exists to improve strategies for clinical management of AIDS patients in poor African countries.

[Cryptococcal meningitis in HIV-infected patients at Bobo-Dioulasso hospital (Burkina Faso)].

In Europe before the advent of the acquired immunodeficiency syndrome (AIDS), fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rarely described and never in young adults. However, rapidly fatal cryptococcal meningitis in young Africans has been known to exist in central Africa for at least 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in this area since 1953, particularly in young patients during the 1950s. It is also known that central African AIDS patients frequently suffer from cryptococcosis, and there is a possibility that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. It appears possible that the central part of the African continent is the area where human immunodeficiency virus originated.

/pdf/the-historical-question-of-acquired-immunodeficiency-2pmeudtqnt.pdf

The historical question of acquired immunodeficiency syndrome in the 1960s in the Congo River basin area in relation to cryptococcal meningitis.

Resume La cryptococcose neuromeningee a pris une importance croissante en Afrique depuis l'avenement du SIDA. Entre 1985–1993, nous en avons hospitalise a Abidjan 149 cas, contre 4 cas de 1969 a 1980. Deux malades etaient VIH negatifs, 141 etaient VIH positifs (94,6 %) mais 6 n'avaient pas ete testes. Cliniquement il s'agissait de meningite pure (17,4 %) de meningoencephalite (80,5 %) de forme asymptomatique (2,1 %) et de forme disseminee (8,5 %). La letalite etait de 86,5 %, mais elle etait moins elevee de maniere statistiquement significative pour les protocoles a base de fluconazole seul ou en relais de l'amphotericine (70 %) par rapport a l'amphotericine seule ou associee a la fluorocytosine (90,2 %). Cette etude montre l'importance et les difficultes diagnostiques et therapeutiques actuelles de la cryptococcose en Cote d'Ivoire.

Aspects actuels de la cryptococcose neuroméningée à Abidjan

Resume Objectifs. – Cette etude avait pour objectifs de determiner la prevalence des affections cerebromeningees a la clinique des maladies infectieuses du CHU de Fann a Dakar, et d'en decrire les aspects epidemiologiques, cliniques et etiologiques. Malades et methodes. – Les donnees ont ete recueillies retrospectivement a partir des dossiers des cas hospitalises entre 2001 et 2003. Resultats. – Le nombre de cas colliges a ete de 470 (11,4 % des admissions), avec un sex-ratio M/F de 1,83 un âge moyen de 33 ans. Parmi ces cas, 89 etaient VIH positif. Le delai moyen d'hospitalisation etait de 11,5 jours et la symptomatologie comprenait : fievre (78 %), coma (64,9 %), syndrome meninge (57,4 %), convulsions generalisees (19 %), deficit moteur (15,5 %), atteinte des nerfs crâniens (7,2 %). Les etiologies etaient representees par le neuropaludisme (85 cas), les meningites purulentes (51 cas), la cryptococcose neuromeningee (37 cas), la tuberculose neuromeningee (11 cas), les suppurations intracrâniennes (10 cas), la toxoplasmose cerebrale (4 cas), les accidents vasculaires cerebraux (11 cas) et les hemorragies cerebromeningees (3 cas). Chez 248 malades (52,8 %), aucune etiologie n'a ete trouvee. La letalite globale a ete de 44,5 % (209 deces). Parmi les survivants, 22 (8,8 %) presentaient des sequelles neurologiques : deficit moteur (12 cas), surdite (5 cas), strabisme avec diplopie (2 cas), syndrome dementiel (2 cas), encephalite postmeningitique (1 cas). Conclusion. – Il importe d'ameliorer le plateau technique des services de diagnostic, d'assurer la prevention des infections opportunistes au cours de l'infection a VIH ainsi qu'une prise en charge multidisciplinaire des affections cerebromeningees.

Profil épidémiologique, clinique et étiologique des affections cérébroméningées observées à la clinique des maladies infectieuses du CHU de Fann à Dakar

Resume Objectifs Preciser la prevalence hospitaliere de la cryptococcose neuromeningee (CNM) et en rapporter les aspects sociodemographiques, cliniques, paracliniques et evolutifs des patients Patients et methodes Il s’agissait d’une etude retrospective portant sur 22 patients VIH positifs hospitalises du 1 er  janvier 2006 au 31 decembre 2009 dans le service de medecine interne du CHU de Treichville pour CNM Resultats La prevalence hospitaliere de la CNM chez les patients infectes par le VIH etait de 0,6 % L’âge moyen des patients etait de 35 ± 4,5 ans et le sex-ratio de 0,5 Le delai moyen d’evolution de la symptomatologie avant hospitalisation representait 10 ± 2,1 jours Le mode d’installation de la maladie etait progressif dans 86,4 % des cas Les signes cliniques dominants etaient la fievre notee dans 100 % des cas et les cephalees dans 95,4 % des cas Les principales anomalies cytochimiques du LCR etaient l’hyperproteinorachie(95,4 %), l’hypoglycorachie (91 %) et l’hyperlymphocytose (100 %) La recherche des Cryptocoques neoformans dans le LCR a l’examen direct apres coloration a l’encre de Chine etait positive dans 72,7 % des cas et apres culture sur milieu de Sabouraud additionne de chloramphenicol dans tous les cas (100 %) Le traitement a consiste en l’administration en monotherapie d’amphotericine B en perfusion chez 54,5 % des patients et en l’administration d’amphotericine B en perfusion avec relais par le fluconazole chez 45,5 % des patients L’evolution a ete mortelle dans 54,5 % des cas Conclusion Cette etude montre une reduction de la prevalence hospitaliere de la CNM dans notre service et une amelioration de son pronostic en rapport avec la tritherapie

Aspects actuels de la cryptococcose neuroméningée chez des sujets adultes infectés par le VIH dans le service de médecine interne du CHU de Treichville d’Abidjan (Côte d’Ivoire)

La cryptococcose au cours du SIDA est tres frequente a Bujumbura: 12,7%. Les donnees clinique, biologique et therapeutique sont ensuite analysees. La cryptococcose est au Burundi une cause majeure de morbidite et de mortalite au cours du SIDA

La cryptococcose à Bujumbura (Burundi). A propos de 80 cas observés en 42 mois

Le but de cette etude est d'analyser les principales caracteristiques epidemiologiques de la maladie ulcereuse gastroduodenale au Burundi a partir de 3282 endoscopies digestives hautes realisees en 3 ans ayant permis le diagnostic de 1476 ulceres (45%). L'ulcere duodenal predomine: pres de 93%

Aspects épidémiologiques de l'ulcère gastroduodénal au Burundi: à propos de 1 476 cas nouveaux observés en 3 ans

The objective of this study is to evaluate the main epidemiological characteristics of gastroduodenal ulcer in Burundi, from 3,282 high gastrointestinal endoscopies, performed over a 3-year period, permitting the diagnosis of 1,476 ulcers (45%): the duodenal ulcer is predominant, almost 93 p. cent. The sex-ratio is 2.75/1. There is a peak of maximum frequency between the ages of 20 and 29 years for duodenal ulcer. The results of this study are consistent with the series published in Africa regarding the location of the ulcer, sex and age. The frequency is high in relation with the series coming from West Africa. Two provinces in the 15 which form Burundi, share between them 50% of ulcer patients. These are the highest regions of the country (average attitude = 1,800 meters), but where the socio-cultural and dietary customs are the same as in the other provinces.

[Epidemiologic aspects of gastroduodenal ulcer in Burundi. Apropos of 1,476 new cases seen in 3 years].

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La cryptococcose à Bujumbura (Burundi). A propos de 80 cas observés en 42 mois

Aspects épidémiologiques de l'ulcère gastroduodénal au Burundi: à propos de 1 476 cas nouveaux observés en 3 ans

[Epidemiologic aspects of gastroduodenal ulcer in Burundi. Apropos of 1,476 new cases seen in 3 years].