Komi Assogba

Neuromeningeal cryptococcosis in sub-Saharan Africa: Killer disease with sparse data.

Introduction: The extent of neuromeningeal cryptococcosis (NMC) has increased since the advent of HIV/AIDS. It has non-specific clinical signs but marked by high mortality. Objective: To analyze the characteristics of the NMC in sub-Saharan Africa. Materials and Methods: We have conducted a literature reviewed on the NMC in sub-Saharan Africa from the publications available on the basis of national and international data with keywords such as “Cryptococcus, Epidemiology, Symptoms, Outcomes and Mortality” and their equivalent in French in July 2011. All publications from 1990 to 2010 with 202 references were analyzed. The following results are the means of different studied variables. Results: We selected in final 43 publications dealing with the NMC which 24 involved 17 countries in Africa. The average age was 36 years old. The average prevalence was 3.41% and the average incidence was 10.48% (range 6.90% to 12%). The most common signs were fever (75%), headaches (62.50%) and impaired consciousness. Meningeal signs were present in 49% of cases. The mean CD4 count was 44.8cells/mm3. The India ink and latex agglutination tests were the most sensitive. The average time before the consultation and the hospital stay was almost identical to 27.71 days. The average death rate was 45.90%. Fluconazole has been the most commonly used molecule. Conclusion: The epidemiological indicators of NMC varied more depending on the region of sub-Saharan Africa. Early and effective taking care of patients to reduce diagnostic delay and heavy mortality remains the challenges.

Human meningitis due to Streptococcus suis in Lomé, Togo: a case report

BackgroundStreptococcus suis is a zoonotic pathogen which represents the leading cause of meningitis in Southeast Asia and an emerging pathogen in the Western world, the main risk factor for infection being contact with pigs. In Africa, the prevalence of S. suis infections in swine and humans is largely unrecognized, with only one recent report of a limited case series.Case presentationWe describe a human case of meningitis due to S. suis in a 32-year-old man living in Togo. The patient had no particular medical history and no risk factors for immunodeficiency but reported regular contact with pork products. Using specific immunological and molecular methods, we characterized the isolate as S. suis serotype 2, ST1, one the most prevalent and virulent clone worldwide. The outcome was favorable after one week of adapted antibiotic therapy but the patient was left with severe hearing disorders.ConclusionsThis work highlights the emergence of this pathogen in Africa and reinforces the need for accurate epidemiological and surveillance studies of S. suis infections and for educating clinicians and exposed groups in non-endemic countries.

Les polyneuropathies dans une double cohorte de pvvih naïfs et sous arv dans trois centres de depistage volontaire et anonyme de Lome, Togo

Since the popularized of ARV therapy, the polyneuropathies continue to increase and can lead to stop treatment in PLHIV/AIDS. The study’s goal was to evaluate the frequency and the profile of the polyneuropathies in HIV patients with and without treatment. A prospective multi centric study was carried out among a double cohort of 180 HIV patients with and without treatment, in three screening voluntary and anonymous centres of Lome. The frequency of the distal symmetric polyneuropathy (DSP) was 32.22% in treated patients and 11.11% in untreated HIV patients. The DSP mainly risk factor were HIV and the ARV therapy. The Stavudine-Lamivudine-Nevirapine combination had been taken by 93.10% (n=27) patients with DSP. The CD4 account was less than 200/mm3 in 40% (n=4) untreated HIV and 58.62% (n=17) HIV treated. A therapeutic combination with stavudine needs a strict follow up in treated HIV patients to stave of distal symmetrical polyneuropathy. Depuis la vulgarisation des ARV, la frequence des polyneuropathies ne cessent d’augmenter pouvant entrainer l’interruption de la poursuite des ARV chez les PVVIH/ SIDA. L’objectif de ce travail a ete d’etudier la frequence et le profil des polyneuropathies chez les PVVIH naifs et PVVIH sous ARV. Patients et Methode : Il s’agissait d’une etude prospective multicentrique portant sur deux cohortes de PVVIH naifs et PVVIH sous ARV depuis au moins trois mois. L’etude a porte sur un echantillon de 180 cas, de janvier a decembre 2007, dans trois centres de depistage volontaire et anonyme de la commune de Lome. Resultats : La frequence de la polyneuropathie distale et symetrique etait de 11,1% chez les PVVIH naifs et 32,2% chez les PVVIH sous ARV. Les facteurs de risque etaient le VIH et la prise d’ARV. La combinaison Stavudine-Lamivudine-Nevirapine a ete prise par 93,10% (n= 27) patients presentant la polyneuropathie. Le taux de CD4 etait PVVIH sous ARV. Conclusion : Une combinaison therapeutique contenant de la Stavudine, et la Lamivudine, INTI neurotoxique necessite une surveillance stricte des PVVIH.

Transe et épilepsie en milieu tamberma au Togo. Études cliniques, électroencéphalographiques et neuropsychologiques de six cas d’odueri (« celles qui tombent »)

Il n’est pas toujours facile de distinguer les vraies crises epileptiques des comportements cliniques spectaculaires, les deux pouvant etre associes ou non. Notre etude avait pour objectif de determiner si les transes que presentaient certaines femmes au cours des rites funeraires etaient en rapport avec des crises epileptiques. Materiels et methodes. Une enquete neuroepidemiologique sur l’epilepsie en milieu tamberma au Togo, menee du 30 novembre 2001 au 29 janvier 2002, a recense 6 femmes qui entraient en transe et tombaient (odueri) lors des rites funeraires (tibenti). Elles ont beneficie d’un examen clinique, neuropsychologique, electroencephalographique et ont ete suivies pendant 5 ans. Resultats. Leur âge moyen etait de 31 ± 12,4 ans ; 5 d’entre elles ne savaient ni lire ni ecrire ; toutes avaient des activites professionnelles et etaient animistes. L’examen clinique et les EEG etaient normaux. Pendant 5 ans, aucune modification clinique ni electroencephalographique n’a ete notee.Elles presentaient 4 fois plus de troubles anxieux severes et 2 fois plus de troubles depressifs severes que les temoins. Conclusion. Des investigations cliniques, electroencephalographiques et un suivi sur une longue periode permettent de distinguer une crise epileptique d’une transe.