Parasitic and fungal central nervous system infections in hospitalised adults living with HIV in Libreville, Gabon: clinical profiles to inform syndromic triage in resource limited settings

Background Central nervous system (CNS) infections are an important cause of morbidity and mortality among people living with HIV (PLWHIV), particularly in resource-limited settings. Cryptococcosis, toxoplasmosis and cerebral malaria often present with overlapping neurological symptoms, complicating diagnosis where confirmatory tests are unavailable. This study aimed to determine the prevalence and associated signs and symptoms of parasitic and fungal infections with neurological tropism in PLWHIV hospitalized in Libreville. Methods A retrospective review was conducted at the Infectious Diseases Ward of the Centre Hospitalier Universitaire de Libreville (IDW-CHUL) between April and September 2021. Data were recorded from the medical files of PLWHIV hospitalised for suspected cryptococcal meningoencephalitis presenting with fever and headache alone or associated with other neurological signs. Diagnoses of cryptococcosis, toxoplasmosis, and malaria were based on microscopy, cryptococcal antigen testing, and brain CT scan. Cases of tuberculosis, other bacterial or viral meningitis were not included. Sociodemographic, clinical, and immunological data were analysed, and associations between symptoms and CNS infections were assessed. Results Among 255 hospitalised PLHIV, most were aged under 55 years (86.3%, n = 220), female (72.5%, n = 185), and severely immunosuppressed (CD4 Conclusion Parasitic and fungal CNS infections remain frequent and severe in hospitalised PLWHIV in Libreville, mainly in advanced disease with profound immunosuppression. In the absence of diagnostic tools, recognition of symptom clusters may guide syndromic triage and empirical therapy.