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7th Call - Dr. Japheth A. Opintan

Project Title: Cryptococcal Meningitis in Hospitalized HIV Patients in Korle-Bu, Accra.

Principal Investigator: Dr. Japheth A. Opintan(Department of Microbiology,UGMS, University of Ghana)

Email Address: jaopintan@chs.ug.edu.gh

Award Amount: GHC 24,990.00

Project Status: On-going

Summary:

Even with increasing access to antiretroviral therapy (ART), cryptococcal meningitis (CM) is increasingly causing high morbidity and mortality, especially in Africa and Asia. The prevalence and outcome of CM in Ghana is unknown. Prospectively, we shall recruit consecutive hospitalized HIV patients (estimated n=200) with clinical symptoms of meningitis at the Fever's Unit of the Korle-Bu Teaching Hospital. Culture and microscopy will be performed on cerebrospinal fluid (CSF) samples taken by lumbar puncture (LP). Sensitivity and specificity analysis of India Ink microscopy will be performed, and isolates of Cryptococcus will further be tested for azole resistance. The outcome of CM will be analyzed from laboratory and clinical data. The study has both clinical and laboratory components, and will be executed in collaboration with our medical collaborators at the Fever’s Unit of the Korle-Bu Teaching Hospital.

The specific aimsof the project are:

1). To investigate the prevalence of CM in hospitalized HIV-infected patients in Accra. Hypothesis 1.1: Meningitis due to Cryptococcus will account for greater than 30% of all cases of meningitis compared to those associated to other aetiologies.

2). To investigate outcome of cryptococcal meningitis in hospitalized HIV- infected patients in Korle-Bu. Hypothesis 2.1: In-hospital mortality rate will be high in patients who are laboratory confirmed with CM compared to those with other aetiologies

3). To determine antifungal resistance levels and genetic diversity of Cryptococcus species Hypothesis 3.1: Patients with CD4 counts ≤ 100 cells/μl will show high azole resistance and genetic diversity compared to those with counts > 100 cell/μl.

This study will potentially change clinical practice and care for HIV patients who present with clinical symptoms of meningitis. In addition, the findings of this study will be used as pilot data to inform the design of clinical intervention(s) targeted at early diagnosis and/or treatment to reduce mortality of CM in Ghana.