Evolutionary prognosis of neuromeningeal cryptococcosis at the university hospital Sylvanus Olympio (Togo)

Abstract

Introduction: Neuromeningeal cryptococcosis (NMC) is the most common form of mycotic infectious meningitis occurring during human immunodeficiency virus (HIV) infection / acquired immunodeficiency syndrome. It is the second most common opportunistic central nervous system disease and the leading cause of clear-fluid meningitis in patients with HIV. Its prognosis remains unfavourable in the majority of cases for several reasons. Objective: To describe the epidemiological and clinical aspects of NMC and its evolutionary profile in adults in the medical departments of the Sylvanus Olympio Teaching Hospital of Lomé. In this retrospective study data were extracted from hospital records in the medical and medical specialty departments of the Sylvanus Olympio University Hospital in Lomé from January 1, 2007 to December 31, 2016. Results: The hospital prevalence of NMC was 1.2%, with a male predominance (M/F = 1.3). All our patients were HIV1 positive and 97.72% had a CD4 count of less than 100 cells/mm3. Direct examination of the cerebrospinal fluid after staining with Indian ink allowed the diagnosis to be made in 93.47% of patients, and culture (in the case of negative direct examination) in 6.53%. The treatment was essentially amphotericin B and flucytosine in 17.39% of cases and fluconazole in 82.60% of cases. All patients died, after an average of 17.34 days of hospitalisation. Conclusion: Because of its high mortality, neuromeningeal cryptococcosis is a diagnosis to be considered on principle in HIV-positive patients with headache, fever or confusional syndrome.