Original Research: A medical audit of the management of cryptococcal meningitis in HIV-positive patients

Cryptococcal meningitis (CM) is caused by an opportunistic encapsulated yeast, Cryptococcus neoformans. Despite recent expansion of antiretroviral treatment (ART) programmes in developing countries, CM remains a major opportunistic infection, and a leading cause of mortality in acquired immune deficiency syndrome (AIDS) patients.1 CM has become the leading cause of community-acquired meningitis (ahead of tuberculous and bacterial meningitis), and if not treated correctly, has a significant mortality.2 In 2009, the global incidence of CM ranged from 0.04-12% per year among persons living with human immunodeficiency virus (HIV)/AIDS. Sub-Saharan Africa had the highest yearly burden estimate (median incidence 3.2%, 720 000 cases, range 144 000-1.3 million). In regions with primarily less developed countries, the estimated case fatality was 55%. However, in sub-Saharan Africa, it was estimated to be 70%.3 Medical audit is central to the process of continuous quality improvement. Quality of care is one of the pillars of clinical governance, the concept that refers to the accountability of a health care system to ensure the correct standard of care for its patients.4 Medical audits are not new in the HIV context.5-7