Toxoplasmosis has emerged as a major opportunistic disease in patients with Acquired Immune Deficiency Syndrome (AIDS). It can manifest itself as a potentially fatal encephalitis, due to the reactivation of latent infections in immune suppression associated with the human immunodeficiency virus (HIV) [1] [2]. Toxoplasmosis is at the top of the list of diseases that occur death in patients with AIDS [3]. Although the incidence of cerebral toxoplasmosis (CT) has decreased as a result of antiretroviral therapy (ART), it is still a serious diagnostic and therapeutic problem and a life-threatening condition [4]. Death proportion among toxoplasmosis in AIDS patients is estimated at around 10% in the United States and up to 30% in Europe [3]. Associated factors and likelihood survival characteristics of toxoplasmic encephalitis in the era of antiretroviral therapy have not been addressed in our context. Knowledge of these factors could help improve the survival of PLHIV. The objective of our study was to identify predictive factors for poor prognosis during cerebral toxoplasmosis in the field of HIV infection.

Socio-economic demographic and clinical characteristics

During our study period, 495 patients were hospitalized at the Department of Infectious and Tropical Diseases at national hospital of Donka are not 87 years old for cerebral toxoplasmosis in the field of HIV or 17.58%.

The characteristics of all patients are described in Table 1.

Cerebral toxoplasmosis was indicative of HIV infection in 43.7% of patients. The clinical picture was dominated by headache (69.0%); focal neurological signs including seizures (28.7%) followed by hemiplegia (21.8%) and hemiparesis (20.7%). All patients presented Infectious syndrome.

In the assessment of the state of consciousness 46.0% was in a state of confusion and 21.8% in a coma. More than half (78.2%) of those present have opportunistic infections, including gastrointestinal candidiasis (20.7%), pulmonary tuberculosis (10.3%), genital herpes (6%), 9%), Kaposi’s disease with a proportion of 2.3%. Forty-five patients were cerebral computed tomography 45/87% (Table 2). Among 87 cases of cerebral toxoplasmosis, we observed 33 deaths, a hospital mortality of 37.9% (Table 3).

Factors Associated with the Death of Patients with Cerebral Toxoplasmosis

Univariate analysis shows that patients living with a partner, on patients with

a CD4 count on the initiation of antiretroviral treatment < 200 cells/mm³ and on the history of risk during hospitalization. Multivariate analysis, of couple living, CD4 counts at inclusion < 200 cells/mm³ and coma were independently associated with death. The risk of death was nearly 10 times higher for living than for those living alone (OR = 9.93 [1.89 - 52.03], p = 0.007). Patients with a CD4 count at initiation of antiretroviral therapy < 200 cells/mm³ were 19 times more at risk than those with a rate ≥ 200 cells/mm³ (OR = 19.04 [2.11 - 171.32] p = 0.009). Comatose were 5 times more likely to die than non-comatose (OR = 5.18 [1.25 - 21.42], p = 0.02).

The proportion of deaths is significantly different between patients with a CD4 count < 200 and those with a CD4 count ≥ 200 (p = 0.009) (Table 4) at the time of HIV testing.

Aim of this study was to identify the predictive factors for poor prognosis during cerebral toxoplasmosis in the service of infectious diseases at the Donka National Hospital. During six months, we found 87 cases of cerebral toxoplasmosis out of a total of 495 cases, with 17.58% of hospital frequency.

It is reported in the literature that relates to the state of the nervous system. It is 10% to 20% of cases, and more than 50% of AIDS patients [5]. Other authors found in Côte d’Ivoire in 2007 16% of cases of cerebral toxoplasmosis [6].

This result denoted delayed diagnosis of HIV in the part and adherence to primary prophylaxis with cotrimozaxole of another party.

Thirty-three cases (33) of deaths were observed with 37.9% as hospital lethality. Studies in Morocco and Cameroon have revealed respective proportions of lethality of 28.57% and 29.9% [7] [8]. These proportions though we will be maintained until our highly active antiretroviral therapy.

This high proportion of mortality was explained after a late diagnosis of the infection, once detected in patients to believe in the disease; this situation associated with the side effects of ARVs causes some patients to consult traditional healers.

Several previous studies of HIV patients on antiretroviral therapy use traditional medicine [9] - [14]. This stay with the healers results in the degradation of the immunity, the appearance of resistance to the treatments leading these patients to the AIDS stage. Finally, it is difficult for parents to honor the prescriptions seen by patients in transit, often with traditional healers or in the labor market. Sanitary facilities not adapted to the management of the base of the financial exhaustion before their admissions to the service of reference.

Multivariate analysis, of couple living, CD4 counts at initiation < 200 cells/mm³ and coma were dependently associated with death.

The authors of a study conducted in Senegal in 2013 found that anemia (p = 0.003), high CD8 + T cell count (p = 0.009) and coma (p = 0.02) were associated factors at death of PHAs with toxoplasmos [15].

The risk of death was 19 times higher in people with a CD4 count < 200 cells/mm³ at initiation of ART. At this stage, the patient is in a state of advanced immune suppression (AIDS) exposed to serious opportunistic infections, moreover, we often see the appearance of several opportunistic infections and this state would lead to death.

The results also showed that comatose were 5 times more likely to die during the stay than non-comatose. The coma denotes a serious encephalic attack we attend an impossibility for the patient to eat. In the absence of adequate resuscitation, we witness the installation of a vicious circle. Lack of adequate nutrition in a previously undernourished patient further weakens the immune system, making this group of patients more likely to die.

Despite the interesting results of this study, it has limitations. Its retrospective nature did not make it possible to know the future of the referred patients, it also did not make it possible to find certain information notably the demonstration of the nonobservance to the TAR, the delay in the diagnosis and the recourse to the triple therapy of the patients.

This study showed that cerebral toxoplasmosis is associated with very high morbidity and mortality in the Infectious Diseases Department of Donka National Hospital. Living in a relationship, CD4 counts at baseline < 200 cells/mm³ and coma were independently associated with death. Special attention to these factors associated with infectious resuscitation and primary prevention in patients with a CD4 T lymphocyte count below 200 cells/mm may improve the prognosis of this pathology.

The authors declare no conflicts of interest regarding the publication of this paper.

Sow, M.S., Sylla, K., Cissé, D., Cissé, F.A., Bah, I., Cissé, K. and Kadio, K.J.J.O. (2019) Pronostic Factors of Cerebral Toxoplasmosis in Department of Infectious and Tropical Diseases at Donka National Hospital. Advances in Infectious Diseases, 9, 243-251. https://doi.org/10.4236/aid.2019.93018