Objective: To describe the clinical, epidemiological and evolutionary aspects of cryptococcal meningitis. Methods: This was a retrospective descriptive study on all HIV-infected patients who had been hospitalized for ...Objective: To describe the clinical, epidemiological and evolutionary aspects of cryptococcal meningitis. Methods: This was a retrospective descriptive study on all HIV-infected patients who had been hospitalized for cryptococcal meningitis between 2006 and 2016 in the principal structures for the care of HIV infected person in Lomé. The diagnosis of meningitis was clinical and confirmed by the presence of cryptococci on Chinese ink or the detection of CSFsoluble antigens. All patients have made the CD4 rate assay and received an antifungal treatment based on fluconazole or Amphotericin B, followed later by antiretroviral triple therapy. Results: A total of 102 patients infected with cryptococcal meningitis (62 men for 40 women) were found. The sex ratio was 1.55. The median age was 34 years with extremes of 15 to 49 years. Clinically, headache was the symptomatic symptom in 100% of cases, prone to long runs and weight loss respectively in the proportions of 45% and 65%. The mean CD4 cell count was 65 ± 22 cells per mm3. The duration of hospital stay was short (less than 7 days) for the deceased. A total of 62 patients were able to receive treatment, 40 of them with fluconazole and 22 with Amphotericin B. The mortality was very high (65%), 25% were lost to follow-up, and 9.5% still in live 3 months after admission to the hospital. Conclusion: Cryptococcal meningitis has a very reserved prognosis. It is to be feared in cases of severe immunosuppression, hence the early detection of HIV for optimal management is important.展开更多
Objective: To determine the incidence of tuberculosis in person living with HIV infected by latent TB and under antiretroviral (ARV) therapy. Method: We studied prospectively for 36 months the occurrence of bacillifor...Objective: To determine the incidence of tuberculosis in person living with HIV infected by latent TB and under antiretroviral (ARV) therapy. Method: We studied prospectively for 36 months the occurrence of bacilliform pulmonary tuberculosis in patients infected with HIV, naive of BCG and receiving antiretroviral treatment. Each patient had an intradermal reaction (IDR) of 10 IU tuberculin Mérieux. The measurement of the nodule is made 72 hours later. During follow-up, patients were reviewed every six months for active tuberculosis. Results: A total of 212 out of 257 patients had an IDR greater than 5 mm, an ITL prevalence of 86.33%. Three patients were lost to follow-up during the study. The predominant female sex is 69.81%. The mean age was 42.8 ± 10.02 years. A previous history of tuberculosis was found in 14.15% of patients and 208 patients (98.11%) had HIV1. In 39.15% of patients, patients had a CD4 count lower than 350 cells/mm3 at baseline in the study. At the end of the three-year follow-up, among the 14 patients, 11 had failed ARV therapy and had developed TB, with an incidence of 2.20 cases per 100 patients. Conclusion: The incidence of active tuberculosis in LTBI was very high in HIV-positive patients with low CD4 count, hence the importance of reliable LTBI screening such as gamma interferon is better than patient follow-up.展开更多
文摘Objective: To describe the clinical, epidemiological and evolutionary aspects of cryptococcal meningitis. Methods: This was a retrospective descriptive study on all HIV-infected patients who had been hospitalized for cryptococcal meningitis between 2006 and 2016 in the principal structures for the care of HIV infected person in Lomé. The diagnosis of meningitis was clinical and confirmed by the presence of cryptococci on Chinese ink or the detection of CSFsoluble antigens. All patients have made the CD4 rate assay and received an antifungal treatment based on fluconazole or Amphotericin B, followed later by antiretroviral triple therapy. Results: A total of 102 patients infected with cryptococcal meningitis (62 men for 40 women) were found. The sex ratio was 1.55. The median age was 34 years with extremes of 15 to 49 years. Clinically, headache was the symptomatic symptom in 100% of cases, prone to long runs and weight loss respectively in the proportions of 45% and 65%. The mean CD4 cell count was 65 ± 22 cells per mm3. The duration of hospital stay was short (less than 7 days) for the deceased. A total of 62 patients were able to receive treatment, 40 of them with fluconazole and 22 with Amphotericin B. The mortality was very high (65%), 25% were lost to follow-up, and 9.5% still in live 3 months after admission to the hospital. Conclusion: Cryptococcal meningitis has a very reserved prognosis. It is to be feared in cases of severe immunosuppression, hence the early detection of HIV for optimal management is important.
文摘Objective: To determine the incidence of tuberculosis in person living with HIV infected by latent TB and under antiretroviral (ARV) therapy. Method: We studied prospectively for 36 months the occurrence of bacilliform pulmonary tuberculosis in patients infected with HIV, naive of BCG and receiving antiretroviral treatment. Each patient had an intradermal reaction (IDR) of 10 IU tuberculin Mérieux. The measurement of the nodule is made 72 hours later. During follow-up, patients were reviewed every six months for active tuberculosis. Results: A total of 212 out of 257 patients had an IDR greater than 5 mm, an ITL prevalence of 86.33%. Three patients were lost to follow-up during the study. The predominant female sex is 69.81%. The mean age was 42.8 ± 10.02 years. A previous history of tuberculosis was found in 14.15% of patients and 208 patients (98.11%) had HIV1. In 39.15% of patients, patients had a CD4 count lower than 350 cells/mm3 at baseline in the study. At the end of the three-year follow-up, among the 14 patients, 11 had failed ARV therapy and had developed TB, with an incidence of 2.20 cases per 100 patients. Conclusion: The incidence of active tuberculosis in LTBI was very high in HIV-positive patients with low CD4 count, hence the importance of reliable LTBI screening such as gamma interferon is better than patient follow-up.
