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[AIDS-related cryptococcal meningitis at the Bobo-Dioulasso Hospital Center: five case reports]
G A Ki-Zerbo1, A Sawadogo, A Millogo
1Service de Médecine Interne, I'Hôpital National Souro Sanou, Bobo-Dioulasso, Burkina Faso.
Abstract:
The authors report five cases of Cryptococcus neoformans meningitis in HIV-positive patients hospitalized in the Souro Sanou National Hospital Center of Bobo-Dioulasso (Burkina Faso). There were 3 men and 2 women with a mean age of 36 years (range: 29 to 47 years). Presenting symptoms were persistent headache and/or mental confusion and neurosensory defects. Cerebrospinal fluid was clear with less than 20 lymphocytes/mm3. Albumin concentration greater than 0.50 g/l was observed in only one case. India ink smear and culture demonstrated strains of Cryptococcus neoformans sensitive to amphotericin B in all five cases, flucytosin in 3 cases, and ketoconazole in two cases. Four patients died within 15 to 32 days after admission (mean 22.5 days). Delayed diagnosis and inconsistent availability of systemic antifungal drugs are major limiting factors in the management of Cryptococcus neoformans meningitis in Burkina Faso.
Insights
Cryptococcus neoformans meningitis in HIV-positive patients is a serious concern in Burkina Faso. Delayed diagnosis and limited antifungal drug availability contribute to high mortality rates.
Area of Science:
- Infectious Diseases
- Neurology
- Public Health
Background:
- Cryptococcus neoformans meningitis is a significant opportunistic infection in individuals with advanced HIV.
- Sub-Saharan Africa, including Burkina Faso, faces a substantial burden of HIV/AIDS and associated opportunistic infections.
Observation:
- Five cases of Cryptococcus neoformans meningitis were observed in HIV-positive patients at a hospital in Bobo-Dioulasso, Burkina Faso.
- Patients presented with symptoms including persistent headache, mental confusion, and neurosensory deficits.
- Cerebrospinal fluid analysis showed clear fluid with low lymphocyte counts, and Cryptococcus neoformans was identified via India ink smear and culture.
Findings:
- All identified Cryptococcus neoformans strains were sensitive to amphotericin B.
- Sensitivity to flucytosine and ketoconazole varied among the strains.
- A high mortality rate of 80% was observed, with deaths occurring between 15 and 32 days post-admission.
Implications:
- Delayed diagnosis and inconsistent access to essential antifungal medications are critical challenges in managing this condition in Burkina Faso.
- Improved diagnostic capabilities and reliable drug supply chains are urgently needed to improve patient outcomes.
- This highlights the need for enhanced HIV care and opportunistic infection management strategies in resource-limited settings.