[Cerebral toxoplasmosis during AIDS in the infectious diseases department of Point-G Teaching Hospital, Bamako, Mali]. / Toxoplasmose Cerebrale Au Cours Du Sida Dans Le Service Des Maladies Infectieuses Du CHU Du Point-G, Bamako-Mali.

Cerebral toxoplasmosis is common opportunistic infections of central nervous system in AIDS. It occurs most often in case of severe immunosuppression. The aim of this study is to investigate the general characteristics of cerebral toxoplasmosis during HIV infection and AIDS in hospital area in Bamako. It is a retrospective study of 5 years (form January 2001 to December 2005), conducted in the infectious diseases department of Point G Teaching Hospital of Bamako. It concerned all patients infected with HIV, hospitalized for cerebral toxoplasmosis. The diagnosis of cerebral toxoplasmosis was based on clinical, C T and therapeutic arguments. A total of 745 patients investigated, 26 met cerebral toxoplasmosis diagnostic criteria (14 men and 12 women). The rate of cerebral toxoplasmosis in the study population was 3.5%. The average age was 38.1 years (18-58 years). Focused neurological deficit (73.07%), intracranial hypertension signs (69.20%), meningeal syndrome (15.40%), seizures (57.69%) and consciousness disorders (30.80%) were the clinical characteristics. Hypodensity with or without peripheral enhancement images (93.75%) were found on CT. The average rate of CD4 T cells was 98.7cells/mm3 (5-473 cells/mm3). Oropharyngeal candidiasis in 61.53% of cases, intestinal cryptosporidiosis (11.53%), herpes zoster (3.84%) and Pott's disease (3.84%) were the opportunistic infections associated. Cotrimoxazole was used in 88.46% of patients and 3 patients (11.54%) received the standard treatment (Sulfadiazine-Pyrimethamine). Antitoxoplasmic treatment led to a clinical improvement in 84.61% and 4 deaths (15.39%). were recorded. The technical platform for etiological diagnosis of toxoplasmosis is not available at the Point-G Teaching Hospital, so in case of encephalitis signs in a HIV positive patient, CT should be urgently perform and a treatment trial must begin without delay.

[Cutaneous drug eruption at hospital in Bamako]. / Toxidermie Medicamenteuse En Milieu Hospitalier A Bamako.

INTRODUCTION: The incidences of cutaneous drug eruption constitute a real public health problem. OBJECTIVE: The aim of this study was to describe the cutaneous drug eruption in Gabriel Touré Hospital in Bamako. MATERIAL AND METHOD: This is a prospective longitudinal study from 1 July 2005 to August 31, 2006. The study included patients with a lesion cutaneous Contemporary taking medication, without other cause and consent. RESULTS: We included 61 cases of toxdermies. The mean age was 28 ± 14.8 years with extremes of 18 and 77 years. The sex ratio was 2.4 for women. Self-medication was most often found in 51% of cases. The fixed drug eruption (EPF) with 26 cases (30.6%); acne with 23 cases (27%), erythema multiforme with 14 cases (16.5%) are the predominant manifestations toxidermy. The causative drugs are molecules with 12.6% with analgesics, NSAIDs with 12.6%, 13.6% with ARVs; sulfonamides with 9.5% with 7.4% beta-lactam; anticonvulsants with 5.2%. The therapeutic management was simple for minor forms. Severe forms have been hospitalized and often the help of intensive care and ophthalmology. Mortality was 2.3%. CONCLUSION: The toxidermy exist in Mali with a frequency more and more increasing. We recommend the systematic toxidermy consultations especially among HIV patients in Mali.

[AIDS related Kaposi's disease in Hospital area in Bamako]. / La Maladie de Kaposi au cours du VIH/Sida en milieu hospitalier de Bamako.

The goal of this prospective work were to describe the clinical, therapeutic and evolutionary aspects of Kaposi's disease occurring during AIDS in the infectious diseases service from October 1, 2004 to September 30, 2005. The diagnosis of the infection by the HIV was based on the positivity of serology with 2 fast tests. That of the Kaposi's disease was based on the clinical aspect and /or histological of the lesions. On these 2189 patients, 37 presented the Kaposi's disease that means a prevalence of 1.6%. They were 17 men and 20 women average age 39.5 years and heterosexuals in 97.30 % of the cases. Kaposi's disease limited on the skin and mucous were most represented within (48.65 %), followed by the skin limited (43.24 %) and mucous localization (8.11%). Papulo-nodulare feature was the major clinical founded to the physical examination in 54.05 %. The rate of average CD4 was 76 cellules/mm3 with the extreme one going from 1 to 512 cellules/mm3. It was favorable at 14 (43.75%) of the 32 patients having profited from antiretroviral treatment. The Kaposi's disease during the AIDS is relatively frequent with the service of the infectious diseases and the prognosis remains severe. However the antiretroviral therapy can improve the prognosis of the skin limited forms.

[Association of urinary tract infections and HIV infection in an internal medicine ward of Hospital of Point G-Bamako-Mali]. / L'association infection urinairie st infection VIH a dans le service de medicine interne de l'Hopital du Point G-Bamako-Mali.

We gathered 14 clinical observations of urinary track infections in AIDS patients in Internal Medicine wards from August 1, 1998 to July 31, 1999. Urinary track infection and HIV were both present in 1.75% of 797 hospitalized patients. The specific prevalence was 14.43% among AIDS patients. The sex ratio (female/male) was 1.33. The mean age of patients was 37.2 years with ranges between 25 years and 59 years. Urinary symptoms were discret. Urinary tract infection was primarily evidenced by urine leucocytes > 10(4) organism/ml and a bacteriuria > 10(5) colony-forming units/ml. The main pathogenswere Escherichia coli (42.85%), Klebsiella pneumoniae (28.57%), Colibacilles app. (21.42%) and Enterobacter cloacae (7.14%). All isolated germs were sensible to the gentamicin, to the amikacin, to the nalidixic acid, to the cefoxitine, to the ceftazidime to the cefotaxime and the ciprofloxacin. Cephalosporin of 3rd generation, aminoglycosides, and fluoroquinolone can be used like treatment of first line in urinary tract infection suspicion case in Bamako. Our patients were highly immunosuppressed with the majority of them being in class IV C of CDC of Atlanta (90%) and CD4 count constantly bellow 200 cells/mm3. The main opportunistic affections were non bacilar bacterial pneumopathies (28.57%), oesophagal mycosis (71.42%), the association of cerebral toxoplasmosis and pulmonary tuberculosis (35.71%). All urinary infections were cured by mean of 5 days of treatment. Very few recidivism was found (1 case).

[The diabetic hand]. / Atteinte de la main chez le diabetique.

The frequent localization of the infection to the hand to ours diabetic patients oppositely to the classic description of diabetic foot leds us to initiate this work, which had the objectif to determine the prevalency and to describe the "diabetic hand" to our patients. For that we have conducted a descriptive retrospective and prospective study in the internal Medecine Service of the National Hospital of Point G (NHPG) and in Traumato Orthopaepics Service of Gabriel Touré Hospital (G.T.H.) in Bamako. In 341 diabetic examined patients 158 infections of soft areas have been listed (46.33%) with a localization on the foot in 87 among them (25.51%) and the hand in 55 (16.13%). The female sex has been the most affected with an average of 52 years old and recent discovered diabetes. The diabetes was of type I in 54.54% of cases and of type II in 45.46%. The reaching of hand was following upon a traumatism (7.28%), a burn (3.63%), an ingrown mail (3.63%); but in 85.46% of cases any front door hasn't been found. The type of damage observed has been the abscess (49.09%), the whitlow (25.46%), the gangrene (21.82%) and the burn (3.63%). We have noticed an ostect in 41.81% of cases. In bacteriologic field, the staphylocoque was the prevailing germ in relating to the negative gram (25%). The curring has required an amputation in almost a third of patients (30.9%) the healing has been gained in 76.3% of cases with sometimes some fonctional important after effects. On death has been noticed in 9.09% of cases.

[Frequency, risk factors and prognostic value of anemia associated with HIV/AIDS in the adult in Mali]. / Fréquence, facteurs de risque et valeur pronostique de l'anémie associée au VIH/SIDA chez l'adulte au Mali.

Anaemia is a common complication of the HIV infection. To understand the mechanism of HIV associated anaemia and to suggest a consequent therapeutic approach in adults in Mali, we undertook a prospective case/control study in two services of reference with essentially adults recruitment in Bamako. We studied the frequency, the risk factors and the prognosis value of this complication in 133 patients with HIV infection matched to 133 others non HIV infected. The average age of our patients was 36.08 +/- 8.80 years (age range: 19 to 66 years). The frequency of anaemia was significantly higher in patients with HIV infection compared to the controls (78.9% vs. 51.9%; OR = 2.46; 95% CI [1.56-3.92]). Anaemia was more frequent in women than in men (p = 0.00003). A significant association between anaemia and thrombopenia or lymphopenia was observed only in patients with HIV infection. The severity of anemia was positively associated with the HIV2 infection and the progression of the HIV disease. Mortality was more frequently associated to the anaemia (p < 10(-5)) in patients infected by HIV. These findings suggest that bone marrow depression leading to a decreased red blood cells production is the main mechanism of HIV associated anaemia in adult in Mali. Therefore, without evidence of a best cost-effectiveness ratio of a human recombinant erythropoietin treatment in the context of countries with a low income, the therapy of this haematological complication must be an emergency focusing on red blood cells transfusions.

La Maladie de Kaposi au cours du VIH/Sida en milieu hospitalier de Bamako

Le but de ce travail prospectif etait de decrire les aspects clinique; therapeutique et evolutif de la maladie de Kaposi associee au VIH/SIDA au service des Maladies Infectieuses du 1er octobre 2004 au 30 septembre 2005. Le diagnostic de l'infection par le VIH etait base sur la positivite de la serologie a 2 tests rapides. Celui de la maladie de Kaposi etait base sur l'aspect clinique et /ou histologique des lesions. Sur ces 2189 patients; 37 ont presente la maladie de Kapozi soit une prevalence de 1;6. Il s'agissait de 17 hommes et 20 femmes d'age moyen de 39;5 ans et heterosexuels dans 97;30 des cas. La localisation cutaneo-muqueuse etait la plus frequente (48;65 ) suivie de la localisation cutanee (43;24 ) et muqueuse (8;11). L'aspect clinique le plus predominant a ete papulonodulaire dans 54;05 des cas. Le taux de CD4 moyen etait de 76 cellules/mm3 avec des extremes allant de 1 a 512 cellules/mm3. Elle a ete favorable chez 14 (43;75) des 32 patients ayant beneficie d'un traitement antiretroviral. La maladie de Kapozi au cours du VIH/SIDA est relativement frequente au service des Maladies Infectieuses et le pronostic reste severe. Toutefois les anti-retroviraux peuvent ameliorer le pronostic des formes localisees a la peau. Mots cles : Prevalence; Maladie Kaposi; VIH/SIDA; Mali