scholarly journals Clinical and prognostic features of cerebral toxoplasmosis in HIV-infected patients in Lubumbashi, Democratic Republic of the Congo

2021 ◽  
Vol 11 (3) ◽  
pp. 79-82
Author(s):  
Joe Kabongo Katabwa ◽  
Olivier Mukuku ◽  
Elie Kabika ◽  
Guy Kandja Lwamba ◽  
Charles Wembonyama Mpoy ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Democratic Republic ◽  
Clinical Manifestations ◽  
Hospital Setting ◽  
Motor Deficit ◽  
Cerebral Toxoplasmosis ◽  
Prognostic Features ◽  
Cell Counts ◽  
Republic Of The Congo ◽  
The Central Nervous System

Introduction: Cerebral toxoplasmosis is the main opportunistic infection of the central nervous system (CNS) during in human immunodeficiency virus (HIV)-infection. The purpose of this study is to describe current epidemiologic, clinical, diagnostic, and prognostic features of cerebral toxoplasmosis during HIV-infection in hospital setting in Lubumbashi. Methods: This descriptive and analytic study examined the records of 21 HIV-positive patients with cerebral toxoplasmosis. Data were collected over 36 months (from January 2015 to December 2017) at the HIV/AIDS Center of Excellence in Lubumbashi (Democratic Republic of the Congo). Results: Twenty-one patients on 4,283 followed for HIV-infection completed the diagnostic criteria (a prevalence of 0.5%) with a sex ratio (M / F) of 1.3 and a mean age of 41.0±6 years. Major clinical manifestations were fever (100%), headaches (100%), motor deficit (61.9%), intracranial hypertension (47.6%), seizures (47.6%), and disorders of consciousness (42.9%). Cerebral imaging studies (4 Computed tomography scan) were performed and showed hypodensities with peripheral enhancement by cockade in 75% of the cases. The mean CD4 T-cell counts was 180.6±161.9 cells / mm3. Co-trimoxazole was the main anti-toxoplasma drug in all cases. The lethality rate was 42.9%. Conclusion: Early detection and primary prevention in HIV-infected patients remain essential to improve the prognosis and survival of these patients.

scholarly journals Autoantibodies Against Ubiquitous and Confined Antigens in Patients With Ocular, Neuro-Ophthalmic and Congenital Cerebral Toxoplasmosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Monica Goldberg-Murow ◽  
Carlos Cedillo-Peláez ◽  
Luz Elena Concha-del-Río ◽  
Rashel Cheja-Kalb ◽  
María José Salgar-Henao ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Molecular Mimicry ◽  
Clinical Manifestations ◽  
Protective Role ◽  
Cross Reactivity ◽  
Ocular Toxoplasmosis ◽  
Cerebral Toxoplasmosis ◽  
Blood Retinal Barrier ◽  
The Central Nervous System

Toxoplasma gondii infection can trigger autoreactivity by different mechanisms. In the case of ocular toxoplasmosis, disruption of the blood-retinal barrier may cause exposure of confined retinal antigens such as recoverin. Besides, cross-reactivity can be induced by molecular mimicry of parasite antigens like HSP70, which shares 76% identity with the human ortholog. Autoreactivity can be a determining factor of clinical manifestations in the eye and in the central nervous system. We performed a prospective observational study to determine the presence of autoantibodies against recoverin and HSP70 by indirect ELISA in the serum of 65 patients with ocular, neuro-ophthalmic and congenital cerebral toxoplasmosis. We found systemic autoantibodies against recoverin and HSP70 in 33.8% and 15.6% of individuals, respectively. The presence of autoantibodies in cases of OT may be related to the severity of clinical manifestations, while in cases with CNS involvement they may have a protective role. Unexpectedly, anti-recoverin antibodies were found in patients with cerebral involvement, without ocular toxoplasmosis; therefore, we analyzed and proved cross-reactivity between recoverin and a brain antigen, hippocalcin, so the immunological phenomenon occurring in one immune-privileged organ (e.g. the central nervous system) could affect the environment of another (egg. the eye).

scholarly journals First Report on Three Cases of Monkey pox in Nord Ubangi Province (Democratic Republic of the Congo)

2020 ◽  
Vol 2 (1) ◽  
pp. 120-125
Author(s):  
Koto-te-Nyiwa Ngbolua ◽  
Guy Kumbali Ngambika ◽  
Blaise Mbembo-wa-Mbembo ◽  
Kohowe Pagerezo Séraphin ◽  
Kogana Kapalata Fabrice ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Clinical Manifestations ◽  
Symptomatic Treatment ◽  
Cross Sectional Study ◽  
The Body ◽  
Cross Sectional ◽  
First Report ◽  
Republic Of The Congo ◽  
Epidemiological Characteristics

Monkey pox is a rare viral zoonotic disease of which clinical manifestations are similar to smallpox, it is transmitted to humans by direct contact with the body of an infected animal, but the transmission can also be human-to-human. The Democratic Republic of Congo is the most endemic country in the world where almost all provinces are affected by this scourge. However, in the administrative configuration currently, monkey pox has not been detected in Nord Ubangi province yet. This cross-sectional study focuses on three cases of patients diagnosed with monkey pox virus at Businga General Hospital in Nord Ubangi province. The findings show that all the three patients were male with a primary education level and their average age was 9±3.46 years. They had some epidemiological characteristics specific to monkey pox, including high fevers, rashes, pruritus and abdominal pain. After two weeks of symptomatic treatment, each patient was able to get out without further complications. For the best of our knowledge, this is the first report on the cases of Monkey pox in Nord Ubangi Province.

scholarly journals Co-infection of malaria and HIV infection in severely undernourished children in the Democratic Republic of the Congo: a cross-sectional study

Parasitology ◽  
2019 ◽  
Vol 147 (2) ◽  
pp. 248-253
Author(s):  
MuziaziaLupemba Jacques ◽  
MaibougeTanko Mahamane Salissou ◽  
Lufuluabo Kaswiyi ◽  
Fei Guan ◽  
Jiahui Lei
Keyword(s):  
Hiv Infection ◽  
Democratic Republic ◽  
Cross Sectional Study ◽  
Enzyme Linked Immunosorbent Assay ◽  
Sectional Study ◽  
Clinical Predictors ◽  
Hiv Seropositivity ◽  
Cross Sectional ◽  
Hiv Serostatus ◽  
Republic Of The Congo

AbstractPurposeThis study aims to determine the prevalence of malaria and HIV seropositivity among children with undernutrition in the Democratic Republic of the Congo.MethodsA cross-sectional study of undernourished children aged between 12 and 60 months in Kalembe-Lembe hospital was carried out. Blood samples were collected for the analyses of malaria parasite, haemoglobin and haematocrit levels. HIV serostatus was determined with rapid HIV antibody tests and enzyme-linked immunosorbent assay. Logistic regression analyses were used to identify clinical predictors of HIV seropositivity.ResultsOf 225 children, 88.9% had malaria; the parasite loads were 16 000 para per μL (38.0%); 24 400 para per μL (56.8%), P < 0.001 and malaria and associated HIV infection accounted for 29.2%. In children aged >12 months, HIV seroprevalence was 29.3%; 86.0% had undernutrition and malaria, 6.8% had undernutrition and HIV and 4.3% had undernutrition, HIV and malaria (P < 0.001). The occurrence of at least three or more symptoms was highly specific (96.4–100.0%) for HIV seropositivity (P < 0.05). The overall mortality rate was 18.4%, higher in children with malaria and HIV (39.6% vs 12.2%, P < 0.001) and those with lower weight gain (4.3 vs 7.5 g kg−1 day−1, P < 0.001).ConclusionsThere was high prevalence of malaria and HIV and mortality among severely undernourished children with malaria and HIV.

scholarly journals Problems of differential diagnosis of focal brain lesions in patients with HIV infection

2020 ◽  
Vol 12 (1) ◽  
pp. 35-39
Author(s):  
M. Yu. Fomina ◽  
M. A. Titova
Keyword(s):  
Differential Diagnosis ◽  
Hiv Infection ◽  
Malignant Tumors ◽  
Clinical Manifestations ◽  
B Cell Lymphoma ◽  
Adverse Outcomes ◽  
Cns Lymphoma ◽  
Cerebral Toxoplasmosis ◽  
Therapy Regimen ◽  
Perinatal Hiv

Currently, the leading cause of social disadaptations and disability of patients at advanced stages of HIV infection, as well as adverse outcomes, is the presence of severe comorbid variants of the course of HIV infection: HIV and co-infection of chronic viral hepatitis, tuberculosis, HIV and malignant tumors, and HIV-associated neurological diseases. In pediatric practice, the combination of HIV-induced and perinatal CNS lesions is the most relevant. The differential diagnosis of these conditions is complicated due to the polymorphism of clinical manifestations and the possibility of combining several pathological conditions simultaneously in patients. Neuroimaging data does not always have clear criteria for determining the exact cause of cerebral damage. The article presents data of own clinical neuroimaging observations of two patients with perinatal and parenteral HIV infection. The nervous system damage was polyetiological in nature and was presented in one case by a combination of HIV-encephalitis, cerebral toxoplasmosis and CNS lymphoma, in the second by the presence of Bourneville-Pringle disease (tuberous sclerosis) with the formation of giant-cell astrocytoma and HIV-induced brain damage. It should be noted that the optimization of the antiretroviral therapy regimen in the case of a combination of B-cell lymphoma and cerebral toxoplasmosis in a child with perinatal HIV infection led to clinical and laboratory remission

scholarly journals Comparison of practicability and effectiveness between unassisted HIV self-testing and directly assisted HIV self-testing in the Democratic Republic of the Congo: A randomized feasibility trial

2020 ◽  
Author(s):  
Serge Tonen-Wolyec ◽  
Charles Kayembe Tshilumba ◽  
Salomon Batina-Agasa ◽  
Roland Marini Djang’eing’a ◽  
Marie-Pierre Hayette ◽  
...  
Keyword(s):  
High Risk ◽  
Hiv Infection ◽  
Democratic Republic ◽  
Linkage To Care ◽  
Feasibility Trial ◽  
Test Results ◽  
Self Testing ◽  
Willingness To Buy ◽  
Republic Of The Congo ◽  
Self Test

Abstract Background. HIV self-testing (HIVST) can be performed using directly assisted and unassisted approaches in facilities or communities to reach different populations. The aim of this study was to compare the practicability and effectiveness of the two delivery approaches for HIVST, unassisted HIVST (UH) and directly assisted HIVST (DAH), in the field setting of Kisangani, the Democratic Republic of the Congo (DRC).Methods. A randomized (1:1), non-blinded, non-inferiority trial using a blood-based and facility-based HIVST method was carried out in four facilities in Kisangani, the DRC, targeting populations at high risk for HIV infection. The primary outcome was the difference in the practicability of the HIV self-test between the two arms. Practicability was defined as successfully performing the test and correctly interpreting the result. Requests for assistance, positivity rate, linkage to care, and willingness to buy an HIV self-test kit constituted the secondary outcomes for HIVST effectiveness. The adjusted risk ratios (aRRs) were calculated using Poisson regression. Results. The rate of successfully performing the test was same (93.2%) in the UH and DAH arms. The rate of correctly interpreting the results was 86.9% in the UH arm versus 93.2% in the DAH arm, for a difference of -6.3%. After the follow-up 72 h later, participants in the UH arm had a significantly lower chance of correctly interpreting the test results than those in the DAH arm (aRR: 0.60; P=0.019). Although the positivity rate was 3.4% among the participants in the DAH arm and 1.7% among those in the UH arm, no significant differences were found between the two arms in the positivity rate, requests for assistance, and linkage to care. Willingness to buy an HIV self-test was higher in the UH arm than in the DAH arm (92.3% versus 74.1%; aRR: 4.20; P<0.001). Conclusion. The results of this study indicate that UH is as practicable and effective as DAH among individuals at high risk for HIV infection in Kisangani, the DRC. However, additional support tools need to be assessed to improve the interpretation of the self-test results when using the UH approach. Trial registration: PACTR201904546865585. Registered 03 April 2019 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=6032

The 1995 Kikwit Ebola outbreak—Model of virus properties on system capacity and function: A lesson for future viral epidemics

2007 ◽  
Vol 2 (5) ◽  
pp. 270-276 ◽  
Author(s):  
Ryan C.W. Hall, MD ◽  
Richard C.W. Hall, MD
Keyword(s):  
Ebola Virus ◽  
Democratic Republic ◽  
Healthcare Providers ◽  
Hospital Setting ◽  
Lessons Learned ◽  
System Capacity ◽  
Voluntary Organizations ◽  
Disease Characteristics ◽  
Republic Of The Congo ◽  
And Function

The 1995 Kikwit Ebola outbreak in the Democratic Republic of the Congo is one of the first Ebola outbreaks to be treated in a hospital setting and is one of the most well-studied Ebola epidemics to have occurred to date. Many of the lessons learned from identifying, containing, and treating the epidemic are applicable to future viral outbreaks. This article looks at the characteristics of the Ebola virus and health system issues, which affected the healthcare providers’ ability to contain and treat the virus. It specifically examines factors such as the disease characteristics, surge capacity, supply issues, press involvement, and the involvement of voluntary organizations.

scholarly journals 1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S510-S511
Author(s):  
Kittipat Aimbudlop ◽  
Sasisopin Kiertiburanakul
Keyword(s):  
Bacterial Meningitis ◽  
Hiv Infection ◽  
White Blood Cells ◽  
Clinical Manifestations ◽  
Hospital Setting ◽  
Polymorphonuclear Neutrophils ◽  
Medical Emergency ◽  
Acute Bacterial Meningitis ◽  
Clinical Presentations ◽  
Acute Meningitis

Abstract Background Acute meningitis is a medical emergency which needs immediate assessment and treatment. Knowing the epidemiology of acute meningitis may guide the physician for promptly empirical therapy as well as minimize morbidity and mortality. In Thailand, there are few studies regarding acute meningitis in adults and most of them have not been updated. We aimed to determine etiology, clinical manifestations, cerebrospinal fluid (CSF) findings and outcomes of patients with acute meningitis. Methods A retrospective cohort study was conducted among adult (age >15 years) patients with acute meningitis who were treated at Ramathibodi Hospital between 2013 and 2017. The list of the patients was retrieved from the hospital database using the International Classification of Diseases, 10th revision (ICD-10) codes. Comparisons of clinical presentations and laboratory investigations between patients with bacterial meningitis and those with non-bacterial meningitis were analyzed. Results A total of 89 patients were included. Of all, 48 (53.9%) patients were men and median age (interquartile range; IQR) was 49 (32.1–63.8) years. The most common coexisting condition was HIV infection (30%), receiving prednisolone (16.9%), and diabetes mellitus (15.7%). Causes of acute meningitis were Cryptococcus neoformans (37%), bacteria (31.5%), Mycobacterium tuberculosis (27%), and virus (4.5%). Common clinical presentations were fever (74%), headache (70.8%), and confusion (31.5%). Older age, higher proportion of patients with diabetes, lower proportion of HIV infection, higher median white blood cells (WBCs) in complete blood count (CBC), lower median platelet, higher median aspartate aminotransaminase, higher median alkaline phosphatase, higher median WBCs, and polymorphonuclear neutrophils (PMNs) percentage in CSF were found in patients with acute bacterial meningitis. By multivariate logistic regression, predicting factors of acute bacterial meningitis were WBCs in CBC (OR 1.02 per 100 cells/mm3 increased; 95% CI 1.01–1.04, P = 0.001), WBCs in CSF (OR 1.04 per 10 cells/mm3 increased; 95% CI 1.01–1.07, P = 0.012) and PMNs percentage in CSF (OR 1.21 per 5% increased; 95% CI 1.07–1.37, P = 0.002). Overall, the median (IQR) duration of hospitalization was 23 (11–29) days. A total of 26 (29%) patients had a complication, such as septic shock, hydrocephalus, seizure, and brain edema. The mortality rate was 7.9%. Conclusion In this setting, the most common cause of acute meningitis in adults is cryptococcosis. In addition, tuberculosis is not uncommon. Awareness of update epidemiology may guide the physicians to initiate appropriate antimicrobial therapy. Disclosures All authors: No reported disclosures.

scholarly journals Comparison of practicability and effectiveness between unassisted HIV self-testing and directly assisted HIV self-testing in the Democratic Republic of the Congo: a randomized feasibility trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Serge Tonen-Wolyec ◽  
Charles Kayembe Tshilumba ◽  
Salomon Batina-Agasa ◽  
Roland Marini Djang’eing’a ◽  
Marie-Pierre Hayette ◽  
...  
Keyword(s):  
High Risk ◽  
Hiv Infection ◽  
Democratic Republic ◽  
Linkage To Care ◽  
Feasibility Trial ◽  
Test Results ◽  
Self Testing ◽  
Willingness To Buy ◽  
Republic Of The Congo ◽  
Self Test

Abstract Background HIV self-testing (HIVST) can be performed using directly assisted and unassisted approaches in facilities or communities to reach different populations. The aim of this study was to compare the practicability and effectiveness of the two delivery approaches for HIVST, unassisted HIVST (UH) and directly assisted HIVST (DAH), in the field setting of Kisangani, the Democratic Republic of the Congo (DRC). Methods A randomized (1:1), non-blinded, non-inferiority trial using a blood-based and facility-based HIVST method was carried out in four facilities in Kisangani, the DRC, targeting populations at high risk for HIV infection. The primary outcome was the difference in the practicability of the HIV self-test between the two arms. Practicability was defined as successfully performing the test and correctly interpreting the result. Requests for assistance, positivity rate, linkage to care, and willingness to buy an HIV self-test kit constituted the secondary outcomes for HIVST effectiveness. The adjusted risk ratios (aRRs) were calculated using Poisson regression. Results The rate of successfully performing the test was same (93.2%) in the UH and DAH arms. The rate of correctly interpreting the results was 86.9% in the UH arm versus 93.2% in the DAH arm, for a difference of − 6.3%. After the follow-up 72 h later, participants in the UH arm had a significantly lower chance of correctly interpreting the test results than those in the DAH arm (aRR: 0.60; P = 0.019). Although the positivity rate was 3.4% among the participants in the DAH arm and 1.7% among those in the UH arm, no significant differences were found between the two arms in the positivity rate, requests for assistance, and linkage to care. Willingness to buy an HIV self-test was higher in the UH arm than in the DAH arm (92.3% versus 74.1%; aRR: 4.20; P < 0.001). Conclusion The results of this study indicate that UH is as practicable and effective as DAH among individuals at high risk for HIV infection in Kisangani, the DRC. However, additional support tools need to be assessed to improve the interpretation of the self-test results when using the UH approach. Trial registration PACTR201904546865585. Registered 03 April 2019 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=6032

CLINICAL PARALLELS IN INFECTIOUS DISEASES OF THE CENTRAL NERVOUS SYSTEM IN PATIENTS WITH HIV

2020 ◽  
pp. 83-87
Author(s):  
K. Yu. Lytvyn ◽  
L. R. Shostakovych-Koretska ◽  
Z. O. Chykarenko ◽  
O. A. Kushnierova ◽  
I. V. Budaeva ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Hiv Infection ◽  
Cranial Nerve ◽  
Opportunistic Infections ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
Cognitive Disorders ◽  
Speech Disorders ◽  
The Central Nervous System

A retrospective analysis of medical records of 451 patients with HIV infection showed that the most common clinical manifestations of cerebral tuberculosis are as follows: headache, fever ≥ 38.0 °C, meningeal symptoms; in toxoplasmosis encephalitis these are headache, paresis of cranial nerves and extremities, incoordination, cognitive disorders, dysarthria, fever ≥ 38.0 °C and convulsions; in mycotic lesions of the CNS they are headache, coordination disorders, positive meningeal symptoms, disturbances of consciousness, cognitive disorders, visual disorders, cranial nerve deficiency, convulsions and dysarthria. The clinical picture of bacterial (exacted) meningitis was dominated by positive meningeal symptoms, headache, fever, impaired consciousness. At the same time, in such neurological manifestations of central nervous system lesions as cranial nerve paresis, mono− and hemiparesis, visual, coordination and speech disorders, which mostly accompany cerebral toxoplasmosis, cerebrovascular diseases, brain tumors, encephalitis of unspecified etiology. Thus, the analysis suggests that the clinical manifestations of various etiologies of lesions of the central nervous system are often nonspecific and probably are stipulated with common morphological changes in brain tissue, which may be associated with the neuropathological effects of HIV, as well as a large impact co−infection. Key words: HIV infection, opportunistic infections, central nervous system, main symptoms.

scholarly journals Clinical signs of tuberculosis relapses in HIV patients

2020 ◽  
Vol 98 (6) ◽  
pp. 32-35
Author(s):  
E. Yu. Zorkаltsevа ◽  
Yu. O. Egorovа
Keyword(s):  
Central Nervous System ◽  
Hiv Infection ◽  
Treatment Efficacy ◽  
Medical Records ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Hiv Positive ◽  
Hiv Patients ◽  
The Central Nervous System ◽  
Hiv Negative

The objective: to study clinical manifestations of tuberculosis relapses and their treatment outcomes in patients with HIV infection.Subjects and Methods. 132 medical records of patients with tuberculosis relapses were analyzed; 69 of them were HIV-positive and 63 were HIV-negative. All of them were admitted to Irkutsk Regional Clinical Tuberculosis Hospital from 2016 to 2019, and then continued treatment of tuberculosis on the out-patient basis. Treatment efficacy was assessed in February 2020.Results. More severe clinical forms of tuberculosis relapses were typical of HIV patients including generalized forms affecting the central nervous system. Therefore, among these patients, the mortality rate is significantly higher (24.6%) than in tuberculosis relapses with no concurrent HIV infection (6.3%), p ≤ 0.05.

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