[Post-circumcision Tetanus: Epidemiological, Clinical, Prognostic and Evolutionary Aspects of 16 Cases Collected at the Department of Infectious and Tropical Diseases in Fann Hospital (Dakar)]. / Tétanos postcirconcision : à propos de 16 cas colligés à la Clinique des maladies infectieuses du CHNU de Fann (Dakar).

This retrospective, descriptive study carried out in the Infectious Diseases Department of CHNU, Fann from 1st January 2012 to 3st December 2016 aimed to describe the epidemiological aspects and the course of post-circumcision tetanus and to formulate public health recommendations. During our study period, 16 cases of post-circumcision tetanus were collected out of a total of 452 patients with tetanus, equivalent to a rate of 3.5%. The median age was 8 years (3-40). None of the patients had a vaccination card. In 63% of cases, circumcision was performed at home, by a practitioner whose qualification was not documented in 63% of cases. All signs of tetanus were found with trismus (100%), dysphagia (63%) and paroxysms (88%). These were mostly Mollaret stage II forms in 14 cases, and grade 3 Dakar score in 7 cases. The median duration of hospitalization was 10 days [6-15]. Mechanical or infectious complications were noted in two cases, with a lethality rate of 13%. Post-circumcision tetanus is a reality in Senegal. Good community awareness, continuous training of staff and implementation of vaccination catch-up strategies for children of circumcised age should eradicate this form of tetanus.

Cette étude rétrospective descriptive, réalisée à la Clinique des maladies infectieuses du CHNU de Fann du 1er janvier 2012 au 31 décembre 2016 avait pour but de décrire les aspects épidémiologiques et évolutifs du tétanos postcirconcision et de formuler des recommandations en termes de prévention. Durant la période d'étude, 16 cas de tétanos postcirconcision ont été colligés sur un total de 452 patients atteints de tétanos, soit une fréquence hospitalière de 3,5 %. L'âge médian était de huit ans (3­40). Aucun des patients ne disposait de carnet de vaccination. Dans 63 % des cas, la circoncision a été effectuée à domicile, par un praticien dont la qualification n'a pas été documentée dans 63 % des cas. Tous les signes du tétanos ont été retrouvés avec le trismus (100 %), la dysphagie (63 %) et les paroxysmes (88 %). Il s'agissait surtout de formes de moyenne gravité classées au stade II de Mollaret dans 14 cas, et au score 3 de Dakar dans sept cas. La durée médiane d'hospitalisation était de dix jours [6­15]. Des complications mécaniques ou infectieuses ont été notées dans deux cas, avec une létalité de 13 %. Le tétanos postcirconcision est une réalité au Sénégal. Une bonne sensibilisation de la communauté, la formation continue du personnel et la mise en place de stratégies de rattrapage vaccinal des enfants en âge d'être circoncis devraient permettre d'éradiquer cette forme de tétanos.

[Tuberculosis Abscess of the Chest Wall on an Immunocompetent Patient in the Teaching Hospital of Dakar (Senegal)]. / Abcès tuberculeux de la paroi thoracique chez une patiente immunocompétente au centre hospitalier universitaire de Dakar (Sénégal).

Tuberculosis remains a problem of public health, in spite of the numerous significant advances noted in the diagnosis in recent years. The involvement of the thoracic wall is a rare extra lung shape. Its clinical presentation is not specific and a collected thoracic tumefaction is the main clinical demonstration. The diagnosis is improved by the use of non-invasive tools such as the Xpert MTB/Rif® test with a good sensibility on the pus. Medical care is based on medical treatment and sometimes associated with surgical treatment.

La tuberculose demeure un problème de santé publique, malgré les nombreuses avancées significatives notées dans le diagnostic ces dernières années. L'atteinte de la paroi thoracique est une forme extrapulmonaire rare. Sa présentation clinique est non spécifique, et une tuméfaction thoracique collectée en est la principale manifestation clinique. Le diagnostic est amélioré par l'utilisation d'outils non invasifs tels que le test Xpert MTB/Rif® avec une bonne sensibilité sur le pus. La prise en charge repose sur le traitement médical quelquefois associé à un traitement chirurgical.

Cryptococcose neuro-méningée : mortalité et facteurs associés au décès chez les patients hospitalisés au service des Maladies Infectieuses du CHNU de Fann

Introduction : La Cryptococcose Neuro-Méningée (CNM) survient souvent sur terrain d'immunodépression et surtout au cours de l'infection à VIH.Objectif : Déterminer la prévalence de la mortalité et les facteurs associés au décès. Patients et méthodes : Etude rétrospective descriptive et analytique, sur des patients hospitalisés de 2011 à 2014, des deux sexes, d'âge supérieur à 18 ans avec une CNM confirmée.Résultats : Trente-quatre cas colligés, dont 31 chez des patients VIH+ (91,1%). L'âge moyen était de 43,17 ans et la majorité avait un âge compris entre 40 et 49 ans. Le sex-ratio était de 1,26 en faveur des hommes. Ils présentaient des maladies chroniques sous-jacentes dans 11,7% des cas. Sur le plan clinique, céphalées (81,8%), fièvre au long cours (76,5%), vomissements (57,6%) et troubles de la conscience (44,1%) étaient notés. Des infections opportunistes étaient objectivées (97%) avec une prédominance de la candidose digestive. Sur le plan biologique, le taux moyen de LT CD4+ était de 117,42/mm3. L'examen direct à l'encre de Chine positif dans 11/23 cas. L'antigène cryptococcique positif dans LCR dans 16/24 cas et l'antigénémie positive pour 20/22 cas. Sur le plan évolutif, la létalité était de 57,6%. La durée de l'infection à HIV< 20 mois et les patients sans traitement ARV étaient les facteurs associés au décès.Conclusion : Dans nos régions elle est l'une des principales causes de méningo-encéphalite chez les sujets VIH+ immunodéprimés. Sa létalité est importante du fait de la non- disponibilité des antifongiques majeurs et du diagnostic tardif de l'infection à VIH

Prevalence of TB/HIV coinfection in antiretroviral-naïve patients at the Fann Ambulatory Treatment Center in Dakar.

To determine the prevalence of tuberculosis and describe its epidemiological, clinical, paraclinical, and therapeutic characteristics and its outcome in patients with HIV. This retrospective, descriptive, and analytical study examined the records of patients with HIV at our outpatient treatment center and selected those who were antiretroviral-naive and presented tuberculosis between January 2008 and December 2012. Among a total of 757 HIV-positive patients, 76 had tuberculosis, for a prevalence of 10 %. The sex ratio of 1.23 favored men. The average age was 42.5 years (range: 25 to 69 years. Nearly all these patients (71 cases) had HIV-1. A history of tuberculosis was reported by 39.5 %. Seventeen patients were malnourished. Management included chemoprophylaxis with cotrimoxazole for 64 patients. The pulmonary form predominated (72.4 %). Among these forms, there were 34 cases of negative microscopy tuberculosis and 21 cases of positive microscopy tuberculosis. The extrapulmonary forms (21 cases) were dominated by tuberculosis in the lymph nodes (11 cases), the pleura (7), pericardium (2), and peritoneum (1). Anemia was found in 44 patients. Severe immunosuppression was noted in 90 %, with CD4+ cell counts <350/mm3. Lethality was 7.9 %. TB/HIV coinfection is a major public health problem in Africa. Better coordination of activities in support of programs for tuberculosis and HIV/AIDS are needed.

Correction: Safety of Seasonal Malaria Chemoprevention (SMC) with Sulfadoxine-Pyrimethamine plus Amodiaquine when Delivered to Children under 10 Years of Age by District Health Services in Senegal: Results from a Stepped-Wedge Cluster Randomized Trial.

[This corrects the article DOI: 10.1371/journal.pone.0162563.].

Safety of Seasonal Malaria Chemoprevention (SMC) with Sulfadoxine-Pyrimethamine plus Amodiaquine when Delivered to Children under 10 Years of Age by District Health Services in Senegal: Results from a Stepped-Wedge Cluster Randomized Trial.

BACKGROUND: It is recommended that children aged 3 months to five years of age living in areas of seasonal transmission in the sub-Sahel should receive Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) during the malaria transmission season. The purpose of this study was to evaluate the safety of SMC with SPAQ in children when delivered by community health workers in three districts in Senegal where SMC was introduced over three years, in children from 3 months of age to five years of age in the first year, then in children up to 10 years of age. METHODS: A surveillance system was established to record all deaths and all malaria cases diagnosed at health facilities and a pharmacovigilance system was established to detect adverse drug reactions. Health posts were randomized to introduce SMC in a stepped wedge design. SMC with SPAQ was administered once per month from September to November, by nine health-posts in 2008, by 27 in 2009 and by 45 in 2010. RESULTS: After three years, 780,000 documented courses of SMC had been administered. High coverage was achieved. No serious adverse events attributable to the intervention were detected, despite a high level of surveillance. CONCLUSIONS: SMC is being implemented in countries of the sub-Sahel for children under 5 years of age, but in some areas the age distribution of cases of malaria may justify extending this age limit, as has been done in Senegal. Our results show that SMC is well tolerated in children under five and in older children. However, pharmacovigilance should be maintained where SMC is implemented and provision for strengthening national pharmacovigilance systems should be included in plans for SMC implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT 00712374.

[Malaria associated with bacterial infection in the department of infectious diseases at the National and University Hospital of Fann, Dakar]. / Paludisme grave et infections bacteriennes associees au service des maladies infectieuses du centre hospitalier National et Universitaire de Fann a Dakar.

OBJECTIVES: To describe severe malaria cases with bacterial infection. PATIENTS AND METHODS: We conducted a prospective, descriptive and analytical study over 8 months. RESULTS: 15 of the 86 severe malaria cases had bacterial infections: enteritis (7 cases), urinary tract infection (4 cases), meningitis (4 cases), pneumonia (cases), sepsis (1 case), and sinusitis (1 case). Convulsions, jaundice, abnormal bleeding, pulmonary edema were more frequent in patients with associated infections. The average number of leukocytes and CRP were significantly higher in patients with bacterial infection. The mean parasite density was higher in patients without bacterial infection (56,362/mm3 vs. 239,162.2 ± 3326/mm 3 ± 7175.3). Lethality was higher in patients with bacterial infection (20% versus 16.9%). CONCLUSION: Bacterial infections are common in severe malaria and may influence the prognosis.

OBJECTIFS: Décrire les cas de paludisme grave avec infection bactérienne associée. PATIENTS ET MÉTHODES: Etude prospective, descriptive et analytique sur 8 mois. RÉSULTATS: Parmi les 86 cas de paludisme grave, 15 avaient des infections bactériennes: Entérite (7 cas), Infections urinaires (4 cas), méningites (4 cas), pneumopathies (cas), septicémie (1 cas), sinusite (1 cas). Les convulsions, l'ictère, le saignement anormal, l'œdème pulmonaire étaient plus fréquents chez les patients présentant des infections associées. Le nombre de leucocytes moyen et la CRP était significativement plus élevé chez les patients avec infection bactérienne. La densité parasitaire moyenne était plus élevée chez les patients sans infection bactérienne (56362/mm3 ± 239162,2 Vs 3326/mm3 ±7175,3). La létalité était plus élevée chez les patients avec infection bactérienne (20% contre 16,9%). CONCLUSION: Les infections bactériennes ne sont pas rares au cours du paludisme grave et peuvent en influencer le pronostic.

Aspects radiologiques de la tuberculose pulmonaire chez les patients infectés par le VIH hospitalisés au service des maladies infectieuses et tropicales de Fann de Dakar, Sénégal

Objectifs : Déterminer la prévalence de la tuberculose pulmonaire chez les personnes vivant avec le VIH et décrire ses aspects radiologiques. Patients et méthodes : Il s'agit d'une étude rétrospective et descriptive réalisée à partir de dossiers de patients infectés par le VIH/Sida et hospitalisés au service des maladies infectieuses et tropicales pour une tuberculose pulmonaire durant la période allant du 1er janvier 2011 au 31 décembre 2013. Résultats : Durant cette période d'étude, nous avons colligé 124 cas de co-infections tuberculose pulmonaire/VIH sur un total de 571 cas de tuberculose toutes formes confondues soit une prévalence de 21,7%. Le sexe masculin était prédominant avec un sex-ratio de 1,48. La notion de contage tuberculeux était retrouvée dans 8,9% des cas. Les signes cliniques classiques de la tuberculose pulmonaire ont été retrouvés notamment l'altération de l'état général (105 cas), la toux chronique (93 cas) et la fièvre chez (105 cas). L'intradermoréaction à la tuberculine était positive dans 7,3% des cas. Les crachats BAAR étaient réalisés dans 73,3% des cas et positifs dans 18,5% des cas. Le GeneXpert était réalisé chez 62 patients et positif dans 9,7% des cas. La radiographie thoracique était normale chez 35 patients et dans les autres cas les lésions radiologiques étaient dominées par : les infiltrats (20 cas); les miliaires (17 cas), infiltrat + opacités réticulo-nodulaires (15 cas), caverne + infiltrats (14 cas), opacités réticulo-nodulaires (13 cas). Dans la plupart des cas (63,7%), la localisation des lésions était diffuse. Conclusion : Les aspects radiologiques habituels de la tuberculose pulmonaire sont modifiés chez les patients infectés par le VIH avec atteintes parenchymateuses plus étendues

Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal.

OBJECTIVE: We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50 cells/µL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load (<50 copies/mL). METHODS: Logistic regression and Cox's proportional hazards model were used to examine risk factors for SIR and the association between SIR and the risk of new clinical events or death, respectively after six months of ARVT. RESULTS: One hundred and two (15.5%) of the 657 patients presented with SIR. Age > 40 years (aOR = 1.74, 95% CI = 1.10-2.75), baseline CD4 ≥ 100 cells/µL (aOR = 2.06, 95% CI = 1.24-3.42), ARVT including AZT (aOR = 4.57, 95% CI=1.06-19.76), and the occurrence of a severe opportunistic infection during the first semester of ARVT (aOR = 2.38 95% CI= 1.49-3.80) were associated with SIR. After six months of ARVT and up to seven years of follow-up, 39 patients with SIR had presented with an opportunistic infection or death (rate= 9.78/100 person-years) compared to 168 with a normal recovery (rate = 7.75/100 person-years) but the difference was not statistically significant (aHR = 1.22, 95% CI = 0.85 to 1.74). CONCLUSION: SIR is less common in our country and is not associated with increased mortality or a greater incidence of opportunistic infections after six months of ARVT.

[Evaluation of tolerance of zidovudine-lamivudine-nevirapine combination in HIV 1 patients in Fann Teaching Hospital in Dakar]. / Évaluation de la tolérance de l'association zidovudine-lamivudine-névirapine chez les patients VIH-1 au Centre hospitalier de Fann à Dakar.

We conducted a study to evaluate the tolerance of the zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving AZT-3TC-NVP combination between 2008 and 2011. Seventy patients were included. Two thirds of the patients presented at least one side effect (44 cases). The digestive disorders (15 cases) and neuropsychiatric (14 cases) were the most frequent. Epigastralgia (20%), headaches (20%) and arthralgias (13%) were main side effects. A maculo-papular exanthema was noted in three cases. During the follow-up, five patients presented with anemia. No patient presented hepatic cytolysis due to NVP. All the patients followed for more than six months presented a side effect against 29.7% when the duration of treatment was equal to or less than 6 months (p=10(-5)). Most of the side effects due to the association AZT/3TC/NVP are minor. The evaluation of the clinical and biological tolerance must be maintained during all the follow-up.

[Elimination of maternal and neonatal tetanus in Senegal: evolution of survey indicators of 2003-2009]. / Élimination du tétanos maternel et néonatal au Sénégal : évolution des indicateurs de surveillance de 2003 à 2009.

OBJECTIVES: This study aimed to estimate the evolution of the maternal and neonatal tetanus in Senegal from the tetanus vaccination coverage among pregnant women, the proportion of deliveries attended by trained medical personnel and the number of cases of tetanus declared by respective districts, helping to identify districts at high risk of neonatal tetanus (NNT). METHOD: Data analysis of the epidemiological surveillance realized from 2003 to 2009 in 65 districts of Senegal. Data were collected from the reports of vaccination usage and from the Statistical Directories of the National Health Information Services of the Ministry of Health & Prevention. A district is at high risk when the incidence of NNT is ≥1 case per 1 000 Live births (LB). RESULTS: There were 153 reported cases of NNT in Senegal between 2003 and 2009. National incidence decreased from 0.08 to 0.03 case per 1 000 LB (p = 0,0008). The vaccination coverage of the pregnant women by at least two doses of tetanus vaccine (VAT2+) increased from 66% in 2003 to 78% in 2009. The percentage of districts that had reached a vaccination coverage ≥80% was 20% in 2003 compared to 60% in 2009 (p = 0.009). The proportion of deliveries attended by qualified medical staff evolved from 53% in 2003 to 67% in 2009 (p = 0,02). By 2009, the incidence of NNT was less than 1 case per 1,000 LBs in all districts. CONCLUSION: Assessing the elimination of maternal and neonatal tetanus in Senegal shows that progress has been made from 2003 to 2009. This was made possible through the organization of vaccination campaigns for women of childbearing age and the improvements in the conditions of deliveries.

[Efficacy and tolerance of tenofovir-lamivudine-efavirenz combination in HIV-1 patients in Fann Teaching Hospital in Dakar]. / Efficacité et tolérance de l'association ténofovir-lamivudine-éfavirenz chez les patients VIH-1 à la clinique des maladies infectieuses du CHNU de Fann à Dakar.

We conducted a study to evaluate the efficacy and tolerance of the tenofovir (TDF), lamivudine (3TC) and efavirenz (EFV) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving TDF-3TC-EFV combination between 2007 and 2011. Collected data was analysed using EpiInfo™ version 6.04. One hundred patients were included, with an average follow-up duration of 27 months and 19 days (± 21 months and 14 days).We observed an average increase in body weight of about 8 kg per annum, with an average rise in CD4 count of 100/mm(3) by the end of the second year. A reduction in viral load with 71% of patients in therapeutic success at 24 month of treatment was noted. Ninety-two patients presented with at least one side effect, mostly being Grade 1 or 2 (96.36%). Neurological (24 patients) and digestive (20 patients) complaints comprised the commonest reported side effects. Four patients had adverse effects severe enough to warrant a change in treatment regimen, principally due to renal insufficiency. Thirteen subjects died. Patients receiving TDF-3TC-EVF combination therapy need rigorous surveillance because this combination, although efficient, is not without significant adverse effects.

[Current profile of HIV-infected patients hospitalized in Dakar (Senegal)]. / Profil actuel des patients infectés par le VIH hospitalisés à Dakar (Sénégal).

Ten years after the introduction of the Senegalese Antiretroviral Drug Access Initiative in 1998, we conducted a retrospective study of the epidemiological and clinical profiles and outcome of HIV-infected patients hospitalized in the Infectious Diseases Clinic of Fann Teaching Hospital in Dakar between 2007 and 2008. During these 2 years, 527 HIV-positive patients were included. The average age of the patients was 41 ± 10 years, and the sex-ratio (F/M) was 1.1; 56% of patients were married. The average interval before admission was 40 ± 57 days. Fever (83%), loss of weight (83%) and cough (54%) were the principal symptoms. Tuberculosis (40.9%) and gastrointestinal candidiasis (38.9%) were the commonest opportunistic infections. Most patients were diagnosed at the AIDS stage (88%) and the CD4+ T lymphocyte count was ≤ 200/mm3 in 86% of cases. Hospital fatality was 44% (231/527). Tuberculosis (36%), bacterial pneumonia (18%) and encephalitis (12%) were the most frequent causes of death. Despite the availability of and free access to antiretroviral drugs in Senegal, the mortality associated with HIV infection remains very high due to late diagnosis. The population must be educated to boost early screening and care.

[Human rabies: diagnostic pitfalls]. / La rage humaine, un diagnostic parfois difficile.

The purpose of this report is to describe two cases of human rabies in Senegal that illustrate possible diagnostic and therapeutic pitfalls even in an endemic area. Although outcome is almost always fatal and interhuman transmission is uncommon, prompt diagnosis of rabies is important since delay increases the risk of exposure to the virus for the entourage.

[Maternal tetanus in Dakar from 2000 to 2007]. / Tétanos maternel à Dakar de 2000 à 2007.

The objective of this study conducted between January 2000 and December 2007 was to assess the current epidemiological, clinical and outcome features of maternal tetanus (MT) observed in the Infectious Diseases Clinic of Fann University Hospital in Dakar, Senegal. A total of 1156 patients were admitted for tetanus during this period including 9 (0.8%) presenting MT. A progressive decrease in the annual number of MT cases was observed. The mean age of MT patients was 28.3 years [range, 18 to 40 years]. Most cases (n=6) involved persons living in suburban areas, as did tetanus in women of childbearing age (WCBA) (51.9% of 129 cases) and in neonates (63.1% of 103 cases) admitted during the same period. All patients had fallen behind the vaccination schedule. Septic abortion (n=7) was the main etiological factor. Although tetanus was graded as moderate in 8 patients (Mollaret stage 2), the death rate was high (44.4%) due to infectious and obstetric complications. This rate was similar to that associated with tetanus in newborns (48.5%), but higher than that associated with tetanus in WCBA (25.6%). The incidence of life-threatening MT is declining in the Infectious Diseases Clinic of Fann University Hospital in Dakar. A systematic immunization program along with campaigns to prevent unwanted pregnancy in women of childbearing age will be needed to eliminate maternal and newborn tetanus in Dakar.

[Tetanus in women of childbearing age at the infectious diseases clinic in Dakar]. / Le tétanos de la femme en age de procréer a la clinique des maladies infectieuses de Dakar.

The objective of this article was to describe the epidemiological and outcome features of tetanus in the woman of childbearing age (WCBAT) and compare them with neonatal tetanus (NT) and other tetanus cases in a hospital department in Dakar from 1998 to 2007. A retrospective study was conducted using the files of WCBAT (15 to 49 years old), NT (3 to 28 days old) and other tetanus cases admitted at the Infectious Diseases Clinic, in Fann University Hospital, from 1998 to 2007. 1484 cases of tetanus were admitted in 10 years, with 176 cases of tetanus of WCBAT (11.8%) and 178 cases of NT (11.9%). In comparison with WCBAT the NT annual hospital rate significantly decreased during the study period whereas other tetanus cases rate remained stable. The average age of WCBAT was 26.1 year old and 57.9% were between 15 and 25 years old. The geographical origin was identical for all patients, with more than 71% coming from suburban areas. Most of the WCBAT cases were housewives (50.9%), single women (75%) without updated tetanus immunization (92%). The main portals of entry of WCBAT were injuries and wounds (67.4%) and maternal tetanus cases were rare (8%), mainly post-abortum. At admission, WCBAT cases were less severe than NT cases but more severe than other tetanus cases. The lethality rate of WCBAT cases (28.4%) was significantly lower than NT cases (50%, p = 0.00003), but higher than the other tetanus cases (22.2%; NS). Prognostic factors were: non-identified or intramuscular injection portal of entry and a Mollaret state III at admission. An intensification of the extended immunization program associated with supplementary immunization campaigns targeting women of child bearing age in high risk districts, are necessary to eradicate neonatal and maternal tetanus in Dakar.

[Parasitic and fungal neuroinfections at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar]. / Neuro-infections parasitaires et mycosiques a la clinique des maladies infectieuses du Chu de Dakar.

OBJECTIVES: This retrospective study was carried out to describe the epidemiological, clinical and aetiological profile of parasitic and fungal neuroinfections at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar. PATIENTS AND METHODS: Data were collected for analysis from patients files recorded from January 1, 2001 to December 31, 2003. RESULTS: We found 126 cases of parasitic and fungal neuroinfections, representing 62% of the total of neuroinfections cases (126/203) and 27% of cerebro-meningeal diseases encountered at the clinic during the study period (126/470). Sex ratio M/F was 1.7 and the mean age of patients was 32 years +/- 14.4. Thirty seven patients (30%) were HIV seropositive. Aetiologies were represented by cerebral malaria (85 cases), neuromeningeal cryptococcosis (37 cases) and toxoplasmosis (4 cases). The overall case fatality rate was 38% (48 deaths/126). The fatality rate varied according to aetiologies: 27% in cerebral malaria, and 59.5% in neuromeningeal cryptococcosis that was found mainly among HIV positive patients (34 cases/37). CONCLUSION: These results give evidence of the frequency and the gravity of the adult's cerebral malaria in Dakar, but also the growing place of the neuromeningeal cryptococcosis in the neuromeningeal opportunist pathology of HIV positive patients.

[Late diagnosis of HIV infection in the Fann, Dakar clinic of infectious diseases: testing circumstances, therapeutic course of patients, and determining factors]. / Dépistage tardif de l'infection à VIH à la clinique des maladies infectieuses de Fann, Dakar: circonstances de diagnostic, itinéraire thérapeutique des patients et facteurs déterminants.

BACKGROUND AND METHODOLOGY: The delay in the diagnosis of HIV infection is a major obstacle to optimal care for this disease. To deal with this problem, we conducted this study among newly diagnosed HIV patients hospitalized in the Fann University Hospital Infectious Diseases Clinic in Dakar. The epidemiological, clinical, biological and outcome aspects are described and patient history reviewed. A qualitative socio-anthropological study was made to understand and describe the logic of the decision processes in the patient's search for treatment. RESULTS: One hundred patients were included, with a mean age of 39.5+/-11.1 years and a sex-ratio: 1.08. The transmission was mainly heterosexual (90%), and chronic diarrhea (64%) and/or chronic cough (66%) were the principal symptoms leading to diagnosis. The mean delay before diagnosis was 5+/-4.27 months. The major opportunistic diseases were tuberculosis (44 cases) and infectious diarrhea (23 cases). Most patients were diagnosed at the AIDS stage (97%) and the death rate was 30% among hospitalized patients after admission. Sixty-eight percent of patients had consulted at least three times, generally a "traditional practitioner", at first and 43% had been hospitalized at least once. The qualitative investigation revealed that the "representation" or the "feeling of severity" of the disease were the principal justifications for consulting the "traditional practitioner" or the physician, respectively. CONCLUSION: Better information for health workers and global population is necessary for an earlier diagnosis of HIV infection in Dakar.