Background: Recent analysis of the Thai national HIV/AIDS surveillance data revealed that cryptococcosis and penicilliosis are among the most common opportunistic infections (OIs) in patients with AIDS. Understanding the epidemiology of fungal OIs in developing countries like Thailand is necessary if effective prevention policies are to be implemented. In order to define the true burden of these OIs, we evaluated the completeness of surveillance reporting among cases at the Regional Hospital (CRRH) in Chiang Rai, a large northern province with a high HIV prevalence. In addition, we described the clinical characteristics and outcome of these OIs. Methods: We defined a case of cryptococcosis or penicilliosis as a clinical or laboratory-confirmed diagnosis of either OI in an HIV infected adult seen at CRRH in the year 2000. Laboratory confirmation was defined by positive culture, serology, or histopathology. We reviewed a convenience sample of medical records for clinical characteristics, and searched for cases in the national surveillance database. Results: We identified 1007 cases, and reviewed records for 779 (77%); 513 (66%) of these were incident cases (median age 32 years, range 19-65; 60% male); 97% of 343 cryptococcosis and 91% of 170 penicilliosis cases were laboratory confirmed, respectively; 40% and 41% of case patients had been reported to the surveillance system; 77% and 80% of case patients had previously been diagnosed with HIV; this OI was the AIDS-defining illness for 45% and 41%; 12% and 11% of cases were fatal. Conclusions: These data suggest that the current surveillance system may substantially underestimate the burden of fungal OIs in Thailand, and that primary antifungal chemoprophylaxis might prevent significant morbidity and mortality, though efficacy and cost-effectiveness need to be evaluated.
Full conference title:
- ICAAC 42nd