Prevalence of cryptococcal meningitis among HIV patients attending Central University Hospital of Kigali
Abstract
Background: Cryptococcal meningitis (CM) is a severe fungal infection caused primarily by Cryptococcus neoformans and less commonly by Cryptococcus gattii. It poses a significant threat to individuals with compromised immune systems, particularly those living with Human Immunodeficiency Virus (HIV). Despite advancements in antiretroviral therapy (ART), CM remains a leading cause of mortality among HIV-infected individuals, especially in low- and middle-income countries.
Aim: This study was done to determine the prevalence of Cryptococcus among HIV-infected patients attending at Central University Hospital of Kigali, Rwanda and the level at which a patient’s CD4 count is significantly associated with cryptococcal meningitis.
Methodology: A retrospective study was conducted at Central University Hospital of Kigali, Rwanda. This study included 60 HIV-infected patients whose serum and CSF samples were examined for Cryptococcus by one of or all 4 tests (CSF culture, CSF CrAg, serum CrAg and Indian Ink) and their results were recorded.
Results: Among the 60 HIV-infected patients enrolled, 8 (13%) were positive for cryptococcal meningitis. Among these 8 patients the CD4 count ranged from 2-200 cells/ul, and 31.82% (7 of 8) was among patients with CD4 count ≤100 c/ul and 6.25% (1 of 8) was among patients with CD4 count levels between 101 c/ul and 200c/ul. Based on the study results, CD4 count levels lower or equal to 100 cells/ul was highly associated with cryptococcal meningitis as the P-value=0.001 and Odd ratio=0.058.
Conclusion: Based on the study results there was a significant association between cryptococcal meningitis and lower CD4 count levels. HIV-infected patients with CD4 counts ≤100 cells had the highest prevalence. Therefore, the level of CD4 count below or equal to 100 cells/ul is highly associated with positive cryptococcal meningitis. However, there were cases of positive CM among HIV patients with CD4 count ≥100 cells/ul.
Keywords: Cryptococcal meningitis, CD4 count, HIV,
Downloads
References
Rajasingham, R., et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. The Lancet Infectious Diseases; 2017;17(8):873-881. https://doi.org/10.1016/S1473-3099(17)30243-8 PMid:28483415
Tenforde, M. W., et al. Mortality from HIV-associated cryptococcal meningitis in Africa: a systematic review and meta-analysis. The Lancet Infectious Diseases;2020;20(8):955-963.
Meya, D. B., & Muzoora, C. Overview of the management of cryptococcal meningitis in sub-Saharan Africa. Therapeutic Advances in Infectious Disease;2020;7:2049936120916014.
Boulware, D. R., et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. The New England Journal of Medicine;2020;382(26):2497-2508.
Rothe, C., et al. Emergence of antifungal resistance in Cryptococcus species: current challenges and future directions. Mycoses;2021;64(11):1312-1322.
Molloy, S. F., et al. A randomized controlled trial of high-dose fluconazole for treatment of cryptococcal meningitis in HIV-infected adults in Africa. Clinical Infectious Diseases;2020;71(5):1258-1265.
Jarvis, J. N., & Harrison, T. S. HIV-associated cryptococcal meningitis. AIDS;2021;35(4):435-441.
Sloan, D. J., et al. Treatment of HIV-associated cryptococcal meningitis: Current approaches and future directions. Current Opinion in Infectious Diseases;2021;34(4):333-340.
Obeagu EI, Obeagu GU, Transfusion Therapy in HIV: Risk Mitigation and Benefits for Improved Patient Outcomes. Asian Journal of Dental and Health Sciences, 2024;4(1):32-37 https://doi.org/10.22270/ajdhs.v4i1.62
van der Horst, C., et al. Management of intracranial pressure in HIV-associated cryptococcal meningitis. Clinical Infectious Diseases;2020;71(2):279-286.
Luma, H. N., Temfack, E., Halle, M. P., Tchaleu, B. C. N., Mapoure, Y. N., & Koulla Shiro, S. Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: a cross sectional study. North American Journal of Medical Sciences;2013;5(8):486-491. https://doi.org/10.4103/1947-2714.117318 PMid:24083225 PMCid:PMC3784927
Wajanga, B. M., Kalluvya, S., Downs, J. A., Johnson, W. D., Fitzgerald, D. W., & Peck, R. N. Universal screening of Tanzanian HIV-infected adult inpatients with the serum cryptococcal antigen to improve diagnosis and reduce mortality: an operational study. Journal of the International AIDS society;2011;14(1):1-7. https://doi.org/10.1186/1758-2652-14-48 PMid:21988905 PMCid:PMC3197468
Mukiza, N., Nakalega, R., Nakanjako, L., Ndikuno, C., Kataike, H., Mirembe, D., ... & Nakku-Joloba, E. Diagnostic accuracy of HIV Viral Load as a marker for Cryptococcal Antigenemia screening at a tertiary hospital in Uganda. 2022. https://doi.org/10.21203/rs.3.rs-1614907/v1
Bogaerts, J., Rouvroy, D., Taelman, H., Kagame, A., Aziz, M. A., Swinne, D., & Verhaegen, J. AIDS-associated cryptococcal meningitis in Rwanda (1983-1992): epidemiologic and diagnostic features. Journal of infection;1999;39(1). https://doi.org/10.1016/S0163-4453(99)90099-3 PMid:10468126
Xu, M., Peng, Z., Xu, C., Chen, Y., Cheng, J., Chi, Y., & Hu, Z. Underlying cryptococcal diseases and the correlation with serum cryptococcal antigen titers in hospitalized HIV-infected patients screened positive for cryptococcal antigenemia.Frontiers in cellular and infection microbiology;2020;10:170. https://doi.org/10.3389/fcimb.2020.00170 PMid:32391288 PMCid:PMC7192964
Nakale, T. Prevalence of cryptococcus among HIV infected patients attending the Intermediate hospital Oshakati, Namibia (Doctoral dissertation, University of Namibia). 2016
Copyright (c) 2024 Ntezirizaza Evariste, Ishimwe Alain Prudence, Uwimana Jeannine, HABIMANA Fidele, MUKANDAYISHIMIYE Chantal, ISHIMWE Diane, MURENZI Didier, NZEYIMANA Godefroid, IKIRIZA Theophilla
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
. 