Malaria is an endemic parasitosis caused by plasmodium. The objective was to evaluate the epidemiological, diagnostic, and therapeutic profile of malaria in outpatient medicine at the NTHC-HKM of Cotonou. This is a cross-sectional and descriptive study, having covered a period of 11 years and 3 months (1/01/2010 to 31/03/2021). Patients who consulted the outpatient clinic of the NTHC-HKM of Cotonou during the study period were included. The diagnosis of malaria was made on the basis of a positive parasite density thick drop. Over 41,960 patients consulted during the period, 95 had malaria, a hospital incidence of 0.2%. Forty-seven patients (49.5%) were male. The mean age was 36.8±14.3 years. The main symptoms were fever in 81 patients (85.2%), asthenia in 45 patients (47.3%) and arthromyalgia in 42 patients (44.2%). Clinically, the general condition was preserved in 61 patients (64.2%), pallor was noted in 4 patients (4.2%) and icterus in 2 patients (2.1%). Hepatomegaly was found in 2 patients (2.1%) and splenomegaly in 1 (1.0%). Biologically, anemia was found in 11 patients (11.6%). CRP was elevated in 10 patients (10.5%). Parasite density varied between 1,200-75,000 red blood cells per microliter. Therapeutically, 45 patients (47.3%) had taken self-medication before diagnosis. All diagnosed patients had been treated. Simple malaria is a pathology rarely encountered in adults in outpatient clinics.
Isosporosis is an opportunistic parasitosis caused by Cystoisospora belli. It was more or less frequently found during HIV immunodepression. Its prevalence has considerably decreased since the democratization of antiretroviral treatments and the implementation of a strategy of systematic global management of People Living with HIV (PLWH) and opportunistic infections. We report the case of a 49-year-old PLHIV patient discovered during the exploration of recurrent diarrhea. This diarrhea was found to be due to Cystoisospora belli. The patient was allergic to cotrimoxazole and was therefore initially treated with ciprofloxacin and tinidazole with poor evolution. The other treatments selected are limited by the lack of access to drugs, both geographically and financially. In view of the persistence of the clinical picture and the continuous presence of the parasite in the stools, several hypotheses have been put forward. That of an under-dosage of the molecule used, of a lack of therapeutic compliance, or of the resistance of the germ to the prescribed molecule. Although the coproculture and antibiogram revealed the sensitivity of the germ to the Ciprofloxacin already prescribed, and to the Cotrimoxazole to which the patient is very allergic, and which can therefore no longer be prescribed. After a second opinion and a review of the literature, the patient was put on Pyrimethamine tablets and Albendazole with folic acid. The evolution was favorable with a significant regression of stools, resumption of appetite, and weight gain after one month. A last coproculture of control did not find any more oocysts of cystoisospora belli. In the face of chronic diarrhea, the systematic search for opportunistic germs in PLWHIV is essential. Management is possible.
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