Profile and acute mortality outcome of patients admitted with cryptococcal meningitis to an urban district hospital in Kwazulu-Natal, South Africa

Abstract

Background: Cryptococcal meningitis (CCM) is one of the leading causes of early mortality in human immunodeficiency virus (HIV)-infected patients. This study was part of a clinical audit aimed at improving care for patients with CCM at an urban district hospital in South Africa. Method: The clinical records of patients (age > 13 years) admitted to the hospital with a diagnosis of CCM between June 2011 and December 2012 were retrospectively reviewed. Descriptive statistics and chi-square analysis were generated with EpiInfo™ 7.1.2.0. Ninety-five per cent confidence intervals were reported, where appropriate. Results: Of the 127 patients admitted with CCM, only 97 (76.4%) knew their HIV status. Only 44.8% (43/96) of those who knew that they were HIV-positive were on antiretroviral therapy (ART). Seventeen of the 25 patients (68%) previously treated for CCM had defaulted on their fluconazole treatment and only 60% (15/25) were on ART. CCM-related mortality at two weeks was 55.9% (71/127). A high cerebrospinal fluid (CSF) fungal load, CD4 count < 100 cells/mm3 and poor CSF inflammatory response were associated with increased mortality risk. However, only the association between poor CSF inflammatory response and mortality was statistically significant (p = 0.03). Conclusion: Acute CCM-related mortality remains high. The number of patients who do not know their HIV status, the number of HIV-positive patients who are not on ART, the high level of nonadherence to their fluconazole medication and the proportion of patients who are not on ART after at least one previous CCM episode indicate that there is a need to develop comprehensive strategies aimed at encouraging HIV testing and improving the retention of patients with regard to HIV care and support.