Cryptococcal antigen positivity combined with the percentage of HIV-seropositive samples with CD4 counts &lt;100 cells/μl identifies districts in South Africa with advanced burden of disease

Coetzee, Lindi M.; Cassim, Naseem; Sriruttan, Charlotte; Mhlanga, Mabatho; Govender, Nelesh P.; Glencross, Deborah K.

doi:10.1371/journal.pone.0198993

Cited by 14 publications

(18 citation statements)

References 14 publications

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“…Cryptococcal meningitis is the leading cause of meningitis is southern Africa [15,22,66,67,68,69,70] and a leading cause of death among people living with HIV. We estimated the occurrence of 543 cases of cryptococcal meningitis per year in Namibia.…”

Section: Discussionmentioning

confidence: 99%

Estimated Burden of Fungal Infections in Namibia

Dunaiski

Denning

2019

JoF

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Namibia is a sub-Saharan country with one of the highest HIV infection rates in the world. Although care and support services are available that cater for opportunistic infections related to HIV, the main focus is narrow and predominantly aimed at tuberculosis. We aimed to estimate the burden of serious fungal infections in Namibia, currently unknown, based on the size of the population at risk and available epidemiological data. Data were obtained from the World Health Organization (WHO), Joint United Nations Programme on HIV/AIDS (UNAIDS), and published reports. When no data existed, risk populations were used to estimate the frequencies of fungal infections, using the previously described methodology. The population of Namibia in 2011 was estimated at 2,459,000 and 37% were children. Among approximately 516,390 adult women, recurrent vulvovaginal candidiasis (≥4 episodes /year) is estimated to occur in 37,390 (3003/100,000 females). Using a low international average rate of 5/100,000, we estimated 125 cases of candidemia, and 19 patients with intra-abdominal candidiasis. Among survivors of pulmonary tuberculosis (TB) in Namibia 2017, 112 new cases of chronic pulmonary aspergillosis (CPA) are likely, a prevalence of 354 post-TB and a total prevalence estimate of 453 CPA patients in all. Asthma affects 11.2% of adults, 178,483 people, and so allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) were estimated in approximately 179/100,000 and 237/100,000 people, respectively. Invasive aspergillosis (IA) is estimated to affect 15 patients following leukaemia therapy, and an estimated 0.13% patients admitted to hospital with chronic obstructive pulmonary disease (COPD) (259) and 4% of HIV-related deaths (108) — a total of 383 people. The total HIV-infected population is estimated at 200,000, with 32,371 not on antiretroviral therapy (ART). Among HIV-infected patients, 543 cases of cryptococcal meningitis and 836 cases of Pneumocystis pneumonia are estimated each year. Tinea capitis infections were estimated at 53,784 cases, and mucormycosis at five cases. Data were missing for fungal keratitis and skin neglected fungal tropical diseases such as mycetoma. The present study indicates that approximately 5% of the Namibian population is affected by fungal infections. This study is not an epidemiological study—it illustrates estimates based on assumptions derived from similar studies. The estimates are incomplete and need further epidemiological and diagnostic studies to corroborate, amend them, and improve the diagnosis and management of these diseases.

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Section: Discussionmentioning

confidence: 99%

Estimated Burden of Fungal Infections in Namibia

Dunaiski

Denning

2019

JoF

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“…Cryptococcal antigen (CrAg) reflex testing of specimens with a CD4 count of ≤ 100 cells/µl was implemented across a network of CD4 testing laboratories in South Africa. 2 This followed the inclusion of CrAg screening in South Africa’s national HIV guidelines in 2015, following recommendations by the World Health Organization (WHO). 3 , 4…”

Section: Introductionmentioning

confidence: 99%

District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa

Cassim

Coetzee

Govender

et al. 2018

African Journal of Laboratory Medicine

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BackgroundCryptococcal meningitis (CM) is a leading cause of mortality among HIV-positive South Africans. Reflex cryptococcal antigen (CrAg) testing of remnant plasma was offered as a pilot prior to implementation in October 2016 in KwaZulu-Natal province. The national reflex CrAg positivity was 5.4% compared to 7.3% for KwaZulu-Natal.ObjectivesThe aim of this study was to interrogate CrAg positivity by health levels to identify hotspots.MethodData for the period October 2016 to June 2017 were analysed. Health district CrAg positivity and prevalence were calculated, with the latter using de-duplicated patient data. The district CrAg positivity and the number of CrAg-positive specimens per health facility were mapped using ArcGIS. For districts with the highest CrAg positivity, a sub-district CrAg positivity analysis was conducted.ResultsThe provincial CrAg positivity was 7.6%. District CrAg positivity ranged from 5.7% (Ugu) to 9.6% (Umkhanyakude) with prevalence ranging from 5.5% (Ugu) to 9.7% (Umkhanyakude). The highest CrAg positivity was reported for the Umkhanyakude (9.6%) and King Cetswayo (9.5%) districts. In these two districts, CrAg positivity of 10% was noted in the Umhlabuyalingana (10.0%), Jozini (10.2%), uMhlathuze (10.5%) and Nkandla (10.8%) subdistricts. In these subdistricts, 135 CrAg-positive samples were reported for the Ngwelezane hospital followed by 41 and 43 at the Hlabisa and Manguzi hospitals respectively.ConclusionCryptococcal antigen positivity was not uniformly distributed at either the district or sub-district levels, with identified facility hotspots in the Umkhanyakude and King Cetswayo districts. This study demonstrates the value of laboratory data to identify hotspots for planning programmatic interventions.

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“…Cryptococcal meningoencephalitis in AIDS patients accounts for approximately 15% of AIDS‐related deaths worldwide; therefore, it is recommended that CrAg should be considered as an indicator of CM risk and associated fatality even in asymptomatic patients . LFA was used to identify CrAg in HIV‐positive individuals in various studies (Table ), which usually included patients with CD4 counts <200 cells/μL who had not received ART. In asymptomatic HIV‐positive patients, the prevalence of cryptococcal antigenemia varies between 1.6% (Ethiopia) and 16.7% (Northeast Nigeria), which is comparable with our result of 11%.…”

Section: Discussionmentioning

confidence: 99%

“…Previous researches indicate that CrAg detection is usually performed in CSF, serum, whole blood, plasma, urine (Table ) and saliva . In terms of monetary value, CrAg‐LFA‐based screening was shown to be highly cost‐effective (2.71 USD/test) and was predicted to result in a 40% reduction in Cryptococcus ‐associated mortality in Uganda, with potential application in most areas of sub‐Saharan Africa .…”

Section: Discussionmentioning

confidence: 99%

Identification of Cryptococcus antigen in human immunodeficiency virus‐positive Turkish patients by using the Dynamiker^® lateral flow assay

Karaman

İlkit

Kuşçu

2019

Mycoses

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Summary Cryptococcus neoformans causes life‐threatening meningoencephalitis, particularly in human immunodeficiency virus (HIV)‐positive individuals with low CD4 levels (<100 cells/μL). Although the burden of cryptococcal meningoencephalitis (CM) in Turkey is low (0.13 cases per 100 000 persons), asymptomatic individuals at risk of cryptococcosis should be screened for antigenemia to prevent the disease and/or promote early CM diagnosis. A lateral flow assay (LFA) is used to detect Cryptococcus antigen (CrAg) in cerebrospinal fluid and serum. We determined Cryptococcus antigenemia prevalence in serum samples of HIV‐positive and HIV‐negative adult patients by using Dynamiker® CrAg‐LFA, a point‐of‐care dipstick test. Patients’ demographic data, CD4 count, HIV‐RNA levels and anti‐retroviral therapy status were recorded. CrAg was detected in 28 (11%) of 254 HIV‐positive patients screened but not in 100 HIV‐negative control individuals; a significant difference was observed in the CrAg‐LFA positivity rate between HIV‐positive and HIV‐negative groups (x2 = 11.970; P < .05). In CrAg‐positive patients, the median CD4 level was 666 cells/μL (115‐1344 cells/μL), with a median viral load of 23 copies/mL (0‐3.69 × 106 copies/mL). In HIV‐positive CrAg‐negative patients, the median CD4 level was 633 cells/μL (31‐2953 cells/μL) and the median viral load was 12 copies/mL (0‐1.95 × 106 copies/mL; P > .05). Results indicate that HIV‐positive patients with both low (<200 cells/μL) and high (>200 cells/μL) CD4 counts should be screened for asymptomatic cryptococcal antigenemia. HIV‐associated asymptomatic cryptococcosis is not uncommon in Turkey, which warrants systematic screening. Updated strategies for CM prevention among HIV‐positive patients should be used even in non‐endemic countries.

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Cryptococcal antigen positivity combined with the percentage of HIV-seropositive samples with CD4 counts <100 cells/μl identifies districts in South Africa with advanced burden of disease

Cited by 14 publications

References 14 publications

Estimated Burden of Fungal Infections in Namibia

Estimated Burden of Fungal Infections in Namibia

District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa

Identification of Cryptococcus antigen in human immunodeficiency virus‐positive Turkish patients by using the Dynamiker^® lateral flow assay

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Cryptococcal antigen positivity combined with the percentage of HIV-seropositive samples with CD4 counts <100 cells/μl identifies districts in South Africa with advanced burden of disease

Cited by 14 publications

References 14 publications

Estimated Burden of Fungal Infections in Namibia

Estimated Burden of Fungal Infections in Namibia

District and sub-district analysis of cryptococcal antigenaemia prevalence and specimen positivity in KwaZulu-Natal, South Africa

Identification of Cryptococcus antigen in human immunodeficiency virus‐positive Turkish patients by using the Dynamiker® lateral flow assay

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Identification of Cryptococcus antigen in human immunodeficiency virus‐positive Turkish patients by using the Dynamiker^® lateral flow assay