Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults

Clinical and Therapeutic Aspects of Cryptococcal Meningitis in West Africa

“…Rather it has a wider geographic distribution and can also thrive in temperate climates, as well as on species of trees other than Eucalyptus . Estimates indicate that worldwide, the burden of human cryptococcal infections ranges between 2 to 30 % and most infected patients have HIV/AIDS (Bicanic, 2006;French, 2002). An observation in the US in 1990 showed an increase to 5000 cases of cryptococcal meningitis infection in AIDS patients, compared to 300 cases in 1980 where half of these cases were www.intechopen.com apparently without signs of immune suppression.…”

Management of HIV-associated cryptococcal disease in South Africa

“…CM accounted for 13 -18% of all deaths in four Ugandan cohorts of HIV-infected persons and 44% of deaths in a cohort of SA miners. [12][13][14][15][16] Although it is well recognised that early diagnosis of HIV infection and initiation of ART before the development of AIDS is the most important way to prevent CM, only half of patients in sub-Saharan Africa know their HIV infection status and only 32% are on ART. [17] Furthermore, a large proportion of patients present to HIV care late.…”

“…[21] The latter intervention is feasible because asymptomatic persons with subclinical cryptococcal disease can be detected from 3 weeks to more than 3 months prior to the development of symptomatic CM, using a simple blood test. [12] The screen-and-treat intervention has been shown to be cost-effective in several settings. [9,22] Based on recent estimates, approximately 2% of asymptomatic SA persons with a CD4 + count <100 cells/µL and no prior diagnosis of CM have cryptococcal antigenaemia.…”

Treatment Principles for Candida and Cryptococcus

“…Cryptococcal antigenemia, indicating early dissemination from the lung, precedes symptomatic meningitis by weeks to months (French et al 2002), with reported prevalence in cohorts of HIV-infected patients with CD4 ,100 cells/mL ranging between 2% and 21% Jarvis et al 2011a). In many countries in sub-Saharan Africa with high prevalence of HIV and cryptococcal coinfection where patients start ART at very low CD4 counts, an increasing proportion of CM now occurs as unmasking disease following commencement of ART .…”