scholarly journals New Insights into HIV/AIDS-Associated Cryptococcosis

ISRN AIDS ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-22 ◽  
Author(s):  
Spinello Antinori
Keyword(s):  
Cryptococcal Meningitis ◽  
Large Body ◽  
Underlying Disease ◽  
Sub Saharan Africa ◽  
Clinical Aspects ◽  
Body Of Knowledge ◽  
Life Threatening ◽  
Sub Saharan ◽  
Inflammatory Syndrome ◽  
Therapy Programme

Cryptococcal meningitis is a life-threatening opportunistic fungal infection in both HIV-infected and HIV-uninfected patients. According to the most recent taxonomy, the responsible fungus is classified into a complex that contains two species (Cryptococcus neoformans and C. gattii), with eight major molecular types. HIV infection is recognized worldwide as the main underlying disease responsible for the development of cryptococcal meningitis (accounting for 80–90% of cases). In several areas of sub-Saharan Africa with the highest HIV prevalence despite the recent expansion of antiretroviral (ARV) therapy programme, cryptococcal meningitis is the leading cause of community-acquired meningitis with a high mortality burden. Although cryptococcal meningitis should be considered a neglected disease, a large body of knowledge has been developed by several studies performed in recent years. This paper will focus especially on new clinical aspects such as immune reconstitution inflammatory syndrome, advances on management, and strategies for the prevention of clinical disease.

scholarly journals Diagnosis of Cryptococcosis and Prevention of Cryptococcal Meningitis Using a Novel Point-of-Care Lateral Flow Assay

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Ashar Dhana
Keyword(s):  
Cryptococcal Meningitis ◽  
Point Of Care ◽  
World Health Organisation ◽  
Lateral Flow ◽  
Sub Saharan Africa ◽  
World Health ◽  
First Case ◽  
Lateral Flow Dipstick ◽  
Life Threatening ◽  
Sub Saharan

Despite access to antiretroviral therapy, mortality from cryptococcal meningitis (CM) is high among persons with advanced HIV infection in sub-Saharan Africa. Cryptococcal antigen (CrAg) is present several weeks to months before the onset of symptoms of meningitis and can be screened to prevent life threatening meningitis. Recently, the World Health Organisation recommended that a new rapid CrAg lateral flow ‘‘dipstick’’ assay (LFA) is to be used to screen HIV-infected persons with CD4 counts of less than 100 cells/µL. In this paper, we describe two cases of cryptococcosis with differing outcomes. In the first case, the new CrAg LFA was used as part of a screen and preemptive treatment strategy to prevent CM. In the second case, our patient had no access to the CrAg LFA and subsequently developed life threatening meningitis. To the best of our knowledge, this is the first case report of cryptococcosis diagnosed using this novel assay.

scholarly journals Management of chronic respiratory complications in children and adolescents with sickle cell disease

2020 ◽  
Vol 29 (157) ◽  
pp. 200054
Author(s):  
Michele Arigliani ◽  
Atul Gupta
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Current Knowledge ◽  
Sub Saharan Africa ◽  
Cell Disease ◽  
Respiratory Complications ◽  
Progressive Decline ◽  
Blood Disorder ◽  
Life Threatening ◽  
Sub Saharan

Sickle cell disease (SCD) is a life-threatening hereditary blood disorder that affects millions of people worldwide, especially in sub-Saharan Africa. This condition has a multi-organ involvement and highly vascularised organs, such as the lungs, are particularly affected. Chronic respiratory complications of SCD involve pulmonary vascular, parenchymal and airways alterations. A progressive decline of lung function often begins in childhood. Asthma, sleep-disordered breathing and chronic hypoxaemia are common and associated with increased morbidity. Pulmonary hypertension is a serious complication, more common in adults than in children. Although there is a growing attention towards respiratory care of patients with SCD, evidence regarding the prognostic meaning and optimal management of pulmonary issues in children with this condition is limited.This narrative review presents state-of-the-art evidence regarding the epidemiology, pathophysiology and therapeutic options for chronic respiratory complications commonly seen in paediatric patients with SCD. Furthermore, it highlights the gaps in the current knowledge and indicates future directions for studies that aim to improve our understanding of chronic respiratory complications in children with SCD.

scholarly journals Reduced Parasite Burden in Children with Falciparum Malaria and Bacteremia Coinfections: Role of Mediators of Inflammation

2016 ◽  
Vol 2016 ◽  
pp. 1-14 ◽  
Author(s):  
Gregory C. Davenport ◽  
James B. Hittner ◽  
Vincent Otieno ◽  
Zachary Karim ◽  
Harshini Mukundan ◽  
...  
Keyword(s):  
Geometric Mean ◽  
Parasite Burden ◽  
Sub Saharan Africa ◽  
Mediation Model ◽  
Multiple Mediation ◽  
Mediators Of Inflammation ◽  
Threatening Condition ◽  
Life Threatening ◽  
Sub Saharan

Bacteremia and malaria coinfection is a common and life-threatening condition in children residing in sub-Saharan Africa. We previously showed that coinfection with Gram negative (G[−]) enteric Bacilli andPlasmodium falciparum(Pf[+]) was associated with reduced high-density parasitemia (HDP, >10,000 parasites/μL), enhanced respiratory distress, and severe anemia. Since inflammatory mediators are largely unexplored in such coinfections, circulating cytokines were determined in four groups of children (n=206, aged <3 yrs): healthy;Pf[+] alone; G[−] coinfected; and G[+] coinfected.Staphylococcus aureusand non-TyphiSalmonellawere the most frequently isolated G[+] and G[−] organisms, respectively. Coinfected children, particularly those with G[−] pathogens, had lower parasite burden (peripheral and geometric mean parasitemia and HDP). In addition, both coinfected groups had increased IL-4, IL-5, IL-7, IL-12, IL-15, IL-17, IFN-γ, and IFN-αand decreased TNF-αrelative to malaria alone. Children with G[−] coinfection had higher IL-1βand IL-1Ra and lower IL-10 than thePf[+] group and higher IFN-γthan the G[+] group. To determine how the immune response to malaria regulates parasitemia, cytokine production was investigated with a multiple mediation model. Cytokines with the greatest mediational impact on parasitemia were IL-4, IL-10, IL-12, and IFN-γ. Results here suggest that enhanced immune activation, especially in G[−] coinfected children, acts to reduce malaria parasite burden.

scholarly journals Cytomegalovirus Viremia Associated With Increased Mortality in Cryptococcal Meningitis in Sub-Saharan Africa

2019 ◽  
Vol 71 (3) ◽  
pp. 525-531 ◽  
Author(s):  
Caleb Skipper ◽  
Mark R Schleiss ◽  
Ananta S Bangdiwala ◽  
Nelmary Hernandez-Alvarado ◽  
Kabanda Taseera ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Opportunistic Infections ◽  
Survival Rates ◽  
Hazard Ratio ◽  
Sub Saharan Africa ◽  
Persons Living With Hiv ◽  
Median Plasma ◽  
Sub Saharan ◽  
Immunodeficiency Syndrome ◽  
Living With Hiv

Abstract Background Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Cytomegalovirus (CMV) viremia may be associated with increased mortality in persons living with HIV who have tuberculosis. It is unknown whether concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections. Methods We prospectively enrolled Ugandans living with HIV who had cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival rates among those with and without CMV viremia. Results Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL, interquartile range [IQR] 259–2390). All samples tested were positive on immunoglobin G serology. The median CD4+ T cell count was 19 cells/µL (IQR 9–70) and did not differ by the presence of CMV viremia (P = .47). The 10-week mortality rates were 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (hazard ratio 2.19, 95% confidence interval [CI] 1.07–4.49; P = .03), which remained significant after a multivariate adjustment for known risk factors of mortality (adjusted hazard ratio 3.25, 95% CI 1.49–7.10; P = .003). Serum and cerebrospinal fluid cytokine levels were generally similar and cryptococcal antigen-specific immune stimulation responses did not differ between groups. Conclusions Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with an over 2-fold higher mortality rate. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect an underlying immune dysfunction (ie, cause vs effect). Clinical Trials Registration NCT01075152.

scholarly journals Physiological Differences in Cryptococcus neoformans Strains In Vitro versus In Vivo and Their Effects on Antifungal Susceptibility

2016 ◽  
Vol 61 (3) ◽  
Author(s):  
Nina T. Grossman ◽  
Arturo Casadevall
Keyword(s):  
Cryptococcus Neoformans ◽  
Cryptococcal Meningitis ◽  
Antifungal Susceptibility ◽  
Sub Saharan Africa ◽  
Content Type ◽  
Laboratory Conditions ◽  
Physiological Differences ◽  
Sub Saharan

ABSTRACT Cryptococcus neoformans is an environmentally ubiquitous fungal pathogen that primarily causes disease in people with compromised immune systems, particularly those with advanced AIDS. There are estimated to be almost 1 million cases per year of cryptococcal meningitis in patients infected with human immunodeficiency virus, leading to over 600,000 annual deaths, with a particular burden in sub-Saharan Africa. Amphotericin B (AMB) and fluconazole (FLC) are key components of cryptococcal meningitis treatment: AMB is used for induction, and FLC is for consolidation, maintenance and, for occasional individuals, prophylaxis. However, the results of standard antifungal susceptibility testing (AFST) for AMB and FLC do not correlate well with therapeutic outcomes and, consequently, no clinical breakpoints have been established. While a number of explanations for this absence of correlation have been proffered, one potential reason that has not been adequately explored is the possibility that the physiological differences between the in vivo infection environment and the in vitro AFST environment lead to disparate drug susceptibilities. These susceptibility-influencing factors include melanization, which does not occur during AFST, the size of the polysaccharide capsule, which is larger in infecting cells than in those grown under normal laboratory conditions, and the presence of large polyploid “titan cells,” which rarely occur under laboratory conditions. Understanding whether and how C. neoformans differentially expresses mechanisms of resistance to AMB and FLC in the AFST environment compared to the in vivo environment could enhance our ability to interpret AFST results and possibly lead to the development of more applicable testing methods.

scholarly journals Atopic dermatitis in adults from sub-Saharan Africa: epidemiological and clinical patterns, severity, and quality of life

2021 ◽  
Vol 12 (1) ◽  
pp. 1-6
Author(s):  
Emmanuel Armand Kouotou
Keyword(s):  
Quality Of Life ◽  
Atopic Dermatitis ◽  
Urban Areas ◽  
Cross Sectional Study ◽  
Lower Limbs ◽  
Sub Saharan Africa ◽  
Clinical Aspects ◽  
Cross Sectional ◽  
Sub Saharan

Background: Atopic dermatitis (AD) is a chronic and recurrent inflammatory dermatitis often associated with other atopic manifestations, such as asthma and allergic rhinitis. This study aimed to determine the epidemiological and clinical aspects of AD and to assess the quality of life (QoL) of patients suffering from AD in our setting. Materials and Methods: This was a cross-sectional study conducted from February through April 2017 in seven hospitals in Cameroon. The study included patients above 18 who presented themselves to a dermatology consultation, were diagnosed with AD, and gave their consent. To assess the severity of AD and evaluate the QoL of the patients, standardized scales, such as SCORAD and QoLIAD, were employed. Results: The study enrolled 46 patients between 18 and 69 years of age with a mean age of 31 ± 12 years and the prevalence of AD at 1.5%. Most of the participants were females, with a sex ratio of 0.4:1, living in urban areas (93.5%). Food (34.8%) and cosmetic products (21.7%) were found as the main risk factors in the occurrence of AD. Upon physical examination, the upper and lower limbs were found to be the most affected in 84.8% and 54.3% of cases, respectively; in addition to cutaneous xerosis (45.7%), lichenification (43.5%), and excoriations (37%). Of the 46 patients, 9 (20%) had severe AD, 32 (70%) had moderate AD, and 5 (10%) had mild AD. QoL was impaired in 43 of the 46 patients (93.5%). Conclusion: Atopic dermatitis is a pathology that impacts the QoL of adults. A QoL assessment is, therefore, an important step in the management of AD.

scholarly journals Public health-relevant consequences of the COVID-19 pandemic on malaria in sub-Saharan Africa: a scoping review

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anna-Katharina Heuschen ◽  
Guangyu Lu ◽  
Oliver Razum ◽  
Alhassan Abdul-Mumin ◽  
Osman Sankoh ◽  
...  
Keyword(s):  
Public Health ◽  
Scoping Review ◽  
Access To Health Care ◽  
Grey Literature ◽  
Malaria Prevention ◽  
Sub Saharan Africa ◽  
Clinical Aspects ◽  
Eligibility Criteria ◽  
Malaria Burden ◽  
Sub Saharan

Abstract Background The COVID-19 pandemic has resulted in unprecedented challenges to health systems worldwide, including the control of non-COVID-19 diseases. Malaria cases and deaths may increase due to the direct and indirect effects of the pandemic in malaria-endemic countries, particularly in sub-Saharan Africa (SSA). This scoping review aims to summarize information on public health-relevant effects of the COVID-19 pandemic on the malaria situation in SSA. Methods Review of publications and manuscripts on preprint servers, in peer-reviewed journals and in grey literature documents from 1 December, 2019 to 9 June, 2021. A structured search was conducted on different databases using predefined eligibility criteria for the selection of articles. Results A total of 51 papers have been included in the analysis. Modelling papers have predicted a significant increase in malaria cases and malaria deaths in SSA due to the effects of the COVID-19 pandemic. Many papers provided potential explanations for expected COVID-19 effects on the malaria burden; these ranged from relevant diagnostical and clinical aspects to reduced access to health care services, impaired availability of curative and preventive commodities and medications, and effects on malaria prevention campaigns. Compared to previous years, fewer country reports provided data on the actual number of malaria cases and deaths in 2020, with mixed results. While highly endemic countries reported evidence of decreased malaria cases in health facilities, low endemic countries reported overall higher numbers of malaria cases and deaths in 2020. Conclusions The findings from this review provide evidence for a significant but diverse impact of the COVID-19 pandemic on malaria in SSA. There is the need to further investigate the public health consequences of the COVID-19 pandemic on the malaria burden. Protocol registered on Open Science Framework: https://doi.org/10.17605/OSF.IO/STQ9D

Europe's Crisis of Legitimacy

2020 ◽  
Author(s):  
Vivien A. Schmidt
Keyword(s):  
Low Income ◽  
Best Practice ◽  
Critical Mass ◽  
Large Body ◽  
Developed Countries ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Infrastructure Development ◽  
Poor Countries ◽  
Sub Saharan

Expectations are high regarding the potential benefits of public–private partnerships (PPPs) for infrastructure development in poor countries. The development community, led by the G20, the United Nations, and others, expects PPPs to help with “transformational” megaprojects as well as efforts to achieve the Sustainable Development Goals (SDGs). But PPPs have been widely used only since the 1990s. The discussion of PPPs is still dominated by best-practice guidance, academic studies that focus on developed countries, or ideological criticism. Meanwhile, practitioners have quietly accumulated a large body of empirical evidence on PPP performance. The purpose of this book is to summarize and consolidate what this critical mass of evidence-based research says about PPPs in low-income countries (LICs) and thereby develop a more realistic perspective on the practical value of these mechanisms. The focus of the book is on Sub-Saharan Africa (SSA), home to most of the world’s poorest countries, although insights from other regions and more affluent developing countries are also included. Case studies of many of the best-known PPPs in Africa are used to illustrate these findings. This book demonstrates that PPPs have not met expectations in poor countries, and are only sustainable if many of the original defining characteristics of PPPs are changed. PPPs do have a small but meaningful role to play, but only if expectations remain modest and projects are subject to transparent evaluation and competition. Experiments with PPP mechanisms underway in some countries suggest ways in which PPPs may be evolving to better realize benefits in poor countries.

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