[Acute Trypanosoma brucei gambiense meningoencephalitis detected by papillary edema]. / Méningo-encéphalite aiguë à Typanosoma brucei gambiense révélée par un oedème papillaire.

A 26 year old woman, living in Brazzaville, was referred by her ophthalmologist about papillo-oedema. Neurological examination showed frontal syndrome and papillo-oedema without another sign of intracranial hypertension. Electroencephalogram revealed bilateral delta waves and bifrontal points. Significant inflammatory syndrome was noted. Cerebrospinal fluid examination showed trypanosomes with an elevated rate of protein and cells. Treatment by tetracosactide and eflornithine gave a good recovery. Authors are stressing the disconcerting feature of this clinical form. An urban from of the disease and the fight against african trypanosomiasis are also discussed.

[Opportunistic parasitic diseases and mycoses in AIDS. Their frequencies in Brazzaville (Congo)]. / Parasitoses et mycoses opportunistes au cours du SIDA. Leurs fréquences à Brazzaville (Congo).

To determine the frequency of opportunistic parasitic and mycotic diseases in adult AIDS patients in the Congo, a study was conducted at l'Hôpital Universitaire de Brazzaville in 1986 and 1987. Diagnosis of AIDS was made using the WHO clinical definition for Africa (Bangui, 1985) and HIV seropositivity Pasteur Elisa test. Oral pharyngeal candidiasis occurred in 36% of cases. Intestinal parasitic profile found in 118 patients, 2/3 of whom were associated with chronic diarrhoea showed clearly relative frequency of isosporiasis (Isospora belli): 9.3% and rarity of crystosporidiosis: 4.2%. 12 meningitic cryptococcosis cases out of 139 patients was confirmed (8.6%); for cerebral toxoplasmosis, it was by comparing the serum toxoplasmosis antibody and cerebrospinal fluid rates on 75 patients that an estimation of 20% was reached. Pneumocytis carinii pneumonia seems to be rare, lower than 10%. No case of disseminated histoplasmosis and malignant strongyloidiasis was observed.

PIP: Studies conducted with locally available means at the University Hospital in Brazzaville have provided data on opportunistic parasitic and mycotic disease in AIDS patients in the Congo. The diagnosis of AIDS was based on the World Health Organization clinical definition for Africa and on positive ELISA tests. Patients were prospectively studied in 1986-87. 12 cases of meningitic cryptococcosis were found in 139 patients studied, for a rate of almost 9% of AIDS cases. Prior to the AIDS epidemic only 2 cases were published in the Congo. 35.6% of 146 cases studied showed oral pharyngeal candidiasis on clinical examination. The frequency of esophageal and bronchopulmonary candidiasis could not be estimated with the means available. 118 AIDS patients had intestinal parasites, of whom 2/3 had chronic diarrhea. 9.3% were caused by Isospora belli and 4.2% by Cryptosporidiosis. Other intestinal flora were apparently affected by routinely administered antiparasite treatments. An estimate of 20% for cerebral toxoplasmosis was obtained by comparing serum toxoplasmosis antibody and cerebrospinal fluid rates for 75 patients. The rate of pneumocystis carinii pneumonia appears on indirect evidence to be under 10%. No cases of disseminated histoplasmosis or malignant strongyloidiasis were observed. The biggest differences between the patterns of opportunistic infection in industrialized countries and especially the US and in the Congo appear to be the lesser frequency in the Congo of pneumocystosis and the greater frequency of Isosporosis and cerebral toxoplasmosis.