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Genetic diversity analyses were performed by sero-genotyping and multi-locus sequence typing on 252 cryptococcal isolates from 13 HIV-positive Ivorian patients followed-up for cryptococcal meningitis. Antifungal susceptibility analyses were performed according to the CLSI M27A3 method. The majority (67.8%) of the isolates belonged to the Cryptococcus neoformans (serotype A) species complex, with 91.9% being VNI and 7.1% being VNII. Cryptococcus deuterogattii VGII (serotype B) represented 16.7% of the strains, while C. neoformans/C. deneoformans VNIII (serotype AD) hybrids accounted for 15.1% of the strains. One strain (0.4%) was not identifiable. Nine different sequence types (STs 5, 6, 23, 40, 93, 207, 311, and a new ST; 555) were identified in the C. neoformans population, while the C. deuterogattii population comprised the single ST 173. The distribution of the strains showed that, while the majority of patients (9/13) harboured a single sequence type, 4 patients showed mixed infections. These patients experienced up to 4 shifts in strain content either at the species and/or ST level during their follow-up. This evolution of diversity over time led to the co-existence of up to 3 different Cryptococcus species and 4 different ST within the same individual during the course of infection. Susceptibility testing showed that all strains were susceptible to amphotericin B while 3.6% of them had a none-wild type phenotype to 5-flucytosine. Concerning fluconazole, 2.9% of C.neoformans serotype A strains and 2.4% of C. deuterogattii had also respectively a none-wild type phenotype to this molecule. All C. neoformans x C. deneoformans serotype AD hybrids had however a wild type phenotype to fluconazole. The present study showed that mixed infections exist and could be of particular importance for care outcomes. Indeed, (i) the different Cryptococcus species are known to exhibit different virulence and different susceptibility patterns to antifungal drugs and (ii) the strains genetic diversity within the samples may influence the susceptibility to antifungal treatment. Author summary: Cryptococcal meningitis is a neglected fungal disease responsible for 181 000 deaths worldwide in 2014, with 75% of deaths occurring in sub-Saharan Africa. Cryptococcal meningitis is caused by environmental yeasts belonging to the Cryptococcus neoformans/Cryptococcus gattii species complexes. The evolution of the diversity of the yeast populations within the patients and during the course of treatment is poorly understood. Indeed, it was believed for a long time that infections were of a single strain type. It was only recently that the complexity of the yeast diversity during infection began to be assessed. Here, the researchers evaluated the diversity of the Cryptococcus population within Ivoirian patients. The purpose was to generate data about the overall diversity of such yeast in Western Africa where the data are scarce and to better understand the evolution of the pathogen populations during patient follow-up. This last point is particularly important because some species are more virulent or naturally more resistant to antifungal treatments and could be an issue in the case of relapses during care protocols. [ABSTRACT FROM AUTHOR]

In HIV-infected patients thromboembolic disease is a complication linked to heightened risk. In Ivory Coast no study has been conducted on HIVinfected patients treated in HIV Services. The aim of our study is to describe HIV-associated thromboembolic manifestations in patients treated or untreated with antiretroviral drugs whose data were collected in the Infectious and Tropical Diseases Service (ITDS). We conducted a retrospective study by reviewing the medical records of HIV-infected patients hospitalized with deep vein thrombosis (DVT), arterial thrombosis and/or pulmonary embolism over the period January 2005-July 2015. Diagnosis was based on Doppler ultrasound of vessels and/or on thoracic angioscanner. Diagnostic, therapeutic and evolutionary features of thromboembolic manifestations in these patients were analyzed. The medical records of 36 patients, including 23 women (64%), with a sex-ratio M/F of 0.57 and an average age of 43±12 years were selected. Deep venous thrombosis (DVT) was found in 26 (72.2%) patients, pulmonary embolism (PE) in 9 (25%) patients and arterial thrombosis in 1 patient (2.8%). DVT was unilateral in 81% of cases and predominantly left-sided in 77% of cases. PE was unilateral and right-sided in 100% of cases while arterial thrombosis was bilateral in 2.7% of cases. In patients with DVT, the femoral vein (39%) and the popliteal vein (35%) were most commonly affected by thrombosis. PE involved the pulmonary arteries in 77.8% of cases while arterial thrombosis involved the left and right internal carotid. The majority of patients was under antiretroviral treatment (69%). The most commonly associated opportunistic infections included oral candidiasis (31%) and tuberculosis (33%). Nine patients died (25%). This study highlights high rates of DVT in HIV-infected patients. Other studies are necessary to better understand the role of HIV in the occurrence of thromboembolic disease. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiological, clinical and prognosis aspects of tetanus in patients hospitalized at the Infectious and Tropical Diseases Unit of Treichville Teaching Hospital. Methods: A retrospective study of the medical records of all patients hospitalized between 2005 and 2014. The "Dakar prognosis score" was established on the basis of six parameters: incubation period, duration of invasion, site of entry, presence of paroxysms, body temperature and pulse rate. A logistic regression model was used to identify the factors associated with death. Results: Overall, 455 cases of tetanus were included, with a predominance of males (86%). Most patients lived in Abidjan (77%). A very high proportion of cases were generalized tetanus (96%), and 137 patients (30%) died. The factors associated with death were age >60 years (aOR 2.76; 95% CI 1.07 to 9.91), being a labourer (aOR 2.83 95% CI 1.07-9.39), a severe Dakar prognostic score (aOR 5.76; 95% CI 2.26-14.72), no intrathecal serotherapy (aOR = 15.6; 95% CI 5.40- 44.84), no penicillin-therapy (aOR 2.33; 95% CI 1.11-4.87) and the presence of complications (aOR 8.53, 95% CI 4.83-15.09). Conclusion: This study identifies a number of factors for a poor prognosis among patients with tetanus admitted to our hospital, indicating that measures to reduce morbidity and mortality due to tetanus should be strengthened and prevention improved in resource limited settings. The prognostic parameters in "the Dakar score" should therefore be adapted to the current epidemiological and clinical contexts in Côte d'Ivoire. [ABSTRACT FROM AUTHOR]

The aim of this work is provide the results of the surgical treatment of strangulated groin hernias and determine morbidity and mortality risk factors. It is a retrospective study related to the 288 records of patients aged 15 years and more, who underwent emergency surgery for strangulated groin hernia from January 2007 to December 2012. Postoperative evolution was assessed on the morbidity, mortality, and length of hospital stay. Mortality and morbidity risk factors were studied. The statistical analysis was conducted with the chi-square test and Fischer's exact test with a significance level of 5 %. Strangulated groin hernias account for 42.2 % of the overall groin hernia operations conducted during the study period (288/697). Necroses were present in 59 (20.5 %) patients. The mortality rate was 6.2 % ( n = 18). Admission time superior or equal to 48 h ( p = 0.002), American Society of Anesthesiologists (ASA) class superior or equal to III ( p = 0.002), presence of preoperative strangulated groin hernia complication (peritonitis, occlusion, hernia abscesses) ( p = 0.001), bowel necrosis ( p = 0.000), and bowel resection ( p = 0.000) were statistically related to a high risk of death. Forty-two ( n = 42) postoperative complications were recorded in 34 (11.8 %) patients. These complications were outnumbered by postoperative parietal suppuration ( n = 26) which led to three cases of evisceration. Bowel necrosis was related to a high risk of postoperative complications ( p = 0.002). Reoperation was necessary for 13 patients. The length of stay in hospital was 4 days (range between 1 and 28 days). The average follow-up period was 7 months. No recurrence was noticed during this period. Delay in consultation, high ASA class, and moreover, bowel necrosis requiring bowel resection are the factors of unfavorable postoperative results. Groin hernias are an avoidable death cause provided that early treatment of strangulated hernias and the elective treatment of non-complicated hernias are conducted. [ABSTRACT FROM AUTHOR]

The article discusses a study to estimate adherence to highly active antiretroviral therapy (HAART) and its determinants in HIV-infected persons in Abidjan, Côte d'Ivoire. Patients on HAART who attended the HIV outpatient clinics self-reported their pill intake. The association of incomplete adherence with patients' characteristics was examined using multivariate logistic regression.