Purchase this article with an account.
Ninani E. Coyne Kombo, Oathokwa Nkomazana, Susan H. Forster, Ron A. Adelman; Ocular Manifestations in HIV/AIDS Patients with Concurrent Cryptococcal Meningitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6223.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
This study seeks to describe the ocular findings in HIV/AIDS patients with cryptococcal meningitis. The secondary goals were estimation of the incidence of visual loss and description of: the risk factors for developing vision loss; other ocular complications associated with cryptococcal meningitis; and ocular complications of HIV infection unrelated to cryptococcal infection.
The setting of the study was Princess Marina Hospital (PMH), a tertiary referral center, in Gaborone, Botswana. Approval for the study was obtained from the IRB at Yale University and the equivalent in Botswana. From June to August 2008, all patients admitted to PMH with HIV/AIDS and cryptococcal meningitis were invited to participate in the study. After consent was obtained, medical data was extracted from their medical charts. Medical history as well as presenting symptoms were obtained through an interview by the investgators. Ophthalmic exams were performed by ophthalmologists.
Fourteen patients were enrolled in the study and one dropped out. Their ages ranged from 16 to 52 years (median 37 years). The mean CD4+ level of the participants was 72 cells/µL (range 10 to 206cells/µL, median 45cells/µL). Twelve out of thirteen participants reported visual symptoms, the most common being: blurry vision, photophobia, and tearing. Ocular findings related to elevated intracranial pressure secondary to cryptococcal meningitis were: ophthalmoplegia (3/13, 23%), papilledema (2/13, 15%), and optic disc atrophy (3/13, 23%). No participant presented with complete blindness, nor did any become completely blind during hospitalization. The in-hospital mortality in this study was 30.8% (4 of 13 patients). There was no intraocular Cryptococcal infection observed. Non-cryptococcal related findings were: clinically diagnosed ocular surface neoplasia (OSSN) in one patient (OD), molluscum contagiosum papules on the eyelids of 2 patients, a pterygium, and a pingueculum each in one patient.
In conclusion, intraocular cryptococcal infection is rare in HIV/AIDS patients. Our data, in agreement with other studies, indicate the high in-hospital mortality (30.8%) of cryptococcal meningitis in HIV/AIDS patients and the low prevalence of intraocular cryptococcal infection. Better understanding of the relationship between cyrptococcal meningitis and ocular manifestations of the disease in the HIV/AIDS population in Botswana and other sub-Saharan nations can have an important impact on ophthalmic and medical care.
This PDF is available to Subscribers Only