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/mm 3 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.

A review of the management and outcome of patients admitted with cryptococcal meningitis at a regional hospital in KwaZulu-Natal province

“…The profile of patients presenting with CCM were young (average age of 34.4 years) and male (64.5%), which is similar to the 65% male predominance reported by Adeyemi from Northdale Hospital in 2015, 17 and highlights the challenge of HIV testing and treating this cohort. In this study, the males were slightly older (mean age = 36 ± 6.9 years) than the females (mean age = 32 ± 6.5 years) (p = 0.046), which is consistent with the findings of other studies, suggesting that women are contracting HIV at a younger age.…”

District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa

“…A study conducted at an urban district hospital between 2011 and 2012 reported that of the 127 patients with confirmed CM, 65 were men (51.2%). 10 In that study, CM affected predominantly the economically active population (mean age, 36 [±9.8] years). 10 While 76% ( n = 97) of patients knew their HIV status, but only 45% ( n = 43) were on ART.…”

Surgical treatment and operation time in human immunodeficiency virus-negative cryptococcal meningitis

“…[ 4 ] HIV is the most important risk factor for CM patients. [ 5 – 7 ] However, infection of Cryptococcus has also been reported in an HIV-negative CM patient recently. [ 8 ] It is now certain that uncontrollable intracranial hypertension and hydrocephalus (HYC) are the 2 major complications affecting the prognosis of CM patients.…”