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Bongomin F, Ekeng BE, Kibone W, Nsenga L, Olum R, Itam-Eyo A, Kuate MPN, Pebolo FP, Davies AA, Manga M, Ocansey B, Kwizera R, Baluku JB. Invasive Fungal Diseases in Africa: A Critical Literature Review. J Fungi (Basel) 2022; 8:jof8121236. [PMID: 36547569 PMCID: PMC9853333 DOI: 10.3390/jof8121236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
- Correspondence:
| | - Bassey E. Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar P.O. Box 540281, Nigeria
| | - Winnie Kibone
- Department of Medicine, School of Medicine, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Lauryn Nsenga
- Department of Medicine, School of Medicine, Kabale University, Kabale P.O. Box 317, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis’s Hospital Nsambya, Kampala P.O. Box 7176, Uganda
| | - Asa Itam-Eyo
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar P.O. Box 540281, Nigeria
| | | | - Francis Pebalo Pebolo
- Department of Reproductive Health, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
| | - Adeyinka A. Davies
- Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University Teaching Hospital, Sagamu P.O. Box 121102, Nigeria
| | - Musa Manga
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4114 McGavran-Greenberg, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Bright Ocansey
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Richard Kwizera
- Translational Research Laboratory, Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala P.O. Box 7178, Uganda
- Makerere Lung Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
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Muzazu SGY, Assefa DG, Phiri C, Getinet T, Solomon S, Yismaw G, Manyazewal T. Prevalence of cryptococcal meningitis among people living with human immuno-deficiency virus and predictors of mortality in adults on induction therapy in Africa: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:989265. [PMID: 36160163 PMCID: PMC9494297 DOI: 10.3389/fmed.2022.989265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cryptococcal meningitis (CM) is a leading cause of adult meningitis in countries with a high burden of HIV. It has remained a significant cause of morbidity and mortality in Africa despite the extensive rollout of HIV antiretroviral therapy (ART). This study aimed to systematically synthesize the evidence on the prevalence of CM among people living with HIV (PLWH) and its predictors of mortality among adults who are on induction antifungal therapy in Africa. Methods PubMed/MEDLINE, Embase, and Google Scholar were searched for randomized clinical trials or observational studies published in Africa from 1995 to April 2021. Pooled prevalence of CM among PLWH was calculated using R-studio Version 1.4.1717 software and the data extracted from eligible studies were pooled as percentage with a 95% confidence interval (CI). Predictors of mortality among adults on induction antifungal therapy were synthesized narratively. Results Out of 364 studies identified, 17 eligible articles were included in the analysis. The prevalence of CM among PLWH in Africa was 5.11% (95% CI 2.71-9.43%; participants = 10,813; studies = 9; I 2 = 97%). In the subgroup analysis, the prevalence was 12.9% (95% CI 4.883-30.0; participants = 533; studies = 3; I 2 = 63%) in the years 1995-2010 and 3.18% (95% CI 1.54-6.45; participants = 10,280; studies = 6; I 2 = 98%) in the years 2011-2021, with the prevalence significantly decreased by 51% (p = 0.02). Predictors of mortality were fluconazole monotherapy, focal neurological signs, low Glasgow coma scale, and delayed diagnosis of CM at varied timepoint. Conclusion Prevalence of CM has significantly decreased from 1996-2010 to 2011-2021 among PLWH on induction therapy in Africa. Fluconazole monotherapy, focal neurological symptoms, diastolic blood pressure < 60 mmHg, and concurrent tuberculosis coinfection were significant predictors of mortality at 2- and 10-weeks timepoints. CM remains a major concern among PLWH despite increases in ART coverage. Improved access to effective antifungal therapies is needed in Africa for timely initiation of combination induction therapy and better treatment outcomes of PLWH. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254113], identifier [CRD42021254113].
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Affiliation(s)
- Seke G. Y. Muzazu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Enteric Diseases and Vaccines Research Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Dawit Getachew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Nursing, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Christabel Phiri
- Levy Mwanawasa University Teaching Hospital, Department of Internal Medicine, Lusaka, Zambia
| | - Tewodros Getinet
- School of Public Health, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Samrawit Solomon
- School of Public Health, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gizachew Yismaw
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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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: 35] [Impact Index Per Article: 8.8] [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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Bandadi FZ, Raiss C, Moustachi A, Lyagoubi M, Aoufi S. [Forty cases of neuromeningeal cryptococcosis diagnosed at the Mycology-Parasitology Department of the Ibn Sina hospital in Rabat, over a 21-year period]. Pan Afr Med J 2019; 33:249. [PMID: 31692764 PMCID: PMC6814906 DOI: 10.11604/pamj.2019.33.249.18011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/07/2019] [Indexed: 11/23/2022] Open
Abstract
La cryptococcose neuroméningée (CNM) est une mycose opportuniste fréquente et sévère causée par une levure encapsulée Cryptococcus neoformans. Elle est fréquente chez l'immunodéprimé en particulier le sujet atteint du virus de l'immunodéficience humaine (VIH) à un stade avancé de la maladie, elle est rare chez l'immunocompétent. Nous rapportons 40 cas de cryptococcose neuroméningée (CNM) diagnostiqués au laboratoire de parasitologie de l'hôpital Ibn Sina de Rabat sur une période de 21 ans (1993 à 2014). Le diagnostic de la cryptococcose neuroméningée a reposé sur la mise en évidence de Cryptococcus neoformans dans le liquide céphalorachidien (LCR) après l'examen direct à l'encre de Chine et la culture sur milieux de sabouraud sans actidione, ainsi que la recherche d'antigènes solubles cryptococciques. Trente cinq patients étaient infectés par le VIH, deux patients étaient apparemment immunocompétents et 3 patients immunodéprimés non VIH (30 hommes et 10 femmes). L'âge moyen des patients était de 38 ans. La cryptococcose neuroméningée était révélatrice de l'infection par le VIH dans 13 cas. Dans 22 cas elle a représenté une complication du SIDA. Vingt sept patients de notre série ont été traités par une monothérapie à base de fluconazole. L'amphotéricine B a été utilisée chez 13 patients. L'évolution a été favorable pour 13 patients (32.5%) et trois cas ont connu une complication (7.5%). Alors que 18 patients sont décédés (45%) et 6 ont été perdus de vue (15%). Pour un diagnostic rapide, la recherche de Cryptococcus neoformons doit être appliquée systématiquement devant le moindre signe neurologique.
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Affiliation(s)
- Fatima-Zahra Bandadi
- Laboratoire Central de Parasitologie-Mycologie Médicale, Centre Hospitalier Ibn Sina de Rabat, Rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Avenue Mohammed Belarabi Elalaoui, BP 6203 Rabat-Instituts, Rabat, Maroc
| | - Chaimae Raiss
- Laboratoire Central de Parasitologie-Mycologie Médicale, Centre Hospitalier Ibn Sina de Rabat, Rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Avenue Mohammed Belarabi Elalaoui, BP 6203 Rabat-Instituts, Rabat, Maroc
| | - Aziza Moustachi
- Laboratoire Central de Parasitologie-Mycologie Médicale, Centre Hospitalier Ibn Sina de Rabat, Rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc
| | - Mohamed Lyagoubi
- Laboratoire Central de Parasitologie-Mycologie Médicale, Centre Hospitalier Ibn Sina de Rabat, Rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Avenue Mohammed Belarabi Elalaoui, BP 6203 Rabat-Instituts, Rabat, Maroc
| | - Sara Aoufi
- Laboratoire Central de Parasitologie-Mycologie Médicale, Centre Hospitalier Ibn Sina de Rabat, Rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Avenue Mohammed Belarabi Elalaoui, BP 6203 Rabat-Instituts, Rabat, Maroc
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Abstract
Because of the limited access to more powerful diagnostic tools, there is a paucity of data regarding the burden of fungal infections in Burkina Faso. The aim of this study was to estimate the incidence and prevalence of serious fungal infections in this sub-Saharan country. We primarily used the national demographic data and performed a PubMed search to retrieve all published papers on fungal infections from Burkina Faso and its surrounding West African countries. Considering the prevalence of HIV infection (0.8% of the population) and a 3.4% incidence of cryptococcosis in hospitals, it is estimated that 459 patients per year develop cryptococcosis. For pneumocystosis, it is suggested that 1013 new cases occur every year. Taking into account the local TB frequency (population prevalence at 0.052%), we estimate the prevalence of chronic pulmonary aspergillosis at 1120 cases. Severe forms of asthma with fungal sensitization and allergic bronchopulmonary aspergillosis are estimated to affect 7429 and 5628 cases, respectively. Vulvovaginal candidiasis may affect 179,000 women, and almost 1,000,000 children may suffer from tinea capitis. Globally, we estimate that roughly 1.4 million people in Burkina Faso (7.51% of the population) suffer from a serious fungal infection. These data should be used to drive future epidemiological studies, diagnostic approaches, and therapeutic strategies.
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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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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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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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9
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El Fane M, Badaoui L, Ouladlahsen A, Sodqi M, Marih L, Chakib A, Marhoum El Filali K. [Cryptococcosis during HIV infection]. J Mycol Med 2015; 25:257-62. [PMID: 26515783 DOI: 10.1016/j.mycmed.2015.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 11/26/2022]
Abstract
Cryptococcosis is a cosmopolitan fungal serious condition due to an encapsulated yeast Cryptococcus neoformans. This is the systemic fungal infection the most common in HIV infection. This yeast is present in the environment and its main entrance in the body is the respiratory tract. Its gravity is linked to its tropism for the central nervous system. It generally affects subjects with severe deficit of cellular immunity and in particular, patients living with HIV. The diagnosis of neuromeningeal cryptococcosis is based on the detection of encapsulated yeasts at microscopic examination of cerebrospinal fluid, the detection of capsular polysaccharide antigen in serum or cerebrospinal fluid, but especially on the culture. A staging is always essential. The prognosis is severe. The control of intracranial hypertension is a major element of prognosis.
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Affiliation(s)
- M El Fane
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc.
| | - L Badaoui
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
| | - A Ouladlahsen
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
| | - M Sodqi
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
| | - L Marih
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
| | - A Chakib
- Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc
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10
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Elkhihal B, Hasnaoui A, Ghfir I, Moustachi A, Aoufi S, Lyagoubi M. [Disseminated cryptococcosis in an immunocompetent patient]. J Mycol Med 2015; 25:208-12. [PMID: 26227506 DOI: 10.1016/j.mycmed.2015.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
Disseminated cryptococcosis is a serious opportunistic fungal infection caused by a yeast-encapsulated fungus of the genus Cryptococcus neoformans. It occurs most often in patients with a significant deficit of cellular immunity and preferentially affects the central nervous system. The skin and the lungs are the most commonly affected sites outside the neuro-subarachnoid location. We report the case of a patient apparently immunocompetent who had a disseminated cryptococcosis. The disease started with the multiple purplish skin lesions, large umbilicated on the face, groin, forearm and leg with progressively increasing volume. This symptomatology had evolved in the context of weight loss and poor general condition. The diagnosis was established by the presence of cryptococcal at the skin biopsy and cerebrospinal fluid. Research of immunosuppression common pathologies were negative. Treatment was initiated based on amphotericin B for 40 days. The patient's condition deteriorates onset of paraplegia and swallowing disorders causing death in an array of cachexia. This observation points out that disseminated cryptococcosis can occur in an immunocompetent patient. The skin lesions may be the first sign of the disease.
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Affiliation(s)
- B Elkhihal
- Laboratoire central de parasitologie-mycologie, centre hospitalier Ibn Sina de Rabat, rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc.
| | - A Hasnaoui
- Laboratoire central de parasitologie-mycologie, centre hospitalier Ibn Sina de Rabat, rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc
| | - I Ghfir
- Laboratoire central de parasitologie-mycologie, centre hospitalier Ibn Sina de Rabat, rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc
| | - A Moustachi
- Laboratoire central de parasitologie-mycologie, centre hospitalier Ibn Sina de Rabat, rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc
| | - S Aoufi
- Laboratoire central de parasitologie-mycologie, centre hospitalier Ibn Sina de Rabat, rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc
| | - M Lyagoubi
- Laboratoire central de parasitologie-mycologie, centre hospitalier Ibn Sina de Rabat, rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc
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