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Cerebral Toxoplasmosis in People Living With HIV: Mortality and Factors Associated with Death

Khardiata Diallo Mbaye, Agbogbenkou Tevi Dela-dem Lawson, Ndèye Aïssatou Lakhe, Viviane Marie Pierre Cisse Diallo, Daye Ka,Ndèye Maguette Fall, Daouda Thioub, Aboubakr Sadikh Badiane, Alassane Sarr, Latyr Junior Diouf, Louise Fortes, Cheikh TidianeNdour, Masserigne Soumaré and Moussa Seydi

Background: Toxoplasmosis is one of the main opportunistic infections during HIV infection. Its cerebral localisation in
immunocompromised patients is severe. In HIV-infected patients, in-hospital mortality remains high. In Senegal, this condition poses a
problem both in terms of diagnosis and treatment.
Methods: We conducted a retrospective study of descriptive and analytical purposes of patients hospitalised for cerebral toxoplasmosis
with an underlying HIV/AIDS condition, in the infectious and tropical diseases department of Fann Teaching Hospital.
Results: We collected 78 patients over a six-year period range from 1 January 2012 to 31 December 2017. The average age was
44 years with a sex ratio of 1.29. In 54% of cases, cerebral toxoplasmosis was the reason of HIV discovery. The symptoms featured poor
general condition with focal signs (82%), fever (27%), headache (62%), consciousness impairment (55%), meningeal signs (27%), and
convulsions (17%). The most common opportunistic infections were of digestive (58%) and neurological (17%) localisations. Paraclinical
investigations outlined that 95% of patients underwent a full blood count that revealed anaemia in 64% of cases. Toxoplasma serology
was positive in 21% of patients. Cerebral CT scans in 71% of cases showed single (25%) and multiple (35%) abscesses. Seventythree
percent of the patients were severely immunocompromised with a mean LTCD4 level of 99 cells/mm3. All patients received a
curative dose of cotrimoxazole. Adherence to anti-toxoplasma treatment was good in 71% of cases, and 53% of our study population
were on ARV treatment. The overall outcome was unremarkable in 71% of cases, with a case fatality rate of 24%. Temporo-occipital
lesions (p=0.014), late initiation of cotrimoxazole (p=0.000) and poor compliance with antitoxoplasmic therapy (p=0.021) as well as ARV
regimen (p=0.012) were correlated to death with a statistically significant difference.
Conclusion: In our regions, this condition is a diagnostic and therapeutic concern related to the difficulty to perform medical imaging
examinations that are not always accessible and to the fact that reference treatment is expensive and not always available. It would
therefore be wise to make diagnostic and therapeutic means more affordable.