ABSTRACT
Facial paralysis is a well-described manifestation of HIV infection. We report 27 cases of peripheral facial paralysis observed at Bobo-Dioulasso Hospital in a prospective study over a period of 9 months: 55 of the cases were HIV positive and 12/15 (80%) were in the 20-39 age group. Nine out of 11 females and 6 out of 16 males were seropositive. 13 of the cases were at stage B of CDC classification and 2 at stage C. ESR was elevated in all the HIV patients. CSF examination revealed lymphocytic pleiocytosis, elevated proteins and a positive HIV serology. CD4 counts were obtained in 8 cases and were under 400/mm3 in 4 cases. The clinical presentation was more severe in HIV seropositives with a longer duration of symptoms. Isolated peripheral facial paralysis associated with an elevated ESR in young adults suggest HIV infection and should lead to HIV counselling and testing.
Subject(s)
Facial Paralysis/complications , HIV Seropositivity/complications , Acquired Immunodeficiency Syndrome/complications , Adult , Burkina Faso , CD4 Lymphocyte Count , Female , Humans , Male , Peripheral Nervous System Diseases/complications , Prospective StudiesABSTRACT
Neurological manifestations of HIV infection are frequent and diverse. Diagnosis is often difficult due to geographical factors. 686 of the 3409 patients admitted to the Internal Medicine ward of Bobo-Dioulasso in 1995-1996 were HIV seropositive. This represents a prevalence of 20.1%. The sociodemographic and clinical characteristics of 101 patients with neurological problems during the study period are reported in this paper. This case series represents 14% of the HIV-positive admissions. The mean age was 35.7 years and 43% of the cases were aged 30 to 40 years. Sex-ratio was 1.6 male for 1 female. Focal deficits were observed in 36 of cases. Peripheral neuropathy (37%), meningitis or meningoencephalitis (20%), fitting (8%) and myelitis (8%) were the other clinical presentations. The etiology of the focal deficits was not ascertained because of the lack of tomodensitometry, specific serology and necropsy. Any neurological manifestation in a HIV seropositive patient should prompt investigations in order to diagnose those infections which can be treated, especially Toxoplasma gondii abscess and Cryptococcus neoformans meningitis.
Subject(s)
HIV Infections/complications , Nervous System Diseases/complications , Adult , Aged , Burkina Faso , Female , Humans , Male , Meningitis/complications , Meningoencephalitis/complications , Middle Aged , Peripheral Nervous System Diseases/complicationsABSTRACT
The authors report five cases of Cryptococcus neoformans meningitis in HIV-positive patients hospitalized in the Souro Sanou National Hospital Center of Bobo-Dioulasso (Burkina Faso). There were 3 men and 2 women with a mean age of 36 years (range: 29 to 47 years). Presenting symptoms were persistent headache and/or mental confusion and neurosensory defects. Cerebrospinal fluid was clear with less than 20 lymphocytes/mm3. Albumin concentration greater than 0.50 g/l was observed in only one case. India ink smear and culture demonstrated strains of Cryptococcus neoformans sensitive to amphotericin B in all five cases, flucytosin in 3 cases, and ketoconazole in two cases. Four patients died within 15 to 32 days after admission (mean 22.5 days). Delayed diagnosis and inconsistent availability of systemic antifungal drugs are major limiting factors in the management of Cryptococcus neoformans meningitis in Burkina Faso.
