Neuromeningeal cryptococcosis in sub-Saharan Africa: Killer disease with sparse data

Abstract

Introduction: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.Materials and 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/mm3. 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.Conclusion: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.

Cryptococcal antigenemia and associated risk factors among ART‐naïve and ART‐experienced HIV‐infected peoples at selected health institutions of Mekelle, Northern Ethiopia

“…However, in this study males, residing in rural areas, CD4 < 100 cells/mm 3 , and being hospitalized were statistically associated with cryptococcal antigenemia. Although cryptococcal infections occur in both sexes, a statistically significant difference in gender was also observed in other studies; this is likely due to poor health‐seeking behavior of men to present later to care (Alemu et al, ; Assogoba et al, ; Ngouana et al, ) and the interaction Cryptococcus with testosterone, which results in increased capsular polysaccharide release and Cryptococcus ‐mediated macrophage death (McClelland et al, ). In addition to this, rural residents were at risk for cryptococcal infection.…”

“…In Africa, cryptococcal‐related infections place a high burden on healthcare resources. It causes a severe and often fatal meningoencephalitis in people living with HIV/AIDS, accounting for 42% to 71% of neuromeningeal cryptococcosis‐related deaths in sub‐Saharan Africa (Assogoba et al, ).…”

Multilocus sequence typing analysis reveals that Cryptococcus neoformans var. neoformans is a recombinant population

“…This life-threatening disease is mainly associated with AIDS patients in the countries where the HIV infection burden is still high such as in sub-Saharan Africa and in South East Asia (Assogba et al, 2015; Park et al, 2009). In developed countries, however, the incidence of cryptococcosis in HIV-infected population is decreasing due to the introduction of high active antiretroviral therapy (HAART).…”

Cryptococcal Meningitis of the HIV-Infected Person in Lom&#233;: About 102 Cases over 10 Years

“…At the immune level, all patients were in the AIDS phase of HIV with a very high viral load greater than 6 Log/ml. Note that cryptococcosis is an opportunistic disease of AIDS and is seen mainly at the terminal phase of the evolution of HIV characterized by a collapse of immunity and a very high plasma viral load as can be seen in many studies [8] [9]. In Togo, the discovery of an HIV infection is still occurring today with to the discovery of an opportunistic infection.…”