Cryptococcal meningitis in patients with acquired immunudeficiency syndrome in prehaart era at Gondar College of Medical Sciences Hospital north-west Ethiopia

Abstract

Background: CIyptococcal meningitis is an important opportunistic funimgal infection that became very common after the era of HIV infection.

Objectives: To determine the magnitude of Clyptococcal meningitis and study the clinical pattern among inpatients with HV infection at Gondar Hospital.

Methods: A descriptive study was done among ELISA confirmed admitted HIV patients. Clinically suspected cases of meningitis underwent lumbar puncture and cerebrospinal fluid analysis. The clinical profile and outcomes of the confirmed Cryptococcal meningitis cases were described.

Results: Among 375 HIV serology positive patients 31 were confirmed to have Cryptococcal meningitis. Their median age was 29 years (range 16-64); and 22 were males. The major manifestation at presentation included headache and fever each in 90% malaise (65%), stiffness of the neck (48%), altered Mentation (32%) and nausea and vomiting (32%), photophobia (23%) and seizure (3.6%). Median duration of illness was 16 days; ranging from 1-40 days. Temperature was above 38.4 degreees C in 80%. Meningial signs were observed in 32% altered Mentation was noted in 29% and focal neurologic deficit in 19% Cerebrospinal fluid examination revealed visually increased pressure (measured opening pressure >200 mmH2O in six patients) in 81% glucose < 50 mg/dl (50-70 mg/ dl) in 55% Protein >40 mg/dl (15-40 mg/dl) in 35% leukocytes count < 20/mm3 (poor prognostic sign) in 58% Indian ink staining detected encapsulated yeasts in 71% C. neoformans was cultivated in 90% of sample. Highest case fatality rate of the disease was observed during the pre HAART era.

Conclusion: Cryptococcal Meningitis is common among patients with immune-suppression. It could be the initial manifestation of HIV infection and should be suspected in any potential HIV infected patient with neurological symptoms especially headache and fever. As it has highest case fatality rate, early diagnosis and prompt therapy is strongly recommended Better treatment options like boosting their immunity with HAART should also be investigated