Cryptococcaemia in a Jamaican Cohort

Abstract

Abstract Background The study objective was to describe the clinical features associated with cryptococcaemia in a Jamaican cohort and determine associated risk factors and outcomes. Methods All blood samples collected at the Microbiology Laboratory at a Tertiary Care Hospital in Jamaica between April 2015 and March 2017 were analysed. De-duplicated patients with cryptococcaemia were selected and their clinical information retrospectively analysed. Results Six patients (three males, three females) ages 22-55 years, were diagnosed with cryptococcaemia. One patient had diabetes and the remaining five were infected with HIV. Over 70% of these patients were non-compliant with anti-retroviral medication and 40% had an associated viral load of >10,000 RNA copies/ml with low CD4 counts. Fifty percent of these patients were diagnosed with sepsis with 33.3% having had meningitis. At least two patients had a lower respiratory tract infection but none were formally diagnosed with pulmonary cryptococcosis. No information was available on environmental sources. All were treated with antifungals but only one had completed the full course of therapy with amphotericin B and fluconazole and was the only patient to survive. Conclusion HIV remains a major risk factor for cryptococcaemia. These research findings suggest that there may be a need to have a high index of suspicion for cryptococcosis in these patients as >50% did not show signs of typical underlying cryptococcal infections. The mortality rate was high in these patients, which would suggest that further studies may be needed in order to determine whether the presence of cryptococcaemia is a possible predictor for a poor outcome. Keywords: cryptococcaemia, fungi, HIV, AIDS, cryptococcus