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Mycopathologia

, Volume 176, Issue 5–6, pp 443–449 | Cite as

Cryptococcal Meningitis in Senegal: Epidemiology, Laboratory Findings, Therapeutic and Outcome of Cases Diagnosed from 2004 to 2011

  • Doudou Sow
  • Roger Clément Tine
  • Khadime Sylla
  • Mansata Djiba
  • Cheikh Tidiane Ndour
  • Thérèse Dieng
  • Jean Louis Ndiaye
  • Babacar Faye
  • Daouda Ndiaye
  • Oumar Gaye
  • Yémou Dieng
Article

Abstract

Background

Cryptococcal meningitis is one of the most important opportunistic infection and a major contributor to early mortality. In sub-Saharan Africa, particularly in Senegal, prevalence of cryptococcal meningitis remains high. This study aimed to describe the epidemiology, laboratory profile, therapeutic and outcome of cases diagnosed in Dakar.

Methods

We analyzed the cryptococcosis cases diagnosed at the department of parasitology–mycology in Fann Teaching Hospital in Dakar from 2004 to 2011. The diagnosis was confirmed by culture on Sabouraud’s dextrose agar and/or by India ink preparation and/or by cryptococcal antigen detection. The diagnosis methods were assessed by using culture as reference.

Results

A total of 106 cases of cryptococcal meningitis were diagnosed. The prevalence of cryptococcal meningitis was 7.8 %. The mean age of the patients was 40.17 ± 9.89 years. There were slightly more male (53.8 %) than female (46.2 %) patients; 89.6 % were found to be infected with HIV, and the median CD4+ count was 27/mm3. Approximately 79.5 % of the patients had <100 CD4+ lymphocytes/mm3. India ink staining presented sensitivity at 94.11 % and specificity at 100 %. Sensitivity and specificity of cryptococcal antigen detection in cerebrospinal fluid were, respectively, 96.96 and 15.78 %. The most frequently used antifungal drug was fluconazole (86.7 %), and the mortality rate was 62.2 % (66 deaths).

Conclusion

Early diagnosis is essential to control cryptococcosis, and countries should prioritize widespread and reliable access to rapid diagnostic cryptococcus antigen assays. But it is important to make available conventional methods (India ink and culture) in the maximum of laboratory in regional health facilities.

Keywords

Cryptococcal meningitis Epidemiology Laboratory profile Therapeutic Outcome 

Notes

Conflict of interest

None.

References

  1. 1.
    Hoang LMN, Maguire JA, Doyle P, Fyfe M, Roscoe DL. Cryptococcus neoformans infections at Vancouver Hospital and Health Sciences Centre (1997–2002): epidemiology, microbiology and Histopathology. J Med Microbiol. 2004;53:935–40.PubMedCrossRefGoogle Scholar
  2. 2.
    WHO: rapid advice: diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children. Geneva 2011. (http://www.who.int/about/licensing/ copyright_form/en/index.html).
  3. 3.
    Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg K. Review of human immunodeficiency virus type 1-related opportunistic infections in Sub-Saharan Africa. Clin Infect Dis. 2003;36:652–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Chariyalertsak S, Sirisanthana T, Saengwonloey O, Nelson K. Clinical presentation and risk behaviors of patients with acquired immunodeficiency syndrome in Thailand, 1994–1998: regional variation and temporal trends. Clin Infect Dis. 2001;32:955–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23:525–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Hakim JG, Gangaidzo IT, Heyderman RS, Mielke J, Mushangi E, Taziwa A, Robertson VJ, Musvaire P, Mason PR. Impact of HIV infection on meningitis in Harare: a prospective study of 406 predominantly adult patients. AIDS. 2000;14:1401–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Gordon SB, Walsh AL, Chaponda M, Gordon MA, Soko D, Mbwvinji M, Molyneux ME, Read RC. Bacterial meningitis in Malawian adults: pneumococcal disease is common, severe, and seasonal. Clin Infect Dis. 2000;31:53–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Van der Horst CM, Saag MS, Cloud GA, Hamill RJ, Graybill JR, Sobel JD, Johnson PC, Tuazon CU, Kerkering T, Moskovitz BL, Powderly WG, Dismukes WE. Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. N Engl J Med. 1997;337:15–21.PubMedCrossRefGoogle Scholar
  9. 9.
    Robinson PA, Bauer M, Leal MA, Evans SG, Holtom PD, Diamond DA, Leedom JM, Larsen RA. Early mycological treatment failure in AIDS associated cryptococcal meningitis. Clin Infect Dis. 1999;28:82–92.PubMedCrossRefGoogle Scholar
  10. 10.
    French N, Gray K, Watera C, Nakiyingi J, Lugada E, Moore M, Lalloo D, Whitworth JA, Gilks CF. Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults. AIDS. 2002;16:1031–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Okongo M, Morgan D, Mayanja B, Ross A, Whitworth J. Causes of death in a rural, population-based human immunodeficiency virus type 1 natural history cohort in Uganda. Int J Epidemiol. 1998;27:698–702.PubMedCrossRefGoogle Scholar
  12. 12.
    Corbett EL, Churchyard GJ, Charalambos S, Samb B, Moloi V, Clayton TC, Grant AD, Murray J, Hayes RJ, De Cock KM. Morbidity and mortality in South African gold miners: impact of untreated disease due to human immunodeficiency virus. Clin Infect Dis. 2002;34:1251–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Soumaré M, Seydi M, Ndour CT, Dieng Y, Diouf AM, Diop BM. Aspects actuels de la cryptococcose neuro-méningée à Dakar. Med Trop. 2005;65:559–60.Google Scholar
  14. 14.
    Bicanic Tihana, Harrison TS. Cryptococcal meningitis. Br Med Bull. 2004;72:99–118.PubMedCrossRefGoogle Scholar
  15. 15.
    Eholie SP, Adou-Brynh D, Domoua K, Kakou A, Ehui E, Gouamene A, Bonnard D, Aoussi E, Bissagnene E, Kadio A. Méningites lymphocytaires non virales de l’adulte à Abidjan (Côte d’Ivoire). Bull Soc Pathol Exot. 2000;93:50–4.PubMedGoogle Scholar
  16. 16.
    Okome nkoumou M, Mbounja loclo ME, Kombila M. Panorama des affections opportunistes au cours de l’infection par le VIH à Libreville, Gabon. Santé. 2000;10:329–37.PubMedGoogle Scholar
  17. 17.
    Dzoyem JP, Kechia FA, Ngaba GP, Lunga PK, Lohoue PJ. Prevalence of cryptococcosis among HIV-infected patients in Yaounde, Cameroon. Afr Health Sci. 2012;12:129–33.PubMedGoogle Scholar
  18. 18.
    Thakur R, Sarma S, Kushwaha S. Prevalence of HIV-associated cryptococcal meningitis and utility of microbiological determinants for its diagnosis in a tertiary care center. Indian J Pathol Microbiol. 2008;51:212–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Taneji J, Mishra B, Bhargava A, Loomba P, Dogra V, Thakur A. Cryptococcal meningitis in a tertiary care hospital. Jpn J Med Mycol. 2009;50:95–9.CrossRefGoogle Scholar
  20. 20.
    Darras-joly C, Chevret S, Wolff M. Cryptococcus neoformans infection in France: epidemiologic features of early prognostic parameters for 76 patients who were infected with Human Immunodeficiency Virus. Clin Infect Dis. 1996;23:369–76.PubMedCrossRefGoogle Scholar
  21. 21.
    Atul K, Patel L, Ketan K, Rajiv R, Shalin S, Jagdish K. Management of cryptococcal meningitis in HIV-infected patients: experience from western India. Indian J Sex Transm Dis. 2010;31:22–6.CrossRefGoogle Scholar
  22. 22.
    Ki-zerbo GA, Sawadogo A, Andonaba JB, Yemeogo A, Ouedraogo I, Tamini M, et al. La Cryptococcose neuroméningée au cours du SIDA au centre hospitalier de Bobodioulasso: Etude préliminaire à l’hôpital de Bobodioulasso. Med d’Afr Noire. 1996;43(1):63–5.Google Scholar
  23. 23.
    Tintelnot K, Lemmer K, Losert H, Schar G, Polak A. Follow-up of epidemiological data of cryptococcosis in Austria, Germany and Switzerland with special focus on the characterization of clinical isolates. Mycoses. 2004;47:455–64.PubMedCrossRefGoogle Scholar
  24. 24.
    Chen S, Sorrell T, Nimmo G, Speed B, Currie B, Ellis D, et al. Epidemiology and host and variety dependent characterization of infection due to Cryptococcus neoformans in Australia and New Zealand. Clin Infect Dis. 2000;31:499–508.PubMedCrossRefGoogle Scholar
  25. 25.
    Kumar S, Wanchu A, Chakrabarti A, Sharma A, Bambery P, et al. Cryptococcal meningitis in HIV infected experience from a North Indian tertiary center. Neurol India. 2008;56:444–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Kisenge PR, Hawkins AT, Maro VP, Mchele JPD, Swai NS, Mueller A, Houpt ER. Low CD4 count plus coma predicts cryptococcal meningitis in Tanzania. BMC Infect Dis. 2007;7:39.PubMedCrossRefGoogle Scholar
  27. 27.
    Dromer F, Lortholary O. Cryptococcose. Encyclopédie Médico-Chirurgicale. 2004;8:613.Google Scholar
  28. 28.
    Millogo A, Ki-Zerbo GA, Andonaba JB, Lankoandé D, Sawadogo A, Yaméogo I, Sawadogo AB. Cryptococcal meningitis in HIV-infected patients at Bobo-Dioulasso hospital (Burkina Faso). Bull Soc Pathol Exot. 2004;97:119–21.PubMedGoogle Scholar
  29. 29.
    Ondounda M, Mounguengui D, Mandji LJ, Magne C, Nziengui MM, Kombila U, Nzenze JR. Neuromeningeal cryptococcosis and AIDS: an 11-case series from Libreville, Gabon. Med Trop. 2010;70:406.Google Scholar
  30. 30.
    Oumar AA, Dao S, Ba M, Poudiougou B, Diallo A. Epidemiological, clinical and prognostic aspects of cryptococcal meningitis in hospital area of Bamako, Mali. Rev Med Brux. 2008;29:149–52.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Doudou Sow
    • 1
  • Roger Clément Tine
    • 1
  • Khadime Sylla
    • 1
  • Mansata Djiba
    • 1
  • Cheikh Tidiane Ndour
    • 2
  • Thérèse Dieng
    • 1
  • Jean Louis Ndiaye
    • 1
  • Babacar Faye
    • 1
  • Daouda Ndiaye
    • 1
  • Oumar Gaye
    • 1
  • Yémou Dieng
    • 1
  1. 1.Department of Parasitology, Faculty of MedicineUniversity Cheikh Anta DIOPDakarSenegal
  2. 2.Infectious Diseases ClinicFann Teaching HospitalDakarSenegal

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