[Pseudo-tumoral invasive fungus infection of the maxillary sinus in Abidjan]. / Infection invasive à champignon filamenteux pseudotumorale du sinus maxillaire à Abidjan.

INTRODUCTION: The invasive fungal infection of the maxillary sinus is a rare and serious disease generally favored by immunosuppression. We report an exceptional case of pseudotumoral invasive fungal infection of the maxillary sinus in an immunocompetent patient. OBSERVATION: A 32-year-old patient consulted for labial and left temporal swelling associated with proptosis and chemosis that has been developing for 18 months. The scanner objectified a filling of the left maxillary sinus, and the ipsilateral orbital cavity, and the surrounding muscles. Histological examination of the surgical specimen revealed invasive fungal infection of the left maxillary sinus. The relevant antifungal therapy, namely voriconazole, could not be administered due to the unavailability of the medicine. However, the patient has received 200mg of itraconazole every 12hours for three weeks. The change proved disappointing with recurrence and significant sequelae, sort of sagging of the right hemifacial, severe limitation of mouth opening and functional loss of the right eye. CONCLUSION: The invasive fungus infections of the maxillary sinus and the orbit are exceptional in immunocompetent patient. Healing is based on early diagnosis and administration of the reference antifungal to face the risk of recurrence.

Pratique du dépistage du cancer du col au Service des Maladies infectieuses et tropicales, Abidjan

Le dépistage systématique du cancer du col de l'utérus chez les femmes infectées par le Vih est recommandé par l'oMS et effectif en Côte d'ivoire depuis 2009. l'objectif était de partager l'expérience de cette pratique en routine chez les femmes infectées par le Vih suivies dans un service d'infectiologie à abidjan. il s'est agit d'une étude rétrospective des dossiers de patientes âgées de 25 à 65 ans, infectées par le Vih, suivies au SMiT entre 2010 et 2014. la technique d'inspection visuelle à l'acide acétique (iVa) a été utilisée pour le dépistage. les données socio-démographiques, cliniques et thérapeutiques recueillies ont été analysées à l'aide des logiciels excel 2007 et STaTa version 13.0. le test statistique utilisé pour comparer les pourcentages était le khi deux ou le test exact de Fischer. les différences observées ont été considérées comme significatives en dessous de 5 %. la variable d'intérêt était la réalisation d'au moins un test iVa en routine. Selon le résultat du test iVa, le profil clinique et immunovirologique des patientes a été analysé en précisant la conduite à tenir selon l'indication. enfin la poursuite du dépistage a été notifiée dans le temps spécifiquement chez les femmes négatives au test initial. entre 2010 et 2014, 4 368 femmes infectées par le Vih étaient éligibles au dépistage du cancer du col. Parmi elles, 301 femmes (6,9 %) en ont bénéficié. l'âge médian était de 38 ans [25 - 58 ans]. la médiane des Cd4 au bilan de suivi lors du test iVa était de 291 cellules/mm3 [2 ­ 1 876 cellules/mm3]. le dépistage était positif pour 24 femmes (8 %) et selon les indications, 6 femmes étaient éligibles à la cryothérapie (26 %), 6 à la résection à l'anse diathermique (26 %) et 10 à la réalisation d'un frottis cervico-vaginal, pour une suspicion de cancer invasif (44 %). les patientes positives au test iVa étaient relativement plus jeune (35 vs 38 ans ; p = 0,03). aucun contrôle ultérieur n'a été effectué chez 90 % (n = 249) de celles qui ont eu un test iVa négatif au premier dépistage. le dépistage systématique est peu réalisé en routine au cours du suivi des femmes Vih. les défis opérationnels doivent être relevés pour une optimisation des soins en afrique

[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.

Efficacite et tolerance du traitement antiretroviral chez les sujets ages a Abidjan

Objectif : Evaluer l'efficacite du traitement antiretroviral chez les sujets ages suivis dans le service des Maladies Infectieuses et Tropicales a Abidjan. Materiel et Methodes : Il s'agit d'une etude retrospective; descriptive et portant sur l'analyse des dossiers de sujets ages d'au moins 60 ans; infectes par le VIH; traites et suivis dans le service des Maladies Infectieuses et Tropicales entre le 1er janvier 1999 et le 31 decembre 2006. L'analyse a porte sur les parametres sociodemographiques (age; sexe); cliniques ARV; (poids; score Karnofsky; stade CDC; affections opportunistes); biologiques (type de VIH; CD4; hemogramme; glycemie; creatininemie; transaminasemie) et therapeutiques (regimesA RV; evolution; effets secondaires). L'efficacite du traitement etait basee sur le pourcentage de patients ayant un taux de CD4 200 / ml et la tolerance basee sur les effets deleteres. Resultats : L'etude a concerne 62 sujets ages (44 hommes / 18 femmes); dont 13 pretraites (21); 46 naifs (74;20) et 48 (77;42) sous chimioprophylaxie au cotrimoxazole. La majorite de l'effectif etait infectee par le VIH1 (93;60) contre 3;20pour le VIH2 et 3;20pour le VIH 1+2. Ils etaient symptomatiques a 93;3avec 67;8au stade SIDA. En trente quatre mois de suivi; 48 patients ont recu un regime de premiere ligne (77;4) ; 13 de deuxieme ligne (20;96) et un seul patient avait un regime de troisieme ligne (1;6). L'analyse des resultats a montre que le pourcentage des patients ayant un taux des CD4 200 etait croissant; passant de 20a M0 a 36a M6 puis 39a M12. Quant aux effets secondaires; ils etaient cliniquement domines par les neuropathies peripheriques (30;5) et biologiquement par l'hypertransaminasemie 2N (32;3). Le taux median de perdus de vue etait de 17;7; et 2 patients (3;22) sont decedes. Conclusion : Le traitement ARV est efficace chez les personnes agees avec peu d'anomalies biologiques; aussi; une etude prospective sur un plus grand echantillonnage permettrait-elle de mieux percevoir les differences avec le sujet jeune

[Efavirenz versus indinavir among HIV-1 naive patients in Abidjan (Ivory Coast)]. / Efavirenz versus indinavir chez les patients naïfs infectés par le VIH-1 à Abidjan (Côte d'Ivoire).

OBJECTIVE: The authors had for aim to compare the therapeutic efficiency and tolerance of 2 NRTI+efavirenz (EFV) versus 2 NRTI+indinavir (IDV) in HIV infected adults in Abidjan. METHODS: A retrospective and multicentric study was made on 327 HIV-1 naive patients, 142 in the EFV group and 185 in the IDV group followed in Abidjan from November 1998 to December 2003. The analysis concerned clinical advents (opportunistic infections) and immunovirological parameters (CD4, viral load). Patients received 2 NRTI such as AZT+3TC or D4T+3TC combined either with EFV or IDV. The principal judgement criterion was therapeutic failure. We assessed the percentage of patients with undetectable viral load and the frequency of grade 3-4 adverse effects after 24 months of follow-up. RESULTS: Clinical improvement of patients' state and regression of opportunistic infections were identical in the two groups. The average gain of CD4 was superior to 177 in EFV versus +219 in IDV (p=0.004). The percentage of patients with undetectable viral load was 66% for EFV versus 59% for IDV (p=0.04). The frequency of adverse effects was more elevated with EFV than IDV, 39% versus 23% (p=0.002) initially, but seemed to decrease later. CONCLUSION: HAART with EFV is at least as efficient as with IDV in terms of reduction of viral load and increased CD4 count and is an excellent low-cost first line treatment.

[Three new cases of visceral leishmaniasis in Côte d'Ivoire]. / Trois nouveaux cas de leishmaniose viscérale autochtone en Côte d'Ivoire.

The objective of this work is to report three cases of visceral leishmaniasis in non-HIV infected native patients in Côte d'Ivoire. The three observations concerned adults aged of 31 and 65 and a five years old child without particular medical or surgery histories. Factors associated with visceral leishmaniasis regarding the younger and the older adults were respectively young age, chronic lymphoid leukaemia and Burkitt lymphoma. Clinical features in the three cases were chronic fever a myeloproliferative syndrome with wasting syndrome and pancytopenia. The diagnosis was confirmed by the existence of Leishmania in bone marrow, ganglionic juice and splenic samples. The species of Leishmania was not identified. Specific treatment was based on intravenous amphotericin B (Fungizone) relayed by Glucantim in one case because of side effects; however the treatment has been unsuccessful. These three new cases show that visceral leishmaniasis is a reality in Côte d'Ivoire therefore an epidemiological survey is requested in order to identify Leishmania species, reservoirs and vectors.

[Morbidity and mortality of tetanus in the infectious and tropical diseases department in Abidjan 1985 - 1998]. / Morbidité et mortalité du tétanos dans le service des maladies infectieuses et tropicales d'Abidjan (1985-1998).

UNLABELLED: In spite of the increase of the antitetanus immunization coverage, tetanus is still one of the main causes of morbidity and mortality in Côte d'Ivoire hospitals. OBJECTIVE: The purpose of this study was to analyse the epidemiological, clinical and prognosis aspects of tetanus in the department of infectious diseases in Abidjan. METHODS: A retrospective analysis was carried out from patients files admitted for tetanus in this department from 1985 to 1998. Tetanus diagnosis was based on clinical arguments. RESULTS: Within a period of fourteen years, 1870 cases of tetanus representing 3% of hospitalised cases were admitted in the infectious diseases department. For 1387 patients answering to the inclusion criteria of the study the ratio MIF was 2.5. The median age was 28 years old (1-85 years). The entrance doors were dominated by cuts (49.3%) and intramuscular injections of drugs (18.7%). Despite the complete vaccination, 7 patients have presented tetanus (0.5%). About 17% have presented progressive complications especially cardio-respiratory complications (41.5%). The total lethality was 31.9% and the after- effects rate 2.3%. The factors of poor prognosis were the age > 60 years old, IM injections, generalised aspect, group III of severity and presence of complications. CONCLUSION: Tetanus frequency certainly drops in infectious and tropical diseases department, but the lethality remains high therefore a reinforcement of the vaccination efforts and a management of patients are recommended.