Disseminated cryptococcosis in a patient with HIV/AIDS at a teaching hospital in Ghana

Abstract

Objective:To raise awareness of the existence of cryptococcal infections in HIV/AIDS patients in Ghana.Method:Detailed postmortem gross and histopathological analysis of an HIV/AIDS patient suspected to have cryptococcal meningitis was carried out and histopathological findings correlated with clinical findings.Results:showed disseminated Cryptococcosis in an HIV/AIDS patient which was confirmed with special stains.Conclusion:cryptococcal infection occurs in HIV /AIDS patients in Ghanaian and when clinically suspected the diagnosis should be pursued vigorously.

Estimated Burden of Serious Fungal Infections in Ghana

“…Unfortunately, the majority of these infections is not diagnosed or misdiagnosed which results in no treatment or wrong treatment. Our literature search showed only four case reports and two epidemiological data on IFIs in Ghana, with diagnosis made post-mortem in three of the reported cases [26,27,28,29,30,35].…”

“…The burden of SFIs in Ghana is unknown with only few epidemiological data and case reports available. Most of these case reports involved postmortem diagnosis, implying a low index of suspicion and treatment [24,25,26,27,28,29,30,31,32,33,34,35,36]. As in other low and middle- income countries (LMIC), absence of diagnostic tools and antifungal drugs coupled with insufficient training of healthcare professionals (regarding fungal diseases) ensures that the mortality and morbidity of SFIs remain unacceptably high.…”

Host Response to Pulmonary Fungal Infections: a Highlight on Cell-Driven Immunity to Cryptococcus Species and Aspergillus fumigatus

“…A recent study demonstrated that macrophage-dependent STAT1 signaling was critical for limiting uncontrolled inflammation in the lung, regulating an optimal Th1/Th2 response, and NO-dependent protection against H99, a virulent strain of C. neoformans [50]. In contrast to Aspergillus , CD4 + T cells are thought to be the most critical component of intact immunity against Cryptococcus [51]. However, a recent study found that even in the presence of sufficient T-cell recruitment, a skewed M2 macrophage polarization led to failure to appropriately phagocytose and eliminate fungal cells, resulting in cryptococcal meningitis in otherwise immunocompetent individuals [52].…”

“…This is illustrated by the high incidence of cryptococcosis in patients suffering from HIV/AIDS [177–179]. Impaired clearance of Cryptococcus is associated with significantly reduced CD4 + and CD8 + T-cell numbers [51, 180]. Both CD4 + and CD8 + T-cells contribute to response to pulmonary Cryptococcus ; their respective roles are discussed in detail in previous reviews [180, 181].…”

Longitudinal Changes in Cd4+, Cd8+ T Cell Phenotype and Activation Marker Expression Following Antiretroviral Therapy Initiation among Patients with Cryptococcal Meningitis

“…Additionally, an impaired immune response not only predisposes to co-infections but also influences the prognostic outcome [22]. Amino acid diversity within the T cell repertiore (TCR) repertoire is a qualitative feature of T cell responses [17,23]. Furthermore, different CD4 + and CD8 + T cell subsets are associated with specific outcomes in both infectious diseases and immune disorders [17,24], which implies that the T cell phenotype, in addition to the number of circulating CD4 + T cells, is crucial in determining the outcome of CM.…”