title: Cryptoccocal meningitis in Yaoundé (Cameroon) HIV infected patients: Diagnosis, frequency and Cryptococcus neoformans isolates susceptibility study to fluconazole.
abstract: Cryptococcal meningitis is a mycosis encountered especially in patients with Acquired Immunodeficiency Syndrome and is fatal in the absence of treatment. Information on epidemiology, diagnosis and susceptibility profile to antifungal drugs, are scarce in Cameroon. Authors evaluated the diagnosis possibilities of the cryptococcal meningitis in Cameroon, and studied the antifungal susceptibility of isolated strains to fluconazole, used as first line treatment of the disease in Cameroon. Between December 2009 and July 2011, 146 cerebrospinal fluids obtained from HIV patients with suspicion of meningitis were analysed. The diagnosis procedure involved macroscopic and cyto-chemical analysis, India ink test, culture on Sabouraud chloramphenicol medium and antigen latex agglutination test. Antifungal susceptibility testing of isolated strains to fluconazole was done by the E-test(®) method. The diagnosis of cryptococcal meningitis gave 28.08% positive cases. Among these patients, 80% were at stages III and IV and 20% at stage I of the HIV infection, according to the WHO previous classification. Cyto-chemical analysis showed current findings in the case of cryptococcal meningitis. India ink test and latex agglutination test exhibited very high sensitivity and specificity (>94%). Fluconazole antifungal susceptibility testing gave MICs lower than 32μg/mL to 92.7% of isolated strains and MICs greater than this value to 7.3% of isolates. These results showed that cryptococcal meningitis remains a real problem among HIV infected patients in Yaoundé. The emergence of fluconazole reduced susceptibility strains is worrying. Nevertheless, efficacy of rapid detection tests is interesting because this will help in rapid diagnosis and treatment of patients.
authors.affiliation: Clinical Biology Laboratory, Yaoundé Central Hospital, Cameroon; UMI 233 UM1-IRD-UCAD-UY1 « TransVIHMI » laboratoire de parasitologie et mycologie médicale UFR pharmacie, université de Montpellier 1, 34093 Montpellier, France; Antimicrobial Agents Unit (AMAU), Laboratory for Phytobiochemistry and Medicinal Plants Study, Department of Biochemistry, Faculty of Science, University of Yaoundé I, Cameroon. Electronic address: ngouanathi@yahoo.com.
authors.forename: T
authors.initials: T
authors.lastname: Kammalac Ngouana
authors.affiliation: Clinical Biology Laboratory, Yaoundé Central Hospital, Cameroon.
authors.forename: J
authors.initials: J
authors.lastname: Dongtsa
authors.affiliation: Clinical Biology Laboratory, Yaoundé Central Hospital, Cameroon; UMI 233 UM1-IRD-UCAD-UY1 « TransVIHMI » laboratoire de parasitologie et mycologie médicale UFR pharmacie, université de Montpellier 1, 34093 Montpellier, France.
authors.forename: C
authors.initials: C
authors.lastname: Kouanfack
authors.affiliation: Clinical Biology Laboratory, Yaoundé Central Hospital, Cameroon.
authors.forename: C
authors.initials: C
authors.lastname: Tonfack
authors.affiliation: National Institute of Statistics, Yaoundé, Cameroon.
authors.forename: S
authors.initials: S
authors.lastname: Fomena
authors.affiliation: UMI 233 UM1-IRD-UCAD-UY1 « TransVIHMI » laboratoire de parasitologie et mycologie médicale UFR pharmacie, université de Montpellier 1, 34093 Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Mallié
authors.affiliation: UMI 233 UM1-IRD-UCAD-UY1 « TransVIHMI » laboratoire de parasitologie et mycologie médicale UFR pharmacie, université de Montpellier 1, 34093 Montpellier, France.
authors.forename: E
authors.initials: E
authors.lastname: Delaporte
authors.affiliation: Antimicrobial Agents Unit (AMAU), Laboratory for Phytobiochemistry and Medicinal Plants Study, Department of Biochemistry, Faculty of Science, University of Yaoundé I, Cameroon.
authors.forename: F-Fekam
authors.initials: FF
authors.lastname: Boyom
authors.affiliation: UMI 233 UM1-IRD-UCAD-UY1 « TransVIHMI » laboratoire de parasitologie et mycologie médicale UFR pharmacie, université de Montpellier 1, 34093 Montpellier, France.
authors.forename: S
authors.initials: S
authors.lastname: Bertout
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D000328:Adult; D000368:Aged; D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use; D001717:Birds; D002163:Cameroon / Q000453:epidemiology; D003455:Cryptococcus neoformans / Q000187:drug effects* / Q000302:isolation & purification; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D015658:HIV Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole
keywords: Cryptococcose; Cryptococcosis; Diagnosis; Diagnostic; Fluconazole; Frequency; Fréquence; HIV infection; VIH