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AIDS. 2006 Nov 14;20(17):2199-206.

Population-based surveillance for cryptococcosis in an antiretroviral-naive South African province with a high HIV seroprevalence.

Author information

  • 1Mycology Reference Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Division of Virology and Communicable Diseases Surveillance, University of the Witwatersrand, Johannesburg 2000, South Africa. kerriganm@nicd.ac.za

Abstract

OBJECTIVES:

To measure the burden of disease and describe the epidemiology of cryptococcosis in Gauteng Province, South Africa.

DESIGN AND METHODS:

The study was an active, prospective, laboratory-based, population-based surveillance. An incident case of cryptococcosis was defined as the first isolation by culture of any Cryptococcus species from any clinical specimen, a positive India ink cryptococcal latex agglutination test or a positive histopathology specimen from a Gauteng resident. Cases were identified prospectively at all laboratories in Gauteng. Case report forms were completed using medical record review and patient interview where possible.

RESULTS:

Between 1 March 2002 and 29 February 2004, 2753 incident cases were identified. The overall incidence rate was 15.6/100 000. Among HIV-infected persons, the rate was 95/100 000, and among persons living with AIDS 14/1000. Males and children under 15 years accounted for 49 and 0.9% of cases, respectively. The median age was 34 years (range, 1 month-74 years). Almost all cases (97%) presented with meningitis. Antifungal therapy was given to 2460 (89%) cases of which 72% received fluconazole only. In-hospital mortality was 27% (749 cases). Recurrences occurred in 263 (9.5%) incident cases. Factors associated with death included altered mental status, coma or wasting; factors associated with survival included employment in the mining industry, visual changes or headache on presentation.

CONCLUSIONS:

This study demonstrates the high disease burden due to cryptococcosis in an antiretroviral-naive South African population and emphasizes the need to improve early recognition, diagnosis and treatment of the condition.

PMID:
17086060
[PubMed - indexed for MEDLINE]
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