Tufa, T.B.; Orth, H.M.; Wienemann, T.; Jensen, B.-E.O.; Mackenzie, C.R.; Boulware, D.R.; Luedde, T.; Feldt, T. Disseminated Cryptococcosis is a Common Finding among Human Immunodeficiency Virus-Infected Patients with Suspected Sepsis and is Associated with Higher Mortality Rates. J. Fungi2023, 9, 836.
Tufa, T.B.; Orth, H.M.; Wienemann, T.; Jensen, B.-E.O.; Mackenzie, C.R.; Boulware, D.R.; Luedde, T.; Feldt, T. Disseminated Cryptococcosis is a Common Finding among Human Immunodeficiency Virus-Infected Patients with Suspected Sepsis and is Associated with Higher Mortality Rates. J. Fungi 2023, 9, 836.
Tufa, T.B.; Orth, H.M.; Wienemann, T.; Jensen, B.-E.O.; Mackenzie, C.R.; Boulware, D.R.; Luedde, T.; Feldt, T. Disseminated Cryptococcosis is a Common Finding among Human Immunodeficiency Virus-Infected Patients with Suspected Sepsis and is Associated with Higher Mortality Rates. J. Fungi2023, 9, 836.
Tufa, T.B.; Orth, H.M.; Wienemann, T.; Jensen, B.-E.O.; Mackenzie, C.R.; Boulware, D.R.; Luedde, T.; Feldt, T. Disseminated Cryptococcosis is a Common Finding among Human Immunodeficiency Virus-Infected Patients with Suspected Sepsis and is Associated with Higher Mortality Rates. J. Fungi 2023, 9, 836.
Abstract
Cryptococcosis is a leading cause of death among people with HIV in sub-Saharan Africa. Limited diagnostic and therapeutic options significantly impair treatment options in Africa. We investigated the burden of cryptococcosis and related mortality among people with HIV and suspected sepsis in Ethiopia. We conducted a prospective cohort at 1) Adama Hospital Medical College and 2) Asella Referral and Teaching Hospital from September 2019 to November 2020. We enrolled adult HIV-infected patients presenting with suspected sepsis and assessed 28-day survival. We performed blood cultures and cryptococcal antigen (CrAg) testing. In total, 82 participants were enrolled with a median age of 35 years and 61% being female. Overall, 11(13%) had positive CrAg tests, of which 5 had Cryptococcus detected in blood cultures. Despite high-dose fluconazole (1200mg/d) monotherapy in patients with positive CrAg tests, the 28-day mortality was 64%(7/11), being significantly higher than in CrAg-negative patients (9%(6/71); p<0.001). Cryptococcosis is the leading cause of mortality among HIV-infected sepsis patients. CrAg screening in HIV-infected patients attending emergency department can minimize the cryptococcosis missing case irrespective of CD4 count and viral load. These findings warrant the need of a bundle approach for diagnosis of HIV-infected persons presenting with sepsis in low- and middle-income countries.
Keywords
Cryptococcal infection; Sepsis; qSOFA; blood culture; HIV; Africa
Subject
Medicine and Pharmacology, Clinical Medicine
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
,
,
