Prevalence of cryptococcus among HIV infected patients attending the Intermediate hospital Oshakati, Namibia
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Date
2016
Authors
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Journal ISSN
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Publisher
University of Namibia
Abstract
Cryptococcus is the most incriminated fungal pathogen that causes cryptococcal meningitis in HIV-infected patients and is known to constitute a major cause of mortality in AIDS patients. Previous studies, mostly from Africa have indicated that positive serum cryptococcus may precede the development of cryptococcal meningitis and cause early mortality among patients with advanced HIV infection. There is no published data on the burden of cryptococcal infections among HIV patients in Namibia; thus the magnitude of cryptococcal diseases associated with HIV is unknown. This study was done to determine the prevalence of cryptococcus among HIV-infected patients attending at Intermediate Hospital Oshakati and the level at which a patient’s CD4 count is significantly associated with cryptococcal antigenemia. A descriptive cross-sectional study was conducted at the Intermediate Hospital Oshakati. The study included 384 HIV-infected patients (231 females and 153 males) whose blood samples were examined for cryptococcus by using IMMY CrAg test kit at the NIP laboratory. Baseline clinical data and demographic information were retrieved from the patient medical records and laboratory information system. Among the 384 HIV-infected patients enrolled, 36 (9.38%) were positive for serum cryptococcal antigen. Among these 36 patients the CD4 count ranged from 2-301 cells/ul and median CD4 count was 72cells/ul. Of the 36 positive cryptococcus cases, 26 (72.22%) had CD4 counts below 100cells/ul. When stratified by CD4 count, 72.22% of patients with ≤100 cells/ul had a positive cryptococcal antigen test as compared to 25.00% with CD4 counts between 101-200 cells/ul and 2.78% with CD4 counts >200 cells/ul. This study demonstrates a high prevalence of cryptococcus among HIV-infected patients receiving their CD4 count measurements at the Communicable Disease Clinic, Intermediate Hospital Oshakati. Based on the study results, the cryptococcal antigen test and CD4 count levels Lower CD4 (≤100 cells/ul) were significantly associated with positivity for serum cryptococcal antigen. The prevalence of cryptococcus among HIV-infected patients was high and as such it calls for drastic public health interventions spearheaded by the Ministry of Health and Social Services (MoHSS). It is recommended that the MoHSS should take the leading role in implementing a routine screening of cryptococcus neoformans antigen among HIV patients with CD4 count ≤100cells/ul. This will improve the accurate early diagnosis and provide the surest way to reverse the deteriorating health status of the Namibian people.
Description
A thesis submitted in partial fulfilment of the requirements for the Degree of Master of Science in Applied Epidemiology
Keywords
Cryptococcus, HIV infected patients