Mortality After Clinical Management of Aids-Associated Cryptococcal Meningitis in Kenya

  • R Baldassarre
  • R Mdodo
  • E Omonge
  • W Jaoko
  • J Bradley
  • P Pappas
  • I Abans
  • S Odera
  • A Suleh
  • PE Jolly

Abstract

Background: Cryptococcal meningitis (CM) is an increasingly prevalent  infection among HIV/AIDS patients and is becoming a leading cause of  morbidity and mortality in Africa. The short-term prognosis and  management of patients with CM may be improved by identifying factors leading to mortality in patients with CM.
Objective: To assess the clinical management and mortality associated with cryptococcal meningitis (CM) in patients with acquired  immunodeficiency syndrome (AIDS) in Kenya.
Design: A retrospective study.
Setting: Kenyatta National Hospital and Mbagathi District Hospital, between August 2008 and March 2009.
Subjects: Seventy six HIV-infected patients confirmed to be CM positive.
Results: Results show that 30 (40%) of 76 patients diagnosed with CM died during hospitalisation after a median hospital stay of ten days (range, 2-73 days). Significant predictors of mortality in the univariate model were Mycobacterium tuberculosis (TB) co-infection (P = 0.04), having been diagnosed with a co-morbid condition such as diabetes mellitus, oral candidiasis and hypertension (P = 0.01), and a low median CD4+ T lymphocyte count (P < 0.001). The multivariable model revealed that male sex, previous or current anti-retroviral therapy (ART) at admission and CD4+ T lymphocyte count less than 50 were significant predictors of mortality. Conversely, a minimum of two weeks of amphotericin B treatment (P < 0.001), initiation of ART (P = 0.007) and monitoring of creatinine and electrolyte levels (P = 0.02) were significantly associated
with survival in the univariate model.
Conclusions: CM-associated mortality in Kenya is high; there is an  opportunity to improve the management and the short-term outcomes of hospitalised HIV positive patients with CM in Kenya.
Published
2014-11-20
Section
Articles

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eISSN: 0012-835X