Cryptococcosis in Patients Living with Hepatitis C and B Viruses

Abstract

Cryptococcosis, a systemic fungal infection, has become a significant, global public health problem. Patients with liver disease have an increased predisposition to infections, such as Cryptococcosis. To report the underlying disease, the variety of etiologic agents involved and the outcomes of the Cryptococcosis in patients living with HBV and/or HCV, we reviewed 34 medical records of patients who were diagnosed with Cryptococcosis by the Mycology Laboratory of Santa Casa Hospital, Porto Alegre, Brazil. Males corresponded to 79% of the patients, and the average patient age was 46.9 years. The cultures of 26/34 patients were positive: 25 patients were infected with Cryptococcus neoformans and one with C. gattii. A total of 14 deaths (41%) occurred. As a criterion of our study, all patients had viral hepatitis infection: 27 (80%) were infected with HCV, five (15%) were infected with HBV, and two patients were infected with both viruses. Because HBV and/or HCV are transmitted among drug users through infected blood, and the end-stage cirrhotic liver must be transplanted, these two population types were well represented in this study and were analyzed in detail. Cryptococcosis patients living with HCV and/or HBV appear to have the same symptoms, mean age and gender distribution as the general Cryptococcosis population. Once Cryptococcosis affects the brain, a high mortality rate ensues; therefore, physicians must be aware of the possible occurrence of this disease in patients living with HCV and HBV.

Tuberculosis/cryptococcosis co-infection in China between 1965 and 2016

“… 13 These pathogenic Cryptococcus species affect patients with immuno-compromising conditions such as HIV infection and individuals who are apparently healthy. 14 , 15 , 16 , 17 A global estimation suggested that each year ~960 000 new cases of cryptococcal meningitis occur in the HIV-positive patient population, leading to ~620 000 deaths within 90 days. 16 Our previous studies revealed unique features of the molecular epidemiology and clinical profiles of cryptococcosis in China, including strain genotype homogeneity and the involvement of a limited number of patients with HIV infection.…”

Disseminated cryptococcosis and hepatitis C virus infection: A fatal co-infection

“…When this species disseminates hematogenously, the central nervous system is the second commonly involved organ. Diagnosis of disseminated cryptococcosis is established based on positive cultures from any two organ sites (e.g., skin, central nervous system, peritoneum, and synovial fluid) or positive blood cultures [4,5]. In our patient, it was not possible to perform lumbar puncture to confirm central nervous system involvement because of patient refusal to undergo any invasive procedure.…”

“…Literature shows that cryptococcosis remains a significant complication in patients who have a predisposing factor or underlying diseases, such as endstage liver disease, renal insufficiency, sarcoidosis, and other conditions [1]. However, it can also affect a certain group of patients who are otherwise phenotypically normal, such as organ transplant recipients, drug users, and patients with HBV/HCV liver disease or renal disease [4]. Disseminated cryptococcal infection in patients suffering from hepatitis is rarely reported.…”

Recurrent pulmonary cryptococcosis during chronic HBV infection

“…[ 15 , 16 ] Although cryptococcosis patients living with HBV do not have specific symptoms, once cryptococcosis affects the brain, a poor outcome is expected. [ 17 ] Therefore, physicians must be aware of pulmonary cryptococcosis in patients living with HBV, especially the disseminated type of cryptococcosis.…”