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But du travail : Décrire les profils épidémiologiques, clinico-paracliniques, thérapeutiques et évolutifs des patients infectés par le VIH qui ont présenté une infection à Cryptococcus neoformans. Matériel et méthode : Étude rétrospective portant sur les dossiers de 27 patients infectés par le VIH suivis au Service des Maladies Infectieuses du CHU Mohamed VI et hospitalisés pour une infection à Cryptococcus neoformans entre janvier 2007 et juillet 2018. Résultats : La prévalence était de 3,37 %. L'âge moyen des patients était de 39,22 ans [19-64] avec une prédominance masculine (21 hommes, 77,7 %). La cryptococcose était révélatrice de l'infection à VIH chez 16 patients (60%). La localisation neuroméningée était présente chez 25 patients (92,6%). Les céphalées dominaient le tableau clinique chez 23 patients (85 %). L'examen à l'encre de chine a permis d'isoler le Cryptococcus neoformans que dans le LCR chez 21 patients (78%) et la culture chez 22 patients (81,5%). Le bilan d'extension montrait des hémocultures positives à Cryptococcus neoformans chez 7 patients (26%). Le taux moyen des lymphocytes CD4 était 56 cellules /mm3. Onze patients (41%) ont été traités par l'association Amphotéricine B + Fluconazole et 16 patients (59%) par Fluconazole en monothérapie. L'évolution était favorable chez 22 patients (81,5%) Conclusion : La fréquence et la gravité de l'infection à Cryptococcus neoformans chez les patients infectés par le VIH implique un dépistage même en absence de signes cliniques en cas d'immunodépression profonde.

Identifying plant extracts that could be used as new treatments for candidiasis and Streptococcus pneumoniae infections.In this work, we tested the activity of the ethanolic and methanolic extracts of Rosmarinus officinalis and Zingiber officinale on Candida albicans, Candida glabrata, Candida tropicalis, Candida krusei and Streptococcus pneumoniae. The anti-microbial activity was first tested in vitro, then in vivo on mice and rats.The results showed that the methanolic extract of Rosmarinus officinalis and the ethanolic extract of Zingiber officinale were the most active on all the tested micro-organisms. The most sensitive species were Candida albicans, Candida krusei and Streptococcus pneumoniae. The in vivo anti-microbial activity reported that the ethanolic extract of Zingiber officinale was the most active on the three species. On the contrary, Candida glabrata and Candida tropicalis were more sensitive to the methanolic extract of Rosmarinus officinalis, but these species were considered as the most resistant yeasts.The ethanolic extract of Zingiber officinale was more active than fluconazole and amoxicillin on Candida albicans, Candida krusei and Streptococcus pneumoniae, so, it could be considered for treating infections by these species. Similarly, the methanolic extract of Rosmarinus officinalis could be effective for treating candidiasis by Candida glabrata and Candida tropicalis.

Introduction : La péritonite fongique (PF) en dialyse péritonéale (DP) est une infection grave qui met en jeu le pronostic fonctionnel du péritoine et le pronostic vital du patient. Elle doit bénéficier d’une prise en charge rapide mais néanmoins peu codifiée. Chaque centre assure donc une prise en charge individualisée de ses patients. Matériels et méthode : Le but de notre étude est de décrire notre expérience de 10 ans à travers nos patients qui ont présenté une PF. Nous avons réalisé une étude rétrospective descriptive des cas de péritonites et extrait les PF documentées dans l’unité de DP. Résultats : La prévalence de la PF était de 5,1%, soit 9 cas. Les signes cliniques prédominant étaient la turbidité du dialysat et les douleurs abdominales. La PF était primitive pour 3 patients. Le traitement antifongique utilisé en majorité était le Fluconazole, associé à une augmentation du nombre des échanges péritonéaux. L’ablation du cathéter de DP a été faite chez 8 patients avec un délai moyen de 5,5 jours. L’évolution globale était favorable et 3 patients ont repris une épuration extrarénale par DP. Nous n’avons déploré aucun décès ni péritonite encapsulante imputable à la DP. Discussion et conclusion : La PF est une complication infectieuse de fréquence variable et un taux de mortalité élevé. Le taux de sortie de la technique de DP est aussi important. L’évolution favorable de nos patients restés en DP laisse présager la possibilité d’un plus grand nombre de patients maintenus en DP après une PF., Bulletin de la Dialyse à Domicile, Vol. 2 No 2 (2019): Bulletin de la Dialyse à Domicile

La cryptococcose neuroméningée (CNM) est une mycose opportuniste fréquente et sévère causée par une levure encapsulée Cryptococcus neoformans. Elle est fréquente chez l'immunodéprimé en particulier le sujet atteint du virus de l'immunodéficience humaine (VIH) à un stade avancé de la maladie, elle est rare chez l'immunocompétent. Nous rapportons 40 cas de cryptococcose neuroméningée (CNM) diagnostiqués au laboratoire de parasitologie de l'hôpital Ibn Sina de Rabat sur une période de 21 ans (1993 à 2014). Le diagnostic de la cryptococcose neuroméningée a reposé sur la mise en évidence de Cryptococcus neoformans dans le liquide céphalorachidien (LCR) après l'examen direct à l'encre de Chine et la culture sur milieux de sabouraud sans actidione, ainsi que la recherche d'antigènes solubles cryptococciques. Trente cinq patients étaient infectés par le VIH, deux patients étaient apparemment immunocompétents et 3 patients immunodéprimés non VIH (30 hommes et 10 femmes). L'âge moyen des patients était de 38 ans. La cryptococcose neuroméningée était révélatrice de l'infection par le VIH dans 13 cas. Dans 22 cas elle a représenté une complication du SIDA. Vingt sept patients de notre série ont été traités par une monothérapie à base de fluconazole. L'amphotéricine B a été utilisée chez 13 patients. L'évolution a été favorable pour 13 patients (32.5%) et trois cas ont connu une complication (7.5%). Alors que 18 patients sont décédés (45%) et 6 ont été perdus de vue (15%). Pour un diagnostic rapide, la recherche de Cryptococcus neoformons doit être appliquée systématiquement devant le moindre signe neurologique.

Leishmaniases are parasitic diseases occurring in endemic tropical and subtropical areas and caused by protozoa of the genus leishmania, transmitted by a diptera (sand fly). We here report a case of topical cutaneous leishmaniasis discovered in a 15-year old boy with painless ulcer on his left leg, who had been staying in South Africa. Clinical examination showed painless non-itchy ulcer, occurred 1 month before, on the antero-internal part of his left leg with crusts and scars caused by insect bites, all evolving in a context of patient's general health status, without mucosal or visceral lesions. Skin biopsy allowed specific parasitologic diagnosis revealing topical zoonotic cutaneous leishmaniasis caused by L. major. The patient underwent topical treatment based on paramomycin and oral fluconazole resulting in ulcer healing at the end of 2 months.

Assessing the use of high-dose fluconazol monotherapy (1200mg or 800mg) in the treatment and prognosis of HIV-associated cryptococcal meningitis in Ivory Coast.A retrospective study carried out from August 2008 to August 2011 based on patients charts suffering from CM in the Abidjan Tropicals and Infectious Disease Unit. Mortality rate and associated factors were analyzed.Forty-six cases of cryptococcal meningitis (2.5% of hospitalizations) were included. The sex-ratio was of 1.2. The median age was 40.5 [35-47] years. The symptomatology was subacute (93.5%). The main clinical symptoms were syndrome of pure meningeal irritation (65%), fever (100%); 35% of patients had encephalomeningits. Twenty-one (45.7%) was ART-naïve patients. Fluconazole 1200mg was prescribed to 29 (63%) patients. Therapeutic lumbar punctures were performed in 42 (91.3) patients. The mortality rate was 50%. Significant predictors of mortality were encephalomeningitis and therapeutic lumbar puncture.Cryptococcal meningitis associated mortality remains high despite the use of high-dose fluconazole monotherapy. Therapeutic lumbar punctures help to improving the prognosis.

In developing countries where systemic antifungal are often unavailable, treatment of filamentous fungi infection as Fusarium is sometimes very difficult to treat. We report the case of a keratomycosis due to Fusarium oxysporum treated by povidone iodine eye drops and oral fluconazole. The diagnosis of abscess in the cornea was retained after ophthalmological examination for a 28-year-old man with no previous ophthalmological disease, addressed to the Ophthalmological clinic at the University Hospital Le Dantec in Dakar for a left painful red eye with decreased visual acuity lasting for 15 days. The patient did not receive any foreign body into the eye. Samples by corneal scraping were made for microbiological analysis and the patient was hospitalized and treated with a reinforced eye drops based treatment (ceftriaxone+gentamicin). The mycological diagnosis revealed the presence of a mold: F. oxysporum, which motivated the replacement of the initial treatment by eye drops containing iodized povidone solution at 1% because of the amphotericin B unavailability. Due to the threat of visual loss, oral fluconazole was added to the local treatment with eye drops povidone iodine. The outcome was favorable with a healing abscess and visual acuity amounted to 1/200th. Furthermore, we noted sequels such as pannus and pillowcase. The vulgarization of efficient topical antifungal in developing countries would be necessary to optimize fungal infection treatment.

Cryptococcosis is a potentially severe infection that usually occurs in a setting of immunosuppression. Its occurrence outside of this context is rare. We report a case of disseminated cryptococcosis revealed by a spectacular skin disease in an immunocompetent patient.A 40-year-old male patient had been presenting multiple nodules and tumors on his face for one month in a context of asthenia and intermittent fever. Histological examination of a skin biopsy revealed encapsulated yeasts strongly suggestive of Cryptococcus neoformans. Mycological examination of the skin biopsy and cerebrospinal fluid isolated Cryptococcus gattii. The blood cultures were positive. Brain MRI demonstrated cryptococcal parenchymal involvement. Screening for primary or secondary immunodeficiency was negative. The patient received amphotericin B 1mg/kg/day and fluconazole 600mg/day but died 2months after diagnosis.Cryptococcosis is a potentially severe infection caused by C. neoformans. This rare condition occurs most commonly in patients with profound deficiency in terms of cellular immunity. Although rare, the occurrence of cryptococcosis in immunocompetent patients is possible, and in this event the signs are highly polymorphic, which usually makes it very difficult to diagnose. The diagnosis of cryptococcosis is based on the identification by direct examination and after staining with India ink of encapsulated yeasts of the Cryptococcus genus. Culture on Sabouraud medium is essential for identification of the species. Treatment for disseminated cryptococcosis involves amphotericin B, often associated with flucytosine IV. In the event of meningitis infection in non-HIV patients, mortality continues to be around 15%, despite adequate medical treatment.Although rare, cryptococcosis can occur in immunocompetent subjects. The prognosis is severe even after treatment.

Les levures du genre Candida spp sont, pour la majorité, commensales, vivant de façon silencieuse au sein des muqueuses buccales et digestives, mais tirent profit du déficit immunitaire de l'hôte pour proliférer. Candida albicans est l'espèce la plus fréquemment isolée, elle est naturellement présente dans la flore intestinal humaine, principalement dans les muqueuses digestives et génitales alors que C. glabrata est devenue aujourd'hui, selon plusieurs études, la deuxième ou troisième espèce pathogène opportuniste, suivi par C. para psilosis, C. kruseï, C. kefir . . . ect. Ces espèces ont tendance à former des biofilms qui sont des formes de virulence, notamment lors de la colonisation de surfaces biotiques et/ou abiotique. Ces biofilms présentent une résistance accrue vis-à-vis des agents antifongiques, dont les plus utilisés au sein des hôpitaux sont l'amphotéricine B « AmB » et le fluconazole. Les tests de sensibilités vis-à-vis de ces derniers montre que les cellules sessiles (formant les biofilms) sont beaucoup plus résistantes que leur homologue planctoniques ; l'AmB a un effet sur les biofiims mais à des concentrations toxiques alors que le fluconazole, qui n'est pas toxique, reste moins efficace. Mots clés : Candida spp, Biofilms, Résistance, Amphotéricine B, Fluconazole. Su mma ry: Candida spp are commensal yeast, living silently in the oral and digestive mucosa, but takes advantage of immune deficiency to proliferate. Candida albicans is the most frequently isolated specie; it is naturally present in the human intestinal flora, mainly in the digestive and genital mucosa; on the other hand, according ta several studies, C. glabrata is the second or third opportunistic pathogen specie, followed by C. para psilosis, C. krusei, C. kefir ... etc. These species are apt ta form biofilms that are particular forms of virulence during surfaces colonization. These biofilms have increased resistance at the most antifungal agents used in hospitals like amphotericin B "AmB" and fluconazole. The antifungal susceptibility testing shows that sessile cells (biofilms) are much more resistant than their planktanic counterpart; AmB has an effect on biofilms at the toxic concentrations; however, fluconazole, which is not toxic, is less effective. Keywords: Candida spp, Biiofilrns, Resistance, Amphotericin B, Fluconazole

Les auteurs rapportent un cas de cryptococcose neuroméningée (CNM) chez un patient de 39 ans, non infecté par le VIH suivi pour une tuberculose de hanche. Le tableau clinique était celui d'une méningite subaiguë. Le diagnostic a été possible grâce à la mise en évidence de cryptocoques dans le LCR. L’évolution a été satisfaisante sous fluconazole.

Introduction : Une majorité de médicaments commercialisés au Canada ne comportent pas d’indications et de posologies pour la population pédiatrique. Les cliniciens sont forcés d’utiliser ces médicaments en tenant compte de données parcellaires publiées dans la littérature, dans les ouvrages de référence, selon l’expérience et la réponse clinique chez les patients. Objectifs : L’objectif principal est de décrire et comparer la nature des données pharmacocinétiques et pharmacodynamiques disponibles chez l’adulte et en pédiatrie. L’objectif secondaire est d’établir une stratégie de recherche reproductible et efficiente sur Pubmed pour retracer rapidement les paramètres pharmacocinétiques et pharmacodynamiques pour un médicament donné. Méthode : Dans un premier temps, nous avons recensé les monographies détaillées des médicaments ciblés des sites de Santé Canada, de la Food and Drug Administration (FDA) et de l’EuropeanMedecines Agency (EMA). De plus, nous avons consulté les monographies scientifiques publiées dans les banques de données Micromedex et Up-todate. À partir des sources identifiées, nous avons extrait les renseignements pertinents relatifs à la pharmacocinétique et à la pharmacodynamie de chacun des trois médicaments ciblés dans un tableau synthèse. Résultats : Un total de 1350 articles scientifiques en pharmacocinétique et pharmacodynamie à propos du l’amlodipine, du sildénafil et du fluconazole publiés ont été identifiés. On note près de neuf fois plus d’articles pour l’amlodipine que le fluconazole. La pertinence de chacune des sources consultées variait selon le médicament ciblé. Nous avons testé respectivement sept stratégies pour l’amlodipine (de 0% à 56% de pertinence), 11 stratégies pour le sildéfanil (de 13% à 60% de pertinence) et neuf stratégies pour le fluconazole (de 0 à 75% de pertinence). Conclusion : Cette revue documentaire décrit et compare la nature des données pharmacocinétiques et pharmacodynamiques disponibles chez l’adulte et en pédiatrie pour l’amlodipine, le sildéfanil et le fluconazole. Aucune source documentaire n’était supérieure aux autres pour ces données. Nous pensons qu’il faut au moins trois sources documentaires, et préférablement deux monographies et une base de données afin d’établir un profil pharmacocinétique et pharmacodynamique complet d’un médicament. La présentation de ces données peut contribuer à sensibiliser les cliniciens à exiger davantage de cohérence de l’industrie pharmaceutique et des promoteurs de recherche clinique dans le dépôt de renseignements complets lors d’une présentation de drogues nouvelles au fin d’obtenir un avis de conformité auprès d’une autorité réglementaire.

Candidemia are the most common fungal infections in hospitals. However, the catheters are subject to be altered by Candida biofilms which increase the risk of invasive nosocomial infections due to the high resistance to antifungal agents. Therefore, the minimum inhibitory concentrations of planktonic (MIC) and sessile cells (CIMS) were evaluated.To review the in vivo biofilms structures of Candida sp. formed on the inner and/or external surfaces of collected catheters, we used scanning electron microscopy (SEM). The level of biofilm resistance was assessed against two conventional antifungal agents: amphotericin B (AmB), which belongs to the class of polyenes, and fluconazole (FLZ) which is an azole.The SEM observation of biofilms of Candida sp. reveals complex structures. Compared to MICs, the calculation of CIMS showed an increase of 32 times with AmB and of 128 times with FLZ.Catheters offer an ideal surface to Candida sp. to form biofilms. This complex structure induces the increase of the resistance of sessile cells against two antifungal agents, AmB and FLZ.

To define the terms of use of pesticides, antifungal, antiviral and antiseptic treatments in urology.A literature search was conducted on MEDLINE for all these treatments used in urology. The molecules were classified by family. Modes of action, indications in urology and adverse effects have been detailed. Authorisation files were consulted and then complemented by a literature analysis.Although parasitic or viral diseases are uncommon in urology, their specific treatment deserves a thorough knowledge of pesticide and antiviral molecules. Antifungal treatments are regularly used in urology with special features to know to improve the efficacy/safety ratio. Antiseptics are used daily in urology and a better understanding of these molecules allows better use.Beyond antibiotics, antiviral, antiparasitic and antifungal deserve a thorough knowledge. Antiseptic although used daily have features little known.

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Non-neuromeningeal cryptococcosis forms resulting from disseminated infection are rarely reported in African literature and are non-documented in Malian medical ward. We report two clinical observations. Case 1: a 26-year-old patient, carrying the HIV-1 infection, in which the clinical examination revealed skin lesions simulating molluscum contagiosum and functional impairment of the lower limbs. Radiography of the lumbar spine showed vertebral osteolysis on L4-L5. Cryptococcal research remained negative in the CSF but positive at histological examination of the skin lesions and in pathological products of lumbosacral drainage. The treatment with fluconazole and ARV led to a favorable outcome. Case 2: a 42-year-old patient, admitted for fever cough, known for his non-compliance to ARVs and in which the examination found a syndrome of pleural condensation and a painful swelling of the outer third of the right clavicle (around the acromio-clavicular joint). Paraclinical investigations concluded in osteolysis of the acromial end of the right clavicle and an image of the right lung with abundant effusion. Cryptococcal research was positive in the pleural effusion and in the product of aspiration of acromio-clavicular tumefaction, negative in CSF. It seems important to think of a cryptococcal etiology even in the absence of clinical meningeal signs in front of any cutaneous sign and any fluctuating swelling in HIV+ patient.

En transplantation, les complications infectieuses sont fréquentes et de diagnostic souvent délicat. Elles peuvent coexister chez le transplanté rénal rendant leur diagnostic encore plus difficile. Le but de ce cas clinique est de discuter les difficultés diagnostiques et de surveillance de deux types de pathologies assez fréquentes chez le transplanté rénal, qui sont la tuberculose et la mycose, à travers l’observation clinique d’une patiente de 24 ans transplantée rénale qui présente une spondylodiscite tuberculeuse et qui développe secondairement une septicémie à Candida non albicans à point de départ urinaire dont le seul point d’appel est la fièvre post opératoire.

Describe systemic antifungal therapy in non-neutropenic adult patients in intensive care unit (ICU).A prospective, observational study was conducted during the first half of 2010 in the 7 ICU in a hospital with medical consultant on antimicrobial therapy. All non-neutropenic consecutive adult patients receiving systemic antifungal therapy for documented or suspected invasive fungal infection (IFI) apart from aspergillosis were included.Out of 1502 patients admitted in ICU, 104 (7 %) underwent systemic antifungal therapy, including 30 (29 %) for a documented IFI and 74 (71 %) for a suspected IFI. Candida albicans was identified in 23 (77 %) of the IFI and 45/52 (86 %) of the broncho-pulmonary and/or urinary colonizations in suspected IFI. Echinocandin was significantly more prescribed in patients with a documented infection (19/30 patients) and fluconazole in patients with a suspected infection (48/74 patients). The first line therapy was primarily stopped after recovery (11/30 patients) or de-escalation (9/30 patients) in documented infections, and for lack of indication (34/74 patients) or due to recovery (21/74 patients) in suspected infections after on average of 7 days of treatment.For ICU non-neutropenic adult patients in our center, antifungal therapy is prescribed two times out of three for suspected, unproved infections, in most cases with fluconazole. Documented infections were more often treated by echinocandin with secondary de-escalation. An interventional prospective study to assess the role of antifungal pre-emptive or empirical therapy is necessary.

Les informations concernant les espèces de Candida responsables de péritonite, les facteurs aggravant la mortalité ainsi que les stratégies thérapeutiques à mettre en oeuvre en probabiliste sont encore limitées. Cette étude prospective regroupe 86 patients adultes hospitalisés dans le service de réanimation chirurgicale du CHU de Rouen, qui ont développé une péritonite fongique entre 2006 et 2011. Les espèces de Candida retrouvées sont C. albicans (n = 68/103 isolats, 66%), C. glabrata (n = 11, 11%), C. tropicalis (n = 7), C. krusei (n = 5), C. parapsilosis (n = 4), C. inconspicua (n =2), C. lusitaniae (n = 2), C. intermedia (n = 1), C. kefyr (n = 1), C. norvegiensis (n = 1), C. utilis (n =1). Sur les isolats testés, 10% étaient résistants ou de sensibilité diminuée au fluconazole. Un traitement probabiliste a été mis en oeuvre dans 79% des cas avec un délai d'instauration moyen de deux jours après la réalisation du prélèvement. La mortalité de notre série est de 37% et apparaît moins importante lorsque l'espèce fongique retrouvé est C.glabrata. La réalisation d'une dialyse ou le recours à des amines vasopressives pour palier un choc hémodynamique durant le séjour hospitalier sont des facteurs accroissant la mortalité.

Cryptococcal meningitis is much less common in children than adults. The purpose of this report is to describe 3 cases of cryptococcal meningitis observed in children admitted to the Neurology Department of the Fann University Hospital Center in Dakar, Senegal between July 2003 and November 2008. There were 2 girls whose ages were 8 and 15 years and one 9-year-old boy. All 3 patients presented acute or chronic meningoencephalitis. Diagnosis was based on direct microscopic examination of India ink preparations of cerebrospinal fluid (CSF) showing Cryptococcus neoformans at direct exam. Two patients were immunocompromised including one presenting severe protein-caloric malnutrition and one infected by HIV-1. The third patient was immunocompetent. All 3 patients were treated by intravenous Fluconazole. The immunocompetent boy died after 1 month of hospitalization due to cardiovascular and respiratory insufficiency. Both girls survived with severe neurosensory sequels. Cryptococcal meningitis that is relatively frequent in adulthood may be underestimated in children and should be tested for in any children presenting meningoencephalitis of undetermined cause.

In the USA, the incidence of invasive candidiasis in neonates is respectively 0.3% of infants over 2500 g and up to 20% of infants less than 1000 g. Their incidence is increasing. Two populations of newborn infants are particularly vulnerable: the premature infants and newborn infants with severe neonatal digestive diseases. Fifty percent of infants hospitalized in NICU are colonized with Candida at the end of the first week of hospitalization; a direct relationship exists between the importance of colonization and the invasive infection risk. C. albicans is the species most often responsible for invasive candidiasis in the newborn. These infections represent the third cause of related-catheter infection in the USA. Mortality rate in neonates linked to this disease is 20 to 50%; morbidity primarily concerns brain and lungs. Neonatal invasive candidiasis risk factors are known and a primary prevention is possible. The diagnosis of neonatal invasive candidiasis is difficult and often delayed because of a polymorphic clinical expression. Empiric and preemptive treatment are based on the use of amphotericin B. Prophylactic treatment using fluconazole of newborns with birth weight ≤ 1000 grams and/or gestational age ≤ 27 weeks gestation is recommended by the American Academy of Paediatrics and the Infectious Diseases Society of America. A better knowledge of French epidemiological data in this area would improve both the diagnosis and therapeutic management of this disease.

Fluconazole is a recommended treatment option for the treatment of invasive candidiasis. Fluconazole is active against most pathogenic Candida spp. except C. kruzei and C. glabrata. Fluconazole is orally well absorbed. Its volume of distribution is reported to be 0.7-1.0 L/kg and it is weakly bound to plasma proteins. The majority of fluconazole dose is excreted via the kidneys. Usually, fluconazole pharmacokinetics display moderate inter-individual variability. However, in presence of renal dysfunction or in pediatrics patients, fluconazole pharmacokinetics might be difficult to predict. Concentration-efficacy relationships are demonstrated whereas concentration-toxicity relationships are sparse. As a consequence, therapeutic drug monitoring is not routinely recommended but can be useful in certain situations.

Description of an uncommon case of postoperative Candida iris nodules.A 70-year-old immunocompetent patient developed whitish iris nodules after phacoemulsification in the left eye, without any other signs of endophthalmitis. Histophathological examination showed spores of candida. These nodules did not respond to intracameral amphotericin B but disappeared with oral fluconazole. However, the functional outcome was poor because of persistant inflammation of the anterior segment.In the presence of postoperative iris nodules, fungal etiology must be considered.

Cryptococcal meningitidis is rare, occurring particularly in adults infected with the HIV virus. The authors report the cases of 2 immunocompetent girls who were 3 and 13 years old. The authors describe the risk factors, the clinical symptoms, and the biological characteristics of the cerebrospinal fluid.

Cryptococcus meningitis is uncommon in childhood. We report a Senegalese case of cryptococcus meningitis diagnosed in an apparently immunocompetent child. A 9-year-old boy was admitted for acute meningoencephalitis. A computerized tomography scan of the brain showed an ischemic lesion in the left caudate and study of cerebrospinal fluid (CSF) revealed cytological and biochemical abnormalities and Cryptococcus neoformans on direct exam and culture. HIV and syphilis antibodies were negative and the blood CD4 lymphocyte count was 804/mm(3). The child had no immunocompromising factors such as hematologic abnormalities, solid tumor, or undernutrition. He was treated with fluconazole intravenously, but clinical outcome was unsuccessful. The patient died after 1 month from cardiovascular and respiratory distress.

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.

Endocarditis is uncommon in infants and is exceptionally related to Candida albicans on pulmonary banding. We report on a case in a 7-month-old infant who had pulmonary artery banding for a ventricular septal defect and who presented with candidal endocarditis. Banding was chosen because of the patient's poor trophic and unstable status, which could be risky for surgery involving extracorporeal circulation. A few weeks after the banding, the patient developed systemic Candida infection, which was treated successfully. At 7 months, cardiac failure appeared without fever or inflammatory signs. Cardiac echography showed that the banding was not protective as well as a hyperechogenic image on the pulmonary bifurcation. The angioscan showed a hypodense thrombus. Emergency surgery was performed consisting of pulmonary artery exploration, thrombectomy, and ventricular septal defect closure. The exploration showed a pulmonary artery perforation caused by the infected pseudoaneurysm and the migration of the banding into the pulmonary artery. The anatomopathologic analysis of the vegetation identified multisensitive Candida albicans. After surgery and prolonged antifungal treatment, progression was satisfactory.

Subacute central nervous system infection must be considered in any infant presenting with progressive encephalopathy. We present the case of an 18-month-old child with normal neuromotor development until the age of 14 months admitted for spastic hypertonia of the legs and arms associated with axial hypotonia. The mother reported that she recently had been found to be HIV-seropositive. HIV antibodies were negative during the first trimester of pregnancy. On the child's blood sample, the HIV test was positive associated with a major decrease in CD4 cell count. Viral load (ARN-PCR) was 720 copies par millilitre. On brain MRI, hypersignals were found in the white matter. HIV related encephalopathy caused by maternal fetal transmission was diagnosed. After 2 months of antiretroviral treatment (azidothymidine, lamivudine, and boosted lopinavir), the child's neurological condition improved. HIV infection must be suspected in all infants with progressive encephalopathy. The HIV test in pregnant women must be proposed at the beginning of pregnancy and repeated during the last trimester.

We report an atypical feature of neuromeningeal cryptococcosis presenting as spinal cystic arachnoiditis and cerebellar cryptococcoma in a child treated for pontine glioma.In November 2003, we diagnosed a pontine glioma in a six-year-old female child. She was initially treated with radiotherapy (54Gy for six weeks) and dexamethasone until July 2006. From January 2004 to September 2006, the patient received 30 cycles of chemotherapy including vincristine 1.5mg/m(2) Day 1, carboplatin 150mg/m(2) Day 1, and temozolomide 150mg/m(2) Days 2-6 every 28 days. In October 2006, the patient suffered spontaneous acute low back pain radiating into both lower limbs revealing lumbar cystic arachnoiditis and cerebellar cryptococcoma. The cerebrospinal fluid (CSF) sample showed lymphocytic pleocytosis and Cryptococcus neoformans; glucose and protein levels were low. First-line medical treatment including liposomal amphotericin B, then fluconazole effectively decreased the pain. However, in February 2007, she presented with cauda equina syndrome and the spinal MRI showed that the lumbar cyst had increased in size. The patient underwent a lumbar laminectomy and cyst removal. Histology confirmed the arachnoiditis with no cancer cells or pathogenic agents.Arachnoiditis and cryptococcoma are rare. They can appear to be a brain neoplasm because of their pseudotumoral aspect. Often, the diagnosis can be made from the CSF sample.