Cerebro-meningeal infections in HIV-infected patients: a study of 116 cases in Libreville, Gabon.
BACKGROUND
Cerebro-meningeal pathology is common in human immunodeficiency virus (HIV) infection and the aetiology is often difficult to ascertain with certainty.


OBJECTIVE
To describe the major suspected and identified causes of meningeal or encephalitic syndromes in HIV infection in Libreville, Gabon.


METHODS
A descriptive study using clinical records of patients hospitalised in the Department of Medicine in the Military Hospital of Libreville (Gabon) between January 2006 and May 2010. Clinical features were evaluated using multivariable logistic regression to evaluate association with the outcome of a clinical improvement or death.


RESULTS
The most frequent neurological symptoms were reduced level of consciousness (54.3%), headache (55.2%), motor deficit (38.7%), and convulsions (36.2%). Cerebral toxoplasmosis represented 64.7% of diagnoses, followed by cryptococcal neuromeningitis in 12.9% of cases. Tuberculoma was diagnosed in 4 cases and lymphoma in 2 cases. In 9.5% of cases, no aetiology was determined. Toxoplasmosis treatment led to clinical improvement in 69.3% of cases with suspected cerebral toxoplasmosis. Overall mortality was 39.7%.


CONCLUSIONS
The diagnosis of neurological conditions in HIV positive patients is difficult, particularly in a low-resource setting. A trial of treatment for toxoplasmosis should be initiated first line with all signs of neurological pathology in a patient infected with HIV.
Department of Infectious and Tropical Diseases, Hôpital d'Instruction des Armées Omar Bongo Ondimba, BP 20404 Libreville PK9, Gabon. magondounda@yahoo.fr.
Magloire
M
Ondounda
Department of Internal Medicine, Hôpital d'Instruction des Armées Omar Bongo Ondimba, BP 20404 Libreville PK9, Gabon. cilozue@doctors.org.uk.
Chinenye
C
Ilozue
Department of Internal Medicine, Hôpital d'Instruction des Armées Omar Bongo Ondimba, BP 20404 Libreville PK9, Gabon. m2caroline@yahoo.fr.
Caroline
C
Magne
D000328:Adult; D017677:Age Distribution; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005681:Gabon / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006772:Hospitals, Military; D006801:Humans; D000069544:Infectious Encephalitis / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D016015:Logistic Models; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D055815:Young Adult
Cerebral lesion; Gabon; HIV; Libreville; neuromeningitis