A review of the management and outcome of patients admitted with cryptococcal meningitis at a regional hospital in KwaZulu-Natal province

Figures & data

Figure 1: Box diagram of the CD4 count distribution of male and female patients admitted to PMMH with confirmed CCM.

Figure 2: CD4 count relative to the number of patients admitted to PMMH with CCM.

Table 1: Profile of patients admitted for CCM at PMMH 2015/2016

Variables	Outcome			Test
	Discharged = 52	Died = 24	p
Symptoms of meningitis
Headache (n = 69)	48	21	0.377	Fisher’s exact test
Photophobia (n = 40)	27	13	0.613	Fisher’s exact test
Confusion (n = 32)	15	9	0.597	Fisher’s exact test
Respiratory symptoms (n = 31)	20	11	0.619	Fisher’s exact test
Previous TB
Previous TB (any) n = 45	32	13	0.614	Fisher’s exact test
ARTs status n = 73*
On ARTs n = 32	24	8	0.321	Fisher’s exact test
Not on ARTs n = 41	26	15	0.321	Fisher’s exact test
ART naive n = 38	25	13	0.376	Fisher’s exact test
Defaulter n = 3	1	2	0.376	Fisher’s exact test
ARTs < 4 weeks	6	3	0.376	Fisher’s exact test
ARTs 5–12 weeks	3	2	0.376	Fisher’s exact test
ARTs > 12 weeks	15	3	0.376	Fisher’s exact test
CD4 count (mean) (64)	63 ± 64	40.4 ± 36.5	0.078	t-test

* Some data missing

Table 2: CSF variables for patients admitted for CCM at PMMH 2015/2016

Variables	Outcome			Test
	Discharged = 52	Died = 24	p
CSF chemistry:
Chloride (mean) (n = 75)	124 ± 6	126 ± 6	0.179	t-test
Glucose (mean) (n = 75)	1.9 ± 0.9	2 ± 0.8	0.615
Protein (mean) (n = 74)	1.4 ± 1.3	0.9 ± 0.8	0.067
Increased CSF globulins (n = 73):
Not increased = 25	14	11	0.577	Fisher’s exact test
Increased+ n = 29	21	8	0.577	Fisher’s exact test
Increased++ n = 4	3	1	0.577	Fisher’s exact test
Increased+++	11	4	0.577	Fisher’s exact test
Lymphocytes (mean) (n = 76)	46 ± 88	29 ± 66	0.353	t-test
Polymorphs (mean) (n = 76)	9.2 ± 24	11 ± 41	0.822	t-test
CSF CLAT + ve (n = 75)**	51	24
Indian ink staining (n = 64):
No yeast cells n = 16	13	3	0.223	Fisher’s exact test
Yeasts cells observed n = 48	29	19	0.223	Fisher’s exact test
Gram stain (n = 75):
No yeast seen (n = 20)	14	6	0.31	Fisher’s exact test
Yeast scanty + (n = 28)	22	6	0.31	Fisher’s exact test
Yeasts moderate ++ (n = 22)	12	10	0.31	Fisher’s exact test
Yeasts numerous +++ (n = 5)	3	2	0.31	Fisher’s exact test
Culture results – CCM confirmed:
No growth (n = 13)	8	5	0.514	Fisher’s exact test
Crypto species (n = 60)	43	17	0.514	Fisher’s exact test

** One patient was CSF CLAT negative but CSF culture positive for Cryptococcus.

Table 3: Treatment given and outcome of patients admitted with cryptococcal meningitis

Treatment options	Discharged, no. (%)	Died, no. (%)	Total
Amphotericin B & fluconazole	47 (72.3%)	18 (27.3%)	65 (85.5%)
Amphotericin B alone	4 (80%)	1 (20%)	5 (6.6%)
High-dose fluconazole alone	4 (100%)	0	4 (5.3%)
Not treated	-	2	2 (2.6%)
Total	55	21	76