Abstract
Background: Cryptococcus neoformans infection is a common fungal infection that is cosmopolitan in distribution and causes a life-threatening disease among HIV-infected patients especially in advanced disease. Screening for cryptococcal antigen (CrAg) in patients enrolling in ART programs may identify those at risk of cryptococcal meningitis and permit targeted use of pre-emptive therapy. Methods: This was a cross survey study of 215 consecutive HIV-infected patients at an ART treatment centre were screened for cryptococcal antigenaemia using the cryptococcalantigen lateral flow assay (CrAg LFA). Study subjects were assessed for clinical features of Cryptococcus neoformans infection. CD4+ cell count, haemoglobin concentration as well as HIV-1 RNA viral load was also compared between cryptococcalantigen positive and negatives. Results: 37 (16.7%) patients were positive for cryptococcal antigenaemia. Cryptococcal antigen positive subjects had a lower median CD4+ cell count (58 cells/uL vs. 273 cells/uL, p<0.001) and higher median viral load (log 3.6 copies/mL vs. log2.3 copies/mL, p=0.05) compared to cryptococcal antigen negative subjects. The commonest predictors of positive CrAg status in the study were; low BMI, low Hb, fever and cough. Conclusion: The study has shown the prevalence of cryptococcal antigenaemia to be high among the study subjects attending this service. Therefore, screening of patients receiving care at this centre may help in identifying individuals who are at risk of cryptococcalmeningitis for prophylactic treatment.
Highlights
It has been over a century since Cryptococcus neoformans was discovered from an environmental source [1,2]
Cryptococcus neoformans primarily enters the body through the respiratory tract, but it has a particular predilection for the central nervous system (CNS)
Two hundred and fifteen people living with HIV aged 18 years and older who were referred to the Antiretroviral Treatment (ART) Clinic at the University of Maiduguri Teaching Hospital, Nigeria
Summary
It has been over a century since Cryptococcus neoformans was discovered from an environmental source [1,2]. Cryptococcus neoformans is an encapsulated, heterobasidiomycetous fungus that is worldwide in distribution as an opportunistic pathogen among HIV patients. The spectrum of clinical infection ranges from a complete asymptomatic state to more severe lifethreatening disseminated disease. Cryptococcus neoformans primarily enters the body through the respiratory tract, but it has a particular predilection for the central nervous system (CNS). Cryptococcal neoformans is not generally considered as part. Cryptococcus neoformans infection is a common fungal infection that is cosmopolitan in distribution and causes a life-threatening disease among HIV-infected patients especially in advanced disease. Screening for cryptococcal antigen (CrAg) in patients enrolling in ART programs may identify those at risk of cryptococcal meningitis and permit targeted use of pre-emptive therapy
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