Mofou Belo

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.

Maladie de forestier chez un jeune adolescent au CHU Campus de Lomé, Togo

L’efficacite d’un traitement de maitrise des cycles oestraux a ete appreciee sur deux races de zebus en elevage semi-intensif du Burkina Faso. L’essai a permis de determiner les proportions d’oestrus induits et de fertilite sur 170 femelles zebus Azawak et zebu Goudali traitees aux implants de norgestomet. Le traitement au norgestomet a consiste a la pose d’un implant a l’oreille pour une duree de 10 jours. Cette pose a ete suivie de deux injections de 2 ml (500 μg) de prostaglandine (Eustrumate) et 2 ml (400 UI) de PMSG (folligon) respectivement aux jours 8 et 10. Le critere majeur de venu en oestrus a ete l’acceptation du chevauchement. Les inseminations ont ete pratiquees en double 48 heures et 72 heures apres la fin du traitement. Le taux moyen d’oestrus induit a ete de 92,9%. Le delai moyen d’apparition de l’oestrus a ete de 33,15 ± 4,35 heures avec des variations entre types raciales. La duree moyenne de l’oestrus a ete de 11,7 ± 1,9 heures. Le taux moyen de fertilite a ete de 31,1%. Mot cles: zebu, oestrus induit, insemination artificielle, norgestomet English Abstract The efficiency of a estrous induced treatments was monitored on two zebu race in semi-intensives farms of Burkina Faso. The assay determined the rate of induced estrus and fertility on 170 zebu Azawak and zebu Goudali cows treated with norgestomet implant. The treatment Azawak zebu cows received Norgestomet ear implant for 10 days associated with estradiol valerate (2ml), and followed with PGF 2α ( 500 μg) and PMSG (400 UI) im injections respectively at days 8 and 10. Inseminations were practiced in double 48 hours and 72 hours after the end of the treatment. The proportion of estrus induced was 92.9% and was significantly affected (P < 0.05) by hormonal treatment. The elapsed time of estrus display was 33.15 ± 4.35 hours with variations between zebu types. The average length of estrus was 11.7 ± 1.9 hours. The average rate of fertility was of 31.1%. Keywords: zebu, estrus induced, artificial insemination, norgestomet

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.