Prevalence and outcome of cryptococcal meningitis among HIV infected patients admitted to a tertiary level facility in an HIV endemic setting in art era.

Abstract

Background: Cryptococcal meningitis (CM) is a common AIDS (acquired immunodeficiency syndrome) - defining illness that contributes to morbidity and mortality among HIV-infected adults in South Africa (SA). Methods: We conducted a retrospective study among HIV infected patients aged ≥13 years, admitted to medical wards to better understand factors that contribute to ongoing high mortality among patients presenting with cryptococcal meningitis. Results: There were 322 lumbar punctures (LP) received from medical wards, from patients presenting with features suggestive of meningitis. A total of 44 CSF samples were deemed abnormal.26 patients had confirmed cryptococcal meningitis. Among those patients, 51.8% (14/27) were female and 48.2% (13/27) were male. No further clinical data available for 3/27 patients due to missing charts,1/27 was HIV uninfected therefore excluded from the study. Headache was the most common 91.3% (21/23) presenting feature, with overall mean duration of symptoms of 2 weeks (range: 1 -3 weeks). On admission 87% (20/23) were known HIV positive, with 13.0% (3/23) confirmed HIV positive during admission. Mean length of stay was 18 days IQR (1-15 day). Lumbar puncture (LP) was done to 95.6% (22/23) and therapeutic LPs were done only in 31.8% (7/22). Renal impairment developed in 39 % (9/23), 2/23 (8.7%) patients developed hydrocephalus, 26.1% (6/23) died, 30.4% (7/23) required further care, while 43.4% (10/23) were discharged. XXII Conclusion: Improving medical management through more effective treatment and prevention services for cryptococcal disease is required.