title: Cryptococcal meningitis in Senegal: epidemiology, laboratory findings, therapeutic and outcome of cases diagnosed from 2004 to 2011.
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/mm(3). Approximately 79.5 % of the patients had <100 CD4+ lymphocytes/mm(3). 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Parasitology, Faculty of Medicine, University Cheikh Anta DIOP, Dakar, Senegal, doudsow@yahoo.fr.
authors.forename: Doudou
authors.initials: D
authors.lastname: Sow
authors.forename: Roger Clément
authors.initials: RC
authors.lastname: Tine
authors.forename: Khadime
authors.initials: K
authors.lastname: Sylla
authors.forename: Mansata
authors.initials: M
authors.lastname: Djiba
authors.forename: Cheikh Tidiane
authors.initials: CT
authors.lastname: Ndour
authors.forename: Thérèse
authors.initials: T
authors.lastname: Dieng
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Ndiaye
authors.forename: Babacar
authors.initials: B
authors.lastname: Faye
authors.forename: Daouda
authors.initials: D
authors.lastname: Ndiaye
authors.forename: Oumar
authors.initials: O
authors.lastname: Gaye
authors.forename: Yémou
authors.initials: Y
authors.lastname: Dieng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003454:Cryptococcus / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D008828:Microbiological Techniques / Q000379:methods; D008875:Middle Aged; D015995:Prevalence; D012675:Senegal / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents