Epidemiological, Clinical and Paraclinical Outcomes of Neuromeningeal Cryptococcosis among HIV Inpatients at the Armed Forces Training Hospital Omar BONGO ONDIMBA in Gabon

Background: The Human Immunodeficiency Virus (HIV) is a chronic pathology, progressively evolving towards a severe immunodepression without antiretroviral treatment. This severe immunodepression corresponds to the Acquired Immunodeficiency Syndrome (AIDS) stage, which favoring the occurrence of opportunistic infections. like Cryptococcosis, a systemic fungal infection with a neuromeningeal tropism due to a mycosis called Cryptococcus neoformans (opportunistic yeast fungus). In Gabon, the last study was conducted in 2016 at Lambaréné Hospital Center, where the authors reported two cases of neuromeningeal cryptococcosis (NMC) with HIV in a rural area, who were not adhering to antiretroviral treatment (ART). Objective: Determine the prevalence, clinical and paraclinical feature of Neuromeningeal Cryptococcosis (NMC) associated with people living with HIV (PLHIV) in the internal medicine department. Materials and Methods: This were a retrospective study of adult inpatient who presented with neuromeningeal cryptococcosis associated with HIV in the internal medicine department of HIA-OBO over a period of 6 years from December 01, 2015 to December 31, 2021. Results: The prevalence was 8,4%. We collected 6 PLHIV inpatients, two men and four women. The most affected age group was 40 to 50 years old with a female predominance. The clinical feature was dominated by the deterioration of the general state (100%), headaches (50%), hemiplegia and fever in 50% of the cases. The main CSF cytochemical outcome were hyperproteinorachia (100%) and hypoglycorachia (83.3%). The diagnosis of NMC was suspected on clinical and biological signs, then confirmed with the identification of cryptococci either by a direct exam with India ink or by culture of the CSF (83.3%). The level of CD4 cells was ≤ 100 cells/mm3 in 66.7% of cases. Thus, classifying PLHIV with this opportunistic disease at stage C3 AIDS according to the CDC Atlanta classification. Conclusion: The clinical signs, the HIV context, the stage of clinical and immunological immunosuppression in PLHIV helped in the diagnosis of NMC; confirmed by the results of direct examination (India ink test) and/or CSF culture on Sabouraud medium to detect Cryptococcus neoformans