Cryptococcosis Neuro-Brain in 42 Patients at the University Hospital of Brazzaville

Abstract

To describe epidemiological, clinical, therapeutic; and evolutionary aspects of Neuromeningeal Cryptococcus (NMC) at Brazzaville University Hospital and to find out factors associated to death. A descriptive and analytical retrospective study of NMC files in the infectious diseases department between January 1 and December 31, 2013. 973 patients were hospitalized, 42 NMC cases (4.3%) were compiled. The mean age was 40.2±10.4 years (17-64 years). The sex ratio M/F was 1.1. The majority (n=23) came from an urban area. HIV infection (n=37-88.1%) was the main point with an average of lymphocyte LTCD4 with 101.3±123.58/mm³. The average patient consultation time was 27.5±33.6. Fever (n=36, 85.7%), headache (n=11, 26.2%) and consciousness disorders (n=13, 31.0%) were the primary reasons for consultation. LCR was clear in 32 patients and neuromeningeal Cryptococcus was confirmed by CSF in all patients (n=42,100%). Treatment was fluconazole (800-2000 mg) in all patients. No adverse effects related to fluconazole were noticed. Six patients underwent lumbar puncture discharge and 23 patients (54.8%) were on antiretroviral therapy. The lethality was 74.0% (n=31), with no significant difference depending on the stage of immunosuppression and etiologic treatment. It was significantly higher in comatose patients with Glasgow ≤8. Neuromeningeal Cryptococcus is a frequent opportunistic infection in our service with high lethality. This shows how important is the prevention which implies the early management of HIV infection.