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 11
- Downloads 0
Resolution of Intrabiliary Ruptured Hepatic Hydatid Cyst after Endoscopic Extraction: Case Report
Hepatic hydatid cyst may rupture into bile ducts in 4-20% of cases leading to cholestasis in 2/3 of cases. We tried to prove that ERCP can replace surgery in treatment of intrabiliary ruptured hydatid cyst. Our patient...
P Wave Dispersion is Associated with Catheter Induced Atrial Fibrillation during Electrophysiological Study
Introduction: If we can predict which patients will develop atrial fibrillation during electrophysiological study (EPS), we can be more careful during catheter placement and reduce the probability of development of atri...
Axial Spondyloarthritis in Inflammatory Bowel Diseases
Rheumatic manifestations are described in 25 to 30% of patients with IBD and represents the most frequent extra intestinal manifestation [1,2]. The association between ankylosing spondylitis and IBD was recognized as...
Choledochal Cyst with Pancreatic Divisum- A Rare Occurrence
Though pancreatic divisum is the most common congenital anomaly of pancreas, its co-occurrence with choledochal cyst is a rare finding with less than ten reported cases in literature. Both these conditions are associate...
Hyperdontia- A Rare Non Syndromic Case
Hyperdontia or Multiple supernumerary teeth have been associated with syndromes and metabolic disorders. Supernumerary teeth without associated syndrome are an uncommon entity. Non-syndromic supernumerary teeth, if asy...