About 54 Cases of Neuromeningtic Cryptococcosis on HIV Infection

Introduction: The advent of antiretrovirals has reduced the prevalence of neuroméningated cryptococcosis (CNS) in patients living with HIV (PLHIV). Objectives: Epidemiological-clinical, paraclinical, therapeutic and evolutionary analysis of 54 cases of CNM in PVVIH. Patients and methods: A retrospective study reporting cases of CNM in patients living with HIV (PLWHIV) collected between January 01, 1993 and June 30, 2017 at the national reference center for the management of HIV infection; EHS service B El Hadi Flici ex EL KETTAR, Algiers. Results: In a group of 1289 PPVIH, 4.2% presented a CNM. The mean age was 39 ± 2years with a sex ratio of (3.15). The CNM was inaugural of HIV infection in 41%. The dominant picture: meningoencephalitis in 50% of cases, febrile headache 28%, fevers isolated 11%, headache isolated 9% and one asymptomatic case. The stiffness of the neck found in fourteen patients. Note that 04 patients developed disseminated form. In 51 lumbar punctures performed, the cephalospinal fluid (LCS) was pathological in 61%, with a clear appearance of 86%. Mean cytoracy: 60 cells / mm3 predominantly lymphocytic in 19 patients. Hyperproteinorachia was found in 18 patients with an average of 0.73 g / l. Hypoglycorachia in 14 patients with an average of 0.36 g/l. direct examination with Indian ink staining identifies Cryptococcus neoformans in 61% of cases, culture on Sabouraud medium supplemented with chloramphenicol positive 80.3%. The search for soluble cryptococcal antigens by the latex agglutination test was positive in 70.6%. In the context of the dissemination report: 63% positive antigenemia, two positive blood cultures, two antigenurias and direct urine tests for cryptococcus were positive, and a skin biopsy performed in one patient was positive. In the induction phase, amphotericin B was prescribed as monotherapy in 87% of cases whereas fluconazole was only prescribed in 7.4% (n = 4) of cases, the combination of both was indicated only in 1.8% and two patients (3.7%) died within 24 hours of diagnosis without receiving antifungal therapy. It is noted that Fluconazole alone at 200 mg / day was initiated at the maintenance phase until the recovery of CD4. The average time after the start of ARVs after beginning the management of the CNM 15 ± 4 days. The result was favorable in 61%, relapse 14.8% and 39% (n = 21) of reported deaths. Conclusion: This study reveals that morbidity and mortality are closely related to the early diagnosis and the initiation of adequate antifungal therapy.