Treatment outcomes of Aids Associated Cryptococcal Meningitis using Emphotericin B and Fluconazole at Mol Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background:- Studies on treatment meningitis using amphotericin outcomes of AIDS associated cryptococcal B and fluconazole vary greatly. Internationally accepted induction therapy is expensive and unavailable in developing countries like Kenya. Objectives: - To determine the prevalence of AIDS-associated cryptococcus meningitis among HIV -infected patients presenting with meningitis and observe 14-day treatment outcomes using amphotericin B compared to fluconazole. Study Design- a prospective cohort study. Setting: Moi Teaching and Referral Hospital (MTRH) medical wards, Eldoret, Kenya Subjects- HIV -infected inpatients ~13years diagnosed with cryptococcal meningitis. Methods- Lumbar puncture was performed on HIV -infected patients admitted with signs and symptoms of meningitis. Cerebrospinal fluid (CSF) was subjected to tests for Cryptococcus neoformans, including Indian ink stain, cryptococcal antigen (CRAG) test and fungal culture. Patients diagnosed with cryptococcus meningitis were started on either amphotericin B (50mg/day) or fluconazole (800mg/day) by the admitting physician depending on drug availability. Patients were consecutively enrolled and followed for 14 days, at which point acute mortality, mycological, clinical, combined clinical/mycological cure and drug related adverse reactions were documented. Results - Between June 2007 and February 2008, 273 HIV-infected patients (131(48%) males, median age 35 years) were evaluated of who 96 (35%) had cryptococcal meningitis. Fifty (52%) were males, median age 36 and median CD4 cell count 61cells/ml. Headache was reported in 79%, fever in 32%, signs of meningism in 45% and focal neurological deficits in 13% of the patients. clinical & mycological Mycological, clinical and combined success rates were 94%, 76% and 73.8% with amphotericin B versus 64.3%, 51% and 45% with fluconazole (p values: 0.019, 0.0115 and 0.00350 respectively. Overall mortality was 15.4%. Acute mortality was 9.5% in the amphotericin B group and 20.4% in the fluconazole group (p= 0.1513). Conclusion: The prevalence of AIDS associated cryptococcal meningitis among HIV- infected patients presenting with meningitis at MTRH was 35%. Patients treated with amphotericin B in the induction period had favorable clinical, mycological, combined clinical and mycological and mortality outcomes than patients treated with fluconazole.