Clinical Characteristics and outcomes of Cryptococcal Meningitis Among ART-naive HIV-AIDS Patients at SPMMC and Zewditu memorial hospital: A Retrospective chart review; Addis Ababa, ETHIOPIA

Abstract

Abstract Background: Cryptococcal Meningitis (CM) is one of the top causes of meningitis in adults in Sub-Saharan Africa (SSA) and other regions with a high prevalence of Human Immunodeficiency Virus (HIV), accounting for over 100,000 incident cases of meningitis per year in the region. It was further estimated that 10–20% of HIV related deaths in Africa are due to CM. Objectives: To assess the clinical charectersitces and treatement outcome of cryptococcal menigitise among ART naïve HIV patient at St. Paul’s Hospital Millennium Medical College and Zewiditu memorial hospital ,Addis Ababa Ethiopia. Methods and material : It is an institutional based retrospective study among new cases of HIVassociated CM who were treated at SPHMMC and Zeweditu memorial hospital ,Addis ababa from January 2018 to December 2022. Data was gathered from HMIS unit, manual registration book and patient’s charts. The collected data was analyzed using SPSS v. 29. Result: A total of 32 patients with CM were studied with female predominance of 53.1% (17).The mean age of patient with CM was 42.09 years (range: 23 and 64 years). The main clinical manifestation was headache and fever account for 81.2% (n=26). No significant difference was found in signs and symptoms between those who died and survived, except for lower GCS at disease onset, which had a significant effect on mortality(p=0.025).. In present study, no statistical difference was detected in the baseline CD 4 count and CSF parameter between survivors and non survivors. Fluconazole was used as monotherapy for all patients except one who used combination therapy with fluconazole and flucytocine. The mortality rate was found to be significantly lower (p-value = 0.027) in patients who had therapeutic lumbar tap. In hospital mortality rate was 34.5%. Conclusions: To reduce deaths and complication of CM, prompt initiation of effective antifungal treatment in line with WHO 2022 treatment guideline is an effective strategy. Keywords: Cryptococcal meningitis, HIV, immunocompromised patient, opportunistic infections