Cerebro-meningeal infections in HIV-infected patients: a study of 116 cases  in Libreville, Gabon.

Magloire Ondounda1, Chinenye Ilozue, Caroline Magne
1. Department of Infectious and Tropical Diseases, Hôpital d’Instruction des Armées Omar Bongo
Ondimba, BP 20404 Libreville PK9, Gabon. magondounda@yahoo.fr
2. Department of Internal Medicine, Hôpital d’Instruction des Armées Omar Bongo Ondimba, BP 20404
Libreville PK9, Gabon. cilozue@doctors.org.uk
3. Department of Internal Medicine, Hôpital d’Instruction des Armées Omar Bongo Ondimba, BP 20404
Libreville PK9, Gabon. m2caroline@yahoo.fr

Abstract
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%.

Conclusion: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.

Keywords: Cerebral lesion, neuromeningitis, HIV, Libreville, Gabon