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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/mm(3). 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.
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L'hyperhomocystéinémie est un facteur de risque vasculaire indépendant et modifiable. Sa place dans les accidents vasculaires cérébraux ischémiques est mal connue en Afrique sub-saharienne.Objectifs Evaluer la prévalence et les facteurs de risque vasculaires associés à l'hyperhomocystéinémie chez des patients à la phase aigue d'une ischémie cérébrale. Methode Il s'agit d'une étude prospective réalisée pendant 12 mois dans le service de neurologie du CHU Campus, portant sur 145 malades victimes d'AVCI. Resultats Nous avions recensé 90 hommes et 55 femmes soit un sex-ratio de 1,6. L'homocystéinémie moyenne globale était de 19.33 µmol/l. L'homocystéinémie était normale chez 44.1 % des patients.L'hyperhomocystéinémie modérée avait été retrouvée chez 44.8 % des patients (n=65) et l'hyperhomocystéinémie intermédiaire chez 11 % (n=16). L'analyse multivariée entre la variable homocystéine (patients avec hyperhomocystéinémie, patients sans hyperhomocystéinémie) et les autres facteurs (sexe, âge, diabète et hypertension artérielle) ne révèle aucune corrélation significative. Enfin 84.9% de nos patients étaient hypertendus tandis que 15.1% présentaient l'hyperhomocystéinémie comme seul facteur de risque cérébro-vasculaire. Conclusion La présence de l'hyperhomocystéinémie chez 55.9 % des patients souffrant d'AVCI impose une prise en charge adéquate de ce facteur de risque vasculaire
Assuntos
Centros Médicos Acadêmicos , Hiper-Homocisteinemia , Prevalência , Fatores de RiscoRESUMO
To ascertain the aetiology, of non traumatic paraplegia retrospective survey, concerning 2396 patients hospitalised from January 1st 1995 to December 31st 1999, was done. Two hundred forty three cases were founded after investigation. The frequency of non traumatic paraplegia was 10.14%. Peripheral motor neuron's causes were 48.97% (119 cases). In this group, tropical neuromyelopathies were the commonest 65.54% (78 cases) while Guillain Barre syndrome was 3.36% (4 cases). Bones, epidural et meningeal (envelope) causes were 38.68% (94 cases). In this group, tuberculosis was 17 cases, tumour 36 cases. Central motor neuron causes were 9.46% (23 cases) with HIV myelitis 13 cases, tumour 3 cases, degenerative conditions 6 cases. It is concluded that the major causes of non traumatic paraplegia in Lome are similar to that reported from sub sahara countries with tropical neuromyelopathies, tumours, tuberculosis and HIV myelitis.
