![]() Similarly, headache and papiledema were both associated with adverse mortality outcomes (Table 2). However a lower GCS score was associated with higher probability of mortality. Reviewing the clinical profile of our patients, fever and headache were common but not significantly different between the survival and mortality groups. Ongoing HIV care, with or without the use of potent antiretroviral agents, has been established as a deterrent to the development of Cryptococcal disease.5 This was substantiated in our findings where, among those with a prior diagnosis of HIV, 83.3 % of patients who died were not on appropriate HIV care, in contrast to 18.1% of those who survived the study period (Table 1). All our patients had CD4 counts less than 130 cells / cumm and a mean CD4 count of about, 72 cells / cumm. This may also represent an inherent selection bias as our institution is well associated with HIV care and offers the largest quantum of HIV related admissions in this part of the country. There is considerable geographic variation in the prevalence of Cryptococcal infection, the incidence being higher in Africa and South East Asia and successively lower in the United States and in Europe.2 Both genders have been equitably represented in earlier studies and this continues to be evident in our findings.3 Cryptococcosis has been seen more frequently in those without a previous diagnosis of HIV, and tends to develop when the CD4 counts drop to 50 cells / cumm or less.4 In our study, 56.7% patients had been diagnosed to have HIV before they were detected to have Cryptococcal meningitis, suggesting current trends of earlier HIV detection. CSF Cryptococcal antigen stood out as the investigation of choice for a diagnosis of Cryptococcal meningitis (Table 3). The mean CD4 count was lower in Group B, suggesting increased mortality at advanced immunodeficiency. ![]() CSF protein > 150 mg / dl and CSF India Ink positivity were commoner in Group B, but could not achieve statistical significance as predictors of mortality. It is the leading infectious cause of meningitis in patients with AIDS and is the initial AIDS defining diagnosis in approximately 2% of patients, mostly occurring in those with CD4 counts 100 cells / µL and an increased CSF opening pressure, were significantly associated with death from Cryptococcal meningitis. ![]() Meningoencephalitis due to Cryptococcus neoformans is the commonest clinical manifestation, although pneumonia, skin and soft tissue infections are also known to occur. In areas which have benefited most from the availability of effective antiretroviral therapy, the incidence of AIDS related cryptococcosis has declined sharply. Since the onset of the HIV pandemic in the early 1980s, the overwhelming majority of cryptococcoses have occurred in patients with AIDS. Our study highlights how simple bedside clinical tools like ophthalmoscopy and CSF manometry can help in risk stratification in this group of patients. CSF pleocytosis was significantly higher in the mortality group.Ĭonclusion: There have been relatively few attempts to focus on poor prognostic markers associated with AIDS related Cryptococcal meningitis in Asian patients. ![]() The study identified several poor prognostic factors including low GCS score, papilledema, elevated CSF opening pressure (>250 mm of H2O) and lack of regular HIV care in those with a prior diagnosis of HIV. Age, sex and previous diagnosis of HIV had no bearing on the survival outcome of patients. Results: Our study documented a mortality rate of 36.7%. Methods: We prospectively studied the clinical, biochemical and mycological parameters of 30 HIV patients diagnosed with cryptococcal meningitis at our centre over a period of 6 months with a view to identify prognostic factors predictive of poor outcome. Objective: Despite the advent and expanding access to antiretroviral therapy, HIV-associated cryptococcal meningitis (CM) remains a significant cause of mortality and morbidity amongst individuals with this infection in resource-limited settings. ![]()
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