Fluconazole 1200 mg ou 800 mg dans le traitement de la cryptococcose neuroméningée en Côte d’Ivoire

Objective. - Assessing the use of high-dose fluconazol monotherapy (1200 mg or 800 mg) in the treatment and prognosis of HIV-associated cryptococcal meningitis in Ivory Coast. Patients and methods. - A retrospective study carried out from August 2008 to August 2011 based on patients charts suffering from CM in the Abidjan Tropicals and Infectious Disease Unit. Mortality rate and associated factors were analyzed. Results. - Forty-six cases of cryptococcal meningitis (2.5% of hospitalizations) were included. The sex-ratio was of 1.2. The median age was 40.5 [35-47] years. The symptomatology was subacute (93.5%). The main clinical symptoms were syndrome of pure meningeal irritation (65%), fever (100%); 35% of patients had encephalomeningits. Twenty-one (45.7%) was ART-naive patients. Fluconazole 1200 mg was prescribed to 29 (63%) patients. Therapeutic lumbar punctures were performed in 42 (91.3) patients. The mortality rate was 50%. Significant predictors of mortality were encephalomeningitis and therapeutic lumbar puncture. Conclusion. - Cryptococcal meningitis associated mortality remains high despite the use of high-dose fluconazole monotherapy. Therapeutic lumbar punctures help to improving the prognosis. (C) 2016 Elsevier Masson SAS. All rights reserved.