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Takoutsing BD, Ooi SZY, Egu C, Gillespie CS, Dalle DU, Erhabor J, Ciuculete AC, Kesici Ö, Awad AK, Dokponou YCH, Khan M, Ikwuegbuenyi CA, Dada OE, Bandyopadhyay S, Bankole NDA. Management and outcome of intracranial fungal infections in children and adults in Africa: a scoping review. BMC Infect Dis 2024; 24:789. [PMID: 39107727 PMCID: PMC11301832 DOI: 10.1186/s12879-024-09694-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Intracranial fungal infections' (IcFIs) varying clinical manifestations lead to difficulties in diagnosis and treatment. African populations are disproportionately affected by the high burden of the disease. There is a lack of clarity as to the diagnostic and treatment modalities employed across the continent. In this review, we aim to detail the management, and outcome of IcFIs across Africa. METHODS This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the review. RESULTS Of the 5,779 records identified, 131 articles were included. The mean age was 35.6 years, and the majority (56.4%) were males. The majority (n = 8,433/8,693, 97.0%) of IcFIs presented as a meningitis, the most common communicable predisposing factor of IcFIs was HIV/AIDS (n = 7,815/8,693, 89.9%), and the most common non-communicable risk factor was diabetes mellitus (n = 32/8,693, 0.4%). Cryptococcus species was the most common (n = 8,428/8,693, 97.0%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 4,390/6,830, 64.3%) for diffuse IcFIs, and MRI imaging (n = 12/30, 40%) for focal IcFIs. The most common treatment modality was medical management with antifungals only (n = 4,481/8,693, 51.6%). The most commonly used antifungal agent in paediatric, and adult patients was amphotericin B and fluconazole dual therapy (51.5% vs 44.9%). The overall mortality rate was high (n = 3,475/7,493, 46.3%), and similar for both adult and paediatric patients (47.8% vs 42.1%). CONCLUSION Most IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. Antifungals regimens used was similar between children and adults. The outcome of IcFIs in Africa was poor for both paediatric and adult patients.
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Affiliation(s)
| | | | - Chinedu Egu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Conor S Gillespie
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - David Ulrich Dalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Joshua Erhabor
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Özgür Kesici
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Ahmed K Awad
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Mehdi Khan
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | | | - Soham Bandyopadhyay
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
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Akaihe CL, Nweze EI. Epidemiology of Cryptococcus and cryptococcosis in Western Africa. Mycoses 2020; 64:4-17. [PMID: 32969547 DOI: 10.1111/myc.13188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/22/2022]
Abstract
Cryptococcosis is a serious and sometimes fatal fungal disease caused by Cryptococcus species. Worldwide, it is estimated to kill over 180 000 annually, with 75% of deaths occurring in sub-Saharan Africa. Though cryptococcal infections are rare in otherwise healthy individuals, there have been reported cases in immunocompetent persons. Most cases occur in individuals who have weakened immune systems, particularly those with advanced HIV/AIDS, thus making West Africa a potential hotspot of the disease. Despite this, there is no recent review article with a focus on published findings on cryptococcosis in Western Africa. Common clinical symptoms include chest pain, dry cough, headache, nausea, confusion, fever, fatigue and stiffness of the neck/neurological impairment. The CNS and the lung remain its preferred target even though rare cases of attack on other parts of the body were reported in this review. Cryptococcal antigen screening and India ink preparation were the most commonly used diagnostic methods. Repeated isolation from environmental samples was observed. Overall, data on the clinical prevalence of Cryptococcus are scarce and variable in the region. The environmental prevalence ranges from 2.3% to 22%. This review covers all published research findings on cryptococcosis in West Africa till date. The epidemiological data will likely be of interest to clinicians within and outside the continent. The nations covered in this review include the following: Benin Republic, Burkina Faso, Cote d'ivoire, Ghana, Guinea, Guinea- Bissau, Mali, Nigeria, Senegal and Sierra Leone. More studies are warranted to fill the observed gaps on the epidemiology of Cryptococcus in the region.
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Tenforde MW, Gertz AM, Lawrence DS, Wills NK, Guthrie BL, Farquhar C, Jarvis JN. Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis. J Int AIDS Soc 2020; 23:e25416. [PMID: 31957332 PMCID: PMC6970088 DOI: 10.1002/jia2.25416] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION HIV-associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub-Saharan Africa (SSA). We performed a systematic review and meta-analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings. METHODS We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized-controlled trials (RCTs) or investigator-managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short-term (in-hospital or two weeks), medium-term (up to 10 weeks) and long-term (up to six months). RESULTS AND DISCUSSION Seventy-nine studies met inclusion criteria. In routine care settings, pooled short-term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole-based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short-term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short-term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized-controlled trials. Few studies evaluated long-term outcomes. CONCLUSIONS Mortality rates from HIV-associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV-associated meningitis in the region.
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Affiliation(s)
- Mark W Tenforde
- Division of Allergy and Infectious DiseasesUniversity of Washington School of MedicineSeattleWAUSA
- Department of EpidemiologyUniversity of Washington School of Public HealthSeattleWAUSA
| | - Alida M Gertz
- Botswana Harvard AIDS Institute PartnershipGaboroneBotswana
| | - David S Lawrence
- Botswana Harvard AIDS Institute PartnershipGaboroneBotswana
- Department of Clinical ResearchFaculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Nicola K Wills
- Department of Clinical ResearchFaculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
- Welcome Centre for Infectious Diseases Research in AfricaInfectious Disease and Molecular Medicine UnitUniversity of Cape TownCape TownSouth Africa
| | - Brandon L Guthrie
- Department of EpidemiologyUniversity of Washington School of Public HealthSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Carey Farquhar
- Division of Allergy and Infectious DiseasesUniversity of Washington School of MedicineSeattleWAUSA
- Department of EpidemiologyUniversity of Washington School of Public HealthSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Joseph N Jarvis
- Botswana Harvard AIDS Institute PartnershipGaboroneBotswana
- Department of Clinical ResearchFaculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
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Abstract
BACKGROUND Neurological disorders in HIV infection are a common cause of morbidity and mortality. The aim of this paper is to provide a narrative overview of up to date information concerning neurological disorders affecting HIV infected persons in Africa. METHODS Seminal research concerning neurological disorders among HIV-infected adults in sub-Saharan Africa from prior to 2000 was combined with an in-depth search of PubMed to identify literature published from 2000 to 2017. The following Mesh terms were used. "Nervous System Diseases" "HIV Infections" and "Africa South of the Sahara" and "Seizures" or "Spinal Cord Diseases" or "Peripheral Nervous System Diseases" or "AIDS Dementia Complex" or "Opportunistic Infections" or "Immune Reconstitution Inflammatory Syndrome" or "Stroke". Only those articles written in English were used. A total of 352 articles were identified, selected and reviewed and 180 were included in the study. These included case series, observational studies, interventional studies, guidelines and reviews with metanalyses. The author also included 15 publications on the subject covering the earlier phase of the HIV epidemic in Africa from 1987 to 1999 making a total of 195 references in the study. This was combined with extensive personal experience diagnosing and treating these neurological disorders. RESULTS Neurological disorders were common, typically occurring in WHO stages III/IV. These were in three main categories: those arising from opportunistic processes mostly infections, direct HIV infection and autoimmunity. The most common were those arising from direct HIV infection occurring in >50%. These included HIV-associated neurocognitive dysfunction (HAND), neuropathy and myelopathy. Opportunistic infections occurred in >20% and frequently had a 6-9-month mortality rate of 60-70%. The main causes were cryptococcus, tuberculosis, toxoplasmosis and acute bacterial meningitis. Concurrent systemic tuberculosis occurred in almost 50%. CONCLUSION Neurological disorders are common in HIV in Africa and the main CNS opportunistic infections result in high mortality rates. Strategies aimed at reducing their high burden, morbidity and mortality include early HIV diagnosis and anti-retroviral therapy (ART), screening and chemoprophylaxis of main opportunistic infections, improved clinical diagnosis and management and programme strengthening.
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Affiliation(s)
- William P Howlett
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Center for International Health, University of Bergen, Norway
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Rosen S, Maskew M, Brennan AT, Fox MP, Vezi L, Ehrenkranz PD, Venter WDF. Improved simplified clinical algorithm for identifying patients eligible for immediate initiation of antiretroviral therapy for HIV (SLATE II): protocol for a randomized evaluation. Trials 2018; 19:548. [PMID: 30305142 PMCID: PMC6180640 DOI: 10.1186/s13063-018-2928-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization recommends rapid (≤ 7 days) or same-day initiation of antiretroviral treatment (ART) for HIV-positive patients. South Africa adopted this recommendation in 2017, but multiple clinic visits, long waiting times, and delays for laboratory tests remain common. Streamlined approaches to same-day initiation that allow the majority of patients to start ART immediately, while ensuring that patients who do require additional services receive them, are needed to achieve national and international treatment program goals. METHODS/DESIGN The SLATE II (Simplified Algorithm for Treatment Eligibility) study is an individually randomized evaluation of a clinical algorithm to reliably determine a patient's eligibility for immediate ART initiation without waiting for laboratory results or additional clinic visits. It differs from the earlier SLATE I study in management of patients with symptoms of tuberculosis (under SLATE II these patients may be started on ART immediately) and other criteria for immediate initiation. SLATE II will randomize (1:1) 600 adult, HIV-positive patients who present for HIV testing or care and are not yet on ART in South Africa. Patients randomized to the standard arm will receive standard-of-care ART initiation from clinic staff. Patients randomized to the intervention arm will be administered a symptom report, medical history, brief physical exam, and readiness assessment. Symptomatic patients will also have a tuberculosis (TB) module with lipoarabinomannan antigen of mycobacteria test. Patients who have satisfactory results for all four components will be dispensed antiretrovirals (ARVs) immediately, at the same clinic visit. Patients who have any negative results will be referred for further investigation, care, counseling, tests, or other services prior to being dispensed ARVs. Follow-up will be by passive medical record review. The primary outcomes will be ART initiation in ≤ 7 days and retention in care 8 months after study enrollment. DISCUSSION SLATE II improves upon the SLATE I study by reducing the number of reasons for delaying ART initiation and allowing more patients with TB symptoms to start ART on the day of diagnosis. If successful, SLATE II will provide a simple and streamlined approach that can readily be adopted in other settings without investment in additional technology. TRIAL REGISTRATION ClinicalTrials.gov, NCT03315013 . Registered on 19 October 2017.
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Affiliation(s)
- S Rosen
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave Room 390, Boston, MA 02118 USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A T Brennan
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave Room 390, Boston, MA 02118 USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
| | - M P Fox
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave Room 390, Boston, MA 02118 USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
| | - L Vezi
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - W D F Venter
- Wits Reproductive Health and HIV Institute, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Chadli S, Aghrouch M, Taqarort N, Malmoussi M, Ouagari Z, Moustaoui F, Bourouache M, Oulkheir S. [Neuromeningeal cryptococcosis in patients infected with HIV at Agadir regional hospital, (Souss-Massa, Morocco)]. J Mycol Med 2017; 28:161-166. [PMID: 29132792 DOI: 10.1016/j.mycmed.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neuromeningeal cryptococcosis (NMC) is a severe and fatal opportunistic infection. Lethality is frequent in the absence of treatment, especially in the presence of HIV co-infection. OBJECTIVE To determine the prevalence, epidemiological, clinical, biological and therapeutic aspects as well as the evolution of NMC for patients infected with HIV. PATIENTS AND METHODS This is a retrospective study of 40 cases of neuromeningeal cryptococcosis diagnosed in HIV-infected patients. Data are collected for 7 years (from January 2010 to December 2016) in the registers of the parasitology laboratory and the infectious diseases department at the regional hospital center in Agadir. RESULTS A reduction in the prevalence of neuromeningeal cryptococcosis in HIV-infected patients was noted from 2010 to 2016 (3.66% to 0.83%). The overall prevalence of NMC was 1.53%. The mean age was 37±10 years old, with 90% of patients aged less than 45 years. The main clinical symptomatology was headache (75%). The main cytochemical abnormalities of cerebrospinal fluid analysis were hyperproteinorachy (60%), hypoglycorachy (63%) and lymphocytosis (50%). The mean CD4 cell count was 47/mm3. Patients were initially treated with amphotericin B, relayed with fluconazole. The overall lethality was 35%. CONCLUSION Neuromeningeal cryptococcosis is a serious opportunistic infection in patients HIV-infected, and the lethality rate remains unacceptable. Fighting NMC in HIV+ patients requires early diagnosis, increased access to antiretrovirals, rapid introduction of appropriate treatment and the prescription of effective systemic antifungals.
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Affiliation(s)
- S Chadli
- Institut supérieur des professions infirmières et techniques de santé (ISPITS), Agadir, Maroc.
| | - M Aghrouch
- Laboratoire des analyses médicales, centre hospitalier régional Hassan II, Agadir, Maroc
| | - N Taqarort
- Faculté polydisciplinaire de Taroudant, université Ibn Zohr, Agadir, Maroc
| | - M Malmoussi
- Service des maladies infectieuses, centre hospitalier régional Hassan II, Agadir, Maroc
| | - Z Ouagari
- Service des maladies infectieuses, centre hospitalier régional Hassan II, Agadir, Maroc
| | - F Moustaoui
- Laboratoire des analyses médicales, centre hospitalier régional Hassan II, Agadir, Maroc
| | - M Bourouache
- Faculté des sciences, université Ibn Zohr, Agadir, Maroc
| | - S Oulkheir
- Institut supérieur des professions infirmières et techniques de santé (ISPITS), Agadir, Maroc
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Rosen S, Fox MP, Larson BA, Brennan AT, Maskew M, Tsikhutsu I, Bii M, Ehrenkranz PD, Venter WDF. Simplified clinical algorithm for identifying patients eligible for immediate initiation of antiretroviral therapy for HIV (SLATE): protocol for a randomised evaluation. BMJ Open 2017; 7:e016340. [PMID: 28554939 PMCID: PMC5726128 DOI: 10.1136/bmjopen-2017-016340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION African countries are rapidly adopting guidelines to offer antiretroviral therapy (ART) to all HIV-infected individuals, regardless of CD4 count. For this policy of 'treat all' to succeed, millions of new patients must be initiated on ART as efficiently as possible. Studies have documented high losses of treatment-eligible patients from care before they receive their first dose of antiretrovirals (ARVs), due in part to a cumbersome, resource-intensive process for treatment initiation, requiring multiple clinic visits over a several-week period. METHODS AND ANALYSIS The Simplified Algorithm for Treatment Eligibility (SLATE) study is an individually randomised evaluation of a simplified clinical algorithm for clinicians to reliably determine a patient's eligibility for immediate ART initiation without waiting for laboratory results or additional clinic visits. SLATE will enrol and randomise (1:1) 960 adult, HIV-positive patients who present for HIV testing or care and are not yet on ART in South Africa and Kenya. Patients randomised to the standard arm will receive routine, standard of care ART initiation from clinic staff. Patients randomised to the intervention arm will be administered a symptom report, medical history, brief physical exam and readiness assessment. Patients who have positive (satisfactory) results for all four components of SLATE will be dispensed ARVs immediately, at the same clinic visit. Patients who have any negative results will be referred for further clinical investigation, counselling, tests or other services prior to being dispensed ARVs. After the initial visit, follow-up will be by passive medical record review. The primary outcomes will be ART initiation ≤28 days and retention in care 8 months after study enrolment. ETHICS AND DISSEMINATION Ethics approval has been provided by the Boston University Institutional Review Board, the University of the Witwatersrand Human Research Ethics Committee (Medical) and the KEMRI Scientific and Ethics Review Unit. Results will be published in peer-reviewed journals and made widely available through presentations and briefing documents. TRIAL REGISTRATION NCT02891135.
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Affiliation(s)
- Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew P Fox
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Bruce A Larson
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alana T Brennan
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Isaac Tsikhutsu
- Kenya Medical Research Institute/Walter Reed Project HIV Program, Kericho, Kenya
| | - Margaret Bii
- Kenya Medical Research Institute/Walter Reed Project HIV Program, Kericho, Kenya
| | | | - WD Francois Venter
- Wits Reproductive Health and HIV Institute, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kouakou GA, Ello NF, Kassi NA, Keita M, Doumbia A, Mossou C, Kassi FK, Tanon A, Ehui E, Eholié SP. [Fluconazole 1200mg or 800mg for cryptococcal meningitis treatment in Ivory Coast]. J Mycol Med 2017; 27:72-78. [PMID: 28108201 DOI: 10.1016/j.mycmed.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/18/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Assessing the use of high-dose fluconazol monotherapy (1200mg or 800mg) in the treatment and prognosis of HIV-associated cryptococcal meningitis in Ivory Coast. PATIENTS AND METHODS A retrospective study carried out from August 2008 to August 2011 based on patients charts suffering from CM in the Abidjan Tropicals and Infectious Disease Unit. Mortality rate and associated factors were analyzed. RESULTS Forty-six cases of cryptococcal meningitis (2.5% of hospitalizations) were included. The sex-ratio was of 1.2. The median age was 40.5 [35-47] years. The symptomatology was subacute (93.5%). The main clinical symptoms were syndrome of pure meningeal irritation (65%), fever (100%); 35% of patients had encephalomeningits. Twenty-one (45.7%) was ART-naïve patients. Fluconazole 1200mg was prescribed to 29 (63%) patients. Therapeutic lumbar punctures were performed in 42 (91.3) patients. The mortality rate was 50%. Significant predictors of mortality were encephalomeningitis and therapeutic lumbar puncture. CONCLUSION Cryptococcal meningitis associated mortality remains high despite the use of high-dose fluconazole monotherapy. Therapeutic lumbar punctures help to improving the prognosis.
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Affiliation(s)
- G A Kouakou
- Service des maladies infectieuses et tropicales, centre hospitalier universitaire de Treichville, 01 BP V3 Abidjan 01, Côte d'Ivoire; Unité de formation et de recherche, des sciences médicales, département de dermatologie-infectiologie, université Félix Houphouët, Boigny d'Abidjan, 01 BP V166 Abidjan 01, Côte d'Ivoire.
| | - N F Ello
- Service des maladies infectieuses et tropicales, centre hospitalier universitaire de Treichville, 01 BP V3 Abidjan 01, Côte d'Ivoire; Unité de formation et de recherche, des sciences médicales, département de dermatologie-infectiologie, université Félix Houphouët, Boigny d'Abidjan, 01 BP V166 Abidjan 01, Côte d'Ivoire
| | - N A Kassi
- Service des maladies infectieuses et tropicales, centre hospitalier universitaire de Treichville, 01 BP V3 Abidjan 01, Côte d'Ivoire; Unité de formation et de recherche, des sciences médicales, département de dermatologie-infectiologie, université Félix Houphouët, Boigny d'Abidjan, 01 BP V166 Abidjan 01, Côte d'Ivoire
| | - M Keita
- Service des maladies infectieuses et tropicales, centre hospitalier universitaire de Treichville, 01 BP V3 Abidjan 01, Côte d'Ivoire
| | - A Doumbia
- Service des maladies infectieuses et tropicales, centre hospitalier universitaire de Treichville, 01 BP V3 Abidjan 01, Côte d'Ivoire; Unité de formation et de recherche, des sciences médicales, département de dermatologie-infectiologie, université Félix Houphouët, Boigny d'Abidjan, 01 BP V166 Abidjan 01, Côte d'Ivoire
| | - C Mossou
- Service des maladies infectieuses et tropicales, centre hospitalier universitaire de Treichville, 01 BP V3 Abidjan 01, Côte d'Ivoire; Unité de formation et de recherche, des sciences médicales, département de dermatologie-infectiologie, université Félix Houphouët, Boigny d'Abidjan, 01 BP V166 Abidjan 01, Côte d'Ivoire
| | - F K Kassi
- Centre de diagnostic et de recherche sur le sida et maladies opportunistes, centre hospitalier universitaire de Treichville, 01 BP V3 Abidjan, Côte d'Ivoire
| | - A Tanon
- Service des maladies infectieuses et tropicales, centre hospitalier universitaire de Treichville, 01 BP V3 Abidjan 01, Côte d'Ivoire; Unité de formation et de recherche, des sciences médicales, département de dermatologie-infectiologie, université Félix Houphouët, Boigny d'Abidjan, 01 BP V166 Abidjan 01, Côte d'Ivoire
| | - E Ehui
- Service des maladies infectieuses et tropicales, centre hospitalier universitaire de Treichville, 01 BP V3 Abidjan 01, Côte d'Ivoire; Unité de formation et de recherche, des sciences médicales, département de dermatologie-infectiologie, université Félix Houphouët, Boigny d'Abidjan, 01 BP V166 Abidjan 01, Côte d'Ivoire
| | - S P Eholié
- Service des maladies infectieuses et tropicales, centre hospitalier universitaire de Treichville, 01 BP V3 Abidjan 01, Côte d'Ivoire; Unité de formation et de recherche, des sciences médicales, département de dermatologie-infectiologie, université Félix Houphouët, Boigny d'Abidjan, 01 BP V166 Abidjan 01, Côte d'Ivoire
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Kassi FK, Bellet V, Doumbia A, Krasteva D, Drakulovski P, Kouakou GA, Gatchitch F, Delaporte E, Reynes J, Mallié M, Menan HIE, Bertout S. First case of mixed infection with Cryptococcus deuterogattii and Cryptococcus neoformans VNI in an Ivorian HIV-positive patient. JMM Case Rep 2016; 3:e005037. [PMID: 28348767 PMCID: PMC5330235 DOI: 10.1099/jmmcr.0.005037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/07/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Cryptococcal meningitis (CM) may be caused by several species of Cryptococcus. CASE PRESENTATION We describe a fatal case of CM in a HIV-positive patient from Ivory Coast infected by Cryptococcus neoformans VNI and Cryptococcusdeuterogattii. Isolates were recovered from cerebrospinal fluid (CSF) prior to systemic antifungal treatment. Six isolates were studied (the entire culture plus five isolated colonies from it). Serotyping was performed via LAC 1 and CAP 64 gene amplification. Genotyping was performed using restriction fragment length polymorphism (RFLP) analysis of the URA5 gene, (GACA)4, (GTG)5 and M13 PCR fingerprinting. URA5-RFLP analysis identified the original culture with two different molecular type combinations. However, URA5-RFLP profiles of the five colonies isolated from the original sample revealed two different species. Four colonies were identified as C.deuterogattii and the last isolate as C.neoformans VNI. The in vitro susceptibility profile was determined using the standard method according to the CLSI M27-A3 protocol. The isolates were susceptible to the tested antifungals (fluconazole, flucytosine and amphotericin B). Treatment with fluconazole (1200 mg day-1) was initiated; however, the patient died 17 days after the onset of antifungal therapy. CONCLUSION This is the first reported case of mixed infection with C. neoformans and C.deuterogattii in a HIV-positive patient.
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Affiliation(s)
- Fulgence K Kassi
- Université Félix Houphouët Boigny, UFR Pharmacie, Laboratoire de Parasitologie et Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les autres maladies infectieuses), CHU de Treichville, BP V3, Abidjan, Cote d'Ivoire; UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie, 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5, France
| | - Virginie Bellet
- UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France
| | - Adama Doumbia
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville , 01 BP V3, Abidjan , Côte d'Ivoire
| | - Donika Krasteva
- UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France
| | - Pascal Drakulovski
- UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France
| | - Gisèle A Kouakou
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville , 01 BP V3, Abidjan , Côte d'Ivoire
| | - François Gatchitch
- UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France
| | - Eric Delaporte
- UMI 233 Service des Maladies Infectieuses et Tropicales, CHU Gui de Chauliac` , Montpellier , France
| | - Jacques Reynes
- UMI 233 Service des Maladies Infectieuses et Tropicales, CHU Gui de Chauliac` , Montpellier , France
| | - Michèle Mallié
- UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France
| | - Hervé I E Menan
- Université Félix Houphouët Boigny, UFR Pharmacie, Laboratoire de Parasitologie et Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les autres maladies infectieuses), CHU de Treichville, BP V3, Abidjan , Cote d'Ivoire
| | - Sébastien Bertout
- UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France
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Dollo I, Marih L, El Fane M, Es-Sebbani M, Sodqi M, Oulad Lahsen A, Chakib A, El Kadioui F, Hamdani A, El Mabrouki MJ, Soussi Abdallaoui M, Karima Z, Hassoune S, Maaroufi A, Marhoum El Filali K. [Retrospective study of neuromeningeal cryptococcosis in patients infected with HIV in the infectious diseases unit of university hospital of Casablanca, Morocco]. J Mycol Med 2016; 26:331-336. [PMID: 27520534 DOI: 10.1016/j.mycmed.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/21/2016] [Accepted: 06/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the cases of neuromeningeal cryptococcosis and to describe the clinical, paraclinical, therapeutic and outcomes of patients. PATIENTS AND METHODS Retrospective study of 43 patients infected with HIV admitted from January first 2010 to June 30th 2015 in the infectious disease unit of UHC Ibn Rochd, for neuromeningeal cryptococcus. RESULTS The mean frequency of neuromeningeal cryptococcosis in patients infected with HIV was 1.4%. The mean age was 39 years and a sex ratio of 1.38. The mean CD4 count was 70 cells/mm3. The diagnosis of HIV was revealed by neuromeningeal cryptococcus in 77% of cases. Fifteen days interval was reported between the first symptom and hospital admission. Headache (77%) was the most represented clinical sign. The cerebrospinal fluid analysis showed hypoglycorachy (67%), hyperproteinorachy (65%) and lymphocytosis (63%). Chinese ink direct examination for Cryptococcus neoformans in CSF was positive in 86% of cases and all cases were positive after culture on Sabouraud's medium. Patients were treated with monotherapy amphotericin B (42%) or fluconazole (28%) and bitherapy amphotéricine B/fluconazole (28%). Fatal evolution was observed in 60% of cases. CONCLUSION Neuromeningeal cryptococcosis remains a severe opportunistic infection in HIV patients with a heavy mortality rate.
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Affiliation(s)
- I Dollo
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc.
| | - L Marih
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
| | - M El Fane
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
| | - M Es-Sebbani
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
| | - M Sodqi
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
| | - A Oulad Lahsen
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
| | - A Chakib
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
| | - F El Kadioui
- Laboratoire de parasitologie-mycologie, CHU Ibn Rochd, Casablanca, Maroc
| | - A Hamdani
- Laboratoire de parasitologie-mycologie, CHU Ibn Rochd, Casablanca, Maroc
| | - M J El Mabrouki
- Laboratoire de parasitologie-mycologie, CHU Ibn Rochd, Casablanca, Maroc
| | | | - Z Karima
- Laboratoire d'épidémiologie, FACULTE de médecine de pharmacie de Casablanca, Casablanca, Maroc
| | - S Hassoune
- Laboratoire d'épidémiologie, FACULTE de médecine de pharmacie de Casablanca, Casablanca, Maroc
| | - A Maaroufi
- Laboratoire d'épidémiologie, FACULTE de médecine de pharmacie de Casablanca, Casablanca, Maroc
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Kassi FK, Drakulovski P, Bellet V, Krasteva D, Gatchitch F, Doumbia A, Kouakou GA, Delaporte E, Reynes J, Mallié M, Menan HIE, Bertout S. Molecular epidemiology reveals genetic diversity among 363 isolates of theCryptococcus neoformansandCryptococcus gattiispecies complex in 61 Ivorian HIV-positive patients. Mycoses 2016; 59:811-817. [DOI: 10.1111/myc.12539] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/21/2016] [Accepted: 07/03/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Fulgence K. Kassi
- Laboratoire de Parasitologie et de Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les autres maladies infectieuses); UFR Pharmacie; CHU de Treichville; Université Félix Houphouët Boigny; Abidjan Côte d'Ivoire
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - Pascal Drakulovski
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - Virginie Bellet
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - Donika Krasteva
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - François Gatchitch
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - Adama Doumbia
- Service des Maladies Infectieuses et Tropicales; CHU de Treichville; Abidjan Côte d'Ivoire
| | - Gisèle A. Kouakou
- Service des Maladies Infectieuses et Tropicales; CHU de Treichville; Abidjan Côte d'Ivoire
| | - Eric Delaporte
- UMI 233 Service des Maladies Infectieuses et Tropicales; CHU Gui de Chauliac; Montpellier France
| | - Jacques Reynes
- UMI 233 Service des Maladies Infectieuses et Tropicales; CHU Gui de Chauliac; Montpellier France
| | - Michèle Mallié
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - Hervé I. E. Menan
- Laboratoire de Parasitologie et de Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les autres maladies infectieuses); UFR Pharmacie; CHU de Treichville; Université Félix Houphouët Boigny; Abidjan Côte d'Ivoire
| | - Sebastien Bertout
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
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Disease patterns and causes of death of hospitalized HIV-positive adults in West Africa: a multicountry survey in the antiretroviral treatment era. J Int AIDS Soc 2014; 17:18797. [PMID: 24713375 PMCID: PMC3980465 DOI: 10.7448/ias.17.1.18797] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 01/06/2014] [Accepted: 01/20/2014] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE We aimed to describe the morbidity and mortality patterns in HIV-positive adults hospitalized in West Africa. METHOD We conducted a six-month prospective multicentre survey within the IeDEA West Africa collaboration in six adult medical wards of teaching hospitals in Abidjan, Ouagadougou, Cotonou, Dakar and Bamako. From April to October 2010, all newly hospitalized HIV-positive patients were eligible. Baseline and follow-up information until hospital discharge was recorded using standardized forms. Diagnoses were reviewed by a local event validation committee using reference definitions. Factors associated with in-hospital mortality were studied with a logistic regression model. RESULTS Among 823 hospitalized HIV-positive adults (median age 40 years, 58% women), 24% discovered their HIV infection during the hospitalization, median CD4 count was 75/mm(3) (IQR: 25-177) and 48% had previously received antiretroviral treatment (ART). The underlying causes of hospitalization were AIDS-defining conditions (54%), other infections (32%), other diseases (8%) and non-specific illness (6%). The most frequent diseases diagnosed were: tuberculosis (29%), pneumonia (15%), malaria (10%) and cerebral toxoplasmosis (10%). Overall, 315 (38%) patients died during hospitalization and the underlying cause of death was AIDS (63%), non-AIDS-defining infections (26%), other diseases (7%) and non-specific illness or unknown cause (4%). Among them, the most frequent fatal diseases were: tuberculosis (36%), cerebral toxoplasmosis (10%), cryptococcosis (9%) and sepsis (7%). Older age, clinical WHO stage 3 and 4, low CD4 count, and AIDS-defining infectious diagnoses were associated with hospital fatality. CONCLUSIONS AIDS-defining conditions, primarily tuberculosis, and bacterial infections were the most frequent causes of hospitalization in HIV-positive adults in West Africa and resulted in high in-hospital fatality. Sustained efforts are needed to integrate care of these disease conditions and optimize earlier diagnosis of HIV infection and initiation of ART.
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Gbangba-Ngai E, Fikouma V, Mossoro-Kpinde CD, Tekpa G, Ouavene JO, Yangba Mongba DSA, Mbelesso P. [Cryptococcal neuromeningitidis in HIV-infected patients in Bangui, in the era of antiretroviral treatment]. ACTA ACUST UNITED AC 2014; 107:106-9. [PMID: 24570116 DOI: 10.1007/s13149-014-0337-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 12/23/2013] [Indexed: 11/30/2022]
Abstract
The cryptococcal neuromeningitis is the most common fungal meningitis infections in the course of HIV/AIDS. This is the number two of opportunist infection of the central nervous system. The authors post the outcomes of a retrospective study conducted related to 122 cases of cryptococcal neuromeningitis observed over for four years ago, in Bangui in the Central African Republic, this at time when antiretroviral treatment has been avaible, corresponding to a prevalence of 6.5%. These infections very aften occur more in female folk, and to patients whose average age is 35 years old, ranging from 18 to 69 years old. The clinical symptoms often found had been headache (98,3.%), fever (95.0%), the impairing of the overall condition of the patient (86.7%) and neck stiffness (85.9%). It makes sense to notice that comorbidity case alowgwith tuberculosis, intestinal candidiasis, bacterial pneumonia and Kaposi's diseases were found out. The screening of the cerebrospinal fluid showed a sound cell count and even low count in 12.2% of cases. Direct examination of cerebrospinal fluid with India ink helps in diagnosis of 97.5% of cases, and the culture carried out from 74 patients was in any case positive. This culture allowed the diagnosis of three patients whose examination along side with India ink has been negative. The CD4 cell count was less than 100/mm(3) in 97.7% of cases. The rate of the fatality cases has been 66.4%, it has been badly impacted by a CD4 count <50/mm(3) and the lack of antiretroviral therapy. Despite the establishment of a national antiretroviral treatment program to do influence the frequency of opportunistic infections whose cryptococcal neuromeningitis, this condition is still present although it is declining. The clinical variability of this disease requires early diagnosis to avoid delayed treatment corollary of a very high mortality as we have observed.
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Affiliation(s)
- E Gbangba-Ngai
- Service des maladies infectieuses du service de santé des armées, BP 430, Bangui, République centrafricaine,
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