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Prevalence of Cryptococcus gattii in Ugandan HIV-infected patients presenting with cryptococcal meningitis
Abel Wembabazi1, Dianah Rhoda Nassozi1, Enid Akot2
1School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
Introduction:
Cryptococcal meningitis (CM) is a life threatening disease and leading cause of opportunistic fungal-related mortality in HIV/AIDS. Most CM infections are caused by C. neoformans species complexes but the prevalence of Cryptococcus gattii species complexes in Uganda is unknown however, it is known in a few other parts of Africa. We estimated the prevalence of C. gattii in patients living with HIV and a diagnosis of cryptococcal meningitis in Uganda.
Methods:
Cryptococcus isolates (n = 200) obtained from cerebrospinal fluid of patients with CM recruited at the Infectious Diseases Institute, Kampala, Uganda, were tested by phenotypic methods. The Cryptococcus isolates were sub-cultured on Sabouraud Dextrose Agar plates for 48 hours. The yeast colonies were examined by India ink stain, urea hydrolysis, and C. gattii was identified by blue pigmentation on CGB agar. The results were analyzed for frequency of C. gattii. Patient demographic characteristics were collected from the case record forms.
Results:
From the 200 patients' case record forms, 87 (43.5%) were female and 113 (56.5%) were male. The median age was 35 (19-64) years. Most patients, 93% (187/200) were from Central Uganda in the districts of Kampala and Wakiso. 97.51% (157/161) of the patients had absolute CD4 lymphocyte counts of less than 200 cells per cubic millimeter; 1.86% (3/161) 200-350 cells per cubic millimeter and 0.62% (1/161) above 500 cells per cubic millimeter. 45.4% (74/163) were not yet on HAART and 54.6% (89/163) were on HAART. 66.7% (58/87) had poor adherence to HAART treatment and 33.3% (29/87) had reported good adherence to HAART treatment. A total of 200 clinical isolates of Cryptococcus isolates were tested. No (0% (0/200) C. gattii was identified among the Cryptococcus isolates.
Conclusion:
In this study among patients living with HIV and a diagnosis of cryptococcal meningitis in Uganda, we found no C. gattii infections.
Insights
This study found no Cryptococcus gattii in Ugandan HIV patients with cryptococcal meningitis. Further research is needed to understand the prevalence of fungal infections in this population.
Area of Science:
- Medical Mycology
- Infectious Diseases
- HIV/AIDS Research
Background:
- Cryptococcal meningitis (CM) is a major cause of mortality in individuals with HIV/AIDS.
- While Cryptococcus neoformans is common, the prevalence of Cryptococcus gattii in Uganda is not well-documented.
- Understanding the distribution of Cryptococcus species is crucial for effective disease management.
Purpose of the Study:
- To determine the prevalence of Cryptococcus gattii in HIV-positive patients diagnosed with cryptococcal meningitis in Uganda.
- To contribute to the epidemiological data on fungal meningitis in sub-Saharan Africa.
Main Methods:
- Phenotypic testing of 200 Cryptococcus isolates from cerebrospinal fluid using CGB agar, India ink stain, and urea hydrolysis.
- Isolates were obtained from patients at the Infectious Diseases Institute in Kampala, Uganda.
- Demographic and clinical data, including CD4 counts and HAART status, were collected.
Main Results:
- None of the 200 Cryptococcus isolates tested positive for Cryptococcus gattii (0%).
- The study population consisted of 200 patients, with a median age of 35 years; 56.5% were male.
- Most patients (93%) were from Central Uganda, and a high proportion had low CD4 counts (<200 cells/mm³).
Conclusions:
- Cryptococcus gattii was not identified in HIV-positive patients with cryptococcal meningitis in Uganda during this study.
- The findings suggest that C. neoformans species complexes are likely the predominant cause of CM in this Ugandan cohort.
- Further epidemiological studies are warranted to confirm these findings and monitor for potential shifts in Cryptococcus species prevalence.
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