Cryptococcal meningitis in Lilongwe and Blantyre, Malawi

Infection with Human Immunodeficiency Virus is widespread in Malawi and cryptococcal meningitis is a common problem in those with AIDS. A review of microbiology laboratory records in Lilongwe and Blantyre between July 1991 and January 1993 identified 31 patients with cryptococcal meningitis. Diagnosis was based on a positive India ink stain of CSF and/or culture of Cryptococcus neoformans. There were 16 men (median age 38 years) and 15 women (median age 28 years) in the investigation. The median duration of symptoms was 2 weeks. The clinical presentation was varied, the most frequent features being headache (97%), neck stiffness (74%), fever (61%) and altered consciousness (58%). CSF WBC count, glucose and protein concentrations were non-specific. Most patients could not afford anti-cryptococcal chemotherapy and their median survival time after diagnosis was 4 days. Patients who could afford such treatment survived for up to several months. Diagnosis is useful for prognostic reasons and may save patients unnecessary treatment if tuberculous meningitis is the alternative diagnosis. Cryptococcal antigen detection tests may improve diagnostic accuracy. The problem of cryptococcal meningitis is likely to become increasingly common as HIV infection becomes more widespread.