Evaluation of Predictive CD4 Count and Clinical Reliability in Detecting Cryptococcus neoformans at Kenyatta National Hospital, Kenya

Abstract

Cryptococcus neoformans, which causes cryptococcal meningitis (CM), is increasingly becoming a fatal fungal infection, especially among HIV/AIDS patients, because the HIV virus targets and destroys CD4 T cells (core cellular immune effector cells), resulting in immunosuppression. The objective of the study was to determine occurrence of CM, CD4T cells counts and assays, in patients suspected/confirmed to have cryptococcal meningitis. The cross-sectional study design involved 51 HIV patients from KNH, during August-September 2008, sampled using Java and Applets method (2006). Results showed that CD4 T cells count among all the patients suspected to be infected with cryptococcal meningitis ranged from 0937 cells/µL; majority had CD4 counts of 200 cells/µL. Since majority of HIV patients (43%) in the sample population, with CD4 counts of 143 cells/µL had cryptococcal meningitis, a CD4 count of 143 cells/µL should be used as the lower limit below which HIV patients should be given prophylactic drugs for the disease, regardless of the prevailing clinical features seen in the affected patients. Reasons to determine why not all patients with HIV had cryptococcal meningitis, despite suggestive clinical features, should be investigated. Key words: CD4 T cell count, Cryptococcus neoformans; Cryptococcal meningitis (CM) and HIV