About 54 Cases of Neuromeningtic Cryptococcosis on HIV Infection
Journal Title: Medical Journal of Clinical Trials & Case Studies - Year 2018, Vol 2, Issue 2
Abstract
Introduction: The advent of antiretrovirals has reduced the prevalence of neuroméningated cryptococcosis (CNS) in patients living with HIV (PLHIV). Objectives: Epidemiological-clinical, paraclinical, therapeutic and evolutionary analysis of 54 cases of CNM in PVVIH. Patients and methods: A retrospective study reporting cases of CNM in patients living with HIV (PLWHIV) collected between January 01, 1993 and June 30, 2017 at the national reference center for the management of HIV infection; EHS service B El Hadi Flici ex EL KETTAR, Algiers. Results: In a group of 1289 PPVIH, 4.2% presented a CNM. The mean age was 39 ± 2years with a sex ratio of (3.15). The CNM was inaugural of HIV infection in 41%. The dominant picture: meningoencephalitis in 50% of cases, febrile headache 28%, fevers isolated 11%, headache isolated 9% and one asymptomatic case. The stiffness of the neck found in fourteen patients. Note that 04 patients developed disseminated form. In 51 lumbar punctures performed, the cephalospinal fluid (LCS) was pathological in 61%, with a clear appearance of 86%. Mean cytoracy: 60 cells / mm3 predominantly lymphocytic in 19 patients. Hyperproteinorachia was found in 18 patients with an average of 0.73 g / l. Hypoglycorachia in 14 patients with an average of 0.36 g/l. direct examination with Indian ink staining identifies Cryptococcus neoformans in 61% of cases, culture on Sabouraud medium supplemented with chloramphenicol positive 80.3%. The search for soluble cryptococcal antigens by the latex agglutination test was positive in 70.6%. In the context of the dissemination report: 63% positive antigenemia, two positive blood cultures, two antigenurias and direct urine tests for cryptococcus were positive, and a skin biopsy performed in one patient was positive. In the induction phase, amphotericin B was prescribed as monotherapy in 87% of cases whereas fluconazole was only prescribed in 7.4% (n = 4) of cases, the combination of both was indicated only in 1.8% and two patients (3.7%) died within 24 hours of diagnosis without receiving antifungal therapy. It is noted that Fluconazole alone at 200 mg / day was initiated at the maintenance phase until the recovery of CD4. The average time after the start of ARVs after beginning the management of the CNM 15 ± 4 days. The result was favorable in 61%, relapse 14.8% and 39% (n = 21) of reported deaths. Conclusion: This study reveals that morbidity and mortality are closely related to the early diagnosis and the initiation of adequate antifungal therapy.
Authors and Affiliations
Achour N1*, Chadi S1, Saaddjaballah A Aissat FZ1, Lamara Mohamed F1, Gueriane Z1, Aknouche K1, Chabani FZ1, Khaled S2, Semani M2 and Amrane A1
Keywords
Related Articles
- EP ID EP752233
- DOI 10.23880/mjccs-16000139
- Views 14
- Downloads 0
Clinical Case Study Strengthens Clinical Acumen
Traditionally almost all medical journals publish 2 to 3 case studies/case reports which are mentioned at the bottom of the list of index and printed on the last pages. Some journals may not include a case report at t...
Bilateral Alive Tubal Ectopic Pregnancy
Ectopic pregnancy is an important cause of maternal mortality. Bilateral tubal pregnancies are rare; the reported incidence is only 1 in 200 000 pregnancies. Detecting bilateral tubal ectopic pregnancy is urgent because...
Sister Mary Joseph's Nodule of a Gastric Origin: About a Case and Literature Review
The nodule of Sister Mary Joseph is a rare tumor whose origin is abdominopelvic. The prognosis is pejorative. We report the case of a patient with umbilical metastasis of a gastric adenocarcinoma treated in the medical...
Usage of Mobile Phone Applications for Dietary Benefits: Perceptions among Dietetics Professionals and Clients in Saudi Arabia
Mobile applications offer a basis for improving diet-based health outcomes and the study sought to investigate the usage of dietary mobile applications as perceived among dietetics professionals and clients. Results ide...
Expression of Cell Adhesion Molecules in Preeclampsia
Aim: The serum P-Selectin and E-Selectin levels of preeclamptic patients attending General Hospital Owerri, Nigeria were evaluated. Materials and Methods: A case control study involving 200 primigravida (100 preeclampt...