Cryptococcose extra-neuroméningée au cours du sida à Bamako, Mali (à propos de 2 observations)

Non-neuromeningeal cryptococcosis forms resulting from disseminated infection are rarely reported in African literature and are non-documented in Malian medical ward. We report two clinical observations. Case 1: a 26-year-old patient, carrying the HIV-1 infection, in which the clinical examination revealed skin lesions simulating molluscum contagiosum and functional impairment of the lower limbs. Radiography of the lumbar spine showed vertebral osteolysis on L4–L5. Cryptococcal research remained negative in the CSF but positive at histological examination of the skin lesions and in pathological products of lumbosacral drainage. The treatment with fluconazole and ARV led to a favorable outcome. Case 2: a 42-year-old patient, admitted for fever cough, known for his non-compliance to ARVs and in which the examination found a syndrome of pleural condensation and a painful swelling of the outer third of the right clavicle (around the acromio-clavicular joint). Paraclinical investigations concluded in osteolysis of the acromial end of the right clavicle and an image of the right lung with abundant effusion. Cryptococcal research was positive in the pleural effusion and in the product of aspiration of acromio-clavicular tumefaction, negative in CSF. It seems important to think of a cryptococcal etiology even in the absence of clinical meningeal signs in front of any cutaneous sign and any fluctuating swelling in HIV+ patient

Première observation malienne d’histoplasmose africaine disséminée à prédominance osseuse chez un enfant VIH négatif. Revue de la littérature

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

Profil epidemio-clinique actuel des co-infections VHB/VIH et VHC/VIH au Centre Hospitalier Universitaire du Point- G, Bamako Mali

Objectif: Déterminer la place du portage des virus des hépatites B et C chez les PVVIH admis en hospitalisation. Méthodologie: L’étude était rétrospective et descriptive sur 10 ans à partir de la base de données, dans les services de références des hépatites virales B et C. Elle a concerné les patients porteurs du VIH et d’antigène HBs et/ou Ac anti-VHC. Résultats: Sur 3024 patients hospitalisés, 123 cas de coïnfections (4,07%) de VIH + VHB (n =115) et VIH+VHC (n =8) ont été recensés. L’âge moyen des patients ayant une coinfection VIH/VHB était de 40,2 ans ± 15,6 vs 43,05 ± 2,07 pour ceux ayant une co-infection VIH/VHC et le sex-ratio (H/F) de 0,33 pour les patients VIH/VHB versus 1,5 pour les patients VIH/VHC. Les facteurs de risque identifiés étaient les partenariats sexuels multiples (50,4%), la transfusion sanguine (5,69%), la sodomie (2,4%) et l’injection intraveineuse de drogues (2,4%). Les patients VIH-VHB étaient sous traitement ARV dans 67,8% des cas (35,6% par TDF/3TC/EFV) comparés aux patients VIH-VHC (traités par AZT/3TC/EFV). Aucune triple association VIH/VHB/VHC n’était diagnostiquée. Conclusion: la co-infection VIH et hépatites virale B et C reste non négligeable en hospitalisation. Le respect des normes de traitement ARV nationales réduiraitle poids de la morbi-mortalité associée à la comorbidité avec le VHB. L’espoir des prochaines subventions du traitement du VHC serait un gage de réduction de sa mortalité. Mots clés: Comorbidité, Infection à VIH, Hépatite à virus B, Hépatite à virus C English Title: Epidemiological and clinical current profile of HBV/HIV and HCV/HIV to the University Hospital Center Area of Point-g, Bamako, Mali English Abstract Objective: To determine the place of hepatitis B and C viruses infection among PLVIH admitted to hospital. . Method: Study was a retrospective and descriptive study over 10 years, from the database in the reference services of viral hepatitis B and C. Results: Of 3024 hospitalized patients, 123 co-infections (4.07%) of HIV + HBV (n = 115, 93.5%) and HIV + HCV (n = 8, 6.5%) were detected. Their mean age was 40.2 years ± 15.6 (HIV / HBV) vs 43.05 ± 2.07 for the HIV / HCV couple with a sex ratio (M / F) equal 0.33 for HIV / HBV couple and 1.5 for HIV / HCV couple. The risk factors identified were multiple sexual partnerships (50.4%), blood transfusion (5.69%), sodomy (2.4%) and intravenous drug injection (2.4%). The carriers of the HIV-HBV couple were on Antiretroviral treatment (67, 8%) particularly treat by TDF / 3TC / EFV in 36,5% compared to the HIV-HCV couple (treated with AZT / 3TC / EFV). No triple case of HIV / HBV / HCV association was diagnosed. Conclusion: HIV coinfection and viral hepatitis B and C remain significant in admission. Compliance with national ARV treatment standards would reduce the burden of morbidity and mortality associated to comorbidities of HBV. Hope for future HCV treatment grants would be a pledge to reduce mortality associated to this virus. Keywords: Comorbidity, HIV infection, Hepatite B, Hepatite

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA).We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region.Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3).This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population