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Aim: This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with Cryptococcal meningitis (CM). These factors include the patient's socioeconomic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy.Methods: Data was collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed CM over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients' mortality risk. 2Results: 87 patients were identified. All except one were HIV positive, of which 55.2% were Antiretroviral Therapy (ART) naïve. A history of previous Tuberculosis (TB) was given by 25 patients (28.7%) and 49 (56.3%) were on TB treatment at admission or started during their hospital stay. In-hospital mortality was 31 %. Statistical analysis showed that ART naïve patients had 9.9 (CI 95% 1.2-81.2, p<0.0032) times greater odds of dying compared to those on ART, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment.Defaulters had 14.7 (CI 95% 1.6-131.6, p<0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7-23.1, p<0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for ART naïve patients and defaulters.Conclusion: CM is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting ART and presentation with nausea and vomiting were associated with a significantly increased mortality risk.

Since the identification of anti-N-methyl-D-aspartate (NMDA) receptor antibodies about 15 years ago, many patients with rapidly progressing psychiatric symptoms, abnormal movements, seizures or unexplained coma, have been diagnosed with autoimmune encephalitis (AE). The symptom onset is often unspecific and might mimic psychiatric disease, but the later course is frequently characterized by severe disease, often requiring intensive care. Clinical and immunological criteria are helpful in identifying the patients, but no biomarkers exist to guide the clinician in therapy or predict outcome. While persons of all ages can be affected by AE, some types of AE affect more children and young adults and are more prevalent in women. This review will focus on encephalitides associated with neuronal cell-surface or synaptic antibodies, which can result in characteristic syndromes, and are often recognizable on clinical grounds. AE subtypes associated with antibodies against extracellular epitopes can occur with or without tumours. Because the antibodies bind and alter the function of the antigen, the effects are often reversible if immunotherapy is initiated, and the prognosis is favourable in most instances. The first part of this series will introduce the topic, provide an overview of current neuronal surface antibodies and how they present, describe the most common subtype, anti-NMDA receptor encephalitis, and discuss the difficulties in recognizing patients with underlying AE amongst patients with new onset psychiatric disorders.

We report the case of an HIV-positive female patient with neurofibromatosis type 1 who was treated for recurrent peptic ulcer disease and later developed diabetes mellitus and chronic diarrhoea. A metastasising somatostatinoma was histologically proven and evidence of a concomitant gastrin-producing neuroendocrine tumour was found. Neuroendocrine tumours (NETs) are very rare neoplasms originating from a wide variety of endocrine and nervous system tissue with the ability to produce different hormones. A somatostatin-and gastrinsecreting NET in a patient with HIV has not been reported in the literature, to the best of our knowledge. We discuss oncogenic pathomechanisms related to the underlying conditions and propose stringent monitoring for tumours in HIV-positive patients with phakomatoses as well as initiation of antiretroviral therapy.