CRYPTOCOCCAL INFECTION IN PLHIV : SERIES OF 12 CASES AT THE LABORATORY OF MOHAMMED VI UNIVERSITY HOSPITAL OF MARRAKECH

Abstract

Background: Cryptococcal infection is opportunistic and causes high morbidity and mortality among severely immunocompromised patients, specially those living with HIV/AIDS (PLHIV). Cryptococcus neoformans is the most frequently identified species, incriminated in 90% of cryptococcal meningitis (CM). Methods: This is a descriptive retrospective study over a 2-years period (2021 - 2022) involving 12 PLHIV in whom we have isolated Cryptococcus neoformans from cerebrospinal fluid (CSF), blood culture, respiratory or skin specimen. All patients received antifungal therapy, associated to therapeutic lumbar punctures for those who presented with increased intracranial pressure. The clinical examination findings, laboratory data and evolution under treatment of these patients were reviewed. Results: The twelve patients were all HIV-infected adults, with median age of 41.25 ± 12.22 years and male predominance with a sex ratio of 1:2. All patients had low CD4 T-cell counts at diagnosis (<100 cells/µl). Neurological involvement existed in all patients of this cohort : Isolated CM was diagnosed in three cases (25%). Nine patients (75%) had disseminated cryptococcosis: Central nervous system (CNS) with positive hemoculture in six cases, CNS and pulmonary involvement with positive hemoculture in two cases, CNS and cutaneous involvement with positive hemoculture in one case. Cryptococcus neoformans was identified in all cases. Of the twelve patients, seven (58%) survived with good response to the treatment. Lethality rate was 42%. Conclusion: This study demonstrates cryptococcal disease is a high mortality infection in PLHIV.Priority should be given to access to rapid diagnostic CrAgtests to accessibility to liposomal amphotericin B. This could improve the clinical outcome of the patients in our moroccan context.