The impact of cryptococcal antigenaemia screening among patients attending King Dinuzulu Hospital

Abstract

Introduction The goal of this study was to give a general overview of Cryptococcus as a cryptococcosis causative agent. The morbidity, mortality and management of this type of infection are discussed, as well as the collaboration between the diagnostic laboratory service and the Department of Health. Aim The goal of this study was to see how cryptococcal antigenemia screening affected patient care at KDH. Objectives To determine whether screening for cryptococcus antigenemia leads to doctors necessary follow-up investigations. To report how often positive serum cryptococcal antigen screening results in cryptococcal meningitis treatment. To see if the current CD4 antigenemia threshold of less than 100 cells/µl is suitable for our patient population. Materials and Method This study took samples from patients at King Dinuzulu Hospital in Durban, eThekwini, KwaZulu-Natal, South Africa. The Laboratory Information System was utilized to diagnose cryptococcal infections in patients’ serum, plasma, and cerebrospinal fluid (CSF), as well as for normal patient management (Trakcare). Clinicians gathered specimens from patients as part of standard clinical care and forwarded them to the laboratory as data sources for this study. Cross-sectional, descriptive, and quantitative research were conducted on these specimens. Results The data that satisfied the inclusion criteria of the study were collected and analysed. Assay of 724 CSF and serum/plasma cryptococcal antigen (CrAg) results, including CSF culture results (n = 264) and CD4 counts (n = 446), were analysed for this section of the study. The bulk of CD4 counts, 433 (97.1%), were < 100 cell/µl whereas 13 (2.9%) were > 100 cells/µL. The number of patients with a CD4 count who stuck to their treatment was 22 out of 62. Eighty-five CrAg positive findings were obtained, with 62 receiving a CD4 count. There were 31 CrAg with a CD4 count of 0-49 cells/µL, 28 with a CD4 count of 50-99 cells/µL, one with a CD4 count of 100-149 cells/µL, one with a CD4 count of 150-199 cells/µL, and one with a CD4 count of more than 200 cells/µL. A higher percentage of patients had a follow up appointment. There was a higher proportion of patients who received a follow-up (10, 55.6%) than those who did not (3, 6.8%) p ˂ 0.001. Furthermore, those who started treatment within seven days had a higher proportion of patients without follow up (81.8 percent, n = 36) than those who had a follow up (0 percent, n = 0). Conclusion In conclusion, there was no positive benefit of CrAg screening on HIV-positive patients attending KDH, as stated in the study’s goal. In terms of the study’s goal and objectives, the findings revealed that the majority of positive CrAg samples were nt followed up on.