Cryptococcus

When I am afraid, I put my trust in You.
In God, whose word I praise, in God I trust; I shall not be afraid.
Psalm 56:3,4

Cryptococcus is a germ I’ve become very familiar with since I came to Kijabe. It’s an unusual germ, a type of yeast which rarely affects humans. Unless they are defenseless, as our AIDS patients are. It can cause pneumonia and meningitis, and we've seen patients covered with cryptococcal skin lesions all over their body.

Jacinta was admitted to Salome ward recently, with headaches, fever, and neck stiffness. Her blood tests showed an extremely low CD4 count, meaning that she had almost no ability to fend off infection. A spinal tap revealed that she had Cryptococcal meningitis.

We started her on intravenous amphotericin, an antifungal drug that works well for Cryptococcus, but can be rather miserable for the patient. Our protocol calls for 14 days of treatment, along with high doses of an oral antifungal drug. Adding to her misery, we also performed daily spinal taps to relieve the pressure buildup in her brain due to the infection.

Three days into treatment, Jacinta began to develop weakness on the right side of her body, an unexpected complication. Worried that she might have an abscess, tumor, or stroke, we talked with her family, and they contacted their relatives and friends to raise the money for a CT scan in Nairobi. Two days later, she left in an ambulance for the scan.

The results surprised us. The scan showed none of the things we had anticipated, but instead showed multiple abnormally dark areas in the brain tissue, especially on the left side. These were due to a second infection with a germ called JC virus, causing a serious and rapidly fatal brain disease called PML.

There’s no treatment for PML, other than drugs to treat her HIV infection in the hopes of boosting her immunity, so that she might be able to fight the virus on her own.

Getting patients started on HIV treatment with antiretroviral drugs isn’t easy. We usually don’t prescribe them in the hospital, because the treatment is complicated and potentially dangerous, so follow-up and education are critical.

So we usually treat the patient’s infections, get them feeling better (if we can – not everyone with endstage AIDS is able to survive), then refer them on to an AIDS treatment clinic near their village. That way, they can be fully educated and enrolled in the AIDS relief program with free, US-funded antiretroviral drugs.

But that can take some time, and Jacinta didn't have long. So we consulted with the AIDS relief people, and asked if they would make an exception, since her disease was quite advanced. They agreed, and after 14 days of antifungal treatment, we sent her home with a supply of antiretroviral drugs and a plan for early follow-up at the AIDS relief clinic in Naivasha, near her home.

Jacinta is a Christian, and has placed her trust in God. She and her family know the importance of following through with her treatment, but they also understand that her condition is very serious, and the outcome is in God’s hands. We were glad to send her home with the hope of improvement with proper treatment.

- Doug