PubMed Health⌕ Search

Biomedical subjects

K Domoua

Publications and source records attributed to K Domoua.

17 recordsLinked to original sources
PubMed2000

[Adult non-viral lymphocytic meningitis in Abidjan (Côte d'Ivoire)].

Our prospective and longitudinal study aimed to analyse the aetiologies, clinical features and prognostic of non viral lymphocytes meningitis (NVLM). We recruited 131 patients, 77 males (59%) and 54 females (41%) sex-ratio 1.4. The mean age was 35 years [15-67]. 117 patients were HIV positive (89%) and 14 (11%) were HIV negative. Feverish meningoencephalitis was present in 85% of cases, with 7 days for mean delay of admission into hospital. 80 germs were found in the C.S.F. 70 Cryptococcus neoformans, 4 Mycobacterium tuberculosis, 3 Streptococcus pneumoniae, 1 Candida albicans, 1 Neisseria meningitis and 1 Trypanosoma gambiense. 63 aetiologies were linked to lymphocytes meningitis by indirect deduction: 41 cases of tuberculous meningitis with lung X-ray anomalies and M. tuberculosis in sputum (11 times), 11 cases of cerebral malaria with Plasmodium falciparum in blood, 11 cases of cerebral toxoplasmosis by significant features with cerebral tomodensitometry. Letality was 53%, 35% of patients improved and 12% were lost to follow-up. Our study shows the difficulties in the management of the NVLM, due to the delay of diagnosis, particularly for tuberculous meningitis.

Adolescent↗
PubMed2000

[Simultaneous resistance to rifampicin and isoniazid in patients with pulmonary tuberculosis].

Percentages of primary and acquired resistance to anti-tuberculosis drugs provide an epidemiological indicator useful for assessing national anti-tuberculosis programs. Rifampicin and isoniazide are widely used in countries with a high prevalence of tuberculosis. In tropical Africa, these drugs are the mainstay treatment for tuberculosis, used both in the initial and long-term regimens. Simultaneous resistance to these two antibiotics would seriously jeopardize therapeutic efficacy. We studied simultaneous rifampicin and isoniazide resistance in patients hospitalized for tuberculosis in the respiratory disease unit of the Treichville University hospital in Abidjan, Ivory Coast. Mycobacterium tuberculosis was isolated in 8 patients. All the strains isolated were resistant to streptomycin. History taking revealed that resistance was observed at the initial prescription in 6 cases. A notion of contagion was present in 4 cases. Six patients were HIV-positive. Surveillance of resistance to anti-tuberculosis drugs is helpful in detecting early changes which could compromise the efficacy of the therapeutic scheme.

AIDS-Related Opportunistic Infections↗
PubMed1999

Efficacy of trimethoprim-sulphamethoxazole prophylaxis to decrease morbidity and mortality in HIV-1-infected patients with tuberculosis in Abidjan, Côte d'Ivoire: a randomised controlled trial.

BACKGROUND: There is a high incidence of opportunistic infection among HIV-1-infected patients with tuberculosis in Africa and, consequently, high mortality. We assessed the safety and efficacy of trimethoprim-sulphamethoxazole 800 mg/160 mg (co-trimoxazole) prophylaxis in prevention of such infections and in decrease of morbidity and mortality. METHODS: Between October, 1995, and April, 1998, we enrolled 771 HIV-1 seropositive and HIV-1 and HIV-2 dually seroreactive patients who had sputum-smear-positive pulmonary tuberculosis (median age 32 years [range 18-64], median CD4-cell count 317 cells/microL) attending Abidjan's four largest outpatient tuberculosis treatment centres. Patients were randomly assigned one daily tablet of co-trimoxazole (n=386) or placebo (n=385) 1 month after the start of a standard 6-month tuberculosis regimen. We assessed adherence to study drug and tolerance monthly for 5 months and every 3 months thereafter, as well as rates of admission to hospital. FINDINGS: Rates of laboratory and clinical adverse events were similar in the two groups. 51 patients in the co-trimoxazole group (13.8/100 person-years) and 86 in the placebo group (25.4/100 person-years) died (decrease In risk 46% [95% CI 23-62], p<0.001). 29 patients on co-trimoxazole (8.2/100 person-years) and 47 on placebo (15.0/100 person-years) were admitted to hospital at least once after randomisation (decrease 43% [10-64]), p=0.02). There were significantly fewer admissions for septicaemia and enteritis in the co-trimoxazole group than in the placebo group. INTERPRETATION: In HIV-1-infected patients with tuberculosis, daily co-trimoxazole prophylaxis was well tolerated and significantly decreased mortality and hospital admission rates. Our findings may have important implications for improvement of clinical care for such patients in Africa.

AIDS-Related Opportunistic Infections↗
PubMed1998

[Efficacy of a short 6 month therapeutic coursefor HIV infected tuberculosis patients in Abidjan, Côte d'Ivoire].

From December 1992 to February 1993, 104 newly diagnosed pulmonary tuberculosis patients were enrolled in a prospective cohort study to assess the response to the 6 month-short-course regimen implemented in Cote d'Ivoire. This treatment encompassed the daily intake of Rifampicin and Pyrazinamide for 2 months followed by Rifampicin and Isoniazid for the remaining 4 months. All the patients were enrolled at the Treichville Tuberculosis Treatment Centre in Abidjan, and a follow-up of 6 months was observed for each patient. All in all, 41 patients were HIV-positive whereas 63 where HIV-negative. No statistical difference was noted between HIV-positive and HIV-negative patients with regard to the completion of therapy (85% versus 87%). The cure rate after an effective 6 month-therapy was similar among HIV-positive and HIV-negative patients (83% versus 84%) as well as the treatment failure rate which was 2.4% and 3% respectively. The results clearly indicate that the 6 month-short-course regimen policy implemented in Côte d'Ivoire is as effective for the treatment of HIV-associated tuberculosis as for the treatment of tuberculosis.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Spectrum of disease among HIV-infected adults hospitalised in a respiratory medicine unit in Abidjan, Côte d'Ivoire.

SETTING: Respiratory medicine wards of the University Teaching Hospital, Abidjan, Côte d'Ivoire. OBJECTIVES: To describe the spectrum of opportunistic infection among human immunodeficiency virus (HIV) infected adults hospitalised in the respiratory medicine unit in Abidjan, and the level of immunosuppression at which these diseases occur. DESIGN: Cross-sectional study. RESULTS: Overall, 75% of patients were HIV-positive: among these patients, the most frequent diagnosis was tuberculosis, in 61%, followed by bacterial pneumonia (15%), Gram-negative septicaemia (particularly non-typhoid Salmonella) (9%) and empyema (5%). Atypical pneumonias appeared to be rare. Most HIV-positive patients had CD4 counts indicative of advanced immunosuppression: 36% had CD4 counts below 100 x 10(6)/l, 19% between 100 and 199 x 10(6)/l, 29% between 200 and 499 x 10(6)/l, and 16% above 500 x 10(6)/l. Overall in-hospital mortality was 27% for HIV-positive patients and 22% for HIV-negative patients (P = 0.5). In a multivariate analysis, the strongest independent risk factors for death were cachexia (odds ratio [OR] 7.4, 95% confidence interval [CI] 2.1-26.3), male sex (OR 4.5, 95% CI 1.2-17.4) and age over 40 (OR 4.1, 95% CI 1.0-17.2). CONCLUSIONS: Tuberculosis and bacterial infections are the major causes of respiratory morbidity in immunosuppressed HIV-infected adults in this population. Efforts to improve the management of HIV-related disease need to focus on prevention and treatment of these infections.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Pulmonary complications of human immunodeficiency virus infection in sub-Saharan Africa].

Based on a selection of articles published in the literature and reports from international AIDS conferences, we present the main pulmonary complications of HIV-infection observed in sub-Saharan Africa. The different clinical studies demonstrate the predominance of infectious complications, mainly tuberculosis (29 to 44%) and bacterial pneumonia (21 to 35%). The frequency of Pneumocystis carinii pneumonia remains low (5 to 19%). Other complications (mycobacterial infection, cytomegalovirus, toxoplasmosis, cryptococcus, aspergillosis, interstitial lymphoid pneumonia, Kaposi sarcoma) are less frequent. The autopsy studies report similar results and mention the predominance of tuberculosis and pneumonia due to common germs as well as the low frequency of pneumocystosis. This analysis of work conducted in sub-Saharan Africa clearly indicate that tuberculosis remains the leading cause of morbidity and mortality in HIV-infected patients.

AIDS-Related Opportunistic Infections↗
PubMed1995

[The new face of tuberculosis in the context of the tuberculosis-HIV association in Abidjan, Ivory Coast].

This article reviews the main clinical aspects and progression of HIV-related tuberculosis in Abidjan. HIV prevalence in tuberculosis patients is high, estimated at 46.2% in 1992, with a clear predominance of HIV-1 over HIV-2. More than 61% of co-infected tuberculous patients meet the WHO's clinical definition of AIDS (the Bangui definition) at the time of diagnosis of tuberculosis. This rates falls to 46-51% when cough is excluded from the definition. On X-rays, the signs of pulmonary tuberculosis in co-infected tuberculous patients are atypical in the advanced stages of HIV infection, when extra-pulmonary localization, mainly mediastinal adenopathy, is frequent. Short-course chemotherapy consisting of 2 months' unsupervised daily treatment with rifampicin/isoniazid/pyrazinamide, followed by 4 months of a daily combination of rifampicin/isoniazid, applied in the Ivory Coast since 15 July 1985, has proved successful in HIV-associated tuberculosis, with treatment effectiveness rates of more than 90%.

Adult↗
PubMed1995

[Autopsy findings in 70 AIDS patients who died in a department of pneumology in Ivory Coast: impact of tuberculosis].

Based on autopsy findings in 70 patients infected by human immunodeficiency virus (HIV) who died in the Pulmonology Department of the Treichville University Hospital Center in Abidjan, Ivory Coast. the authors assess the incidence of tuberculosis as the cause of death and analyze the clinical, bacteriologic, and histologic features of the disease. in this population. Pulmonary tuberculosis was the first cause of death in this series accounting for 31 cases (44.2%). In 12 cases (38.7%), microscopic identification failed during hospitalization and the disease had been misdiagnosed as common bacterial pneumonia. In 29 cases (93.5%) pulmonary tuberculosis was associated with abdominal involvement. In 17 cases (54.8%) involvement of more than two organs was observed. Of the 60 abdominal sites detected during the autopsy of the 31 patients with pulmonary tuberculosis, there were 19 (31.3%) in lymph nodes, 18 (30%) in the liver, 14 (23.3%) in the spleen, and 9 (14.9%) in the kidneys. Histologic features were remarkable by the absence of typical tuberculous granulomas. The findings of this study confirm the high incidence of disseminated tuberculosis in patient infected by HIV as noted in a number of previous studies.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Etiologic aspects and therapeutic problems of purulent pleurisy in Abidjan (Côte d'Ivoire)].

We present the results of a retrospective study of 127 cases of empyema admitted to the pneumophtisiology department of the Centre hospitalier universitaire de Treichville (Abidjan), between January 1985 and December 1989. We present the pathogens identified in the pleural fluid and the course of the disease during treatment by repeat thoraco-centesis and systemic antibiotics. During the study period, pleural empyema represented 2.7% of all admissions to the pneumophtisiology department, and 20.5% of those presenting with pleural effusions. Bacteriological examination was recovered in 88 of the 127 patients, and was positive in 57 cases (64.7% of those examined). Of those with positive bacteriology, 50 (56.8%) had non-tuberculous bacterial infections, and 7 (7.9%) had tuberculous infection. Among the non-tuberculous bacterial infections, Gram-negative bacilli were most common (72%), and Pseudomonas was the species most frequently identified (48%). The mean stay in hospital was 47 days (range 10-143) and in 82 patients (64.6%), the outcome was favourable. The presentation was complicated by encystment in 36 cases (28.4%) and 9 patients (7%) died in hospital.

Cote d'Ivoire↗
PubMed1994

[Aspects of thoracic radiography of patients with tuberculosis and HIV infection in Ivory Coast].

The aim of this prospective study was to investigate the main features of standard chest X-ray in patients with concomitant tuberculosis and HIV infection. From 21 December 1992 to 21 February 1993, we compared 45 chest X-rays of HIV+patients with pulmonary tuberculosis with those of 73 HIV negative patients with pulmonary tuberculosis. Our results revealed that extrapulmonary thoracic localizations were remarkably frequent in HIV+tuberculosis patients (57.8% versus 22% in HIV-patients; P < 0.05). Extrapulmonary localizations were frequently mediastinal lymph nodes (82.7%). Parenchymal involvement was often extensive including frequent miliary images (20% versus 38.3% in HIV-patients). Thus despite the lack of CD4 counts in our study, we were able to observe that about one half the co-infected tuberculosis patients had reached the stage of AIDS as defined by the CDC in 1987. These findings are in agreement with those reported in the literature and would suggest that thoracic manifestations of tuberculosis is a good marker of the state of immunodepression.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Prevalence of pneumocystosis in HIV infected patients in a pneumology unit. Autopsy study performed in Abidjan (Côte d'Ivoire)].

Autopsies were performed in the Pathology Department of the Treichville University Hospital, Abidjan, Ivory Coast in 70 HIV infected subjects who had died in the Department of Pneumophtisiology. The prevalence of Pneumocystis carinii pneumonia was determined. None of the patients had received prophylaxis against P. carinii and none had bee treated for pneumocystosis. Autopsies were performed within 6 to 48 hours after death and the diagnosis of pneumocystosis was confirmed with the Gomori-Grocott staining technique on lung specimens. Among the 70 autopsies Pneumocystis carinii pneumonia was observed in 6. Thus the prevalence of P. carinii pneumonia in these patients infected with HIV was 8.57%.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Hemoptysis: main etiologies observed in a pneumology department in Africa].

The aim of this work was to ascertain the main aetiologies of haemoptysis observed in the pneumo-phtisiology unit at the University Hospital of Treichville at Abidjan, Ivory Coast. A retrospective survey covering 5 years revealed 142 cases. The annual incidence of haemoptysis was 2.5% of the unit's admissions. The mean age of the patients was 33.2 years and 56.3% were at least 41 years of age. Men were predominate (72.5%). The haemoptysis was a sign of thoracic disease in 66.9% of the cases. The chest X-ray was judged abnormal in all the cases and suggested the aetiology in 87.3%. The main aetiologies were pulmonary tuberculosis (49.3%) and acute pneumopathy (with or without abscess) (13.3%). Other causes included bronchectasis (11.2%) and pulmonary aspergilloma (7.7%), followed by bronchogenic cancer (4.2%). The results of this study indicated that tuberculosis remains one of the main causes of haemoptysis at Abidjan.

Adult↗
PubMed1993

[Pulmonary diseases and retrovirus infections. A pathological study in 70 cases].

A necroscopic study, conducted in the Pathology Department of the Centre Hospitalier Universitaire (CHU) de Treichville in Abidjan, included 70 seropositive subjects who died in the Pneumophtisiology Department. We attempted to determine the different pulmonary affections occurring during infection with the human immunodeficiency virus (HIV). This study demonstrated the predominant role of tuberculosis (44%) and bacterial pneumonia (30%) which remain the predominant aetiologies. Other opportunistic affections were rare including: Pneumocystises, Mycobacteriaceae, and Cytomegalovirus infection and the Kaposi sarcoma. The absence of pulmonary cryptococcosis and non-Hodgkin lymphoma were also noted. Necroscopic examinations do not necessarily provide evidence of the in vivo pathologies, the autopsy being able to identify only the causal diseases or those present at death.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Acute bacterial pneumonia in retroviral infections. Epidemiologic, clinical, radiologic, bacterial and developmental aspects].

From a prospective study starting January 8 to 1990 October 20, the authors discuss 70 cases of acute pneumopathy, supposed to be bacteriologic in patients infected by HIV. The observed pneumopathies are more frequent in young adults, with a pic between 20 to 40 (67.15 p.c). The positivity rate of hemocultures was estimated at 17.14 p.c. with a clear predominance of non typhic Salmonellae. The evolution observed, generally favourable at 72.85 p.c was fatal in 17.15 p.c.

Adult↗