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High burden of cryptococcal antigenemia and meningitis among patients presenting at an emergency department in Maputo, Mozambique | Journal Article / Research | MSF Science Portal
Journal Article
|Research

High burden of cryptococcal antigenemia and meningitis among patients presenting at an emergency department in Maputo, Mozambique

Deiss R, Loreti C, Gutierrez AG, Filipe E, Tatia M, Issufo S, Ciglenecki I, Loarec A, Vivaldo H, Barra C, Siufi C, Molfino L, Antabak NT
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Abstract
BACKGROUND
Cryptococcal meningitis is a leading cause of HIV-related mortality in sub-Saharan Africa, however, screening for cryptococcal antigenemia has not been universally implemented. As a result, data concerning cryptococcal meningitis and antigenemia are sparse, and in Mozambique, the prevalence of both are unknown.

METHODS
We performed a retrospective analysis of routinely collected data from a point-of-care cryptococcal antigen screening program at a public hospital in Maputo, Mozambique. HIV-positive patients admitted to the emergency department underwent CD4 count testing; those with pre-defined abnormal vital signs or CD4 count ≤ 200 cells/μL received cryptococcal antigen testing and lumbar punctures if indicated. Patients with CM were admitted to the hospital and treated with liposomal amphotericin B and flucytosine; their 12-week outcomes were ascertained through review of medical records or telephone contact by program staff made in the routine course of service delivery.

RESULTS
Among 1,795 patients screened for cryptococcal antigenemia between March 2018-March 2019, 134 (7.5%) were positive. Of patients with cryptococcal antigenemia, 96 (71.6%) were diagnosed with CM, representing 5.4% of all screened patients. Treatment outcomes were available for 87 CM patients: 24 patients (27.6%) died during induction treatment and 63 (72.4%) survived until discharge; of these, 38 (60.3%) remained in care, 9 (14.3%) died, and 16 (25.3%) were lost-to follow-up at 12 weeks.

CONCLUSIONS
We found a high prevalence of cryptococcal antigenemia and meningitis among patients screened at an emergency department in Maputo, Mozambique. High mortality during and after induction therapy demonstrate missed opportunities for earlier detection of cryptococcal antigenemia, even as point-of-care screening and rapid assessment in an emergency room offer potential to improve outcomes.

Countries

Mozambique

Subject Area

HIV/AIDSfiloviruscryptococcal meningitiscryptococcal antigenemia

Languages

English
DOI
10.1371/journal.pone.0250195
Published Date
26 Apr 2021
PubMed ID
33901215
Journal
PLOS One
Volume | Issue | Pages
Volume 16, Issue 4, Pages e0250195
Issue Date
2021-04-26
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