| dc.description.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. | en_US |
