Prevalence and mortality of cryptococcal disease in adults with advanced HIV in an urban tertiary hospital in Sierra Leone: a prospective study.
Background: The global annual estimate for cryptococcal disease-related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count < 100/μl. As there is no previous...
| Publicado en: | BMC Infectious Diseases Vol. 20; no. 1; pp. 1 - 8 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | Journal Article |
| Publicado: |
BioMed Central
2/14/2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=141752159&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 141752159 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14712334 1CHU jtl: BMC Infectious Diseases issn: 14712334 maglogo: N pubinfo: dt: 2/14/2020 vid: 20 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 141752159 141752159 NLM32059703 10.1186/s12879-020-4862-x NLM32059703 141752159 ppf: 1 ppct: 7 formats: tig: atl: Prevalence and mortality of cryptococcal disease in adults with advanced HIV in an urban tertiary hospital in Sierra Leone: a prospective study. aug: au: Lakoh, Sulaiman Rickman, Hannah Sesay, Momodu Kenneh, Sartie Burke, Rachael Baldeh, Mamadu Jiba, Darlinda F. Tejan, Yusuf S. Boyle, Sonia Koroma, Comfort Deen, Gibrilla F. Beynon, Fenella affil: Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone sug: subj: Antigens, Fungal Blood HIV Infections Microbiology Cryptococcosis Epidemiology Cross Sectional Studies Cryptococcus Inpatients Statistics and Numerical Data Hospitals, Special Statistics and Numerical Data Sierra Leone Cryptococcosis Mortality HIV Infections Mortality Female Antifungal Agents Therapeutic Use Cryptococcosis Diagnosis AIDS-Related Opportunistic Infections Mortality AIDS-Related Opportunistic Infections Drug Therapy Epidemiological Research Adult Cryptococcosis Drug Therapy Prospective Studies AIDS-Related Opportunistic Infections Epidemiology AIDS-Related Opportunistic Infections Diagnosis Meningitis, Cryptococcal Diagnosis HIV Infections Drug Therapy Male Fluconazole Therapeutic Use Meningitis, Cryptococcal Drug Therapy Meningitis, Cryptococcal Epidemiology Prevalence Impact of Events Scale Scales Adult: 19-44 years Female Male ab: Background: The global annual estimate for cryptococcal disease-related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count < 100/μl. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone.Methods: A prospective cohort study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm3 from January to April 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with 8 weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher's exact test was used to compare categorical variables.Results: A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm3 (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days). Eight participants had a positive blood CrAg, giving a prevalence of 4.7% (95% CI: 2.4-9.2%). Of those with a positive CrAg, CSF CrAg was positive in five (62.5%). Five (62.5%) CrAg-positive participants died within the first month, while the remaining three were alive and established on ART at 8 weeks.Conclusion: A substantial prevalence of cryptococcal antigenaemia and poor outcome of cryptococcal disease were demonstrated in our study. The high mortality suggests a need for the HIV programme to formulate and implement policies on screening and pre-emptive fluconazole therapy for all adults with advanced HIV in Sierra Leone, and advocate for affordable access to effective antifungal therapies. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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