[Cerebral toxoplasmosis in the infectious diseases department of the CHU du Point G in people living with HIV]. / La toxoplasmose cerebrale dans le service de maladies infectieuses du CHU du Point G chez les personnes vivant avec le VIH.

Toxoplasmosis is defined as a cosmopolitan protozoan disease caused by an obligate intracellular coccidia, Toxoplasma gondii. The advent of HIV infection has made cerebral toxoplasmosis one of the most widespread neurological opportunistic infections. METHOD: We conducted a descriptive cross-sectional study with retrospective review of files of cerebral toxoplasmosis on HIV infected patients who had been hospitalized in the infectious diseases department of Point G University Hospital between January 1st, 2014 and September 30th, 2019. RESULTS: During the study period, the frequency of cerebral toxoplasmosis was 10.1% and in 46.4% of the patients, the diagnosis led to the discovery of HIV co-infection. The clinical features were characterized by fever, headaches, and motor deficit at 86.6%, 84.5% and 69.1% respectively. Roundel image on computed tomography was most represented and was found in 24.4% of patients. Anti-toxoplasma treatment based on trimethoprim /sulfamethoxazole (TMP/SMX) associated with folinic acid was initiated in 78 patients out of 90, but 19 patients had a contraindication or adverse effects to this combination and were treated with clindamycin. HAART was initiated in 31 patients out of 45 (68.9%) newly diagnosed. The overall prognosis was limited with a mortality rate of 42%. CONCLUSION: The prevalence of cerebral toxoplasmosis was high in our study, 10.1%. To reduce this prevalence, chemoprophylaxis should be initiated in all HIV-infected patients with a CD4 count below 200 cells/mm3.

INTRODUCTION: La toxoplasmose est une protozoose cosmopolite due à Toxoplasmagondii. Avec l'avènement du VIH, la toxoplasmose cérébrale est une des infections opportunistes neurologiques les plus répandues. MÉTHODE: Nous avons mené une étude transversaledescriptive à collecte rétrospective portant sur des cas de toxoplasmoses cérébrales sur terrain d'immunodépression aux VIH ayant séjourné en hospitalisation dans le service des maladies infectieuses du CHU de Point G du 1er janvier 2014 au 30 septembre 2019. RÉSULTATS: La prévalence de la toxoplasmose cérébrale était de 10,1%. Chez 46,4% des patients, le diagnostic de toxoplasmose cérébrale avait permis la découverte d'une coïnfection à VIH. Le tableau clinique était dominé par la fièvre, les céphalées et le déficit moteur soit respectivement 86,6%, 84,5% et 69,1%. L'image en cocarde à la tomodensitométrie a été retrouvée chez 24,4% des patients. Le traitement anti-toxoplasmique à base de triméthoprime/sulfaméthoxazole (TMP/ SMX) associée à l'acide folinique a été conduit chez 78 patients sur 90. Dix-neuf patients avaient une contre-indication ou des effets indésirables à l'association TMP/ SMX et ont été traités par la clindamycine. Le traitement ARV a été initié chez trente-un patients sur 45 nouvellement dépistés soit 68,9%. Le pronostic chez nos patients était réservé et marqué par une mortalité de 42%. CONCLUSION: La prévalence de la toxoplasmose cérébrale était élevée dans notre étude soit 10,1%. Pour diminuer cette prévalence, la chimio-prophylaxie doit être instaurée chez tous les patients infectés par le VIH et ayant un taux de CD4 inférieur à 200 cellules/mm3.

Features of malaria among patients HIV infected in a Department of Infectious Diseases in Bamako

Introduction. We studied malaria in HIV infected subjects hospitalized in the department of infectious diseases at Point G Teaching Hospital in Mali, with the objective to have current data on malaria in patients infected by HIV. Materials and methods. We conducted a prospective study from October, 1st 2016 to September 30th 2018 in patients seropositive for HIV having positive thick smear for Plasmodium and hospitalized in the department of infectious diseases at Point G Teaching Hospital. We collected sociodemographic, clinical and lab data form those patients. Data have been entered and analyzed using SPSS20.0 software. Results. Hospital frequency of malaria among People living with HIV was 24.4% (151/618). This population has a mean-age of 44.1±12.4 y/o and a sex ratio (M/F) of 0.86. Majority of patients were at WHO stage IV of HIV infection (63.4%). Symptoms were by decreasing frequency: fever (98.3%); headache (86.4%); anorexia (72.9%); asthenia (61.0%) and vomiting (42.4%). the mean parasitemia was 172.9±352.1 trophozoite/mm3 . Mean hemoglobin level was 9.1±3.2 g/dl and the mean CD4 count was 9±3 cell/mm3 . Severe malaria was independent from WHO HIV stage and from immunologic deficiency. The malaria treatment when correctly followed conduct to good improvement of the anemia (p = 0.03) and the negativity of the parasitemia (p = 0.00). Death in our HIV patient is linked to association with severe malaria (p = 0,012). Conclusion. Malaria is relatively common and severe among PLWHA in Mali. Prompt treatment is still effective and must be implemented to ensure a good prognosis. Despite cotrimoxazole chemoprophylaxis, a certain number of PLHIV suffer from malaria, raising the hypothesis of plasmodium resistance to antifolates.

[Role Of Emigration In The Spread Of HIV Infection In The Region Of Kayes, Mali]. / Place De L'Emigration Dans La Propagation De L'Infection A VIH Dans La Region De Kayes, Mali.

AIM: To determine the impact of emigration on HIV transmission in the Kayes region. PATIENTS AND METHODS: It was a cross-sectional study conducted in 2007 in the Fousseyni DAOU Hospital of Kayes. A total of 109 subjects were included - all participants were over 14 years old and were diagnosed as HIV positive. The variables studied were knowledge, attitudes and behaviors regarding HIV/AIDS, the notion of traveling outside of Mali and emigration. Pearson Chi2 and Fisher test were used for a bivariate analysis. RESULTS: The female/male sex ratio was of 2.51. In this data pool, 32.3% (10/31) of men were emigrants. More than a third 37.2% (29/78) of women had an emigrant as a sexual partner. There was no significant difference in the levels of knowledge regarding HIV between emigrants and those who never went abroad. The likelihood of having had relations with a sex worker in the preceding 12 months was nine times higher for an emigrant than to a non-emigrant [OR=9.13, CI 95% (2.20 - 37.84)].An emigrant was five times more likely to have at least two sexual partners [OR=5.11, CI 95% (1.37-18.94)]. CONCLUSION: This study showed that emigration is an important factor regarding the spread of HIV in the region of Kayes Mali. Sensitization of the candidates to emigration must be reinforced.

OBJECTIF: Déterminer la place de l'émigration sur la transmission du VIH dans la région de Kayes. PATIENTS ET MÉTHODES: Il s'agissait d'une étude transversale menée en 2007 à l'hôpital Fousseyni DAOU de Kayes. Au total 109 sujets de plus de 14 ans dépistés VIH positif ont été inclus. Les variables ont été les connaissances, attitudes et comportements par rapport au VIH/SIDA, la notion de voyage à l'extérieur du Mali et l'émigration. Le Chi2 de Pearson et le test exact de Fischer ont été utilisés pour l'analyse bivariée. RÉSULTATS: Le sex ratio a été de 2,51 en faveur du sexe féminin. Dans cette série, 32,3% (10/31) des hommes étaient des émigrants. Plus d'un tiers soit 37,2% (29/78) des femmes avaient comme partenaire sexuel un émigré. Il n'y a pas eu de différence significative entre les niveaux de connaissance en matière de VIH selon qu'on soit émigré ou non. Les risques qu'un émigré fréquente une professionnelle de sexe, 12 mois avant notre interview ont été 9 fois supérieurs à ceux d'un non émigré [OR=9,13 ; IC 95% (2,20 ­ 37,84)]. Un émigré était cinq fois plus susceptible d'avoir au moins deux partenaires sexuels [OR=5,11, 95% IC, (1,37 ­ 18,94)]. CONCLUSION: Cette étude a montré que le phénomène de l'émigration est un facteur d'expansion du VIH dans la région de Kayes au Mali. La sensibilisation des candidats à l'émigration doit être renforcée.

[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.