Clinical Profile of 24 AIDS Patients with Cryptococcal Meningitis in the HAART Era: A Report from an Infectious Diseases Tertiary Hospital in Western Romania.

Iosif Marincu,Oana Suciu,Mihai Mares,Cosmin Citu,Madalina Timircan,Felix Bratosin,Melania Lavinia Bratu,Adrian Vasile Bota,Iulia Vidican,Mirela Loredana Grigoras,Stefan Frent

doi:10.3390/diagnostics12010054

Iosif Marincu, Oana Suciu + Show 9 more

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https://doi.org/10.3390/diagnostics12010054

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Abstract

Management of cryptococcal infections among patients suffering from acquired immunodeficiency syndrome (AIDS) represents a medical challenge. This retrospective study aims to describe the disease management and outcomes among 24 AIDS patients who suffered from Cryptococcus neoformans meningitis. The parameters evaluated from our patients’ database records include epidemiological data, clinical manifestations, biochemical and microbiological analysis of patients’ cerebrospinal fluid (CSF), treatment profiles, and disease outcomes. All patients included in the study had a lymphocyte count of less than 200 CD4/mm3. Of the 24 patients included in this study, five had been diagnosed with HIV infection since childhood, after receiving HIV-infected blood transfusions. The most prominent symptom was fatigue in 62.5% of patients, followed by nausea/vomiting and headache. Seven patients had liver cirrhosis due to hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, while Kaposi sarcoma and cerebral toxoplasmosis were found in two patients. Six out of 24 patients died due to bacterial sepsis and acute respiratory distress syndrome (ARDS). High intracranial pressure was the strongest predictive factor for mortality (OR = 2.9), followed by ARDS (OR = 1.8), seizures at disease onset (OR = 1.4), and diabetes mellitus (OR = 1.2). Interestingly, patients younger than 40 years old had a significantly lower survival rate than that of the older patients. Before developing Cryptococcal meningitis, all patients had low adherence to the early ART treatment scheme and skipped the follow-up visits. All patients received a combination of amphotericin B and flucytosine as induction therapy, adding fluconazole for maintenance. Simultaneously, AIDS HAART was initiated at diagnosis of the cryptococcal infection. A combined regimen of antifungals and highly active antiretroviral therapy showed improved patient recovery with minor side effects.

Highlights

People living with human immunodeficiency virus (HIV) infection are prone to opportunistic infection with several microorganisms, including Cryptococcus neoformans yeast
A total of 24 patients with cryptococcal meningitis secondary to acquired immunodeficiency syndrome (AIDS) treated in the hospital were enrolled in this study
Our findings conclude that cryptococcal meningitis occurs in most instances in longstanding HIV and cases of noncompliance with therapeutic orders for AIDS, when severely decreased CD4 levels allow most opportunistic infections to develop

Summary

Introduction

People living with human immunodeficiency virus (HIV) infection are prone to opportunistic infection with several microorganisms, including Cryptococcus neoformans yeast. This fungus has encapsulated morphology, causing a disease known as cryptococcal meningitis (CM) [1]. In Romania, a developing European country, the problem of HIV-positive adults is acute because a lot of people have been infected since childhood, before 1989, in the Communist era, by improper medical care and lack of screening for donated blood transfusions. In Europe, by 2018, 2,300,000 people were living with HIV, with ART being available to 54% (1,258,000) of them [3]. Regarding HIV/AIDS management in Europe, improvement for testing and diagnosis is needed because data from two large cohort studies (EuroSIDA and COHERE) released in 2020 report that around half of HIV diagnoses in Europe are late [4]

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