Prognostic Factors in Neuromeningeal Cryptococcosis at Brazzaville University Hospital

Objective: Helping to improve the management of neuromeningeal cryptococcosis at Brazzaville University Hospital. Patients and Method: Descriptive and analytical cross-sectional study of neuromeningeal cryptococcosis cases hospitalized in the infectious diseases department between January 1, 2021 and October 31, 2024 in HIV-infected patients, receiving or not highly active antiretroviral therapy and having given free and informed consent to participate in the present study. Results: A total of 2170 patients were hospitalized during the study period, including 79 for neuromeningeal cryptococcosis, i.e. 3.6% of admissions. Mean age was 43.7 ± 11 (19-74) years, female (n=45 ;57%), housewife (n=19 ;24.1%), single (n=59 ;74.7%) and urban resident (n=76 ;96.2%). Fever (n=30;38%) and disturbed consciousness (n=23;29.1%) were the main reasons for consultation for more than 15 days (29;36.7%). The mean Glasgow score was 9.8 ± 3.2 (2-13), with neck stiffness (n=30;38%). Oral candidiasis (n=22;27.8%) and silky trichopathy (n=33;42%) were present. The CSF was clear in 100% of cases, with mean lymphocyte counts of 85.7 ± 23.9 (14-100) and mean glycorrhaphy of 0.9 ± 0.7 (0.5-4). Direct examination with India ink was positive in 64.6% of cases (n=51), and culture was performed in 5 patients. Cerebral CT scans, when performed (n=21), revealed ventricular dilatation in 14 patients (17.7%). The mean time to treatment was 5.7± 6.1 (1- 31) days. Fluconazole was used as monotherapy (n=68;86.1%), combined with Oncotyl (n=12;15.2%). Corticosteroid therapy was prescribed (n=71;89 ,9%). The mean length of hospital stay was 18.9 ± 11.3 (2-44) days, and the outcome was unfavorable in 55.7% of cases (n=44). IRIS and ICH occurred in 10 and 12 cases respectively. Case fatality was 55.7%. Poor prognostic factors were age (p=0.006), ventricular dilatation (p=0.001), radiographic abnormality (p=0.001) and neurological disorders (P<0.0001). Conclusion: The hospital prevalence of neuromeningeal cryptococcosis remains high at Brazzaville University Hospital. The poor prognostic factors identified are those described in the literature. Lethality remains high, linked to neurological and CT scan disorders. Prevention remains the only effective measure, and involves early detection and management of HIV/AIDS infection.