La Cryptococcose Neuro-Meningee Et L\'infection Au Vih Dans Le Service De Medecine Du Centre Hospitalier Et Universitaire De Yaounde, Cameroun

Abstract

Contexte La cryptococcose est une affection fungique frequente chez les personnes immunodeprimees pour laquelle peu d'etudes ont ete menees au Cameroun. But Decrire les aspects epidemiologiques, cliniques, biologiques et evolutifs de la cryptococcose neuro-meningee. Materiel et methodes Etude retrospective et descriptive menee a partir des dossiers medicaux des patients hospitalises pendant 57 mois dans le service de medecine interne du Centre Hospitalier et Universitaire de Yaounde (CHUY). Resultats Trente et trois cas de meningite cryptococcique ont ete diagnostiques sur les 3655 patients hospitalises. Le sexe masculin etait predominant (21 homme/12 femmes). L'âge moyen des patients etait de 39,81 ans. Les manifestations cliniques etaient : les cephalees (26 cas /33), la fievre (25 cas /33), les signes meninges (18 cas /33), les troubles de la conscience (9 cas/33) et les crises epileptiques generalisees (8 cas /33). L'infection par Mycobacterium tuberculosis etait la pathologie associee (10 fois/33) la plus frequente. La duree moyenne de l'evolution des symptomes avant le diagnostic etait de 14,93 jours. La serologie VIH etait positive chez 32 patients sur 33. La moyenne des lymphocytes CD4 etait de 29,94/mm3 et la mediane a 8 CD4 / mm3. Quatorze patients sur les 33 (42,2%) sont decedes dans un delai de 1 a 21 jours. Cette lourde mortalite est correlee au retard de mise en route d'un traitement adequat, a la coexistence d'une infection a Mycobacterium tuberculosis et a la mauvaise observance du traitement. Conclusion Chez tout patient presume infecte par le VIH, presentant un syndrome meninge franc ou fruste avec des cephalees, des troubles de la vigilance et des crises epileptiques, la realisation systematique d'une ponction lombaire et la recherche des cryptocoques dans le LCR sont recommandees afin de mettre en route rapidement un traitement adequat, afin de diminuer la mortalite qui reste elevee Background Cryptococcus neoformans is an important fungal pathogen in immunocompromised patients. Cryptococcal meningitis has not been well studied in Cameroon. Aim To describe the epidemiological, clinical, biological aspects and course of cryptococcal meningitis in patients admitted in the Yaounde University Teaching Hospital. Materials and methods: Retrospective and descriptive study conducted over a 57-month period in the Yaounde University Teaching Hospital. Results During this period, cryptococcal meningitis was diagnosed in 33 patients among the 3,655 patients who were hospitalised in the Internal Medicine service. There was a male predominance (21 males/ 12 females) in our study. The mean age of the patients was 39.81 years. The clinical features were variable: Headaches (26 cases /33), fever (25/33), signs of meningitis (18/33), altered consciousness (9/33) and generalised epileptic seizures (8/33). Mycobacterium tuberculosis infection was the most associated with cryptococcal meningitis (10 cases /33). The mean period of evolution was 14.93 days and the median was 9 days. HIV serology was positive in 32 patients /33. The mean CD4 lymphocyte count was 29.94/mm3 and the median was 8/mm3. Fourteen of 33 patients (42.2%) died within 1 to 21 days. This high mortality was correlated to the association of Mycobacterium tuberculosis infection, to the delay of diagnosis, and to treatment non compliance. Conclusion A systematic search for cryptococcal meningitis is recommended in all patients suspected for or known to be immune compromised, who present with headaches, altered consciousness and epileptic seizures with or without neck stiffness and no localising signs. Early and adequate treatment of cryptococcal meningitis in these patients will contribute to reducing the still high mortality rate in Cameroon. Keywords : Cryptococcus neoformans, Meningitis, immunosupression, HIV, Cameroon African Journal of Neurological Sciences Vol. 25 (2) 2006: pp. 13-20