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. 2010 Dec;87(12):481-7.

The prevalence, clinical features, risk factors and outcome associated with cryptococcal meningitis in HIV positive patients in Kenya

R Mdodo  1 , K Brown, E Omonge, W Jaoko, J Baddley, P Pappas, M Colette Kempf, I Aban, S Odera, A Suleh, P E Jolly
Affiliations

The prevalence, clinical features, risk factors and outcome associated with cryptococcal meningitis in HIV positive patients in Kenya

R Mdodo et al. East Afr Med J. 2010 Dec.

Abstract

Objectives: To determine the prevalence, clinical features, risk factors and outcomes associated with cryptococcal meningitis (CM) in human immunodeficiency virus (HIV) positive patients at two referral hospitals in Nairobi, Kenya.

Design: Prospective, observational study.

Setting: Kenyatta National Hospital (KNH) and Mbagathi District Hospital (MDH), Nairobi, Kenya.

Subjects: Three hundred and forty HIV patients presenting with suspected CM.

Results: Of three hundred and forty suspected CM patients, 111 (33%) were diagnosed with CM by CrAg. Among CM patients, in-hospital mortality was 36% (38/106), median age was 35 years (range, 19-60 years) and median CD4 count was 41 cells/microL (n = 89, range 2-720 cells/microL). Common clinical manifestations among CM patients included headache 103 (93%), neck stiffness 76 (69%) and weight loss 53 (48%). Factors independently associated with CM were male sex, headache, blurred vision and previous antifungal drug use. Night sweats and current use of anti-retroviral therapy were associated with reduced risk for CM.

Conclusions: There is a high prevalence of CM and CM-associated mortality in HIV patients at KNH and MDH despite treatment with antifungal and anti-retroviral drugs. This study demonstrates the need to address the existing inadequacies of CM patient outcomes in Kenya.

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