Cryptococcus Meningitis in a Cohort of HIV Positive Kenyan Patients: Outcome after Two Weeks of Therapy

Abstract

Background: Cryptococcus meningitis is the most lethal meningitis in patients with HIV/AIDS. It is invariably fatal if not treated appropriately and promptly. In sub- Saharan Africa with the highest prevalence of HIV/AIDS, response to treatment of cryptococcal meningitis has seldom been assessed. Objective: To describe the clinical features, laboratory findings, CD4+ cell counts and clinical outcome after a two-week treatment course of patients having cryptococcal meningitis. Design: Longitudinal, prospective, consecutive entry study. Setting: Kisumu District Hospital, Nairobi Rheumatology Clinic and Mater hospital between July 2001 and May 2007. Subjects: One hundred and forty one patients with cryptococcus meningitis. Main outcome measures:CD4+cellcount,cerebrospinalfluid(CSF) biochemistry/ microbiology, morbidity and mortality. Results: One hundred and forty one patients (80 males and 61 females) with cryptococcus meningitis were included. Mean age and CD4+ cell counts was 36.12 ± 9.1 years (15- 75) and 66.9 ± 102.8 cells/μl (1-1058) respectively. One hundred and forty one (83%) patients had CD4 + cell counts <100 cells/μl implying severe immunosuppression. Two (1.4%) patients had CD4+ cells > 350 cells/μl and 22 (15.6%) patients had CD4+ cell counts between 100-350 cells/μl. Ten (six males and four females) died within one week (four amphotericin B, three fluconazole, three no treatment). Eighty one patients were simultaneously initiated on HAART. Conclusion: Cryptococcal meningitis has a good clinical outcome when promptly and appropriately managed despite the low CD4+ cell count. Measures to avail amphotericin B and fluconazole at the mid level healthcare facilities must be enhanced.