Cryptococcal meningitis in human immunodeficiency virus-infected patients in Harare, Zimbabwe.
A prospective observational study was conducted over a 10-month period to determine the clinical and laboratory manifestations of cryptococcal meningitis in Zimbabwe, a country where antifungal agents are not widely available. Eighty-nine patients with cryptococcal meningitis (median age, 34 years; range, 11-63 years; 56 males) were identified from 406 patients for whom a clinical diagnosis of meningitis had been made. All patients tested were positive for antibody to human immunodeficiency virus. Cryptococcal meningitis was the first AIDS-defining illness in 88% of patients. Typical presentations were headache, mental impairment, and meningism (median duration, 14 days; range, 1-180 days). The median CD4+ cell count was 70/microL (range, 0-651/microL). The cumulative median survival from the time of diagnosis was 14 days (range, 0-233 days); 22% of patients survived for >30 days. Independent indicators of a good prognosis were not identified. This study provides a unique basis for the development of novel management strategies for patients with cryptococcal meningitis who reside in resource-poor countries.
Heyderman
R S
RS
Department of Medicine, Medical School, University of Zimbabwe, Harare.
Gangaidzo
I T
IT
Hakim
J G
JG
Mielke
J
J
Taziwa
A
A
Musvaire
P
P
Robertson
V J
VJ
Mason
P R
PR
D017088:AIDS-Related Opportunistic Infections / Q000503:physiopathology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D002648:Child; D003453:Cryptococcosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016921:Meningitis, Fungal / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D015030:Zimbabwe