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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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Ezenabike C, S Ashaka O, A Omoare A, Fadeyi A, K Salami A, O Agbede O. Cryptococcal antigen among HIV1-infected individuals in north-central Nigeria. Curr Med Mycol 2021; 6:43-48. [PMID: 33628981 PMCID: PMC7888519 DOI: 10.18502/cmm.6.2.3662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose The potential for the invasion of the central nervous system by Cryptococcus species is underscored by the presence of this organism in the blood of immunocompromised individuals. Early adoption of sensitive methods for the diagnosis of Cryptococcus species will reduce the high morbidity and mortality associated with this disease. Regarding this, the aim of the present research was to detect cryptococcal antigen among HIV1- infected individuals in north-central Nigeria. Materials and Methods This prospective cross-sectional study was carried out on HIV-1 infected individuals accessing care at three health facilities in north-central Nigeria between November 2014 and March 2017. For the purpose of the study, blood samples were collected from 300 HIV1-infected individuals within the age group of 3-65 years. The CD4+ T-cell count was determined, and the samples were analyzed for cryptococcal antigenemia using the methods of lateral flow assay (LFA) and culture technique. Results Cryptococcus antigen was detected in 19.67% (59/300) of the patients, and only 25.4% (15/59) of the LFA-positive samples showed Cryptococcus species growth on Sabouraud dextrose agar after 3 days. Furthermore, fungal growth was observed in one of the specimens, which was LFA negative. Additionally, 30 of the 59 LFA-positive patients had cryptococcal antigen in their serum with a CD4+ T-cell count of < 150 cells/mm3. Conclusion As the findings of the present study indicated, infection with Cryptococcus species is a problem among HIV-infected patients in the region under study. Therefore, all HIV patients, especially those with a CD4+ T-cell count of < 150 cells/mm3, referring to the HAART clinics in Nigeria, should be screened for cryptococcal antigen.
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Affiliation(s)
- Chimezie Ezenabike
- Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Oluwaseyi S Ashaka
- Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Adesuyi A Omoare
- Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Abayomi Fadeyi
- Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Alakija K Salami
- Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Olajide O Agbede
- Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
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Oladele R, Ogunsola F, Akanmu A, Stocking K, Denning DW, Govender N. Opportunistic fungal infections in persons living with advanced HIV disease in Lagos, Nigeria; a 12-year retrospective study. Afr Health Sci 2020; 20:1573-1581. [PMID: 34394217 PMCID: PMC8351866 DOI: 10.4314/ahs.v20i4.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Nigeria has a large estimated burden of AIDS-related mycoses. We aimed to determine the proportion of patients with AIDS-related opportunistic fungal infections (OFIs) at an urban antiretroviral treatment (ART) centre in Nigeria. Methods A retrospective analysis of a cohort of ART-naïve, HIV-infected patients, assessed for ART eligibility and ARTexperience at the PEPFAR outpatient clinic at Lagos University Teaching Hospital over a 12-year period (April 2004-February 2016) was conducted. Results During this period, 7,034 patients visited the clinic: 4,797 (68.2%) were female; 6161 patients had a recorded baseline CD4 count, and the median CD4 count was 184 cells/µl (IQR, 84–328). A baseline HIV-1 viral load (VL) was recorded for 5,908 patients; the median VL was 51,194 RNA copies/ml (IQR, 2,316–283,508) and 6,179/7046(88%) had initiated ART. Some 2,456 (34.9%) had a documented opportunistic infections, of whom 1,306 (18.6%) had an opportunistic fungal infection. The total number of OFI episodes was 1,632: oral candidiasis (n=1,473, 90.3%), oesophageal candidiasis (n=118; 8%), superficial mycoses (n=23; 1.6%), Pneumocystis pneumonia (PJP) (n=13; 0.8%), and cryptococcal meningitis(CM) (n=5; 0.4%). 113 (1.6%) were known to have died in the cohort. Conclusion Approximately 1 in 5 HIV-infected patients in this retrospective cohort, most of whom had initiated ART, were clinically diagnosed with an OFI. Improved access to simple accurate diagnostic tests for CM and PJP should be prioritised for this setting.
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Affiliation(s)
- Rita Oladele
- University of Lagos College of Medicine, Medical Microbiology & Parasitology
| | | | | | - Katie Stocking
- University Hospital of South Manchester NHS Foundation Trust
| | - David W Denning
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Oladele RO, Jordan A, Akande P, Akanmu SA, Akase IE, Aliyu S, Denning DW, Chiller T. Tackling cryptococcal meningitis in Nigeria, one-step at a time; the impact of training. PLoS One 2020; 15:e0235577. [PMID: 32628714 PMCID: PMC7337344 DOI: 10.1371/journal.pone.0235577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/17/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Nigeria is estimated to have 25,000 cases of cryptococcal antigenemia (CrAg) annually. CrAg screening with pre-emptive fluconazole treatment is recommended but not yet implemented in Nigeria. Trainings were conducted to improve health-care provider (HCP) awareness and clinical skills in the management and prevention of cryptococcal meningitis (CM). METHODS HCPs providing care for people living with HIV were targeted for training at 13 sites from April to November 2018 Course content was adapted from CDC Cryptococcal Screening Program Training Manual and LIFE-website. "Hands-on" training on CrAg testing and lumbar puncture was included. A 14-point pre and post-test assessment instrument was designed to capture the impact of the training and focus group discussions (FGDs) were conducted. RESULTS A total of 761 HCPs were trained. 519 HCPs completed the pre-test evaluation while 470 (90.6%) took part in the post-test evaluation. Post-training, HCPs were significantly more likely to respond correctly to all 14 assessment items, with the mean percentage score rising to 91.0% from a pre-training value of 60.0%. FGDs revealed that many of the HCPs were not aware of the CrAg screening and pre-emptive treatment recommendations in Nigerian guidelines, and reported not having seen or managed a case of CM. Also, they highlighted challenges with routine CrAg screening due to a lack of access to CD4 testing, CrAg test kits, antifungal drugs, as well as the need for similar trainings across all tiers of care in Nigeria. CONCLUSION Training significantly improved HCPs' understanding of Nigerian policy on CrAg screening, CM diagnosis and best management practices. This training could be included in routine capacity building efforts for HCPs involved in HIV care in Nigeria.
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Affiliation(s)
- Rita O Oladele
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Alexander Jordan
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | | | | | - Iorhen E Akase
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sani Aliyu
- National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - David W Denning
- Global Action Fund for Fungal Infections (GAFFI), Geneva, Switzerland
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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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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Akase IE, Olowoyo O, Oladele RO, Obiako RO, Warris A, Akanmu SA. Cryptococcal meningitis after ART: Need for proper baseline evaluation in the era of 'Test & Treat'. Med Mycol Case Rep 2019; 24:58-60. [PMID: 31049279 PMCID: PMC6479266 DOI: 10.1016/j.mmcr.2019.04.003] [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: 02/25/2019] [Revised: 03/28/2019] [Accepted: 04/11/2019] [Indexed: 12/15/2022] Open
Abstract
Cryptococcal meningitis (CM) contributes significantly to high early mortality in the setting of advanced HIV. In resource poor settings, the current HIV disease management approach is focused on commencing antiretroviral therapy (ART) on the same day of HIV diagnosis (‘Test and Treat’). The HIV program in Nigeria does not currently provide CrAg screening for patients with newly diagnosed and advanced HIV disease. We report a case of severe cryptococcal meningitis presenting following the commencement of ART. There is clear benefit in the early commencement of ART among HIV infected patients and to prevent patients lost to follow-up as aimed with the ‘Test & Treat’ approach. However, this approach needs to be balanced against the risk of IRIS and its associated morbidity and mortality when those patients are not being properly evaluated for opportunistic infections being present without overt symptoms.
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Affiliation(s)
- Iorhen E Akase
- Infectious Disease Unit, Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olamide Olowoyo
- Department of Medicine, Federal Medical Center, Ebute-Metta, Lagos, Nigeria
| | - Rita O Oladele
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Lagos, Nigeria.,College of Medicine, University of Lagos, Lagos, Nigeria
| | - Reginald O Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria.,Neurology Unit, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Adilia Warris
- MRC Center for Medical Mycology, Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, UK
| | - Sulaimon A Akanmu
- College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Lagos, Nigeria
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Opintan JA, Awadzi BK, Biney IJK, Ganu V, Doe R, Kenu E, Adu RF, Osei MM, Akumwena A, Grigg ME, Fahle GA, Newman MJ, Williamson PR, Lartey M. High rates of cerebral toxoplasmosis in HIV patients presenting with meningitis in Accra, Ghana. Trans R Soc Trop Med Hyg 2018; 111:464-471. [PMID: 29373741 DOI: 10.1093/trstmh/trx083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022] Open
Abstract
Background Data on adult meningitis among patients infected with the human immunodeficiency virus (HIV) is scarce in western sub-Saharan Africa, including Ghana. Methods HIV-infected adults with a provisional diagnosis of meningitis were consecutively enrolled, between August 2014 and January 2016. After patient data collection, cerebrospinal fluid (CSF) was obtained and evaluated for microbiological aetiologies, cell counts and biochemistry. Caregiver clinicians provided limited data for inpatients at the end-point of discharge or death. Results Complete data sets from 84 patients were analysed (inpatients=63, outpatients=21). Median age was 40 years with 56% (47/84) being females. Only 30% (25/84) of the patients were on antiretroviral therapy (ART). CD4+ T-cell count was available for 81% (68/84) of patients and 61.9% (52/84) had counts below 150 cells/μL [median and interquartile range=56 (13.8-136)]. Microbiological aetiologies were detected in 60.7% (51/84) patients with the following distribution-Toxoplasmosis (25%), Epstein-Barr virus (28.6%), Cytomegalovirus and Cryptococcus (2.4%) each. Co-infection was identified in 20.7% (17/84) of the patients. Conclusion Patients presenting with symptoms of meningitis had advanced HIV/AIDS, a quarter of whom had cerebral toxoplasmosis or infection with EBV. A high index of suspicion, laboratory exclusion of cryptococcal meningitis and prompt patient management with anti-toxoplasmosis empiric therapy may thus be required for optimal treatment.
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Affiliation(s)
- Japheth A Opintan
- Department of Medical Microbiology, School of Biomedical & Allied Health Sciences, University of Ghana
| | - Benedict K Awadzi
- Department of Medical Microbiology, School of Biomedical & Allied Health Sciences, University of Ghana
| | | | - Vincent Ganu
- Korle-Bu Teaching Hospital, Fevers' Unit, Accra, Ghana
| | - Richard Doe
- Korle-Bu Teaching Hospital, Fevers' Unit, Accra, Ghana
| | - Ernest Kenu
- Korle-Bu Teaching Hospital, Fevers' Unit, Accra, Ghana
| | - Rita F Adu
- Department of Medicine, School of Medicine & Dentistry, University of Ghana
| | - Mary M Osei
- Department of Medical Microbiology, School of Biomedical & Allied Health Sciences, University of Ghana
| | - Amos Akumwena
- Department of Medical Microbiology, School of Biomedical & Allied Health Sciences, University of Ghana
| | - Michael E Grigg
- Laboratory of Clinical Immunology & Microbiology, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Gary A Fahle
- Laboratory of Clinical Immunology & Microbiology, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Mercy J Newman
- Department of Medical Microbiology, School of Biomedical & Allied Health Sciences, University of Ghana
| | - Peter R Williamson
- Laboratory of Clinical Immunology & Microbiology, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Margaret Lartey
- Department of Medicine, School of Medicine & Dentistry, University of Ghana.,Korle-Bu Teaching Hospital, Fevers' Unit, Accra, Ghana
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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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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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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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Bamba S, Barro-Traoré F, Sawadogo E, Millogo A, Guiguemdé RT. [Retrospective study of cases of neuromeningeal cryptococcosis at the University Hospital of Bobo Dioulasso since accessibility to antiretroviral in Burkina Faso]. J Mycol Med 2012. [PMID: 23177811 DOI: 10.1016/j.mycmed.2011.12.074] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIMS OF THE STUDY To study the prevalence of neuromeningeal cryptococcosis since the availability of antiretroviral drugs and to determine the epidemiological profiles, clinical and biological treatment of neuromeningeal cryptococcosis cases diagnosed in the service of parasitology and mycology of university hospital center of Bobo-Dioulasso from 2002 to 2010. PATIENTS, MATERIAL AND METHODS We included all patients diagnosed with neuromeningeal cryptococcosis for which the presence of the fungi was observed on microscopic examination of cerebrospinal fluid after staining with Indian ink. Data were collected from the registers of the clinical service and from the laboratory of the university hospital center of Bobo Dioulasso. RESULTS The prevalence of neuromeningeal cryptococcosis was 1.8% (61/5129). A decrease in the prevalence was observed from 2002 to 2010 (3.1%, to 0.2%). This decrease occurred even though the number of patients treated with antiretroviral drugs increase. Headaches were the predominant clinical signs (81.9%). The CD4 median count was 56/mm(3). All patients were successfully treated with fluconazole in relay to amphotericin B intravenous. Lethality rate is 27.8%. CONCLUSION The overall prevalence of 1.8% of neuromeningeal cryptococcosis observed in this study was lower than that in previous studies in the same laboratory in 2001. The arrival of antiretroviral drugs could have contributed to the decline in the prevalence of neuromeningeal cryptococcosis in this study.
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Affiliation(s)
- S Bamba
- Service de parasitologie-mycologie, centre hospitalier universitaire Sanou Souro, BP 1091, Bobo-Dioulasso, Burkina Faso.
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