The Prevalence Of Cryptococcosis And Associated Risk Factors In HIV/AIDS Patients Attending Kiswa Health Centre, Kampala.

Abstract

Background: Cryptococcosis is a fungal disease affecting both humans and animals. In humans, the infection is usually opportunistic principally caused by Cryptococcus neoformans (C. neoformans). In Uganda, Cryptococcosis is a common infection among people living with HIV (PLWHIV) and often presents serious disease unless detected and treated early. In Kiswa Health Centre (KHC), there are no diagnostic strategies to screen for Cryptococcosis and yet data from monthly reports indicate treatment of Cryptococcosis. It is on this background that this study has come up. Methodology: The study was carried out in KHC found in Kampala Capital City Authority (KCCA) about 5km from the city centre with a major aim of determining the prevalence and the risk factors associated with Cryptococcosis among HIV/AIDS patients attending KHC. A blood sample (about 4mls in a plain tube) was collected from each of the 185 participants. Serum crAg was performed and results reported. Results: Among the study participants, 10/185 (5.41% 95% CI=2.62 to 9.72) were found to have Cryptococcosis. There were 9 (5.49%) females who were infected and 1(4.76%) male participant who had cryptococcosis with no difference in the rates of infection. The average age of participants was 49.56 years (SD=16.55) and the median age was 46years (IQR=39-63). Participants were categorized into children and teenagers (5-24 years), Youth (25- 35 years) adults (36-59 years) and elderly (>59years) with varying frequencies of 7 (3.78%), 25(13.51%), 88(47.57%) and 65(35.14%) respectively. Among children and teenagers, none was infected but the infection was observed among youth (2/25; 8.00%) adults (5/88; 5.68%) and elderly (3/65; 4.62%) and there was no statistical significance of the differences in the infection rates among the groups. There was a high prevalence among those who reared birds (6.6%) than that (3.08) of those who never reared birds but it was not statistically significant. The mean CD4 cell count was 152.5cells/μl. Persons with CD4 cell counts ≤100 were 180 (97.3%) while those who had CD4 cell counts above 100 were 05 (2.7%). This study reported that Cryptococcosis was found only in those individuals with CD4 cell counts below 100. Out of the 185 participants recruited in the study, 93 (50.27%) had a low BMI. Cryptococcosis was however isolated in only those with low BMI. 63/185 (34.05%) of the study participants reported to have used anti-biotics before. 6/10 (60%) of these were found to have Cryptococcosis (X2 = 5.86). The prevalence among those who reared birds was higher (6.6%) than that (3.08%) of those who never reared birds but it was not statistically significant. Conclusion: The overall prevalence of Cryptococcosis among PLWHIV attending KHC is relatively low (5.41%). A decline in CD4 cell count, low BMI and prior anti-biotic use were risk factors associated with the development of Cryptococcosis. Routine screening for Cryptococcosis among PLWHIV should be incorporated in their routine care package.