The pattern of neurological diseases in elderly people in outpatient consultations in Sub-Saharan Africa.

BACKGROUND: Neurological diseases are frequent in older adults, affecting between 5% and 55% of people age 55 and older. They are associated with a high risk for adverse health outcomes, including mortality, disability, institutionalization and hospitalization. Little is known about the epidemiology and clinical pattern of neurological disorders of the elderly in developing countries. Although many studies have demonstrated the areas where the burden of neurological diseases lies, elderly patients in Sub-Saharan Africa have received little attention. We performed this descriptive study to understand the burden of disease faced by Cameroonian neurologists and geriatricians. METHODS: The records of all out-patient neurological consultations from May 2005 to December 2011 were collected at the Clinique Bastos, the sole clinic with adult neurological consultations during the study period in Yaoundé, the political capital of Cameroon. All medical records were reviewed by a neurologist and neurological diagnoses were classified according to ICD-10. RESULTS: Among a total of 912 patients, 187 (20.5%) were aged 60 and older. According to the ICD-10 classification, episodic and paroxysmal disorders were present in 18.7% of patients, extrapyramidal and movement disorders in 14.6%, and nerve, nerve root and plexus disorders in 13.3%. The most common neurological diseases of the elderly in this study were lumbar arthrosis (14%), dementia (Alzheimer's type, vascular) (12.4%), Parkinson's disease (10.2%), and polyneuropathy (9.1%). CONCLUSION: Degenerative diseases like dementia and Parkinson's disease as well as strokes and headaches are frequently encountered neurological diseases in elderly patients in Sub-Saharan Africa. It is important that standard treatment regimes, often Ministry of Public Health based, are adhered to these diseases.

Comparison of the clinical profile of Parkinson's disease between Spanish and Cameroonian cohorts.

BACKGROUND: There are limited data in terms of the clinical profile of Parkinson's disease in sub-Saharan African patients. OBJECTIVE: To compare the clinical profile and access to standard antiparkinsonian therapies of a Cameroonian cohort of patients with an age, sex, and disease duration-matched Spanish cohort (Longitudinal Study of Parkinson's disease, ELEP). METHODS: Observational, cross-sectional design. Demographic data were collected and the following ELEP assessments were applied: Scales for Outcomes in Parkinson's disease (SCOPA) Motor, Autonomic, Cognition, Sleep and Psychosocial; Hoehn and Yahr staging; modified Parkinson Psychosis Rating Scale; Cumulative Illness Rating Scale-Geriatrics; Hospital Anxiety and Depression Scale; pain and fatigue visual analog scales; Zarit, and EuroQoL. RESULTS: 74 patients with idiopathic Parkinson's disease were included (37 from each country) with a mean age of 64.4±10.5 years old, 70.3% males, and mean disease duration of 5.6±5.9 years. Compared to the Spanish cohort, Cameroonians were intermittently treated, less frequently received dopaminergic agonists (p<0.001), had a trend for taking lower doses of levodopa (p=0.06), and were more frequently on anticholinergics (p<0.0005). Cameroonians were more severely impaired in terms of motor (Hoehn Yahr stage, p=0.03; SCOPA-Motor, p<0.001), cognitive status (p<0.001), anxiety and depression (p<0.001), psychosis (p=0.008), somnolence, fatigue and pain (p<0.001, respectively), caregiver burden (p<0.0001), and quality of life (p=0.002). Instead, autonomic, comorbidity, and nocturnal sleep problems were similarly found. CONCLUSIONS: Limited and intermittent access to dopaminergic drugs has a negative impact on motor symptoms, nonmotor symptoms and quality of life in patients with Parkinson's disease and their caregivers.

Crises epileptiques au cours de la toxoplasmose cerebrale chez les patients immunodeprimes au V IH

Décrire les caractéristiques des crises épileptiques au cours de la toxoplasmose cérébrale (TC) chez les patients immunodéprimés au VIH à l'Hôpital Général de Douala (HGD).Matériel méthodes Il s'agissait d'une étude descriptive rétrospective des cas de TC diagnostiquée entre janvier 2000 et décembre 2012. La prévalence, le type, la fréquence des crises épileptiques et les thérapeutiques antiépileptiques ont été étudiées. Les patients avec un antécédent de crises épileptiques étaient exclus. Le test de Khi-2 a été utilisé pour rechercher les facteurs associés à la survenue des crises épileptiques tandis que le test de Student a été utilisé pour comparer les moyennes. P < 0,05 était considéré comme statistiquement significatif. Résultats 146 patients étaient inclus avec 78 femmes pour un sex-ratio de 0,87 en faveur des femmes. L'âge moyen était de 39,38 ± 9,88 ans. Le taux de CD4 moyen était de 115,63 ± 142,70 éléments/ml. La prévalence des crises épileptiques était de 45,2% et 61% des épileptiques étaient répétées. Les crises épileptiques généralisées prédominaient avec 75,8%. Seuls la fièvre (p < 0,012), les céphalées (p < 0,004), le syndrome d'hypertension intracrânienne (p < 0,038), un taux de CD4 < 50/ mm3 (p < 0,02) et un taux d'hémoglobine <10g/dl (p < 0,017) étaient statistiquement associés à la survenue des crises épileptiques. Un traitement antiépileptique était prescrit chez 43,2% des patients. Conclusion Les crises épileptiques sont fréquentes au cours de la toxoplasmose cérébrale. Elles peuvent se répéter et justifier d'un traitement antiépileptique

Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: a cross sectional study.

BACKGROUND: Cryptococcal meningoencephalitis (CM) kills about half a million human immunodeficiency virus (HIV) patients per year, mostly in Africa. AIM: The aim of this study was to determine the prevalence, clinical presentation and in-hospital outcome of CM among HIV-infected patients in Douala. MATERIALS AND METHODS: A cross-sectional clinical note review of 672 HIV-1 patients' files admitted from January 1 (st) 2004 to December 31 (st) 2009 at the Internal Medicine unit of the Douala General Hospital, Cameroon was performed. Only patients diagnosed of CM by microscopy of Indian ink stained cerebrospinal fluid (CSF) were studied. RESULTS: The prevalence of CM in the study was 11.2%. Mean age of patients was 36.9 ΁ 12.7 years. Median cluster of differentiation 4 (CD4) cell count was 23 cells/µL, (interquartile range [IQR]: 10-61) and 62.7% of CD4 cell counts were >50 cells/µL. The most prevalent symptom was headache in 97.3% of patients. In CSF, median proteins was 0.9 g/L (IQR: 0.6-1); median glucose 0.2 g/L (IQR: 0.1-0.3) and median leucocyte count 54 cells/µL (IQR: 34-76) mostly of mixed cellularity. The case fatality rate was 52% and low CD4 cell count was strongly associated with death, odd ratio 4.6 (95% confidence interval: 2.6-8.0, P > 0.001). CONCLUSION: The high case fatality of CM in Douala warrants adequate diagnostic measures and optimization of standardized treatment to reduce mortality.

Tuberculous meningitis: presentation, diagnosis and outcome in hiv-infected patients at the douala general hospital, cameroon: a cross sectional study.

INTRODUCTION: Tuberculous meningitis (TBM) the most fatal presentation of tuberculosis (TB) especially in HIV-infected patients is a real diagnostic and therapeutic challenge worldwide. In Cameroon where HIV and TB are amongst the leading public health problems, the magnitude of TBM has not been defined. Therefore, the objective of this cross sectional study was to describe the presentation and in-hospital outcome of TBM among HIV patients in Douala as well as its diagnostic difficulties. METHODS: We did a clinical case note analysis of all HIV-1 infected patients treated for TBM in the Internal medicine unit of the Douala General Hospital, between January 1st 2004 and December 31st 2009. The diagnosis of TBM was made using clinical, laboratory [cerebrospinal fluid (CSF) analysis] and/or brain computerised tomographic (CT) scan features. RESULTS: During the study period, 8% (54/672) of HIV-infected patients had TBM. Their mean age was 40.3 ± 12.7 years. The main presenting complaint was headache in 74.1% (40/54) of patients. Their median CD4 cell count was 16 cells/mm3 (IQR: 10 - 34). CSF analysis showed median protein levels of 1.7 g/l (IQR: 1.3 - 2.2), median glucose level of 0.4 g/l (IQR: 0.3 - 0.5) and median white cell count (WCC) count of 21 cells/ml (IQR: 12 - 45) of which mononuclear cells were predominant in 74% of CSF. Acid fast bacilli were found in 1.9% (1/54) of CSF samples. On CT scan hydrocephalus was the main finding in 70.6% (24/34) of patients. In hospital case fatality was 79.6% (43/54). CONCLUSION: TBM is a common complication in HIV-infected patients in Douala with high case fatality. Its presumptive diagnosis reposes mostly on CSF analysis, so clinicians caring for HIV patients should not hesitate to do lumbar taps in the presence of symptoms of central nervous system disease.

Toxoplasma encephalitis in HIV/AIDS patients admitted to the Douala general hospital between 2004 and 2009: a cross sectional study.

BACKGROUND: It is estimated that about a third of the world's population is chronically infected with Toxoplasma gondii. Toxoplasma encephalitis (TE), which occurs as a reactivation of quiescent chronic infection, is one of the leading causes of central nervous system (CNS) infection in AIDS. Its diagnosis in most centres still remains difficult. We opted to describe the clinical and radiological features of TE as well as in-hospital outcome and its associated factors. METHODS: We carried out a cross sectional study on the clinical case notes of adult patients admitted and treated for TE at the Douala General Hospital, Cameroon between January 1st 2004 to December 31st 2009. RESULTS: Of 672 patients admitted during the study period, 14.4% (97/672) had TE. The mean age was 36.9 ± 14.1 years and the median CD4 cell count was 68/mm3 (IQR): 43 - 103). Headache and fever were the most common presenting symptoms in 92.8% (90/97) and 87.6% (85/97) of patients. Annular contrast enhanced lesions were the most common brain scan finding in 81.4% (79/97) of patients. In-hospital mortality was 29.9% (29/97). Altered sensorium, presence of focal signs, neck stiffness and low CD4 cell count were factors associated with mortality. Adjusting for low CD4 count, altered sensorium remained strongly associated with fatality, adjusted odd ratio (AOR) 3.5 (95% CI 1.2 - 10.5). CONCLUSION: Toxoplasma encephalitis is common among AIDS patients in Douala. Its high case fatality warrants adequate and compliant prophylactic therapy in severely immune depressed patients as well as early initiation of antiretroviral therapy in HIV-infected patients.

HIV-Associated Central Nervous System Disease in Patients Admitted at the Douala General Hospital between 2004 and 2009: A Retrospective Study.

Background. Studies on HIV-associated central nervous system (CNS) diseases in Cameroon are rare. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. Methods. From January 1, 2004 and December 31, 2009, we did at the Douala General Hospital a clinical case note review of 672 admitted adult (age ≥ 18 years) HIV-1 patients, and 44.6% (300/672) of whom were diagnosed and treated for HIV-associated CNS disease. Results. The mean age of the study population was 38.1 ± 13.5 years, and median CD4 count was 49 cells/mm(3) (interquartile range (QR): 17-90). The most common clinical presentations were headache (83%), focal signs (40.6%), and fever (37.7%). Toxoplasma encephalitis and cryptococcal meningitis were the leading aetiologies of HIV-associated CNS disease in 32.3% and 25% of patients, respectively. Overall mortality was 49%. Primary central nervous system lymphoma (PCNSL) and bacterial meningitis had the highest case fatality rates of 100% followed by tuberculous meningitis (79.8%). Low CD4 count was an independent predictor of fatality (AOR: 3.2, 95%CI: 2.0-5.2). Conclusions. HIV-associated CNS disease is common in Douala. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality.

HIV-associated sensory neuropathy in HIV-1 infected patients at the Douala General Hospital in Cameroon: a cross-sectional study.

BACKGROUND: Peripheral neuropathy (PN) which is the most common neurological complication of HIV infection is under recognised and undertreated especially in resource limited settings. This ailment which has a negative impact on the quality of life of HIV/AIDS patients exists in different clinical patterns of which HIV-associated Sensory neuropathy (HIV-SN) is the most common affecting up to two thirds of patients with advanced disease in some settings. In Cameroon where HIV is a major public health problem, the burden of HIV-SN has not yet been well defined. METHODS: Using the Brief Peripheral Neuropathy Screening (BPNS) tool validated by the AIDS Clinical Trial Group (ACTG) we carried out a cross sectional study to determine the prevalence of HIV-SN and its associated factors among HIV-1 patients at the Douala General Hospital between 1st July and 31st October 2011. HIV-SN was defined as the presence of neuropathic symptoms and at least an abnormal perception of vibrations of a 128Hz tuning fork on the great toe or abnormal ankle reflexes or both and expressed as a percentage of the study population. RESULTS: Out of 295 patients studied, 21% had HIV-SN. In HIV-SN patients the median duration of HIV infection was 79.8 months (IQR 46 - 107.5) and their median CD4 count 153cells/µL (IQR 80 - 280). Patient recall and clinical chart review showed that, 83.9% had neuropathic symptoms prior to HAART initiation and 16.1% after HAART initiation. Low CD4 count, history of alcohol intake and history of anti-tuberculosis treatment were strongly associated with HIV-SN (AOR 2.5, 2.8 and 2.9 respectively). CONCLUSIONS: HIV-SN is common among patients with advanced HIV infection in Cameroon. This simple diagnostic tool (BPNS) should therefore be routinely used to detect those with HIV-SN or at risk so as to minimise the negative impact it has on their quality of life.