[Fluconazole 1200mg or 800mg for cryptococcal meningitis treatment in Ivory Coast]. / Fluconazole 1200mg ou 800mg dans le traitement de la cryptococcose neuroméningée en Côte d'Ivoire.

OBJECTIVE: Assessing the use of high-dose fluconazol monotherapy (1200mg or 800mg) in the treatment and prognosis of HIV-associated cryptococcal meningitis in Ivory Coast. PATIENTS AND METHODS: A retrospective study carried out from August 2008 to August 2011 based on patients charts suffering from CM in the Abidjan Tropicals and Infectious Disease Unit. Mortality rate and associated factors were analyzed. RESULTS: Forty-six cases of cryptococcal meningitis (2.5% of hospitalizations) were included. The sex-ratio was of 1.2. The median age was 40.5 [35-47] years. The symptomatology was subacute (93.5%). The main clinical symptoms were syndrome of pure meningeal irritation (65%), fever (100%); 35% of patients had encephalomeningits. Twenty-one (45.7%) was ART-naïve patients. Fluconazole 1200mg was prescribed to 29 (63%) patients. Therapeutic lumbar punctures were performed in 42 (91.3) patients. The mortality rate was 50%. Significant predictors of mortality were encephalomeningitis and therapeutic lumbar puncture. CONCLUSION: Cryptococcal meningitis associated mortality remains high despite the use of high-dose fluconazole monotherapy. Therapeutic lumbar punctures help to improving the prognosis.

Seven native cases of dengue in Abidjan, Ivory Coast.

OBJECTIVE: We had for aim to describe the epidemiological, clinical, biological, and outcome features of dengue fever in Abidjan, in 2010. PATIENTS AND METHODS: We retrospectively studied the files of patients hospitalized for dengue fever in 2010, in Abidjan. The diagnosis was made on clinical symptoms and positive dengue PCR and/or IgM. RESULTS: Seven patients were included (5 men, 2 women, median age of 51years [31-65years]). They presented with a febrile pain syndrome (n=7), jaundice (n=3), rash (n=2), and hematemesis complicated by thrombocytopenia (n=6) and leukopenia (n=5). Three patients had a positive IgM serology and 4 had a positive dengue PCR for DENV-3. The outcome was favorable for 6 patients, and 1 patient died of severe hemorrhage. CONCLUSION: The authors advocate the implementation of epidemiological surveillance of dengue and vector control in the Ivory Coast.

[Antiretroviral therapy with three nucleoside reverse transcriptase inhibitors in treatment-naive HIV-infected patients in Abidjan (Cote d'Ivoire)]. / Le traitement antirétroviral à base de trois inhibiteurs nucléosidiques de la transcriptase inverse chez les patients naïfs infectés par le VIH à Abidjan (Côte d'Ivoire).

This study assesses the results of initial antiretroviral therapy with 3 nucleoside reverse transcriptase inhibitors over the first 12 months of treatment. Patients' general health improved significantly during the year, with a significant mean weight gain (from 59.3 kg to 65.12 kg) and a strong regression in the frequency of opportunistic infections over the study period, from 38% to 2% (P<0.0001). The mean CD4 T-cell count rose from 242.8 to 390.5 cell/mm(3), for a mean increase of 147.7 cells/mm(3). Accordingly, antiretroviral treatment with three nucleoside reverse transcriptase inhibitors is effective and is a useful alternative in a country with limited resources.

[First case of Stevens-Johnson syndrome in a patient treated by Triomune in Abidjan, Côte d'lvoire]. / Premier cas de syndrome de Stevens-Johnson chez un patient traité par association de stavudine, lamivudine et névirapine à Abidjan, Côte d'Ivoire.

The authors report the first case of Stevens-Johnson syndrome which has occurred in a 45 year old patient treated by Triomune containing névirapine. Triomune is used within the context of the African antiretroviral initiative access. It was a mild form whose evolution was favourable when nevirapine was stopped. The prevalence of this affection should increase with the larger use of nevirapine in our countries and the attention of both prescriber and patient must be requested.