[Persistent, cavitating, non-tuberculous pneumopathy in a patient with HIV: the role of Candida?]. / Pneumopathie persistante et excavee non tuberculeuse chez un patient infecte par le VIH: rôle de candida?

Fungal agents are not common cause of pneumonia. In favorables conditions mycosis can cause atypical clinical and radiographic figures. Authors report the observation of a 45 years and VIH-positive patient presenting a persistant and excavating pneumonia probably caused by Candida albicans.

Pneumopathie persistante et excavee non tuberculeuse chez un patient infecte par le VIH : role de candida ?

Les mycoses sont une cause peu commune de pneumopathie. Dans certaines circonstances favorables; elles peuvent etre a l'origine de tableaux cliniques et radiologiques trompeurs; pouvant faire errer le diagnostic

[Tuberculous pleural effusion and HIV infection at the pulmonary disease clinic in Abidjan, Ivory Coast]. / Pleurésies tuberculeuses et infection à VIH en milieu pneumologique à Abidjan, Côte d'Ivoire.

Clinical, radiographic, biological, histological and pathological data from thirty HIV-infected patients with tuberculous pleural effusion were prospectively collected at the pulmonary disease clinic at the University teaching hospital of Treichville in Abidjan from April to December 1999. Patients mean age was 35 years, ranging from 16 to 79. The white cell count in the serous effusion pleural fluid was high with predominant lymphocytes. Microscopy examination of the aspirate did not show AFB. The Tuberculin Skin Test remained negative for 16 patients (53%). Multiple pleural biopsies showed typical tuberculous follicles in 19 patients (63%) and a non-typical inflammatory reactions in eleven patients (37%).

[Aetiologies of pleural effusions in HIV-infected patients in Abidjan, Côte-d'Ivoire]. / Etiologies des pleurésies chez les patients infectés par le VIH a Abidjan, Côte-d'Ivoire.

From December 1995 to March 1996 a cross sectional study was carried out in the pulmonary Medicine Unit of Treichville in Abidjan. In order to specify the main aetiologies of pleural effusion, an investigation was conducted among 35 adult patients (19 men and 16 women) suffering from pleuritis. Overall, the mean age was 32.2 years (range: 19-53 years). All the patients underwent a standard chest x-ray a skin test with 10 units of tuberculin, a whole blood cells count with CD4 T cells count and HIV test. The following analysis were performed on the pleural fluid for all patients: cytological, bacteriological and mycobacteriological examination. Some patients underwent as well a pleural biopsy performed by Abram's needle. Pleural fluid was clear in 24 cases (69%). Empyema was found in 8 cases (23%) and hemorrhagic fluid in 3 cases (9%). Tuberculosis was the dominant aetiology of pleuritis noted in 29 patients (83%), followed by far by non-tuberculous bacterial infections in 6 patients (17%). Tuberculosis associated with common bacterial infections was noted in 3 cases.

[Relapse of pulmonary tuberculosis in the context of tuberculosis-HIV co-infection in Abidjan (Côte d'Ivoire). Short note]. / Rechute de la tuberculose pulmonaire bacillifère dans le contexte de la co-infection tuberculose-VIH à Abidjan (Côte d'Ivoire).

A cohort study was carried out from October 2001 to March 2002, in order to analyze the main characteristics of 53 adults patients (38 HIV-positive and 15 HIV-negative), who had a relapse of pulmonary tuberculosis. The observance in the first period of the treatment of tuberculosis was regular in 79% of tuberculous patients infected by the HIV (30/38) and in 87% of tuberculous patients who where HIV-negative (13/15) (p = 0.7). The relapse occurred before one year after recovery in 74% among the HIV-positive (28/38) and in 33% among the HIV-negative patients (5/15) (p = 0.00). Most of the HIV-positive patients (74%) had CD4 counts under 200/mm3 and 80% of the HIV-negative patients had more than 500 CD4 counts/mm3 (p = 0.00). After two months of retreatment following the relapse diagnosis, the rate of improvement in patients was about 16% in HIV infected (6/38) and about 67% in HIV-negative patients (10/15) (p = 0.00).

[Antitubercular drug treatment failure and HIV infection in Abidjan (Ivory Coast)]. / Echec du traitement antituberculeux et infection due au VIH à Abidjan (Côte d'Ivoire).

A retrospective study from 1989 to 1993 was carried out on eighty patients out of 106 cases of tuberculosis treatment failure; representing 2.2% of persons with active pulmonary tuberculosis followed at the tuberculosis screening center of Abidjan. The rate of HIV seropositivity was 43.7%. At the beginning of the therapy, 80% of HIV-positive and 89% of HIV-negative had diffuse pulmonary lesions (no significant difference: P > 0.05. At the end of second month therapy, 49% of co-infected and 51% of HIV-negative patients showed bacteriological negative sputum. The treatment administered after reporting failure, led to 63% of recovery among the HIV-positive (22/35) and 62% among the HIV-negative (28/45). On the other hand, the rate of patients out of touch was high in both populations; respectively 29% of HIV infected and 31% of HIV-negative spreading the risk of contamination of neighbourhood by probably resistant bacilli.

[Efficacy of a short 6 month therapeutic coursefor HIV infected tuberculosis patients in Abidjan, Côte d'Ivoire]. / Efficacité du régime thérapeutique court de six mois chez les tuberculeux infectés par le VIH à Abidjan, Côte d'Ivoire.

From December 1992 to February 1993, 104 newly diagnosed pulmonary tuberculosis patients were enrolled in a prospective cohort study to assess the response to the 6 month-short-course regimen implemented in Cote d'Ivoire. This treatment encompassed the daily intake of Rifampicin and Pyrazinamide for 2 months followed by Rifampicin and Isoniazid for the remaining 4 months. All the patients were enrolled at the Treichville Tuberculosis Treatment Centre in Abidjan, and a follow-up of 6 months was observed for each patient. All in all, 41 patients were HIV-positive whereas 63 where HIV-negative. No statistical difference was noted between HIV-positive and HIV-negative patients with regard to the completion of therapy (85% versus 87%). The cure rate after an effective 6 month-therapy was similar among HIV-positive and HIV-negative patients (83% versus 84%) as well as the treatment failure rate which was 2.4% and 3% respectively. The results clearly indicate that the 6 month-short-course regimen policy implemented in Côte d'Ivoire is as effective for the treatment of HIV-associated tuberculosis as for the treatment of tuberculosis.