Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Abstract

Abstract. Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (P = 0.0047), intracranial increased pressure (P = 0.047), and severe malnutrition (P = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.

Infective capacity of Cryptococcus neoformans and Cryptococcus gattii in a human astrocytoma cell line

“…The dissimilarities between the two species in HLA class II expression and intracellular survival of blastoconidia are of interest because previous studies comparing C. neoformans and C. gattii showed that the clinical course and presentation were explained by host immunosuppression . Intrinsic characteristics such as the virulence mechanisms of each causative cryptococcal species may help explanation the diverse clinical presentations .…”

“…Cryptococcal meningoencephalitis is an invasive fungal disease responsible for an estimated 1 million cases of infection and approximately 620 000 deaths per year . This mycosis is one of the most important causes of death in patients with acquired immunodeficiency syndrome (AIDS), representing approximately 40% of deaths among this group of patients . Cryptococcosis is mainly caused by Cryptococcus neoformans and Cryptococcus gattii species complexes.…”

“…Cryptococcus neoformans var. grubii is considered an opportunistic pathogen, and the molecular type VNI is the most common cause of infection in HIV‐infected patients, occurring in approximately 80% of cases, and in patients with haematological malignancies and those receiving immunosuppressive therapy after organ transplant . Cryptococcus gattii serotype B has been implicated more often in the infection of immunocompetent hosts since its emergence in 1999, which resulted in an outbreak on Vancouver Island and nearby regions in British Columbia, Canada .…”

“…Conversely, during C. gattii infection, the lungs are affected in approximately 70% of the cases. Interestingly, pulmonary and cerebral cryptococcomas are more likely to form during C. gattii than C. neoformans infection . Cryptococcus gattii is relatively rare as a disease agent, although recent studies suggest that C. gattii may be underdiagnosed …”

The status of cryptococcosis in Latin America

“…Pure meningoencephalitic forms are less frequent, and the presence of cryptococcomas very rare ( Reséndiz et al 2008 , Klock et al. 2009 , Mantilla and Cárdenas 2009 , Torres et al 2016 ).…”