M-1851. A Comparison of Cryptococcal Cases With and Without Recurrent Disease in South Africa, 2005-2006
Session: Slide Session: Clinical Mycology
Monday, October 27, 2008: 12:00 AM
Room: Room 145A
Background: The factors associated with recurrent cryptococcosis (CC) have not been fully explored in South Africa. Methods: Cases of CC, reported to a national surveillance program from January 2005 through December 2006, were defined based on positive India ink test, antigen test, or culture. Cases at enhanced surveillance sites (ESS), where clinical data were available, and which survived to be discharged from hospital, were included. Recurrent disease was defined as laboratory evidence of CC during subsequent hospitalization or >30 days after incident diagnosis. Cases with recurrent disease (group R) were compared to cases without recurrent disease (group N), with regard to baseline data collected during 1st hospitalization. Results: Of 10,828 incident cases, 3,579 (33%) cases presented to ESS; clinical data for the 1st hospital admission were available for 3,104/3,579 (87%). Of these, 1,276 (41%) died during hospitalization and were excluded. 1,828 cases were included, 287 in group R and 1,541 in group N. A smaller proportion of cases was treated with amphotericin B (AmB) in group R vs. group N (62/287 (22%) vs. 520/1541 (34%) respectively; p<0.0001). Conversely, a larger proportion of cases was treated with fluconazole (Flu) in group R vs. group N (187/287 (65%) vs. 829/1541 (54%) respectively; p=0.003). A larger proportion of cases in group R was hospitalized for <14 days (201/272 (74%)) vs. group N (1044/1530 (68%)); this difference was not statistically significant (p=0.06).
Conclusions: Amongst CC cases surviving to discharge at 1st hospitalization, cases with recurrent disease were more likely to have received Flu induction therapy.
For GERMS-SA, Alan Karstaedt, MBBCh2, Anwar Hoosen, MBBCh3, Cheryl Cohen, MBBCh3, Halima Dawood, MBBCh4, Nelesh Govender, MBBCh5, Susan Meiring, MBBCh3, Vanessa Quan, MBBCh3, Xoliswa Poswa, MBBCh6, Yacoob Coovadia, MBBCh3 and  N. Govender, None., (1)Chris Hani Baragwanath Hospital, (2)National Health Laboratory Service, (3)Grey's Hospital, (4)National Health Laboratory Service, Sandringham, South Africa, (5)Ampath

Alan Karstaedt qualified MB.BCh at the University of the Witwatersrand, Johannesburg, South Africa and specialised in internal medicine. His career has been spent at the Chris Hani Baragwanath Hospital, Soweto, South Africa where he is currently Director of the Infectious Diseases Division and the Adult HIV Clinic in the Department of Medicine.

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