[Epidemiological, clinical and evolving HIV-positive patients referred to the University Hospital of Point G, Bamako, Mali]

We conduct a longitudinal descriptive study in the department of infectious diseases to CHU of Point G during 18 months. It concerned adult patients referred from another care center. All the patients underwent systematic clinical examination and complementary exploration. Our sample was 352 HIV+ patients, with a mean age of 37.8 ± 9.8 years and a sex ratio (M/F)=0.94 shared among patients receiving ARV treatment (ART-s) and not (n-ART). Delay of reference was 5 ± 4.4 days. All patients benefited from clinical and paraclinical examinations. In both groups patients were mostly from level II. On admission, 132 cases were ART-s (38%). The main reasons for consultation were mainly fever [87.9%, p <0.05] and vomiting [17.4%, p =0.005] in the ART-s. Cough (p=0.9), and diarrhoea (p=0.5] were most noted in the n-TARV no statistically significant (no SS). Other reference reasons were similar in the 2 groups: headache (p=0.4), dyspnea (p=0.1). Selected diagnoses were dominated by tuberculosis (p=0.6) for n-ART no SS. Nontuberculosis infectious pneumonia (p=0.8) and cerebral toxoplasmosis (p=0.8) were comparable in the two groups. Severe systemic bacterial infections occurred more noted in the n-TARV (p=0.7). Malaria has been the main non-AIDS defining disease in the n-ART [-p=0.07] no SS. Patients were seen to late stage a corollary of a more collapsed of immunity in n-ART group [93.3%, p <0.05]. The fatality rate was similar in both groups (43.2%). Pathological factors were mainly tuberculosis (p=0.3) no SS. The factors involved significantly in TARV-s were non-tuberculosis bacterial pneumonia (p=0.001). The hospital mortality of HIV and AIDS is still important. Despite free ARVs and the large number of support center, the delay in diagnosis is a key as well as the lack of monitoring of patients factor.

[Malian first observation of disseminated African histoplasmosis with predominant bone localizations in an HIV-negative child in Bamako (Mali). Review of the literature]

Endemic deep fungal infections are still under recognised diseases in daily medical practice because of their rarity in sub-Saharan area. The African histoplasmosis Histoplasma capsulatum var. duboisii (H. capsulatum duboisii) is the most frequent variety described in Mali through limited studies in adult patients, since the first case described by Catanei and Kervran (1945). Our case report is a disseminated histoplasmosis in a young 6-year-old african child. He was male and rural. The infectious localisations were mucosae, skin, lymphnodes, urinary tract and bones. Evolution has been marred by an episode of worsening of symptoms despite initial clinical improvement with ketoconazole. After healing of mucocutaneous lesions, we noticed a limitation of ampliation of both wrists. The radiographic bone lesions were lysis of the right lower end of the right radius and cubitus and fragmentation of cubital epiphysis of the same arm. Lacunes were present on the fifth right finger in metatarsus and phalanx; lacune and blowing aspect of the second phalanx of the left third finger was noted. The disseminated form of African histoplasmosis may occur in HIV-negative subject. The prognosis depends on early diagnosis and administration of appropriate and well-conducted therapy.

[Mortality and morbidity of tetanus in the infectious diseases department, Point G teaching hospital, in Bamako, Mali (2004-2009)]

Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

[Upper gastrointestinal endoscopy during Kaposi's sarcoma to the Point G Hospital, Bamako (Mali): case study 20]

INTRODUCTION

Since the advent of HIV, Kaposi's sarcoma has become one of the most common opportunistic infections and the first cancer in patients with HIV. This cancerous disease occurs most often on the skin but also the viscera. Digestive localization was often observed during the search for other locations before the cutaneous form. No studies in Mali has focused on the upper gastrointestinal location.

OBJECTIVES

To describe the epidemiological and clinical aspects of Kaposi's sarcoma in the upper gastrointestinal endoscopy.

METHODS

This was a retrospective descriptive study from June 2005 to February 2009 in the center of endoscopy of the Point G Hospital including all patients seen in upper gastrointestinal endoscopy during the study period.

RESULTS

20 cases were reported from a total of 5068 endoscopy performed during this period a frequency of 0.39% hospital. These 20 cases were identified in all 31 patients with cutaneous localization of Kaposi's sarcoma is a frequency of 64.5%. The sex ratio was equal to 0.81. The average age was 36.8 years ± 8.92 years. The stomach and esophagus were found most locations. All patients were HIV positive. The CD4 count below 200 cells/mm3 was observed in 95% of patients.

[Neuromeningeal cryptococcosis in Mali]

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 +/- 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV-positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between I and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains.

[Lymphocytic meningitis in Bamako, Mali]

We conducted a prospective survey from January 2001 to March 2002. Our objective was to study etiologic, clinic, and prognostic aspect of lymphocytic meningitis in hospital of Point G to Bamako. We included 35 patients with 25 male (71. 4%) and 10 female (28. 6%), sex - ratio (M / F) equal 2. 5. The median age was of 35 ± 25.4 years (range, 16 - 66 years). HIV serology was positive 26 cases (83. 9%). Clinical presentations were different. We observed 15 cases of encephalitis, 12 cases of meningoencephalitis, 2 cases of meningitis and 6 cases of febrile syndrome. Mean duration of hospitalization was 32. 6 ± 68 days. Mean of lymphocyte was 85.3 ± 25.9% among leukocytes in cerebrospinal fluid of 31 patients. Analysis of cerebrospinal fluid (CSF) identified in 9 cases Cryptococcocus neoformans. In 16 cases etiology was determination based on indirect arguments. In 9 cases viral meningoencephalitis diagnosis was made by exodiagnosis. It concerned 2 cases of TB meningitis, 1 case of cerebral toxoplasmosis, 1 case of decapitate bacterial meningitis and 1 case of cerebral tumor. Malaria thick smear permits to diagnosticate 1 case of cerebral malaria and 1 case of uncomplicated malaria. There are still 10 cases in which the cause remained unknown during study. HIV infection provides principally lymphocytic meningitis. Co morbidity with HIV is associated to lethality at 75%. But no statistical difference with patients without HIV (p = 0.52). Our work puts in exergue all problematic and hold correct of lymphocytic meningitis in our country.

[Undesirable effects of medicine in the Internal Medicine Service of the University Hospital Center du Point G]

The aim of this study was to determine the frequency of adverse reactions to drugs, the WHO grade, describe the clinical features and identify the drug responsible. This was a descriptive cross-sectional study which took place from February 2005 to January 2006 in the Internal Medicine Department at the hospital point G. Were included in this study, all patients hospitalized during the study period, which presented adverse drug reactions (ADRs) that the relation of cause and effect was certain or likely. Thus, 47 ADRs were identified in 39 patients of 426 admitted during the same period a frequency of 9.2%. The average age of our patients was 48.5 ± 16.5 years. The sex-ratio was 1.6 for women. Eighty-two percent of our patients had an ADR and 18% more than one. The WHO grade 1 was the most met or 36.2%, followed by grades 4 and 2 respectively 27.7% and 25.5%. Antidiabetics were responsible for adverse reactions in 46.8% and 21.3% in TB. Adverse events were neurological in 53.2% and type of manifestations of hypoglycemia 46.8% (22/47 cases), polyneuritis 6.4% (3 / 47 cases) and 29.8% in digestive cases dominated by vomiting 12.8% (6 / 47 cases), the epigastria pain 6.4% (3 / 47 cases). The outcome was favorable in 87.2% of cases, however, 3 cases of death among those over 60 years all grade 4 WHO. ADRs deserve special attention to this high death rate (6.4% 3/47 cases) where the interest to search systematically for all patients under medical treatment with a good clinical examination and questioning some thoroughly.

[Neuromeningeal cryptococcosis in non-HIV patients to CHU ward of Point G in Bamako (Mali): 3 case report]

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.

[Peritoneal disease in AIDS at the hospital services in Bamako]

The objective of this work was to evaluate peritoneum attack in AIDS affected patients. IT was a cross sectional descriptive study from October 2000 to May 2003 in services of Internal Medicine of the Hospital of the Point G and Hepato-Gastro-enterology of the Hospital Gabriel Touré and that concerned patient hospitalization files, registers of laparoscopy and registers of anatomopathology results. Have been included in this study, patients HIV positive presenting an abdominal symptomatology as abdominal pain, ascite, hepatomegaly, splenomegaly and that benefitted a laparoscopy with oriented biopsies of lesions. Anatomopathology exam of biopsy fragments has been made in the National institute of Research in Public Health (INRSP) of Bamako, Mali and in Pharo, Marseille in France. In term of this study 20 patients have been included. The mean age of our patients was 40.1 +/- 11 years with a sex ratio equal 1. Married women were the socio-professional category the most affected (45%). The clinical symptomatology was dominated by ascite (70%), abdominal pain (45%), abdominal meteorism (40%), hepatomegaly (35%), splenomegaly (30%). Peritoneal localization was the most frequent (50%). Granulations were the laparoscopic aspect the most met (80%) and confirmed in 80% cases by histology. Hepato-peritoneal tuberculosis was the most frequent etiology (60%) come then the non specific inflammations (30%), the lipophagic granulome (5%), and non specific granulomatose inflammations (5%). This study is characterized by an increased frequency of hepato-peritoneal tuberculosis during the pathology of peritoneum in AIDS affected patients. It deserves to be searched and treated for patients' survival.

[Digestive parasitic diseases to HIV/AIDS infected patients of internal medicine and infectious diseases wards of the hôpital du Point "G" Bamako - Mali]

We conducted a prospective study in internal medicine and infectious diseases wards of the hospital of Point " G " in Bamako, Mali from January to December 2002. Overall 112 patients HIV positive, thirty-five patients (31,25%) had at least a digestive parasitic disease. We found that the most frequent parasite in stools sample were protozoa (82,85%). The second most frequent parasites were helminthes (20,33%). HIV/AIDS opportunistic parasites represented 40% of all parasites found. These included 25,71% cases of Cryptosporidium sp, 8,57% cases of Isospora belli and 5,71 % for microsporidia. The functional signs of our patients were mostly asthenia and weight loss. The physical signs were conjunctive pallor (71, 42%) and diarrhea (85, 71%). Generalized itching was present in 54, 28% of cases and abdominal pains in 25, 71% of cases. The global lethality was 37, 14% (13/35). The deaths were due to the HIV infection. The parasites appear even frequent at patients infected by HIV/AIDS, in spite of the advent of antiretroviral therapy. The efficient molecule research against the opportunist parasite must constitute one of our priorities in tropical area.

[Association of urinary tract infections and HIV infection in an internal medicine ward of Hospital of Point G-Bamako-Mali]

We gathered 14 clinical observations of urinary track infections in AIDS patients in Internal Medicine wards from August 1, 1998 to July 31, 1999. Urinary track infection and HIV were both present in 1.75% of 797 hospitalized patients. The specific prevalence was 14.43% among AIDS patients. The sex ratio (female/male) was 1.33. The mean age of patients was 37.2 years with ranges between 25 years and 59 years. Urinary symptoms were discret. Urinary tract infection was primarily evidenced by urine leucocytes > 10(4) organism/ml and a bacteriuria > 10(5) colony-forming units/ml. The main pathogenswere Escherichia coli (42.85%), Klebsiella pneumoniae (28.57%), Colibacilles app. (21.42%) and Enterobacter cloacae (7.14%). All isolated germs were sensible to the gentamicin, to the amikacin, to the nalidixic acid, to the cefoxitine, to the ceftazidime to the cefotaxime and the ciprofloxacin. Cephalosporin of 3rd generation, aminoglycosides, and fluoroquinolone can be used like treatment of first line in urinary tract infection suspicion case in Bamako. Our patients were highly immunosuppressed with the majority of them being in class IV C of CDC of Atlanta (90%) and CD4 count constantly bellow 200 cells/mm3. The main opportunistic affections were non bacilar bacterial pneumopathies (28.57%), oesophagal mycosis (71.42%), the association of cerebral toxoplasmosis and pulmonary tuberculosis (35.71%). All urinary infections were cured by mean of 5 days of treatment. Very few recidivism was found (1 case).