Malin A, Robertson V, Musvaire P, Chagonda E, Sarbah S, Pithie A; International Conference on AIDS.
Int Conf AIDS. 1993 Jun 6-11; 9: 362 (abstract no. PO-B09-1360).
Univ. of Zimbabwe Medical School, Marare.
BACKGROUND: Cryptococcal meningitis is common in Zimbabwe, yet financial constraints have resulted in a policy of no active treatment. This pilot study was designed to: (I) assess the impact of both disease and infection rates in HIV-positive individuals, (II) distinguish early from late cryptococcal meningitis (clinical and laboratory characteristics) with the view to a cost-benefit study of anti-fungal treatment. METHODS: Blood and CSF samples were collected from 40 undiagnosed, consecutive, consenting adults admitted as acute medical emergencies requiring a lumbar puncture. Blood was collected from two further groups known to be HIV-positive: (I) 62 with pneumonia and (II) with a diagnosis other than pneumonia or meningitis. CSF samples were subjected to standard microbiological and biochemical analysis and all blood and CSF samples were assayed for cryptococcal antigens. RESULTS: Of the 40 patients who had a lumbar puncture, 26 (65%) had meningitis. Of those with meningitis, 23/24 were HIV-positive (96%). Pathogens were identified in 24 cases: 17 (65%), Cryptococcus neoformans: 5 (19%), probable tuberculosis (CSF lymphocytosis, high protein, low glucose): and 2 (8%) bacterial. There were 19 (73%) males, average age 37 years; female average age 30 years. The majority of the remaining 14 patients had malaria, epilepsy or a pyrexia of unknown origin. Of those with cryptococcal meningitis 12/17 (71%) were india-ink positive and 11/17 (65%) culture-positive. A further 5 (29%) were india-ink and culture-negative but cryptococcal antigen positive and had laboratory and clinical features of a non-pyogenic meningitis plus failure to respond to high-dose penicillin and chloramphenicol. A CSF leukocytosis was was absent in 12/17 (71%) whilst glucose was low in 13/15 (87%) and protein was high in 10/16 (67%). Of the 62 HIV-positive patients with either lobar or interstitial pneumonia, 2 (3.25%) were strongly cryptococcal antigen positive and both were cases of lobar pneumonia (2/22, 9.1%). Of the 66 HIV-positive patients without meningitis or pneumonia, 5 (7.6%) were positive. CONCLUSIONS. Almost all cases of meningitis were associated with HIV infection and Cryptococcus accounted for the majority. Over a quarter of these and india-ink-negative but antigen-positive. A CSF leukocytosis was usually absent in those with cryptococcal disease. Standard CSF analysis without antigen testing will result in incorrect or missed diagnosis, especially mistaking cryptococcal meningitis for TB meningitis. In only a small proportion of pneumonia/HIV-positive patients was Cryptococcus identified. A significant number of HIV-positive patients without pneumonia or meningitis were cryptococcal antigen positive. A treatment study is required to assess responses in the different groups of cryptococcal infection.
Publication Types:
Keywords:
- Adult
- Antigens, Fungal
- Cryptococcosis
- Cryptococcus
- Cryptococcus neoformans
- Female
- HIV Infections
- HIV Seropositivity
- Humans
- Male
- Meningitis
- Meningitis, Cryptococcal
- Zimbabwe
- immunology
Other ID:
UI: 102204281
From Meeting Abstracts