La cryptococcose neuroméningée au cours de l’infection à VIH à Bangui, à l’ère du traitement antirétroviral

Abstract

The cryptococcal neuromeningitis is the most common fungal meningitis infections in the course of HIV/AIDS. This is the number two of opportunist infection of the central nervous system. The authors post the outcomes of a retrospective study conducted related to 122 cases of cryptococcal neuromeningitis observed over for four years ago, in Bangui in the Central African Republic, this at time when antiretroviral treatment has been avaible, corresponding to a prevalence of 6.5%. These infections very aften occur more in female folk, and to patients whose average age is 35 years old, ranging from 18 to 69 years old. The clinical symptoms often found had been headache (98,3.%), fever (95.0%), the impairing of the overall condition of the patient (86.7%) and neck stiffness (85.9%). It makes sense to notice that comorbidity case alowgwith tuberculosis, intestinal candidiasis, bacterial pneumonia and Kaposi's diseases were found out. The screening of the cerebrospinal fluid showed a sound cell count and even low count in 12.2% of cases. Direct examination of cerebrospinal fluid with India ink helps in diagnosis of 97.5% of cases, and the culture carried out from 74 patients was in any case positive. This culture allowed the diagnosis of three patients whose examination along side with India ink has been negative. The CD4 cell count was less than 100/mm(3) in 97.7% of cases. The rate of the fatality cases has been 66.4%, it has been badly impacted by a CD4 count <50/mm(3) and the lack of antiretroviral therapy. Despite the establishment of a national antiretroviral treatment program to do influence the frequency of opportunistic infections whose cryptococcal neuromeningitis, this condition is still present although it is declining. The clinical variability of this disease requires early diagnosis to avoid delayed treatment corollary of a very high mortality as we have observed.

Cryptococcosis Neuro-Brain in 42 Patients at the University Hospital of Brazzaville

“…The long consultation time is typical in sub-Saharan Africa and is justified by the denial of the underlying disease that requires patients to consult traditionally before resorting to the hospital only tardily (Aoufi et al, 2008;Aoussi et al, 2012). Fever and headache were the major signs in our patients as illustrated in the literature (Gbangba-Ngai et al, 2014). However, it should also be noticed the non-specificity of clinical signs in neuromeningeal Cryptococcus with the possibility of rough or atypical forms (Soumare et al, 2005).…”

“…The mean value of albuminorrachia was 0.50 g/l and Cryptococci was identified after CSF staining with Chinese ink in all patients (n = 42,100%). The mean delay in confirming the diagnosis was 5 days (Aberg et al, 1999;Aoufi et al, 2008;Eholié et al, 2000;Aoussi et al, 2012;Sow et al, 1998;Millogo et al, 2004;Kivukuto et al, 2012;Gbangba-Ngai et al, 2014;Soumare et al, 2005). There were thirty-seven weakened immune system patients with HIV1 (88.1%).…”

“…Neuromeningeal cryptococcosis occurs very commonly in HIV-infected and profoundly immunosuppressed patients so that it constitutes the second opportunistic infection once there is AIDS (Aberg et al, 1999). In the United States, more than 80% of reported cases occur in positive HIV individuals (Gbangba-Ngai et al, 2014). The long consultation time is typical in sub-Saharan Africa and is justified by the denial of the underlying disease that requires patients to consult traditionally before resorting to the hospital only tardily (Aoufi et al, 2008;Aoussi et al, 2012).…”

About 54 Cases of Neuromeningtic Cryptococcosis on HIV Infection

“…The mean age in our patients is 39 ± 2 years [18-84years] and the sex ratio 3.15 (41 males and 13 females) are consistent with what was reported in previous studies or the young age testifying to an active sex life and the masculine gender predominate because men by their work and their activities outside are more exposed to the germ [4,9]. 76% of our patients are diagnosed at the AIDS stage (the CNM is revealing in 41%, occurring in 24% after a recent HIV seropositivity and in 11% in patients lost to follow-up) like the majority of African patients confirming the problem of HIV testing and care in Algeria, despite awareness-raising campaigns and the free provision of ARVs since 1998 [8,10].…”

“…Our study showed that the number of cases of CNM has increased significantly for two decades with resurgence in the last six years CRD Algiers in connection with the increase in the number of PLWHA followed in our institution. The average frequency is 4.2%, this result is higher than reported in Tunisia 3.47%, Morocco 1.4%, India 1.32% and Cote d'Ivoire 0.6% and lower than that of the Central African Republic 6.5% [4][5][6][7][8]. The mean age in our patients is 39 ± 2 years [18-84years] and the sex ratio 3.15 (41 males and 13 females) are consistent with what was reported in previous studies or the young age testifying to an active sex life and the masculine gender predominate because men by their work and their activities outside are more exposed to the germ [4,9].…”