The prevalence and clinical course of HIV-associated pulmonary cryptococcosis in Uganda.

Department of Medicine, Makerere University, Kampala, Uganda.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 02/2010; 54(3):269-74. DOI: 10.1097/QAI.0b013e3181ce6b19
Source: PubMed

ABSTRACT The prevalence and clinical course of pulmonary cryptococcosis in Sub-Saharan Africa are not well described.
Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between September 2007 and July 2008 with cough >or=2 weeks were enrolled. Patients with negative sputum smears for acid-fast bacilli were referred for bronchoscopy with bronchoalveolar lavage (BAL). BAL fluid was examined for mycobacteria, Pneumocystis jirovecii, and fungi. Patients were followed 2 and 6 months after hospital discharge.
Of 407 patients enrolled, 132 (32%) underwent bronchoscopy. Of 132 BAL fungal cultures, 15 (11%) grew Cryptococcus neoformans. None of the patients were suspected to have pulmonary cryptococcosis on admission. The median CD4 count among those with pulmonary cryptococcosis was 23 cells per microliter (interquartile range = 7-51). Of 13 patients who completed 6-month follow-up, 4 died and 9 were improved, including 5 who had started antiretroviral therapy but had not received antifungal medication.
Pulmonary cryptococcosis is common in HIV-infected tuberculosis suspects in Uganda. Early initiation of antiretroviral therapy in those with isolated pulmonary infection may improve outcomes, even without antifungal therapy. This finding suggests that some HIV-infected patients with C. neoformans isolated from respiratory samples may have colonization or localized infection.

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    ABSTRACT: The genus Cryptococcus includes at least 37 different species, of which, two are important human pathogens: Cryptococcus neoformans and Cryptococcus gattii. These fungi are opportunistic pathogens and etiologic agents of cryptococcosis disease in humans and animals. A variety of virulence factors interfere with the establishment of cryptococcal infection is usually acquired via inhalation of environmental basidiospores or desiccated yeasts. Cryptococcosis has gained medical importance over the last decade due to the AIDS pandemic, and become an emerging pathogen of immunocompetent individuals, especially in children. This disease in humans may involve every tissue, including cutaneous and pulmonary sites, but the most serious manifestation is central nervous system involvement with meningoencephalitis. In this review, we briefly described the taxonomy, the fungus biology, epidemiology and clinical manifestations of cryptococcosis in immunocompetent and immunocompromised individuals.
    The Open Epidemiology Journal 09/2013; 6:9-17. DOI:10.2174/1874297101306010009
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    Abdu K. Musubire, David B. Meya, Robert Lukande, Andrew Kambugu, Paul R. Bohjanen, David R. Boulware
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    ABSTRACT: The introduction of antiretroviral therapy (ART) may lead to unusual paradoxical and unmasking presentations of opportunistic infections. Intra-abdominal cryptococcosis is a rare manifestation of Cryptococcus. We present the case of an HIV-infected patient on ART, with a history of cryptococcal meningitis who presented with subacute, worsening abdominal pain during immune recovery. This evolved into chronic abdominal pain, with thickened bowel, and abdominal lymphadenopathy, while receiving empiric tuberculosis treatment. At 6-months, he developed intestinal perforation due to a histologically confirmed cryptococcoma.
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    ABSTRACT: Background and objectiveIn low and middle-income countries where HIV infection is prevalent, identifying patients at high risk of dying from lower respiratory tract infections is challenging and validated prognostic models are lacking. Serum procalcitonin may be a useful prognostic tool in these settings. We sought to determine if elevated serum procalcitonin is associated with increased in-hospital mortality and to combine serum procalcitonin with available clinical characteristics to create a clinically useful prognostic model. Methods We conducted a prospective, nested case-control study of 241 HIV-infected adults admitted to Mulago Hospital in Kampala, Uganda with cough ≥2 weeks in duration. We collected demographic and clinical information, baseline serum for procalcitonin analysis, and followed patients to determine in-hospital mortality. ResultsSerum procalcitonin was a strong and independent predictor of inpatient mortality (aOR = 7.69, p = 0.01, sensitivity = 93%, negative predictive value = 97%). Best subset multivariate analysis identified 3 variables that were combined into a prognostic model to risk stratify patients; these variables included respiratory rate ≥30 breaths/minute (aOR = 2.07, p = 0.11), oxygen saturation 0.5 ng/ml (aOR = 7.69, p = 0.01). The predicted probability of inpatient mortality ranged from 1% when no variables were present, to 42% when all variables were present. Conclusions Elevated serum procalcitonin >0.5 ng/ml is an independent predictor of in-hospital mortality. Elevated serum procalcitonin, tachypnea, and hypoxemia may be combined into a prognostic model to identify patients at high risk of dying in the hospital. This model may be used to estimate the probability of death and to guide triage and treatment decisions.
    Respirology 02/2014; DOI:10.1111/resp.12237 · 3.50 Impact Factor

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