Cryptococcal Meningitis in Human Immunodeficiency Virus–Infected Patients in Harare, Zimbabwe

Abstract

A prospective observational study was conducted over a 10-month period to determine the clinical and laboratory manifestations of cryptococcal meningitis in Zimbabwe, a country where antifungal agents are not widely available. Eighty-nine patients with cryptococcal meningitis (median age, 34 years; range, 11-63 years; 56 males) were identified from 406 patients for whom a clinical diagnosis of meningitis had been made. All patients tested were positive for antibody to human immunodeficiency virus. Cryptococcal meningitis was the first AIDS-defining illness in 88% of patients. Typical presentations were headache, mental impairment, and meningism (median duration, 14 days; range, 1-180 days). The median CD4+ cell count was 70/microL (range, 0-651/microL). The cumulative median survival from the time of diagnosis was 14 days (range, 0-233 days); 22% of patients survived for >30 days. Independent indicators of a good prognosis were not identified. This study provides a unique basis for the development of novel management strategies for patients with cryptococcal meningitis who reside in resource-poor countries.

Study the Utility of Cryptococcal Latex Agglutination Test in HIV-Positive and Negative Patients Suspected of having Cryptococcal meningitis and Compare with India Ink Preparation and Fungal Culture

“…Heyderman et al, in their study found that India ink preparation was positive for C. neoformans for 76 (85%) of 89 patients, CSF culture was positive for 77 (87%) out of 899 (Heyderman et al, 1998). In a study done by Khanna et al, India ink staining was positive in 13 out of the total 18 (72.2%) HIV-positive patients whereas, fungal culture was positive in all cases (Khanna et al, 1996).…”

Cryptococcus neoformans α Strains Preferentially Disseminate to the Central Nervous System during Coinfection

“…Cryptococcal meningitis occurs in 6 to 10% of AIDS patients in the United States and is the first AIDSdefining illness in 40% of these patients (19,31,52,62). In sub-Saharan Africa, where highly active antiretroviral therapy is less common, C. neoformans accounts for 45% of all cases of meningitis in adults; many individuals present with cryptococcosis as their first AIDS-defining illness, and the mean survival rate after diagnosis can be as short as 4 days (29,32,35,50). Cryptococcus occurs in three varieties or species that can be distinguished based on genetic and phenotypic differences.…”

The use of mannitol in HIV-infected patients with symptomatic cryptococcal meningitis

“…The mechanism underlying the elevated ICP in HIV-associated CM has not been well-defined. Cerebrospinal fluid (CSF) inflammatory responses tend to be modest therefore may be a less important contributor to elevated ICP in many cases of HIV-associated CM (4,5). At least, in severe cases, accumulation of fungal elements in arachnoid granulations, which causes CSF outflow obstruction, leads to the raised ICP (6,7).…”