First report of cryptococcosis due to Cryptococcus gattii sensu stricto VGI in an Ivorian HIV negative patient.

INTRODUCTION: Cryptococcus gattii species complex is endemic to tropical and subtropical regions and is described as a causative agent of cryptococcosis in immunocompetent individuals. CASE PRESENTATION: We describe the first case of cryptococcosis in a HIV-negative patient from Ivory Coast infected by Cryptococcus gattii sensu stricto VGI. Isolates were recovered from cerebrospinal fluid (CSF) prior to systemic antifungal treatment up to 42 days after detection of the presence of yeasts in the CSF. Eighteen isolates were recovered, genetic diversity and antifungal susceptibility analyses were performed. All the isolates belonged to the Cryptococcus gattii sensu stricto (B;VGI) and were identified as a new sequence type (ST) 553 by Multilocus Sequence Typing (MLST) analyses. Susceptibility testing showed that all the strains had a wild-type phenotype for fluconazole, amphotericin B and flucytosine. Treatment with fluconazole (1200mg/day) was initiated with success. CONCLUSION: This is the first case report of the presence of C. gattii sensu stricto VGI in a HIV-negative ivorian patient and the second report of the presence of species from the C. gattii complex species in this country.

[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.

Antiretroviral chemoprophylaxis in children and adolescents victims of rape in Abidjan.

OBJECTIVE: We described the use of antiretroviral drugs to prevent HIV transmission among children and adolescents victims of rape in Abidjan (Ivory Coast). MATERIALS AND METHOD: We conducted a retrospective and descriptive study on children (0-9 years) and adolescents (10-19 years) victims of rape between 2000 and 2013. We analyzed the patients' socio-demographic characteristics and the modality of the chemoprophylaxis. RESULTS: We included 10 children and 89 adolescents in the study. The median age was 16 years old (3-19 years). The median time to consultation was 23.5 hours (5-152 hours). The antiretroviral chemoprophylaxis was administered to 92 patients (93%). No HIV and HBV seroconversion was observed after a 3-month follow-up. CONCLUSION: A better management of rape victims is required in Abidjan.

[Efficiency and safety of antiretroviral treatment among the elderly in Abidjan]. / Efficacite et tolerance du traitement antiretroviral chez les sujets ages a Abidjan.

OBJECTIVE: To evaluate the efficacy of antiretroviral treatment in elderly people followed at the Unit for Infectious and Tropical Diseases at the University Hospital in Abidjan. MATERIAL AND METHODS: We performed a retrospective descriptive study of the files of people aged at least 60 years, infected by HIV who were treated and followed-up in the Unit between 1 January 1999 and 31 December 2006. We analysed sociodemographic (age, sex), clinical (weight, Karnofsky scale, CDC, opportunistic infections), biological (HIV, CD4, haemogram, glycaemia, creatininaemia, transaminasaemia) and therapeutic (antiretroviral regimens, evolution, side-effects) parameters. The efficacy of treatment was evaluated as the percentage of patients with < 200 CD4/ml, and its safety was based on deleterious effects. RESULTS: We studied 62 patients (44 men, 18 women), of whom 13 had been treated (21%), 46 had not been treated (74.2%) and 48 (77.4%) were undergoing chemoprophy-laxis with cotrimoxazole. Most were infected with HIV1 (93.6%), 3.2% with HIV2 and 3.2% with both HIV1 and HIV2. The majority (93.3%) was symptomatic, and 67.8% had AIDS. During 34 months of follow-up, 48 patients (77.4%) received first-line treatment, 13 (21%) received second-line and only one patient (1.6%) had third-line treatment. The percentage of patients with more than 200 CD4/ml increased from 20% at baseline to 36% at 6 months and 39% at 12 months. The main clinical side-effect was peripheral neuropathy (30.5%), and the main biological effect was hypertransaminasaemia > 2N (32.3%). The median rate of loss to follow-up was 17.7%, and two patients (3.2%) died. CONCLUSION: Antiretroviral treatment is effective in the elderly, with few biological disorders. A prospective study of a larger sample would elucidate the differences from younger people in the efficacy of such treatment.

[Antiretroviral prophylaxis after non-occupational exposure to HIV in Abidjan (Cote d'Ivoire)]. / Prophylaxie antirétrovirale après expositions non professionnelles au VIH à Abidjan (Cote d'Ivoire).

OBJECTIVE: The aim of this study was to assess the tolerability and adherence to all non-occupational post-exposure prophylaxis (PEP) for cases of HIV exposure in Abidjan. METHOD: We retrospectively studied all post-exposure prophylaxis for non-occupational exposures to HIV prescribed from January 1st, 2000 to December 31st, 2007 in the Abidjan infectious diseases department. We analyzed the types of exposure, socio-demographic characteristics of patients, antiretroviral therapy regimens, adherence and tolerability, duration of the treatment, and post-exposure follow-up. RESULTS: Over these eight years, we managed 128 consultations for non-professional exposures to HIV (50 male [39%], 78 female patients [61%]), average age 24.8 years (four-54 years). The most frequent exposures were due to rape (n=74), condom rupture (n=29), and occasional unprotected sex (n=21). The average delay before consultation was 20.8 hours. The antiretroviral chemoprophylaxis included a protease inhibitor in 93% of the cases; 80.5% of patients completed 28 days of chemoprophylaxis, while 8.6% interrupted the treatment, and 10.9% were lost to follow-up. The most frequent adverse effects were gastrointestinal, reported by 79 patients (61.7%). Only 34 patients (26.6%) returned for clinical and biological post-exposure follow-up with HIV control at third month, without documented seroconversion. CONCLUSION: Cases of sexual exposure to HIV are the main indication for post-exposure prophylaxis in Abidjan, except for occupational exposure to blood. However, post-exposure prophylaxis should be available in the units of primary care, such as emergencies departments.