Department of Parasitology, Faculty of Medicine, University Cheikh Anta DIOP, Dakar, Senegal,
Mycopathologia. 2013 Dec;176(5-6):443-9. doi: 10.1007/s11046-013-9710-8. Epub 2013 Oct 25.
Cryptococcal meningitis is one of the most important opportunistic infection and a major contributor to early mortality. In sub-Saharan Africa, particularly in Senegal, prevalence of cryptococcal meningitis remains high. This study aimed to describe the epidemiology, laboratory profile, therapeutic and outcome of cases diagnosed in Dakar.
We analyzed the cryptococcosis cases diagnosed at the department of parasitology-mycology in Fann Teaching Hospital in Dakar from 2004 to 2011. The diagnosis was confirmed by culture on Sabouraud's dextrose agar and/or by India ink preparation and/or by cryptococcal antigen detection. The diagnosis methods were assessed by using culture as reference.
A total of 106 cases of cryptococcal meningitis were diagnosed. The prevalence of cryptococcal meningitis was 7.8 %. The mean age of the patients was 40.17 ± 9.89 years. There were slightly more male (53.8 %) than female (46.2 %) patients; 89.6 % were found to be infected with HIV, and the median CD4+ count was 27/mm(3). Approximately 79.5 % of the patients had <100 CD4+ lymphocytes/mm(3). India ink staining presented sensitivity at 94.11 % and specificity at 100 %. Sensitivity and specificity of cryptococcal antigen detection in cerebrospinal fluid were, respectively, 96.96 and 15.78 %. The most frequently used antifungal drug was fluconazole (86.7 %), and the mortality rate was 62.2 % (66 deaths).
Early diagnosis is essential to control cryptococcosis, and countries should prioritize widespread and reliable access to rapid diagnostic cryptococcus antigen assays. But it is important to make available conventional methods (India ink and culture) in the maximum of laboratory in regional health facilities.
隐球菌性脑膜炎是最重要的机会性感染之一，也是导致早期死亡率的主要原因。在撒哈拉以南非洲，尤其是塞内加尔，隐球菌性脑膜炎的患病率仍然很高。本研究旨在描述在达喀尔诊断的病例的流行病学、实验室特征、治疗和结局。
我们分析了 2004 年至 2011 年期间在达喀尔法恩教学医院寄生虫学-真菌学系诊断的隐球菌病病例。诊断通过沙氏葡萄糖琼脂和/或印度墨水准备和/或隐球菌抗原检测的培养来确认。使用培养作为参考评估诊断方法。
共诊断出 106 例隐球菌性脑膜炎。隐球菌性脑膜炎的患病率为 7.8%。患者的平均年龄为 40.17±9.89 岁。男性（53.8%）略多于女性（46.2%）；89.6%的患者感染了 HIV，中位数 CD4+计数为 27/mm3。约 79.5%的患者的 CD4+淋巴细胞/mm3<100。印度墨水染色的敏感性为 94.11%，特异性为 100%。脑脊液中隐球菌抗原检测的敏感性和特异性分别为 96.96%和 15.78%。最常使用的抗真菌药物是氟康唑（86.7%），死亡率为 62.2%（66 例死亡）。
早期诊断对于控制隐球菌病至关重要，各国应优先考虑广泛和可靠地获得快速诊断隐球菌抗原检测。但在区域卫生机构的最大实验室中提供常规方法（印度墨水和培养）很重要。
