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

La cryptococcose neuro-méningée au 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 1 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

e-Pilly TROP Maladies infectieuses tropicales

L’e-Pilly TROP est un ouvrage d’infectiologie tropicale destiné aux médecins et aux étudiants en médecine des pays francophones du Sud. La prise en compte des différents niveaux de la pyramide sanitaire dans ces pays le rend aussi accessible aux infirmiers des centres de santé communautaires urbains et des structures de santé intermédiaires des zones rurales. Par définition, les Pays En Développement accroissant progressivement leurs capacités de diagnostic biologique et de traitement, les outils de prise en charge correspondent aux moyens des niveaux périphériques comme à ceux des niveaux hospitaliers de référence

Les envenimations ophidiennes dans une clinique privee « Néné » de kati et revue de la litterature

Objectif: Rapporter 5 observations cliniques de morsures de serpent chez des sujets admis en milieu de soins et faire une revue de la littérature. Méthodologie: Nous avons effectué une analyse d’une série de 5 dossiers médicaux de patients admis pour morsures de serpents. Résultats: Les patients de notre série étaient d’un âge moyen de 24,8 ans avec des extrêmes de 11 ans (observation 4) et 44 ans (observation 5). Un seul cas était de sexe féminin (observation 3). Les circonstances d’expositions étaient les travaux champêtres pour 2 cas, le ramassage de bois (2 cas) et la promenade nocturne pour 1 cas. Les sites de morsures étaient majoritairement le membre inferieur (4 cas). Un patient avait le site de morsure sur le pouce du doigt (observation 4). L’étape initiale de la prise en charge a été effectuée par le traditherapeutique dans tous les cas. Les délais de consultations ont été de 48 heures (2cas) 72 heures (2 cas) et de 12 heures chez 1 cas. Le syndrome hémorragique a été noté dans la majorité des cas à l’admission (4 patients) et le délabrement musculaire dans 1 cas (observation 5). Ils ont tous bénéficié de sérothérapie antivenimeux. L’évolution fut favorable pour l’ensemble des patients. Conclusion: les cas de morsures de serpent sont de plus en plus rencontrés au cours de nos activités de soins. Une meilleure connaissance et la maitrise des bonnes pratiques de la prise en charge des envenimations ophidiennes permettraient une amélioration du pronostic des cas. Mots clés: Morsures, Serpents, Sérum antivenimeux, Mali English Title: The ophidian envenomations in a private clinique “Néné”area in Kati and review of literature English Abstract Objectif: to report 5 clinical observations of snakebite in subjects admitted to healthcare settings and review literature. Methods: We performed an analysis of a series of medical records of patients for snakebite. Results: The patients in our series were of an average age of 24.8 years with extremes of 11 years (case 4) and 44 years (cases 5). Only one was female (case 3). The exposure circumstances were field work concerning 2 cases, wood collection (2 cases) and night walk for 1 case. The bite sites were mainly on the lower limb (4 cases). For 1 patient this site located on the thumb (case). In all cases, the initial step of consultation was effect to the traditional therapy pratician. They consult in the health structures only after failure of the traditional treatment thus at the stage of complications whose management remains uncertain and burdened with heavy. The consultations delay were 48 hours (2 cases), 72 hours (2 cases) and 12 hours in one 1 case. Hemorragic syndrome has been reported in the majority of cases at admission (4 patients) and muscle decay in one case (case 5). All of ours patients received antivenom serotherapy. Evolution was favorable for all patients. Conclusion: Snake bites are also encountered in our care structures. A better knowledge and mastery of good rules for taking care ophidian envenomations would improve the prognosis of cases. Keywords: Bites, Serpents, Antivenous Serum, Mal