Management of Cryptococcal Meningitis in AIDS: The Need for Specific Studies in Developing Countries

Abstract

Cryptococcosis is a deadly opportunistic infection caused by an encapsulated yeast Cryptococcocus neoformans. The major predisposing factor is the profound cellular immune defect caused by HIV infection. Despite major advances in the treatment of HIV infection with HAART cryptococcosis is still diagnosed in Western countries especially in patients who have limited access to health care. In sub-Saharan Africa and Southeast Asia cryptococcosis remains a major concern representing the third most common cause of hospital admission and the cause of 44% of HIV infection-related deaths in South Africa. Meningitis is diagnosed in ~90% of HIV-infected patients who have cryptococcosis and C. neoformans currently represents the first or second microorganism that causes meningitis in adults in several African countries. Recent data obtained by the French Cryptococcosis Study Group have suggested that the observation of any evidence of cryptococcosis on the basis of positive antigen detection the presence of encapsulated yeasts during direct examination or histological analysis and/ or the isolation of C. neoformans from any body site should be immediately followed by sampling and culture of CSF blood and urine samples and by serum antigen titration to evaluate fungal burden and to optimize induction treatment. (excerpt)