Cryptoccocal meningitis and HIV in the era of HAART in Côte d'Ivoire.

OBJECTIVE: The authors had for aim to describe the management of cryptococcal meningitis in HIV infected adults, in Ivory Coast. PATIENTS AND METHODS: A retrospective study was made from January 1, 2005 to December 31, 2008 on the files of consecutive hospitalized patients presenting with cryptococcal meningitis, at the Treichville University Hospital, Infectious and tropical diseases department (Abidjan). The socio-demographic, clinical, and biological aspects as well as the outcome were analyzed. RESULTS: Eighty patients presenting with cryptococcal meningitis, (2.6% of hospitalized patients) were included: 41 men (51.25%) and 39 women (48.75%); mean age: 40 years (range 26 to 58 years). The delay before consultation was 5.4 days, range 2-12 days). The mains symptoms were headache (83.7%), fever (63.7%), and consciousness disorders (60%). Meningo-encephalitis accounted for 75% of the clinical presentations; 54 patients (67.5%) were naive of antiretroviral treatment (mean CD4: 45/mm(3) (range 5-103/mm(3)), while 26 (32.5%) had received antiretrovirals before presenting with cryptococcal meningitis (Nadir CD4=81/mm(3)). Amphotericin B relayed by fluconazole was prescribed to 86.2% of the patients, associated with a therapeutic lumbar puncture for 30 patients. The death rate was 41.2%. CONCLUSION: In spite of antiretroviral treatment availability in Ivory Coast, cryptococcal meningitis remains frequent with a high death rate. This study stresses the importance of early management to improve the prognosis.

[Epidemiology of tinea capitis in Abidjan, Cote d'Ivoire]. / Epidémiologie des teignes a Abidjan (Côte d'Ivoire).

Tinea capitis is a dermatosis of the scalp due to dermatophytes that can cause hair loss. It remains a significant endemic problem mainly in school children in tropical regions. The purpose of this case-control study carried out in the Dermatology Center of Treichville Hospital was to identify risk factors for tinea capitis in Abidjan, Cote d'Ivoire. A total of 80 cases were recruited on the basis of clinical findings showing one or several plaques showing desquamation or parakeratosis suggestive of tinea capitis. Diagnosis was confirmed by mycology using samples seeded on Sabouraud-chloramphenicol glucose agar and incubated at 27 degrees C for a mean period of 15 days. Species identification was based on growth rate, macroscopic aspect of isolates, production and potential diffusion of pigment, and microscopic examination. Controls were the next patient of the same age and sex with no evidence of mycosis. All subjects were questioned about previous history of mycosis, duration of tinea capitis lesions, functional signs, grooming habits, and pet-keeping. Size of selection was calculated by epi info 6.04 fr according to following estimations: percentage of exposed subjects in control group: 30%; percentage of exposed subjects in case group: 50%; probability threshold of 5% to find a difference between case and control groups even though there was no difference; and probability threshold of 20% to find no difference between cases and controls even though there was a difference. Study findings demonstrated a 3 times higher incidence of tinea capitis in boys than in girls and a peak during childhood especially between the of 5 to 9. The most frequent etiologic agents were Trichophyton soudanense and Microsporum langeroniise. Subjects at highest risk lived in dwellings having less than 4 rooms, used soap to wash the hair, cut their hair with a blade, and had low income.

In vitro activity of amphotericin B, fluconazole and voriconazole against 162 Cryptococcus neoformans isolates from Africa and Cambodia.

In order to determine the potential role that various antifungal agents might have in the management of cryptococcosis in tropical areas, the in vitro susceptibility of Cryptococcus neoformans isolates from Africa ( n=52) and Cambodia ( n=110) to three antifungal agents (amphotericin B, fluconazole and voriconazole) were compared using the E-test method. The results of this study (i) confirm the value of the E-test for testing the in vitro susceptibility of C. neoformans towards voriconazole; (ii) provide the first evidence demonstrating good activity of amphotericin B, fluconazole and voriconazole against Cambodian isolates; and (iii) show there are differences in susceptibility between African and Asian C. neoformans isolates, with Cambodian isolates appearing less susceptible to the agents tested but with amphotericin B maintaining good activity.

[Severe malaria in native adults in Abidjan (Côte d'Ivoire)]. / Paludisme grave de l'adulte autochtone à Abidjan (Côte d'Ivoire).

Our retrospective study carried out from 1985 to 1998 in the Unit of Infectious Diseases in Abidjan aimed at describing the epidemiological, clinical and prognosis features of severe malaria among native adults. Within 14 years, we have listed 274 cases of severe malaria for 54 098 hospitalizations (0.5%). 164 men and 110 women were recorded (sex-ratio = 1.5), aged of 33 years (16-86), among them 48% were HIV positive. 23% of the patients had already received an antimalarial treatment. The main clinical presentation was cerebral malaria (78%). The other manifestations were respiratory symptoms (13%), kidney failure (11%), anaemia (11%), macroscopic haemoglobinuria (6%), hypoglycaemia (9%), cardiovascular shock (4%). The average parasite load in blood was 27 222 plasmodium/microl (25 000 - 180200). The treatment used was quinine IV (172 patients), and arthemeter (102 patients). The outcome was favourable in 232 cases (84%) and 42 patients died. Prognosis factors identified were age > 65 years, Glasgow coma score < 7, convulsions, cardio-vascular shock, macroscopic haemoglobinuria. HIV infection has not been identified as a pejorative factor Our results confirm that severe malaria in native adult is a reality in tropical area. This study shows how difficult it is to have an adequate care management regarding this pathology in our context.

[Serological survey of acquired toxoplasmosis in women of child-bearing age in Yopougon (Abidjan, Côte d'Ivoire)]. / Dépistage sérologique de la toxoplasmose acquise chez les femmes en âge de procréer dans la commune de Yopougon (Abidjan, Côte d'Ivoire).

The seroprevalence of toxoplasmosis was assessed from August 2000 to March 2001 on 1025 women in child-bearing age while consulting in the preventive health center (PHC) of Yopougon (Abidjan). Indirect immunofluorescent test was used for detection of IgG and Remington test for detection of IgM. Among the women under investigation, 60% were found to be IG seropositive, including 0.4% IgM seropositive. Soil and food were sources of contamination. When compared to previous studies conducted in the same region for several years, these results give evidence of a stability of the seroprevalence of toxoplasmosis, contributing to increase the risk of toxoplasmic encephalitis occurrence in AIDS patients.

Epidémiologie des teignes à Abidjan (Côte d'Ivoire)

Due à des dermatophytes, la teigne est une dermatose du cuir ch evelu pouvant entraîner la chute des ch eveux. Elle reste un problème d'actualité car elle sévit à l'état endémique touchant surtout les enfants d'âge scolaire. Notre étude avait pour objectif de rechercher les facteurs de risque de teigne à Abidjan. Nous avons réalisé une enquête cas-témoins au Centre de Dermatologie du CHU de Treichville. Quatre-vingt (80) cas ont été recrutés sur la base de symptômes cliniques et confirmés après un prélèvement mycologique ensemencé sur milieu gélosé de Sabouraud-chloramphénicol et sur milieu gélosé de Sabouraud- chloramphénicol- cycloheximide, incubé à 27°C pendant 15 jours en moye n n e. Au terme de cette étude, nous avons noté : la prédominance masculine de l'affection avec un sex ratio de 3 ; la prédominance de l'atteinte dans l'enfance avec un pic entre 5 et 9 ans ; que Trichophyton soudanense et Microsporum langeronii partagent les étiologies de façon équivalente ; que les sujets les plus exposés à la teigne habitent dans un logement de moins de 4 pièces, utilisent le savon pour le lavage des cheveux, se font couper les cheveux avec une lame et ont de faibles ressources économiques

Human pentastomiasis discovered postmortem.

The autopsy of an 18-year-old girl who had died suddenly at home revealed generalised pentastomiasis. The location of this disease in the intestines was responsible for death by hemorrhagic enterocolitis. This discovery constituted an atypical case in our daily practice of forensic medicine.

[Therapeutic efficacy of chloroquine in the uncomplicated malaria due to Plasmodium falciparum in hospital patients in central Ivory Coast (1997-2000)]. / Efficacité thérapeutique de la chloroquine dans le traitement du paludisme simple dû à Plasmodium falciparum des consultants hospitaliers dans le centre de la Côte d'Ivoire (1997-2000).

A study in vivo of Plasmodium falciparum sensitivity to chloroquine was carried out from April 1997 to February 2000 at Yamoussoukro, Kossou and Bouaké in the central region of Côte d'Ivoire. This study was included in the national Plasmodium falciparum-sensitivity program. One hundred and sixteen subjects consulting for suspected malaria were included according to the WHO's standard of 14 days. Chloroquine was administered on a dosage of 25 mg/kg, spread over three days. Among 108 subjects who finished the treatment, 26.9% (29/108) had therapeutic failure to chloroquine (23 precocious therapeutic failure and 6 late therapeutic failure). Chloroquine was more efficacious in Yamoussoukro (87.5% of clinical appropriate response) and Bouaké (82.5%) than in Kossou (61.7%). Parasitic reduction on subjects with therapeutic failure was higher than 85%. The risk of therapeutic failure is not linked to age of patient. Before a revaluation of this situation, chloroquine should always be recommended as a first-line treatment for uncomplicated malaria for the local populations.

[Clinical trial of amodiaquine in the community of Attécoubé (Abidjan, Côte d'Ivoire)(May-December 1955)]. / Essai clinique de l'amodiaquine dans la commune d'Attécoubé (Abidjan, Côte d'Ivoire) (mai-décembre 1995).

A prospective study in the municipality of Attécoubé (Abidjan, Côte d'Ivoire) evaluated the sensitivity of P. falciparum to amodiaquine with a posology of 35 mg/kg over 3 days (1st day: 15 mg/kg; 2nd day: 10 mg/kg; 3rd day: 10 mg/kg) as well as its tolerance of this dosage. One hundred five WHO in vivo standard tests were performed over 7 days on subjects aged > 15 years from May to December 1995. The subjects were carriers of varying number of trophozoites: between 1000 to 34,000 trophozoites were recorded with a mean of 5193 trophozoites by microliter. We divided the subjects into two groups: group A with 43 patients to whom we administered medication and group B with 62 subjects who took their medication on their own. Clinical and parasitological verifications were made on D0, D2 and D7. Biological verification was conducted for 31 subjects of group A by mean of SGOT and SGPT quantity determination on D0 and D2. This survey revealed that 1.9% of P. falciparum malaria patients had precocious therapeutic failure to amodiaquine (35 mg/kg over 3 days) in this area. Clinical and biological tolerance was good and there was no difference between the two groups. We suggest that amodiaquine might be used for uncomplicated malaria at first intention in Abidjan.

Bilan des examens parasitologiques du sang pour la recherche du paludisme a l'Institut Pasteur de Cote d'Ivoire (I.P.C.I.) en 1992: impact de la chimiotherapie sur les resultats de laboratoire

Au cours de l'annee 1992; le service de parasitologie de l'I.P.C.I. a effectue 1435 examens pour la recherche du paludisme. 269 resultats positifs ont ete obtenus; soit 18;74 pour cent de paludisme confirme contre 1166 resultats negatifs. 429 sujets; soit 29;89 pour cent ont recu un traitement antipaludique avant l'examen; 645 sujets; soit 44;94 pour cent n'ont recu aucun traitement prealable et pour 361 sujets; soit 25;15 pour cent aucune indication n'est donnee sur la prise du medicament. Parmi les patients qui ont consomme des medicaments; 17;01 pour cent avaient encore une goutte epaisse positive et chez les malades non traites 20;15 pour cent sont positifs. Lorsqu'on considere les produits consommes; sept specialites viennent largement en tete avec un pour centage d'utilisation de 84;71 pour cent. Par odre decroissant; ce sont: la Nivaquine; La Flavoquine; l'Halfan; l'Arsiquinoforme; le Quinimax; le Quiniforme et le Fansidar. Dans la presque totalite des cas de resultats positifs apres la prise de medicaments (89;88 pour cent) les doses sont infracuratives. 10 malades (2;73 pour cent); bien qu'ayant suivi le protocole therapeutique conseille pour le medicament choisi ont une goutte epaisse positive. Les auteurs ont conclu que l'inadaptation des doses etait le fait de la forte proportion d'automedication. L'echec therapeutique chez les 10 malades pourrait s'expliquer par l'existence de la chimioresistance dont celle a la chloroquine est deja reconnue

Interêt de la chimioprophylaxie antipalustre chez l'enfant

Les auteurs ont evalue l'efficacite de la chimioprophylaxie a la chloroquine des enfants dans la region d'Abidjan. L'evaluation a ete realisee au cours du second trimestre de 1992 aux urgences pediatriques du CHU de Cocody chez 133 enfants ages de 3 mois a 6 ans hospitalises pour acces palustre. 36;84 pour cent des enfants ne pratiquaient pas de chimioprophylaxie; 41;35 pour cent des hospitalises pratiquaient une chimioprophylaxie irreguliere et 21;80 pour cent des malades pratiquaient une chimioprophylaxie reguliere. Cette etude montre que la chimioprophylaxie antipalustre n'empeche pas toujours la survenue d'acces palustre grave chez l'enfant en zone d'endemie

Etiologies fongique et parasitaire des vulvo-vaginites a Abidjan. [lettre]

Une etude retrospective d'une annee d'activite allant de janvier 1989 a decembre 1989 du laboratoire de parasitologie-mycologie de la Faculute de Medecine d'Abidjan; portant sur 124 prelevements vaginaux; a permis aux auteurs de trouver un taux de positivite globale de 56;45 pour cent. Par ordre de frequence; ils ont trouve Candida albicans a un taux de 38;70 pour cent; Candida tropicalis 5;64 pour cent; puis Candida guillermondii 0;80 pour cent. Au cours de cette meme etude; Trichomonas vaginalis a ete mis en evidence 17 fois par l'examen direct; soit une prevalence de 13;70 pour cent