dc.contributor.author | Abdulsamad, M | |
dc.date.accessioned | 2013-06-03T10:02:43Z | |
dc.date.available | 2013-06-03T10:02:43Z | |
dc.date.issued | 2007 | |
dc.identifier.citation | Master of Medicine, Internal Medicine, University of Nairobi | en |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/28689 | |
dc.description.abstract | Background: Cryptococcal meningitis caused by the environmental
encapsulated fungus Cryptococcus neoformans, is an important and often fatal
infection whose incidence has multiplied severally after the advent of HIV.
Correct diagnosis and appropriate treatment is required to reduce the high
mortality rates associated with it.
Objective: To determine the culture yield and the sensitivity of India ink as a
diagnostic tool; To determine the sensitivity patterns of Cryptococcus
neoformans to amphotericin B, fluconazole, miconazole and 5 flucytosine;and to
determine the prevalent serotype of Cryptococcus neoformans at Kenyatta
National Hospital.
Study design: Cross-sectional study. •
Setting: In-patient medical wards, Kenyatta National Hospital, Nairobi, Kenya.
Study population: All patients admitted to medical wards of Kenyatta National
Hospital with clinical diagnosis of meningo-encephalitis .
Study method: Patients with meningo-encephalitis were subjected to a lumbar
puncture after excluding contra-indications. CRAG test was done on the CSF
obtained. Positive CSF samples were subjected to India ink stain. The CSF was
cultured and sensitivity patterns to amphotericin B, fluconazole, miconazole and
5 flucytosine were determined. Sero-typing of the isolates was carried out. The
HIV status of the cases was determined.
Data entry and analysis: Data was entered into a computer database then
analysed using SPSS version 12. Descriptive statistics were used for both
continuous and cateqorical data. Inferential statistics were used to determine
associations. The p value of <0.05 was considered significant.
Results: Three hundred and seven CSF specimens were obtained during a 3
month period. Sixty one tested positive for CRAG (19.8%).Three specimens
grew other fungi (T.mucoides-2 andT.Beigelii-1) on further microbiological
analysis. Fifty eight specimens were thus analysed.
India ink was found to be positive in 33 CSF samples (56.9%); culture positive
samples were 39 (67.2%).
Three isolates (7.7%) had MICs of >2I-Jg/ml for amphotericin B and were thus
resistant. Twenty eight isolates (71.8%) were susceptible to fluconazole having
MICs of <4I-Jg/ml; 8 patients (20.5%) had MICs of between 8 and 161-Jg/mland
were categorized as intermediate resistant; 3 (7.7%) were highly resistant having
MICs of >16I-Jg/ml. Miconazole susceptible isolates were 37(94.9%) having MICs
of <1.0I-Jg/ml; only 2 isolates had MICs >1I-Jg/ml signifying resistance. 5-
Flucytosine susceptible isolates were 19 (48.7%) having MICs <4I-Jg/ml;13
(33.3%) patients had MICs of between 8 and 161-Jg/ml and were in the
intermediate resistant group whereas 7 patients (17.9%) fell in the highly
resistant category with MICs of >32I-Jg/ml.
Fifty. seven had underlying HIV and cryptococcus meningitis was the AIDS
defining illness in 65.5% of them. One patient repeatedly tested negative for
ELISA but this was not confirmed by a PCR.
All 39 isolates cultured were sero-type A (Cryptococcus Neoformans var grubit).
Conclusion: India ink that is currently being used widely as the sole diagnostic
test for cryptococcal meningitis has a very low sensitivity thus misses a number
of cases leading to misdiagnosis and inappropriate treatment decisions. The
sensitivity patterns though concerning especially to Amphotericin B show that the
isolates are still susceptible to the tested anti-fungals invitro. | en |
dc.language.iso | en | en |
dc.publisher | University of Nairobi | en |
dc.title | Sensitivity patterns, serotypes of cryptococcusneoformans and diagnostic value of india ink in patients with cryptococcal meningitis at Kenyatta National Hospital. | en |
dc.type | Thesis | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
local.publisher | School of Medicine, University of Nairobi | en |