title: Neuromeningeal cryptococcosis in sub-Saharan Africa: Killer disease with sparse data.
abstract: BACKGROUND
  The extent of neuromeningeal cryptococcosis (NMC) has increased since the advent of HIV/AIDS. It has non-specific clinical signs but marked by high mortality.
  
  
  OBJECTIVE
  To analyze the characteristics of the NMC in sub-Saharan Africa.
  
  
  METHODS
  We have conducted a literature reviewed on the NMC in sub-Saharan Africa from the publications available on the basis of national and international data with keywords such as "Cryptococcus, Epidemiology, Symptoms, Outcomes and Mortality" and their equivalent in French in July 2011. All publications from 1990 to 2010 with 202 references were analyzed. The following results are the means of different studied variables.
  
  
  RESULTS
  We selected in final 43 publications dealing with the NMC which 24 involved 17 countries in Africa. The average age was 36 years old. The average prevalence was 3.41% and the average incidence was 10.48% (range 6.90% to 12%). The most common signs were fever (75%), headaches (62.50%) and impaired consciousness. Meningeal signs were present in 49% of cases. The mean CD4 count was 44.8cells/mm(3). The India ink and latex agglutination tests were the most sensitive. The average time before the consultation and the hospital stay was almost identical to 27.71 days. The average death rate was 45.90%. Fluconazole has been the most commonly used molecule.
  
  
  CONCLUSIONS
  The epidemiological indicators of NMC varied more depending on the region of sub-Saharan Africa. Early and effective taking care of patients to reduce diagnostic delay and heavy mortality remains the challenges.
authors.affiliation: Department of Neurology, Campus University Teaching Hospital, Lomé, Togo.
authors.forename: Komi
authors.initials: K
authors.lastname: Assogba
authors.affiliation: Department of Neurology, Campus University Teaching Hospital, Lomé, Togo.
authors.forename: Mofou
authors.initials: M
authors.lastname: Belo
authors.affiliation: Department of Infectious Diseases, Sylvanus Olympio University Hospital, Lomé, Togo.
authors.forename: Majeste Ihou
authors.initials: MI
authors.lastname: Wateba
authors.affiliation: Department of Neurology, Calavi University Hospital, Cotonou, Benin.
authors.forename: Dieu Donné
authors.initials: DD
authors.lastname: Gnonlonfoun
authors.affiliation: Department of Neurology, University Hospital of Brazzaville, Brazzaville, Congo.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ossou-Nguiet
authors.affiliation: Neurology Department, General hospital of Yaoundé, Cameroon.
authors.forename: Berenger B C
authors.initials: BB
authors.lastname: Tsanga
authors.affiliation: Neurological Clinic, University Hospital of Fann, Dakar, Senegal.
authors.forename: Moustapha
authors.initials: M
authors.lastname: Ndiaye
authors.affiliation: Department of Neurology, Campus University Teaching Hospital, Lomé, Togo.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Grunitzky
keywords: Cryptococcus neoformans; Sub-Saharan Africa; epidemiology; neuromeningitis