The Clinical and Laboratory setting of Cryptococcal meningitis as seen at the University Teaching Hospital, Lusaka and to evaluate efficacy of fluoconazole in its therapy

Abstract

Three hundred and sixty seven patients with cryptococcal meningitis were seen during the period from December, 1995 to December, 1996 though only one hundred and thirty patients were actually recruited.This was a prospective study designed to determine the prevalence of cryptococcal meningitis at the University Teaching Hospital and to determine its clinical setting, laboratory setting and the efficacy of Fluconazole as prime therapy in its treatment as is the practice in the hospital at the moment. Cryptococcal meningitis is now the leading cause of meningitis in the University Teaching Hospital and affects predominantly patients who are under forty five years old (82.5%) though its sex ratio seems to be 1:1. It primarily occurs in the setting of immunosuppression as the HIV seropositivity was 96.15% in patients evaluated and the CD4 counts were below 200 in 83.33% of the patients.The study has confirmed that cryptococcal meningitis is a cause of chronic meningitiswith a mean duratiion of presentation of twenty one days before diagnosis is made. And with 96.15% of the cases being seropositive for HIV infection, it is clearly an AIDS defining finding. Other features are non-specific and are mainly those of chronic ill health, pruritic rash, oral candidiasis and recurrent enteritis. Papilloedema occurs in 18.5% of patients while none of the patients had visual loss. Neck rigidity and other signs of meningitis may or may not be present. Cryptococcal meningitis is associated with a high mortality. Even though patients were exposed to six weeks of Fluconazole at the accepted dosage 84.09% had died within this period. With better results known to occur with other regimen such as Amphotericin B and Flucytosine, it may be concluded that Fluconazole is not a drug of first choice. For the moment, it is suggested that UTH reverts to standard therapy as is the practice elsewhere.