scholarly journals Diagnosis and Management of Central Nervous System Cryptococcal Infections in HIV-Infected Adults

2019 ◽  
Vol 5 (3) ◽  
pp. 65 ◽  
Author(s):  
Caleb Skipper ◽  
Mahsa Abassi ◽  
David R Boulware
Keyword(s):  
Clinical Trial ◽  
Central Nervous System ◽  
Nervous System ◽  
Intracranial Pressure ◽  
Cryptococcal Meningitis ◽  
Sub Saharan Africa ◽  
Hiv Disease ◽  
Diagnosis And Management ◽  
Sub Saharan ◽  
Advanced Hiv Disease

Cryptococcal meningitis persists as a significant source of morbidity and mortality in persons with HIV/AIDS, particularly in sub-Saharan Africa. Despite increasing access to antiretrovirals, persons presenting with advanced HIV disease remains common, and Cryptococcus remains the most frequent etiology of adult meningitis. We performed a literature review and herein present the most up-to-date information on the diagnosis and management of cryptococcosis. Recent advances have dramatically improved the accessibility of timely and affordable diagnostics. The optimal initial antifungal management has been newly updated after the completion of a landmark clinical trial. Beyond antifungals, the control of intracranial pressure and mitigation of toxicities remain hallmarks of effective treatment. Cryptococcal meningitis continues to present challenging complications and continued research is needed.

scholarly journals Disseminated Histoplasmosis; A Threat in Advanced HIV Disease Population in Sub-Saharan Africa?

2021 ◽  
pp. 115-144
Author(s):  
Christine E. Mandengue ◽  
Bassey Ewa Ekeng ◽  
Rita O. Oladele
Keyword(s):  
Histoplasma Capsulatum ◽  
Clinical Stage ◽  
Sub Saharan Africa ◽  
World Health ◽  
Hiv Disease ◽  
African Countries ◽  
Tb Treatment ◽  
Disseminated Histoplasmosis ◽  
Sub Saharan ◽  
Advanced Hiv Disease

Background: Histoplasmosis is a neglected acquired immune deficiency syndrome (AIDS)-defining disease in sub-Saharan African countries, which is commonly misdiagnosed as tuberculosis (TB) due to similar imagery and clinical features; patients usually receive presumptive anti-TB treatment that is considered as anti-TB treatment failure. Patients with advanced human immunodeficiency virus (HIV) disease (AHD), CD4<200/mm3 or World Health Organisation clinical stage 3 or 4, develop disseminated histoplasmosis (DH) diagnosed at a late stage or at post-mortem, owing to poor clinical suspicion, lack of rapid diagnosis tools to offer rapid and accurate results, and non-availability and accessibility of appropriate antifungal medications. We report 31 cases of DH amongst patients with AHD in sub-Saharan African population from the literature, highlighting the challenging care issue in sub-Saharan Africa. Results: Out of 31 reported cases 64.51% (20/31) were caused by Histoplasma capsulatum var capsulatum, 48.38% (15/31) being immigrants in Europe, Canada and Japan, with 41.93% (13/31) mortality, and 6 cases having no reported outcome. The poor index of suspicion on the part of clinicians; the lack of skilled laboratory personnel and rapid and accurate diagnosis tools of histoplasmosis for a proper detection of either classical or African histoplasmosis coexisting in many sub-Saharan African countries; and the non-availability and accessibility of appropriate antifungal medications were the most challenges in caring DH in advanced HIV disease population in sub-Saharan Africa. Conclusion: there is a need for prompt and routine screening of advanced HIV disease patients in sub-Saharan Africa for histoplasmosis as an AIDS-defining illness.

scholarly journals HIV and Chagas Disease Coinfection, a Tractable Disease?

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Betiana Guidetto ◽  
Melisa Tatta ◽  
Veronica Latini ◽  
Milene Gonzales ◽  
Adelina Riarte ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Antiretroviral Therapy ◽  
Chagas Disease ◽  
Early Treatment ◽  
Central Nervous System Involvement ◽  
Hiv Disease ◽  
Newly Diagnosed ◽  
Disease Reactivation ◽  
Advanced Hiv Disease

Abstract We present 2 patients born in Argentina who were newly diagnosed with advanced HIV disease and Chagas disease reactivation with central nervous system involvement. The patients received concurrent benznidazole treatment and antiretroviral therapy, showing good response. Improvement in morbidity and mortality due to early treatment makes this treatment appropriate for coinfected patients.

scholarly journals Later cART Initiation in Migrant Men from Sub-Saharan Africa without Advanced HIV Disease in France

PLoS ONE ◽  
2015 ◽  
Vol 10 (3) ◽  
pp. e0118492 ◽  
Author(s):  
Laure-Amélie de Monteynard ◽  
Rosemary Dray-Spira ◽  
Pierre de Truchis ◽  
Sophie Grabar ◽  
Odile Launay ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
Hiv Disease ◽  
Cart Initiation ◽  
Sub Saharan ◽  
Advanced Hiv Disease

Framework for the implementation of advanced HIV disease diagnostics in sub-Saharan Africa: programmatic perspectives

2020 ◽  
Vol 7 (7) ◽  
pp. e514-e520
Author(s):  
Zibusiso Ndlovu ◽  
Rosie Burton ◽  
Rosanna Stewart ◽  
Helen Bygrave ◽  
Teri Roberts ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
Hiv Disease ◽  
Disease Diagnostics ◽  
Sub Saharan ◽  
Advanced Hiv Disease

scholarly journals COVID-19 pandemic: the implications of the natural history, challenges of diagnosis and management for care in sub-Saharan Africa

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Lawrence Omo-Aghoja ◽  
Emuesiri Goodies Moke ◽  
Kenneth Kelechi Anachuna ◽  
Adrian Itivere Omogbiya ◽  
Emuesiri Kohworho Umukoro ◽  
...  
Keyword(s):  
Public Health ◽  
Natural History ◽  
Low Income ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Diagnosis And Management ◽  
Severe Acute Respiratory Infection ◽  
Identification Technique ◽  
Sub Saharan ◽  
Policies And Programs

Abstract Background Coronavirus disease (COVID-19) is a severe acute respiratory infection which has afflicted virtually almost all nations of the earth. It is highly transmissible and represents one of the most serious pandemics in recent times, with the capacity to overwhelm any healthcare system and cause morbidity and fatality. Main content The diagnosis of this disease is daunting and challenging as it is dependent on emerging clinical symptomatology that continues to increase and change very rapidly. The definitive test is the very expensive and scarce polymerase chain reaction (PCR) viral identification technique. The management has remained largely supportive and empirical, as there are no officially approved therapeutic agents, vaccines or antiviral medications for the management of the disease. Severe cases often require intensive care facilities and personnel. Yet there is paucity of facilities including the personnel required for diagnosis and treatment of COVID-19 in sub-Saharan Africa (SSA). It is against this backdrop that a review of key published reports on the pandemic in SSA and globally is made, as understanding the natural history of a disease and the documented responses to diagnosis and management is usually a key public health strategy for designing and improving as appropriate, relevant interventions. Lead findings were that responses by most nations of SSA were adhoc, paucity of public health awareness strategies and absence of legislations that would help enforce preventive measures, as well as limited facilities (including personal protective equipment) and institutional capacities to deliver needed interventions. Conclusion COVID-19 is real and has overwhelmed global health care system especially low-income countries of the sub-Sahara such as Nigeria. Suggestions for improvement of healthcare policies and programs to contain the current pandemic and to respond more optimally in case of future pandemics are made herein.

Lhermitte-Duclos Disease with Cervical Arteriovenous Fistula

2018 ◽  
Vol 80 (02) ◽  
pp. 134-137
Author(s):  
Anwar Haq ◽  
Ibrahim Alzahrani ◽  
Essam Shail ◽  
Abdulaziz Almubarak
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Intracranial Pressure ◽  
Obstructive Hydrocephalus ◽  
Rare Condition ◽  
Vascular Lesions ◽  
Pten Gene ◽  
Vascular Tumors ◽  
Arteriovenous Fistulas ◽  
Cowden’S Syndrome

AbstractLhermitte-Duclos disease is a rare condition with less than 250 cases reported in the literature. It was considered a neoplastic or hamartomatous growth in the cerebellum. It commonly presents with symptoms of high intracranial pressure or obstructive hydrocephalus. Surgical resection is often curative. The lesion is associated with PTEN gene mutation, and it is considered to be one of the diagnostic criteria of Cowden's syndrome. Vascular tumors are reported in this syndrome, including glioblastomas and meningiomas. Furthermore, central nervous system vascular lesions were also reported in Lhermitte-Duclos disease, such as deep venous anomalies and brain arteriovenous fistulas. A report of an asymptomatic spinal cervical AVF in a patient with Lhermitte-Duclos disease was published in 2006. We present the second case of Lhermitte-Duclos disease associated with an asymptomatic spinal cervical AVF in a 17-year-old young woman with literature review of central nervous system vascular lesions in Lhermitte-Duclos disease.

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