Cryptococcal meningitis

ABSTRACT Introduction: cryptococcal meningitis is a condition of sustained clinical course, three or more weeks, with the pathogen involved being an encapsulated yeast, Cryptococcus Neoformans. Frequency of this meningitis is rising due to the increase of immunosuppressive conditions among patients. At present it is considered one of the most common fungal infections in patients with AIDS. Objectives: To describe clinical and paraclinical presentations, treatment, complications and mortality in hospitalized patients with cryptococcal meningitis at the National Hospital (Itaugua). Methods: Descriptive, observational, retrospective, cross-sectional study, conducted in patients with meningoencephalitis by C. neoformans admitted to the Department of Internal Medicine and Critical Care Unit, Department of Internal Medicine Itaugua National Hospital between April 2009 and July 2012. Results: 13 patients were taken in. There was a male gender predominance (76%) within the third decade of life (38%). Patients had unspecific clinical presentations, with fatigue, anorexia, weight loss (92%) followed by headache. The predominant neurological involvement was meningeal irritation (77%). Cerebrospinal fluid (CSF) cytochemical was compatible with chronic meningitis in 92%, Chinese ink (+) in 92%, CSF culture (+) to C. neoformans in 46% and blood cultures (+) in 38%. 62% of the patients were HIV (+), all in clinical state C3. The most common tomographic skull image was brain edema (54%). The majority of patients in the induction phase were treated with amphotericin B (85%). In the consolidation phase the drug that was used was fluconazole (58%). Morbidity was 77%, complications were blindness, hearing loss, hydrocephalus, seizures. 6 patients died (46%) of which 5 patients were HIV (+). Conclusions: The largest number of cases was seen in young adult men associated with HIV diagnosis. The diagnosis was based on Chinese ink and confirmation of growth of C. neoformans CSF cultures. Mortality was 46%.