scholarly journals Cryptococcal Meningitis amomg HIV-Infected and HIV-Uninfected Patients in Jos, North Central Nigeria

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
M O Okolo ◽  
K I Onyedibe ◽  
F Dabe ◽  
E F Obishakin ◽  
EA Envuladu ◽  
...  
Keyword(s):  
Cryptococcus Neoformans ◽  
Clinical Features ◽  
Cryptococcal Meningitis ◽  
Antifungal Susceptibility ◽  
Bivariate Analysis ◽  
North Central ◽  
Healthcare Facilities ◽  
Tertiary Healthcare ◽  
Genomic Studies ◽  
Susceptibility Tests

Cryptococcal meningitis is a global opportunistic infection caused by several serovars of Cryptococcus neoformans and Cryptococcus gattii with significant morbidity and mortality, particularly in immunocompromised patients. Management principles involve early and specific diagnosis followed by appropriate antifungal therapy. The study was conducted among in-patients with clinical features of meningitis admitted into tertiary healthcare facilities in Jos, north-central Nigeria from November 2017 to December 2018. Cerebrospinal fluid and blood samples were collected from the patients for culture and sensitivity, serology and genomic studies. Univariate and bivariate analysis was carried out using STATA (version 14IC). The serologic prevalence of cryptococcal meningitis among patients with clinical features of meningitis was 16.8%. The prevalence among HIV-infected and HIV-uninfected patients were 13.4% and 18.8% respectively. The antifungal susceptibility of the Cryptococcus neoformans isolated from sample cultures at MIC90ug/ml to Amphotericin B, Fluconazole and Itraconazole were all within the reference range. Gene accession numbers of cryptococcal isolates deposited in the gene bank include MK886574.1, MK886568.1, MK886570.1, MK886563.1, MK886560.1, MK886573.1, MK886562.1, MK886558.1. Cryptococcus neoformans are a major cause of meningitis in both HIV-infected and HIV-uninfected patients. This study highlights the fact that routine surveillance should be put in place for culture, antifungal susceptibility tests and genomic studies to ascertain the antifungal susceptibility pattern and genotypes of cryptococcus in circulation.

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 Comparisons of cryptococcal meningitis caused by Cryptococcus neoformans between HIV-negative patients with and without lung infection in two Chinese university hospitals

2019 ◽  
Author(s):  
Ming Yang ◽  
Fengjun Sun ◽  
Fu Liu ◽  
Wei Feng ◽  
Qian Yuan ◽  
...  
Keyword(s):  
Cryptococcus Neoformans ◽  
Clinical Features ◽  
Cryptococcal Meningitis ◽  
Medical Records ◽  
Maxillary Sinusitis ◽  
Lung Infection ◽  
University Hospitals ◽  
Chinese University ◽  
Multivariable Analyses ◽  
Hiv Negative

Abstract Background Lung infection may cause many symptoms, such as fever and headache, that may be confused with cryptococcal meningitis (CM) symptoms. This study aimed to investigate the discrepancy in clinical features and outcomes of CM between HIV-negative patients with and without lung infection.Methods We retrospectively reviewed the medical records of patients with CM admitted to two hospitals in Southwest China from 1 January 2014 to 31 December 2018.Results A total of 71 patients was included during the 5 years, among which 35 (49.3%) patients had lung disease. CM occurred more frequently in male (62.9% vs. 44.4%, P=0.12) and young (≤30 years, 31.4% vs. 16.7%, P=0.30) patients with lung infection than in the patients without lung infection, with more fever (77.1% vs. 30.6%, P=0.001) and less central nervous system symptoms (5.7% vs. 16.7%, P=0.28) and vomiting (25.0% vs. 14.3%, P=0.26). In addition, patients with lung infection presented higher percentages of white blood cell (WBC) counts ˂20×106/L (45.7% vs. 22.2%, P=0.036) and lower percentages of ethmoid sinusitis, maxillary sinusitis, paranasal sinusitis, and otitis media than patients without lung infection (8.6% vs. 30.6%, P=0.02). The Cryptococcus neoformans isolates were sensitive to itraconazole, voriconazole, fluconazole, and amphotericin B but resistant to flucytosine. Patients with lung infection had higher mortality at discharge compared with patients without lung infection (8.6% vs. 0, P=0.12). Multivariable analyses showed that WBC counts ˂20×106/L was significantly associated with treatment outcome (OR=0.01, 95% CI=0-0.833, P=0.041).Conclusions There were significant discrepancies in clinical features between CM patients with and without lung infection. Clinicians must consider the divergences in the diagnosis of CM in patients with lung infection.

scholarly journals Characterization of Cryptococcus Neoformans Strains From Cases of Cryptococcal Meningitis in India

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Harish C Gugnani ◽  
Thomas G. Mitchell ◽  
Anubha Paliwal-Joshi ◽  
Ashok Rattan
Keyword(s):  
Cryptococcus Neoformans ◽  
Mating Type ◽  
Antifungal Susceptibility ◽  
In Vitro Assays ◽  
Molecular Type ◽  
Minimal Inhibitory Concentrations ◽  
Susceptibility Tests ◽  
In Vitro Antifungal Susceptibility

Reports of clinical isolates of Cryptococcus neoformans often lack information on their mating types, molecular types, and in vitro antimycotic susceptibilities. This study compares these and other related characteristics of fifteen strains of C. neoformans obtained from cases of meningitis in different regions of India. PCR was used to determine the mating type and serotype of each strain, and Amplified Fragment Length Polymorphism was used for molecular typing of the strains. In vitro assays compared the proteinase and phospholipase activities of the strains, and the Clinical and Laboratory Standards Institute (CLSI) protocol was used to determine their minimal inhibitory concentrations (MICs) to amphotericin B (AMB), itraconazole, and fluconazole. All strains were identified as C. neoformans var. grubii (serotype A), possessed the alpha mating type, and belonged to molecular type VNII. Ten of the strains demonstrated strong proteolytic activity, and the remaining five were weakly proteolytic. Nine of the strains were positive for phospholipase. In vitro antifungal susceptibility tests, determined the MIC (µg/ml) values for AMB, itraconazole, and fluconazole to be 0.03-0.5, 0.002-03, and 2-4 µg/ml, respectively. Remarkedly, all 15 strains belonged to the relatively rare molecular type, VNII. This report is one of few studies to characterize clinical strains of C. neoformans from India.

Evaluation of Clinical Profile, Diagnostic Tests, And Prognosis of Cryptococcal Meningitis in HIV Infected Patients in Western India

2020 ◽  
Vol 20 ◽  
Author(s):  
Deepak Kumar ◽  
Suresh Bishnoi ◽  
Durga Shankar Meena ◽  
Gopal Krishana Bohra ◽  
Naresh Midha ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Features ◽  
Cryptococcal Meningitis ◽  
Fatal Outcome ◽  
Clinical Profile ◽  
Western India ◽  
Antigen Test ◽  
Cryptococcal Antigen ◽  
India Ink ◽  
Csf Examination

Background: Cryptococcal meningitis is a dreaded complication in HIV infected patients. It was associated with high mortality and morbidity before the advent of Highly Active Anti-Retroviral Therapy. A study was planned in our institute to evaluate the clinical profile, laboratory findings, and prognostic factors for survival in these patients. Settings and Design: A prospective hospital-based observational study, conducted in the Department of Medicine at a tertiary care centre in western Rajasthan. Method and Material: HIV infected patients presenting with clinical features of meningitis, and positive CSF culture for Cryptococcus were included in our study. All cases underwent detailed clinical history, physical examinations and relevant laboratory investigations including CD4 count and CSF examination. Results: 48 HIV infected cryptococcal meningitis patients were analysed, and the most common presenting clinical features were headache (85.42%), and fever (72.92%), followed by neck stiffness (62.50%). CSF examination was also done for Cryptococcal Antigen test which was reactive in all cases (100%), and India ink staining was positive in 43 cases (89.58%). Significant fatal outcome was associated with patients presenting with altered sensorium, loss of consciousness, cranial nerve palsy and CD4 cell count of less than 100. Similarly, on laboratory and imaging diagnosis, cryptococcal antigen test (>3+reactive), fundus examination (papilloedema) and abnormal CT/MRI brain imaging were associated with poor survival. Conclusion: Cryptococcal meningitis is a potentially lethal infection in immunocompromised individuals and should be diagnosed early with high clinical suspicion as around 10% of the cases may not be detected on India ink staining and a large proportion (75%) of cases may have normal imaging at initial evaluation. Early diagnosis, watchful eye on prognostic factors and treatment is vital to improve outcome in these patients.

scholarly journals Determinants of Cervical Cancer Screening Uptake among Women in Ilorin, North Central Nigeria: A Community-Based Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Ajibola Idowu ◽  
Samuel Anu Olowookere ◽  
Aderonke Tolulope Fagbemi ◽  
Olumuyiwa Ayotunde Ogunlaja
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Statistical Significance ◽  
Effective Control ◽  
Bivariate Analysis ◽  
North Central ◽  
Nigerian Women ◽  
Screening Uptake ◽  
Cancer Of The Cervix

Introduction. Cancer of the cervix is the leading cause of cancer deaths among women in developing countries. Screening is one of the most cost effective control strategies for the disease. This study assessed the determinants of cervical cancer screening uptake among Nigerian women.Methodology. This cross-sectional study was conducted using multistage sampling technique among 338 participants in Ilorin, North Central Nigeria. A pretested questionnaire was used for data collection and data analysis was done using SPSS version 21. Chi-square test was used for bivariate analysis while binary logistic regression was used for multivariate analysis. Statistical significance was set atp<0.05.Results. Only 8.0% of the respondents had ever been screened for cancer of the cervix. The proportion of women who had ever been screened was significantly higher among those who demonstrated positive attitude to screening (81.5%,p=0.001), respondents who were aware of the disease (100.0%,p=0.001), and those who were aware of cervical cancer screening (88.9%,p=0.001). Respondents who had negative attitude had 63% lesser odds of being screened compared to those who had positive attitudes towards screening (AOR; 0.37, 95% CI; 0.01–0.28).Conclusion. There is urgent need to improve the knowledge base and attitude of Nigerian women to enhance cervical cancer screening uptake among them.

scholarly journals Trends in Antifungal Drug Susceptibility of Cryptococcus neoformans Isolates Obtained through Population-Based Surveillance in South Africa in 2002-2003 and 2007-2008

2011 ◽  
Vol 55 (6) ◽  
pp. 2606-2611 ◽  
Author(s):  
Nelesh P. Govender ◽  
Jaymati Patel ◽  
Marelize van Wyk ◽  
Tom M. Chiller ◽  
Shawn R. Lockhart ◽  
...  
Keyword(s):  
South Africa ◽  
Cryptococcus Neoformans ◽  
Amphotericin B ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Drug Susceptibility ◽  
Population Based ◽  
Content Type ◽  
Microdilution Method ◽  
Broth Microdilution Method

ABSTRACTCryptococcus neoformansis the most common cause of meningitis among adult South Africans with HIV infection/AIDS. Widespread use of fluconazole for treatment of cryptococcal meningitis and other HIV-associated opportunistic fungal infections in South Africa may lead to the emergence of isolates with reduced fluconazole susceptibility. MIC testing using a reference broth microdilution method was used to determine if isolates with reduced susceptibility to fluconazole or amphotericin B had emerged among cases of incident disease. Incident isolates were tested from two surveillance periods (2002-2003 and 2007-2008) when population-based surveillance was conducted in Gauteng Province, South Africa. These isolates were also tested for susceptibility to flucytosine, itraconazole, voriconazole, and posaconazole. Serially collected isolate pairs from cases at several large South African hospitals were also tested for susceptibility to fluconazole. Of the 487 incident isolates tested, only 3 (0.6%) demonstrated a fluconazole MIC of ≥16 μg/ml; all of these isolates were from 2002-2003. All incident isolates were inhibited by very low concentrations of amphotericin B and exhibited very low MICs to voriconazole and posaconazole. Of 67 cases with serially collected isolate pairs, only 1 case was detected where the isolate collected more than 30 days later had a fluconazole MIC value significantly higher than the MIC of the corresponding incident isolate. Although routine antifungal susceptibility testing of incident isolates is not currently recommended in clinical settings, it is still clearly important for public health to periodically monitor for the emergence of resistance.

scholarly journals Candidaemia in a tertiary hospital in Nigeria

2014 ◽  
Vol 3 (1) ◽  
Author(s):  
Rita O. Oladele ◽  
Rashidi A. Bakare ◽  
Michael A. Petrou ◽  
Oyinlola O. Oduyebo ◽  
Malcolm Richardson
Keyword(s):  
Immunosuppressive Agents ◽  
Univariate Analysis ◽  
Antifungal Susceptibility ◽  
Tertiary Hospital ◽  
Bivariate Analysis ◽  
Contributing Factors ◽  
Therapeutic Modalities ◽  
Crude Mortality Rate ◽  
Increased Risk ◽  
Immunosuppressed Patients

Background: Candidaemia is a widely-studied and reviewed topic in the developed world; however, there is a dearth of information on nosocomial candidaemia in Nigeria, despite the increasing use of more invasive therapeutic modalities, immunosuppressive agents and increasing incidence of immunosuppression as a result of malignancies and HIV.Objectives: To determine the hospital-based frequency of candidaemia in a tertiary hospital in Ibadan, Nigeria.Method: This was a prospective descriptive study which included 230 immunosuppressed patients. All isolates were identified to the species level using both conventional and automated methods. Thereafter, all Candida species isolated were tested for antifungal susceptibility using the broth microdilution method.Results: Candidaemia occurred in 12 (5.21%) of the 230 study patients, with C. tropicalis accounting for 50% of the infections. Four patients (33.3%) presented with C. parapsilosis, one (8.3%) with C. albicans and one (8.3%) with a mixed infection of C. albicans and C. tropicalis. All 12 isolates were sensitive to fluconazole (minimal inhibitory concentration < 8 mg/mL). Univariate analysis revealed that old age, multiple surgeries and long-term hospitalisation were significant contributing factors for the occurrence of candidaemia. Eleven (91.7%) of the 12 patients with candidaemia had Candida colonisation of other sterile sites including the bladder, peritoneum and trachea. Furthermore, bivariate analysis revealed that mucositis (p = 0.019) and diarrhoea (p = 0.017) were significantly associated with an increased risk of candidaemia. The crude mortality rate of candidaemia was 91.7%.Conclusion: This study highlights the significance of nosocomial candidaemia and the need for proactive laboratory investigation and clinical management of this life-threatening disease.

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