Current Aspects of Neuromeningeal Cryptococcosis in the Infectious Diseases Unit at Brazzaville University Hospital

Ossibi Ibara BR^{1, 2,} , Ngolet Ocini L^{1, 3}, Sekangué Obili G^{1, 4}, Ekat M², Adoua Doukaga T^{1, 2}, Angonga Pabota E², Bendett P², Kinga F², Mvoumbo Mavoungou G² and Bintsindou P²

¹Université Marien Ngouabi, Faculty of Health Sciences, Brazzaville-Congo

²Infectious Disease Unit, CHU de Brazzaville-Congo

³Clinical haematology Unit, CHU de Brazzaville-Congo

⁴Laboratory of Parasitology-mycology, CHU de Brazzaville-Congo

Cite this paper:
Ossibi Ibara BR, Ngolet Ocini L, Sekangué Obili G, Ekat M, Adoua Doukaga T, Angonga Pabota E, Bendett P, Kinga F, Mvoumbo Mavoungou G and Bintsindou P. Current Aspects of Neuromeningeal Cryptococcosis in the Infectious Diseases Unit at Brazzaville University Hospital. American Journal of Infectious Diseases and Microbiology. 2021; 9(2):56-60. doi: 10.12691/ajidm-9-2-5

Abstract

Objectives: To determine the current prevalence of neuromeningeal cryptococcosis (CNM) at the Brazzaville University Hospital and to identify the associated factors. Patients and method: This is a cross-sectional, descriptive and analytical study of CNM cases admitted to the infectious diseases unit between January 1, 2018 and March 31, 2021, i.e. 39 months. The diagnosis was made by positive direct examination of the LCS after India ink staining. Results: Eighty-three hospitalized patients (3.4% of admissions) with average age 40.5 ± 10.8 years (17-72 years), female (n = 51; 61.4%). The sex ratio was 0.6. They were civil servants (n = 22; 26.5%), single (n = 54; 65.1%). These patients lived in cities (n = 82; 98.8%), with a high school education (n = 42; 50.6%). They were immunocompromised in particular to HIV (n = 78; 94%), leukaemia (n =2; 2,4%), detected in hospital (n = 34; 44.9%) where they consulted for fever and headache respectively in 55 cases (66, 3%) and 44 cases (53%). Glasgow ranged from 8-13 in 34.9% (n = 29). Tuberculosis was the associated opportunistic infection in 25.3% of cases (n = 21). The mean cytorachia was 95.2 ± 200.6 (1-1300) / mm3 and the mean proteinorachia was 1.3 ± 0.9 (0.4-2.6) g / l. LCS pressure was> 250 in 5 cases (6%). The direct LCS examination was positive for all patients (100%). CD4 was <200 in 56.6% (n = 47) Fluconazole was administered between 1200-2000 mg in 72 patients (86.7%) and 15 of them (18.1%) had received a discharge puncture. ART was prescribed in 63.9% (n = 53) and it was combined with TDF + FTC + EFV in 41% (n = 34). The outcome was death in 50.6% (n = 42) due mainly to HIC (n = 16; 19.3%) and related to tuberculosis (p = 0.004). Conclusion: CNM remains an opportunistic infection in adults and young people, frequent at Brazzaville University Hospital, occurring after advanced immunosuppression, often in association with tuberculosis. Its lethality is still high in connection with intracranial hypertension. Its prevention involves detection and early management of HIV infection.

Keywords:
Neuromeningeal cryptococcosis current aspects CHU Brazzaville

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