Microbiology & Infectious Diseases
Open AccessPrognostic Factors in Neuromeningeal Cryptococcosis at Brazzaville University Hospital
Authors: Adoua Doukaga Makouka T, Bendett Lebaho P, Sekangue Obili G, Ekat M, Angonga Pabota E, Ossibi Ibara BR.
Abstract
Objective: Helping to improve the management of neuromeningeal cryptococcosis at Brazzaville University Hospital.
Patients and Method: Descriptive and analytical cross-sectional study of neuromeningeal cryptococcosis cases hospitalized in the infectious diseases department between January 1, 2021 and October 31, 2024 in HIV-infected patients, receiving or not highly active antiretroviral therapy and having given free and informed consent to participate in the present study.
Results: A total of 2170 patients were hospitalized during the study period, including 79 for neuromeningeal cryptococcosis, i.e. 3.6% of admissions. Mean age was 43.7 ± 11 (19-74) years, female (n=45 ;57%), housewife (n=19 ;24.1%), single (n=59 ;74.7%) and urban resident (n=76 ;96.2%).
Fever (n=30;38%) and disturbed consciousness (n=23;29.1%) were the main reasons for consultation for more than 15 days (29;36.7%). The mean Glasgow score was 9.8 ± 3.2 (2-13), with neck stiffness (n=30;38%). Oral candidiasis (n=22;27.8%) and silky trichopathy (n=33;42%) were present. The CSF was clear in 100% of cases, with mean lymphocyte counts of 85.7 ± 23.9 (14-100) and mean glycorrhaphy of 0.9 ± 0.7 (0.5-4). Direct examination with India ink was positive in 64.6% of cases (n=51), and culture was performed in 5 patients. Cerebral CT scans, when performed (n=21), revealed ventricular dilatation in 14 patients (17.7%). The mean time to treatment was 5.7± 6.1 (1- 31) days. Fluconazole was used as monotherapy (n=68;86.1%), combined with Oncotyl (n=12;15.2%). Corticosteroid therapy was prescribed (n=71;89 ,9%). The mean length of hospital stay was 18.9 ± 11.3 (2-44) days, and the outcome was unfavorable in 55.7% of cases (n=44). IRIS and ICH occurred in 10 and 12 cases respectively. Case fatality was 55.7%. Poor prognostic factors were age (p=0.006), ventricular dilatation (p=0.001), radiographic abnormality (p=0.001) and neurological disorders (P
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