Cryptococcal Meningitis amomg HIV-Infected and HIV-Uninfected Patients in Jos, North Central Nigeria

Abstract

Cryptococcal meningitis is a global opportunistic infection caused by several serovars of Cryptococcus neoformans and Cryptococcus gattii with significant morbidity and mortality, particularly in immunocompromised patients. Management principles involve early and specific diagnosis followed by appropriate antifungal therapy. The study was conducted among in-patients with clinical features of meningitis admitted into tertiary healthcare facilities in Jos, north-central Nigeria from November 2017 to December 2018. Cerebrospinal fluid and blood samples were collected from the patients for culture and sensitivity, serology and genomic studies. Univariate and bivariate analysis was carried out using STATA (version 14IC). The serologic prevalence of cryptococcal meningitis among patients with clinical features of meningitis was 16.8%. The prevalence among HIV-infected and HIV-uninfected patients were 13.4% and 18.8% respectively. The antifungal susceptibility of the Cryptococcus neoformans isolated from sample cultures at MIC90ug/ml to Amphotericin B, Fluconazole and Itraconazole were all within the reference range. Gene accession numbers of cryptococcal isolates deposited in the gene bank include MK886574.1, MK886568.1, MK886570.1, MK886563.1, MK886560.1, MK886573.1, MK886562.1, MK886558.1. Cryptococcus neoformans are a major cause of meningitis in both HIV-infected and HIV-uninfected patients. This study highlights the fact that routine surveillance should be put in place for culture, antifungal susceptibility tests and genomic studies to ascertain the antifungal susceptibility pattern and genotypes of cryptococcus in circulation.