Prevalence and mortality of cryptococcal disease in adults with advanced HIV in an urban tertiary hospital in Sierra Leone: a prospective study

Abstract

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/mm 3 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/mm 3 (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.

Three-year mortality in cryptococcal meningitis: Hyperglycemia predict unfavorable outcome

“…The present study showed that the 3-year mortality rate in the cohort with CM was 54.2% (45 deaths in 83 patients). Previous studies showed high short-term mortality in patients with CM [ 1 – 4 ]. A study in Uganda found that the 5-year mortality rate of HIV-infected patients with symptomatic CM was 58% [ 9 ].…”

“…In earlier studies, the treatment outcomes between studies varied according to the local availability of medical resources, especially for the accessibility of adequate anti-fungal agents [ 14 ]. The 1-year mortality of HIV-associated CM in low- and middle-income countries, Europe (including Russia) and North America was estimated to be approximately 70%, 40%, 30% and 20%, respectively [ 1 ]. In this study, we consecutively recruited HIV-infected and HIV-seronegative patients.…”

“…Cryptococcus species, most commonly causing cryptococcal meningitis (CM), was estimated to cause over 180,000 deaths per year globally. The mortality of CM with human immunodeficiency virus (HIV) infection in low-income countries might exceed 70% [ 1 , 2 ]. Although CM was considered rare among non-immunosuppressed hosts, the prognosis remained poor in developed countries [ 3 ].…”

The burden of serious fungal infections in Sierra Leone: a national estimate

“…Notwithstanding, data from a recent study on cryptococcal diseases in Sierra Leone demonstrated a substantial burden among patients with advanced human immunodeficiency virus (HIV) disease. 13 In this article, we reviewed the existing literature on fungal epidemiology in Sierra Leone, identified knowledge gaps, and propose solutions to address the challenges on the prevention and control of fungal diseases in Sierra Leone and similar countries.…”

Epidemiology of Cryptococcus and cryptococcosis in Western Africa

“…A new prospective by Lakoh et al 106 cohort study aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone was carried out. One hundred and seventy patients (mean age 36) and median CD4 count of 45 cells/mm 3 were screened.…”