Cryptococcal Meningoencephalitis in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Douala, Cameroon: A Cross Sectional Study

Abstract

Background:

Cryptococcal meningoencephalitis (CM) kills about half a million human immunodeficiency virus (HIV) patients per year, mostly in Africa.

Aim:

The aim of this study was to determine the prevalence, clinical presentation and in-hospital outcome of CM among HIV-infected patients in Douala.

Materials and Methods:

A cross-sectional clinical note review of 672 HIV-1 patients’ files admitted from January 1 ^st 2004 to December 31 ^st 2009 at the Internal Medicine unit of the Douala General Hospital, Cameroon was performed. Only patients diagnosed of CM by microscopy of Indian ink stained cerebrospinal fluid (CSF) were studied.

Results:

The prevalence of CM in the study was 11.2%. Mean age of patients was 36.9 ΁ 12.7 years. Median cluster of differentiation 4 (CD4) cell count was 23 cells/μL, (interquartile range [IQR]: 10-61) and 62.7% of CD4 cell counts were >50 cells/μL. The most prevalent symptom was headache in 97.3% of patients. In CSF, median proteins was 0.9 g/L (IQR: 0.6-1); median glucose 0.2 g/L (IQR: 0.1-0.3) and median leucocyte count 54 cells/μL (IQR: 34-76) mostly of mixed cellularity. The case fatality rate was 52% and low CD4 cell count was strongly associated with death, odd ratio 4.6 (95% confidence interval: 2.6-8.0, P > 0.001).

Conclusion:

The high case fatality of CM in Douala warrants adequate diagnostic measures and optimization of standardized treatment to reduce mortality.