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AIDS-associated cryptococcal meningitis in Rwanda (1983-1992): epidemiologic and diagnostic features
J Bogaerts1, D Rouvroy, H Taelman
1Centre Hospitalier de Kigali, Rwanda.
Objectives:
to document the trend of AIDS-associated Cryptococcus neoformans meningitis (CM) in Kigali, Rwanda, during 1983-1992, and to highlight some diagnostic and epidemiological features of the disease.
Methods:
during the study period, 3476 cerebrospinal fluid (CSF) specimens from 2824 adults (1578 men, 1246 women) were analysed in the Laboratory of Microbiology at the Centre Hospitalier de Kigali, Rwanda, Central Africa, using direct examination, culture and detection of the cryptococcal antigen (CrAg) in the CSF.
Results:
CM was diagnosed among 549 (19%) patients (347 men, 202 women) and was by far the leading cause of meningitis before Neisseria meningitidis (n=115), Streptococcus pneumoniae (n=68), Mycobacterium tuberculosis (n=26). E. coli, Klebsiella pneumoniae, non-typhoid Salmonella (n=l5) and streptococci (n=4). The number of CM increased from one case in 1983 to 130 new cases in 1992. All 293 tested CM patients had HIV-1 antibodies. The male/female ratio declined from 3.31 during 1983-1987 to 1.58 during 1988-1992. CM showed a seasonal fluctuation, the highest number of infections being observed during the long rainy season. The sensitivity and specificity of the latex test for diagnosing CM was 98% and 99%, respectively. Cryptococcus neoformans var. gattii was cultured from eight (1.6%) of the 499 culture positive patients.
Conclusion:
CM is an important opportunistic infection among AIDS patients in Central Africa. It remains a problematic diagnosis in areas with limited diagnostic facilities.
Insights
AIDS-associated Cryptococcus neoformans meningitis (CM) significantly increased in Kigali, Rwanda, from 1983-1992, becoming the leading meningitis cause in HIV-1 patients. Diagnostic challenges persist in resource-limited settings.
Area of Science:
- Infectious Diseases
- Epidemiology
- Mycology
Background:
- Cryptococcus neoformans meningitis (CM) is a significant opportunistic infection in individuals with Acquired Immunodeficiency Syndrome (AIDS).
- Understanding the epidemiological trends and diagnostic features of CM is crucial for public health interventions, especially in resource-limited regions.
Purpose of the Study:
- To document the incidence and trends of AIDS-associated Cryptococcus neoformans meningitis (CM) in Kigali, Rwanda, between 1983 and 1992.
- To describe key diagnostic and epidemiological characteristics of CM in this population.
Main Methods:
- Analysis of 3476 cerebrospinal fluid (CSF) specimens from 2824 adult patients at the Centre Hospitalier de Kigali.
- Utilized direct examination, culture, and cryptococcal antigen (CrAg) detection for diagnosing CM.
- Investigated patient demographics, seasonal patterns, and diagnostic test performance.
Main Results:
- Cryptococcus neoformans meningitis (CM) was diagnosed in 19% of patients, significantly exceeding other meningitis causes like Neisseria meningitidis and Streptococcus pneumoniae.
- A marked increase in CM cases was observed, from one in 1983 to 130 in 1992, with all tested patients positive for HIV-1.
- The latex test demonstrated high sensitivity (98%) and specificity (99%) for CM diagnosis.
Conclusions:
- AIDS-associated CM is a major opportunistic infection in Central Africa, particularly impacting HIV-1 positive individuals.
- Effective diagnosis of CM remains a challenge in areas with limited healthcare and diagnostic infrastructure.
- The rising trend highlights the need for improved diagnostic access and management strategies for cryptococcal meningitis in endemic regions.