Research
Neuromeningeal Cryptococcosis: A Fatal Disease in Tropical Practice
Background: Neuromeningeal cryptococcosis (NMC) frequency has increased since the appearance of HIV/ AIDS infection with high mortality rate. Objective: To assess the clinical and epidemiological features of the NMC in hospital field. Patients and method: It was a retrospective study carried out on patients at 4 public health structures in the largest region of the country from 2005 to 2009. The mainly criteria were HIV+ conditions and the research of cryptococcus neoformans in CSF by Indiana ink test. The anthropometric, clinical, therapeutic and follow up data were also collected. Results: The study covered 41,327 patients. HIV + patients were 18.52% (7653/41327). CSF was analyzed in 1758 with 978 samples from HIV+ subjects. The research of cryptococcus in CSF was performed in 19.40% (341/1758). It was positive in 2.35% (8 cases). Culture was negative for all patients. Hospital frequency was 0.02% and 0.10% in HIV+ patients. The incidence rate was 1.6. The average age was 36 years (28 and 45 years), including 5 men and 3 women. The principal symptoms were marked by fever (75%) and headache (62.5%), associated to oropharyngeal candidiasis in 37.50%. T-lymphocytes accounts means was 37.4 cells /mm3.All patients were treated with fluconazole. The hospital length stay was 12.25 days. The mortality rate was 62.5%. Discussion: NMC remains under estimate with non specific signs. Early diagnostic and rapid therapeutic approaches are the challenges to achieve for all neurologists in tropical setting. Conclusion: We recommend to research cryptococcus in CSF forwards any meningo encephalitis in HIV infected patient.
Protein S Deficiency and Ischemic Stroke
The protein S deficiency is an ischemic stroke main risk factor in black young people. The authors report three patients of 37, 45 and 56 years old of age who presented ischemic stroke with hemi body deficit (two lefts and one right). No personal or family history of any cardiovascular diseases and risk factor were found except protein S deficiency with 15%, 22% and 32%. One died at eight months later of follow up by stroke relapse, the second had completely health recovery after six months, and the third patient remained with partial paralysis. The research of protein S deficiency must be born in mind in patient with ischemic stroke if any other risk factor was not found.
