Neuromeningeal Cryptococcosis and Tuberculosis Coinfection in Bamako: A One-Year Case Series.

Cryptococcosis and tuberculosis are life-threatening opportunistic infections that occur in apparently immunocompetent or severely immunocompromised individuals worldwide. As both infections are strongly linked to HIV infection, they may share certain clinical manifestations, and the interaction of their treatments should be considered. However, despite their similarity, concurrent tuberculosis and cryptococcal infections have rarely been reported in West Africa. Herein, we present 3 cases of neuromeningeal cryptococcosis and lung tuberculosis coinfection collected prospectively over a year at the Department of Infectious Diseases of the Point G Teaching Hospital in Bamako. Two patients had HIV disease, and the third patient had no underlying immunosuppressive illnesses. Thus, active screening for tuberculosis and cryptococcosis, particularly in individuals with HIV, can reduce misdiagnosis and ensure appropriate coinfection management. Moreover, this may reduce mortality due to AIDS-related opportunistic infections in resource-limited settings.

[Ear tuberculosis concomitant with pulmonary localization in an HIV-immunosuppressed patient, in Bamako, Mali]. / Tuberculose auriculaire concomitante à une localisation pulmonaire chez un patient immunodéprimé par le VIH, à Bamako, Mali.

Introduction/Rationale: Tuberculosis remains a major public health issue. It is an opportunistic pathology, very common in HIV-immunocompromised persons, classifying it at the WHO stage 4. Ear tuberculosis remains a rare and under-diagnosed clinical form. We report here a case of ear tuberculosis concomitant with pulmonary localization in an HIV-immunosuppressed person on triple antiretroviral therapy aged 32 years hospitalized in Bamako (Mali) to discuss the diagnostic and therapeutic difficulties posed by this rare localization. Description of the case: The patient had a chronic productive cough, otalgia and right chronic purulent otorrhea. The search for acid-resistant bacilli was positive for direct examination in gastric casing fluid and swabbing of the ear pus, confirming the diagnosis of tuberculosis. Anti-tuberculosis treatment instituted for 6 months associated with adjuvants resulted in complete healing of the patient. Discussion/conclusion: Although rare, ear localization must be actively sought. Etiological treatment must be instituted upon confirmation of the diagnosis to avoid complications and sequelae.

[Neuromeningeal cryptococcosis in an HIV-negative patient with pulmonary tuberculosis in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako, Mali]. / Cryptococcose neuroméningée chez une patiente séronégative pour le VIH atteinte de tuberculose pulmonaire au service de Maladies infectieuses et tropicales du CHU du Point G de Bamako, Mali.

Neuromeningeal cryptococcosis and pulmonary tuberculosis are respectively serious mycotic and bacterial infections occurring in a subject regardless of its HIV serological status. We report here a case of neuromeningeal cryptococcosis associated with pulmonary tuberculosis and malnutrition in an HIV-seronegative patient with a CD4 count of 750/mm3, to highlight some particularities opposed to certain literatures. This is an 18-year-old patient, housewife, from Bamako, admitted in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako on March 13, 2022 for fever and impaired consciousness. Her symptomatology appears to have gradually set in over a month, preceded by headache resistant to paracetamol, jet vomiting and irregular dry cough, initially treated with ceftriaxone, artesunate and paracetamol for confirmed malaria and suspicion of bacterial meningitis before admission. In whom no known medical-surgical history, no use of topical corticosteroids, no immunosuppressive therapy, no alcohol or tobacco, and no immunosuppressive pathology was found. The diagnoses of neuromeningeal cryptococcosis, pulmonary tuberculosis and undernutrition were retained in view of clinical and microbiological arguments. Diabetes, sickle cell disease, viral hepatitis B and C, kidney failure and cancer, which are immunosuppressive pathologies, were not found. She was successfully treated with first-line oral antituberculous drugs and fluconazole infusion. Three interests are drawn from this clinical case: neuromeningeal cryptococcosis is not only the prerogative of HIV-positive subjects, a high CD4 count does not always mean immunocompetence and fluconazole is an effective therapeutic alternative for neuromeningeal cryptococcosis.

Peoples' attitude toward COVID-19 vaccine, acceptance, and social trust among African and Middle East countries.

Background: To end the COVID-19 pandemic, a large part of the world must be immune to the virus by vaccination. Therefore, this study aimed to gauge intent to be vaccinated against COVID-19 among ordinary people and to identify attitudes towards vaccines and barriers for vaccine acceptance. Methods: The study population comprises 1880 people residing in different countries that answer a prepared questionnaire. The questionnaire topics are demographics, historical issues, participants' attitudes and beliefs regarding vaccines, concerns, and vaccine hesitancy. Results: Attitudes and beliefs relating to vaccines in general, and the COVID-19 vaccine, were ascertained. Overall, 66.81% of the contributors would like to be vaccinated against COVID-19, while %33.19 did not intend to be vaccinated. Reasons for COVID-19 vaccine hesitancy included concern regarding vaccine side effects, fear of getting sick from the uptake of the vaccine, and the absence of accurate vaccine promotion news. Individuals with higher education believe that India (68.6%) produces the best vaccine (P <0.001), while healthcare workers think the Chinese vaccine (44.2%) is the best (P =0.020). Individuals with higher education have not been vaccinated, not be healthcare workers, and females were the most contributors to effective of the vaccine in reducing mortality from COVID-19 disease. Conclusion: Given the degree of hesitancy against COVID-19 vaccination, a multifaceted approach to facilitate vaccine uptake that includes vaccine education, behavioral change strategies, and health promotion, is paramount.

[Localised tetanus with no obvious entry site: about a case in Bamako (Mali)]. / Tétanos localisé sans porte d´entrée apparente: à propos d´un cas à Bamako (Mali).

Tetanus is a major public health problem in sub-Saharan Africa. Localised tetanus is rare, unlike generalized tetanus which has been sufficiently described in the literature. We report a case of localised tetanus with no obvious entry site managed in the Department of Infectious Diseases in Bamako. The study involved a retired nurse aged 59 years who had not undergone tetanus booster immunisation within the last 10 years, corresponding to the date of her last delivery. She was referred to our Hospital with dysphagia associated with inability to open the buccal cavity. Patient's history was characterized by long-term therapy associated with many specialized consultations without any improvement. The diagnosis of localised tetanus with no obvious entry site was retained after having excluded any other local disorder. Outcome was favorable ten days after adequate management. Underdiagnosed or unknown to health-care providers, localised tetanus may mimic other diseases delaying diagnosis and management. Targeted campaign to build awareness should be implemented in order to improve adherence with immunization schedules.

[Tuberculosis and HIV coinfection complicated by nosocomial infection caused by Klebsiella pneumoniae: about 4 cases in a Department of Infectious diseases in Mali]. / Co-infection tuberculose-VIH compliquée d'une sur infection nosocomiale à Klebsiella pneumoniae: à propos de 4 observations dans un Service de Maladies Infectieuses au Mali.

Nosocomial infections are a real global public health problem. Pulmonary tuberculosis and HIV co-infection increases the incidence of nosocomial infections because of immunosuppression and iterative hospitalizations. We here report four cases of patients aged 28, 36, 42 and 52 years co-infected with HIV and tuberculosis (multifocal tuberculosis in 2 patients, miliary tuberculosis, bacteriologically confirmed tuberculosis), all with CD4 < 100 cells/mm3. During the intensive-phase, patients received antitubercular drugs and antiretroviral therapy (ART). They had been admitted to the Department of Infectious Diseases at the G-Point University Hospital with productive cough and/or hyperthermia following hospital stay greater than 48 hours. Patients' history revealed that one patient had not been compliant with tuberculosis treatment because of adverse reactions classified as minor. There had been no clinical improvement in the three remaining patients despite their optimal compliance to different treatments. Cytobacteriological examination of sputum and/or testing of the feeding tubes, blood cultures and specific samples allowed to identify multidrug-resistant Klebsiella pneumoniae. The clinical course of these patients was favorable under specific antibiotic therapy. Nosocomial infections may be misinterpreted and associated with poor therapeutic response in patients receiving TB treatment. Cytobacteriological examination of the biological fluids should be systematic in patients co-infected with HIV and tuberculosis and hospitalized for at least 48 hours, in whom pulmonary signs and/or fever persist despite their good compliance to treatment.