Cryptococcal meningitis in a tertiary hospital in Pretoria,mortality and risk factors

Abstract

Aim

This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with cryptococcal meningitis. These factors include the patient’s socio-economic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy.

Methods

Data were collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed cryptococcal meningitis over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients’ mortality risk.

Results

A total of 87 patients were identified. All except one were HIV-positive, of which 55.2% were antiretroviral therapy naïve. A history of previous tuberculosis was given by 25 patients (28.7%) and 49 (56.3%) were on tuberculosis treatment at admission or started during their hospital stay. In-hospital mortality was 31%. Statistical analysis showed that antiretroviral therapy naïve patients had 9.9 (CI 95% 1.2–81.2, p < 0.0032) times greater odds of dying compared to those on antiretroviral therapy, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment. Defaulters had 14.7 (CI 95% 1.6–131.6, p < 0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7–23.1, p < 0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for antiretroviral therapy naïve patients and defaulters.

Conclusion

Cryptococcal meningitis is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting antiretroviral therapy and presentation with nausea and vomiting were associated with a significantly increased mortality risk.

Keywords

AIDS highly active antiretroviral therapy viral disease

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References

Shisana

Rehle

Simbayi

. South African National HIV prevalence, incidence and behavior survey, Cape Town: HSRC press, 2012.

Johnson

Mossong

Dorrington

. Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med 2013; 10: e1001418–e1001418.

McCarthy

Cohen

Schneider

. Cryptococcosis in Gauteng: Implications for monitoring of HIV treatment programmes. SAMJ 2008; 98: 452–454.

Bicanic

Harrison

. Cryptococcal meningitis. Br Med Bull 2005; 72: 99–118.

Jarvis

Harrison

Corbett

. Is HIV-associated tuberculosis a risk factor for development of cryptococcal disease? AIDS 2010; 24: 612–614.

Jarvis

Meintjes

Williams

. Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases. BMC Infect Dis 2010; 10: 67–67.

Lessels

Mutevedzi

Heller

. Poor long-term outcomes for cryptococcal meningitis in rural South Africa. SAMJ 2011; 101: 251–252.

Sogbanmu

John

Lalloo

. Management of cryptococcal meningitis in adults at Mthata Hospital Complex, Eastern cape, South Africa. S Afr J HIV Med 2014; 15: 104–107.

Southern African HIV Clinician Society. The Guideline for the prevention, diagnosis and management of cryptococcal meningitis among HIV-infected persons: 2013 update. S Afr J HIV Med 2013; 2: 76–86.

10.

Haddow

Colebunders

Meintjes

. Cryptococcal immune reconstitution inflammatory syndrome I HIV-1-infected individuals: proposed clinical case definitions. Lancet Infect Dis 2010; 10: 791–802.

11.

Park

. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS 2009; 23: 525–530.

12.

Sachdeva

Randev

Sharma

. A retrospective study of AIDS-associated cryptomeningitis. AIDS Res Hum Retroviruses 2012; 28: 1020–1026.

13.

Majumder

Mandal

Bandyopadhyay

. Prognostic markers in AIDS-related cryptococcal meningitis. J Assoc Physicians India 2011; 59: 152–154.

14.

De Vedia

Arechavala

Calderon

. Relevance of intracranial hypertension control in the management of Cryptococcus neoformans meningitis related to AIDS. Infection 2013; 41: 1073–1077.

15.

Kendi

Penner

Koech

. Predictors of outcome in routine care for cryptococcal meningitis in Western Kenya: lessons for HIV outpatient care in resource-limited settings. Postgrad Med J 2013; 89): 73–77.

16.

Anekthananon

Manosuthi

Chetchotisakd

. Predictors of por clinical outcome of cryptococcal meningitis in HIV-infected patients. Int J STD AIDS 2011; 22: 665–670.

17.

Brinkhof

MWG

Pujades-Rodriguez

Egger

. Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis. PLoS One 2009; 4: e5790–e5790.

18.

McGuire

Munyenyembe

Szumilin

. Vital State of pre-ART and ART patients defaulting from care in rural Malawi. Trop Med Int Health 2010; 15: 55–62.

19.

Miller

Ketlhapile

Rybasack-Smith

. Why are antiretroviral treatment patients lost to follow up? A qualitative study from South Africa. Trop Med Int Health 2010; 15: 48–54.

20.

Loyse

Thangaray

Easterbrook

. Cryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries. Lancet Infect Dis 2013; 13: 629–637.

Cryptococcal meningitis in a tertiary hospital in Pretoria,mortality and risk factors – A retrospective cohort study