Cryptococcus neoformans meningitis in an immunocompetent adult: A case report

Numbi, Georges Yumba; Mwad, Berthe Kamalo; Mukuku, Olivier; Mwamba, Claude

doi:10.25082/agpm.2020.01.002

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…Out of 31 full‐text articles examined, one additional study was excluded as it was a review article. Of 30 studies that were included in the present systematic review (Figure 1), 25 studies were conducted in the clinical setting, 9,11,12,15,20‐40 one was an environmental study, 10 and four studies specifically focused on the laboratory characterisation of Congolese isolates 41‐44 . The basic characteristics of the clinical studies are summarised in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The remaining four cases were described before the 1980s. Interestingly, Numbi et al described a seemingly immunocompetent patient (610 CD 4 cells per µl) who developed Cryptococcus neoformans s.l meningitis, based on the diagnostic tools available in the region 35 . However, it cannot be excluded that in similar cases there may be other underlying factors, not necessarily related to HIV/AIDS, which may similarly undermine immunity against infection by these yeasts.…”

Section: Discussionmentioning

confidence: 99%

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Cryptococcosis in the Democratic Republic of Congo from 1953 to 2021: A systematic review and meta‐analysis

Bive

Kasumba

Nani-Tuma

et al. 2022

Mycoses

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Cryptococcosis is a common opportunistic infection associated with HIV/AIDS. The present review systematically describes the clinical and biological aspects of cryptococcosis in the Democratic Republic of Congo (DRC) and estimates its 2020 burden in people living with HIV (PLHIV). Following PRISMA guidelines, we searched online databases for records of cryptococcosis/Cryptococcus spp. in the DRC. Meta-analysis was then performed to estimate summary statistics and the corresponding 95% confidence intervals (CI). A total of 30 studies were included. These included 1,018 cryptococcosis patients, including 80.8% with neuromeningeal cryptococcosis (NMC) and predominantly immunocompromised due to HIV/AIDS (97.6%). The NMC mean prevalence was estimated at 9.63% (95% CI: 5.99-14.07). More than one in two patients (52.7%) under treatment died. Monotherapy with fluconazole was the main treatment administered (80.6%). Furthermore, we estimate that about 9,265 (95% CI: 5,763-13,537) PLHIV had cryptococcosis in 2020, in DRC; of which about 4,883 (95% CI: 3,037-7,134) would have died in the same year. Among isolates in all included studies, 74 strains have been characterised. Of these, 82.4% concerned Cryptococcus neoformans sensu lato (s.l) (exclusively of serotype A and mostly of molecular types VNI and VNII) and 17.6% concerned Cryptotoccus gattii s.l (belonging to serotype B/molecular type VGI). Cryptococcosis remains common with an unacceptably high mortality rate.A large number of PLHIV affected by and dying from cryptococcosis in 2020 demonstrates its heavy burden among the Congolese PLHIV. To mitigate this burden, it is important to improve the quality and accessibility of care for all PLHIV.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cryptococcosis in the Democratic Republic of Congo from 1953 to 2021: A systematic review and meta‐analysis

Bive

Kasumba

Nani-Tuma

et al. 2022

Mycoses

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“…Its localization is multisystem; however, this yeast has a marked tropism for the central nervous system, causing meningoencephalitis. 1 It is a basidiomycete that is found in the environment, and its gateway into the body is the pulmonary airway. 2 It is the infectious agent responsible for cryptococcosis.…”

Section: Introductionmentioning

confidence: 99%

“…NMC has increased significantly in frequency since 1985 due to the increase in the number of cases diagnosed in patients infected with HIV, with the number of HIV-negative patients being stable. 1 In Africa, it is currently one of the main major opportunistic infections that complicate HIV infection. 2,3 NMC during HIV infection is a major problem in diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

Neuromeningeal cryptococcosis in HIV-infected patients in Lubumbashi, Democratic Republic of the Congo

Katabwa¹,

Mukuku²,

Lwamba³

et al. 2021

JNSK

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Introduction: Neuromeningeal cryptococcosis (NMC) is a severe and fatal opportunistic infection. Lethality is higher in the absence of treatment, especially in HIV co-infection. The objective of the present study was to determine the prevalence, epidemiological, clinical, biological, and therapeutic features as well as the outcome of NMC in HIV-infected patients. Methods: This is a retrospective study of 108 cases of NMC diagnosed in HIV-infected patients. Data were collected over 36 months (from January 2015 to December 2017) at the HIV/AIDS Center of Excellence in Lubumbashi (Democratic Republic of the Congo). Results: The overall prevalence of NMC is 2.5%. The mean age of the patients was 41.5±13.1 years, with 72.2% aged less than 50 years. The main clinical symptomatology was headache (100%) and fever (100%). The main cytochemical CSF abnormalities were hyperproteinorachia (91.9%), hypoglycorachia (94%) and hyper-lymphocytosis (98.2%). The mean CD4 count was 168.7±137.1/mm3. All patients were treated with fluconazole. The overall lethality was 43.5%. Conclusion: NMC is a serious opportunistic infection in HIV-infected patients, and the case fatality rate remains unacceptable. Management of NMC in HIV-positive patients requires early diagnosis, increased access to antiretrovirals and prompt initiation of appropriate treatment.

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Cryptococcosis in Africa: What the data tell us

et al. 2023

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Cryptococcosis is a neglected tropical disease and the main cause of fungal related deaths in HIV-positive persons in Africa. It is an AIDS-defining illness that has almost surpassed tuberculosis (TB) in mortality despite wide coverage with antiretroviral therapy. What is known about the cryptococcosis burden in Africa is from estimations based on data from a few studies on the infection burden and associated complications. Consequently, the projected implications of cryptococcosis in Africa have been based on these estimations. This systematic review is aimed at providing unique and up-to-date data on the burden of cryptococcosis in Africa using published hospital-based research data on cryptococcosis in HIV infected and uninfected persons. The review also focuses on providing temporal data on the availability of diagnostic and therapeutic options for cryptococcosis in Africa. From our results, about 40948 cases of cryptococcosis were reported in Africa from 1969-2021, and the highest prevalence of cryptococcosis was from southern Africa. The most isolated species was C. neoformans 42.4%(17710/41801) and only 1.3%(549/41801) isolates were C. gattii. C. neoformans (serotype A) VN I 64.5%(918/1522) was the most prevalent serotype in Africa while C. gattii (serotype C) VG IV was thought to pose a huge danger. However, C. neoformans (serotype A) VN I continued to be the major threat in Africa. Due to the limited availability of molecular typing methods and the widespread use of culture, direct microscopy, and serological techniques for diagnosis, 23542 isolates were uncharacterized. Amphotericin B and flucytosine combination therapy is highly recommended for treatment of cryptococcal meningitis. However, these drugs are expensive and remain largely unavailable in most African countries. Amphotericin B requires laboratory facilities to monitor for toxicity. Although fluconazole monotherapy is the readily available treatment option for cryptococcosis, drug resistance and high mortality have been recorded in majority of cases in Africa. The lack of awareness, and paucity of published data on cryptococcosis is likely to have contributed to the underestimation of cases in Africa and led to underprioritisation of this important disease.

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Cryptococcus neoformans meningitis in an immunocompetent adult: A case report

Cited by 3 publications

References 13 publications

Cryptococcosis in the Democratic Republic of Congo from 1953 to 2021: A systematic review and meta‐analysis

Cryptococcosis in the Democratic Republic of Congo from 1953 to 2021: A systematic review and meta‐analysis

Neuromeningeal cryptococcosis in HIV-infected patients in Lubumbashi, Democratic Republic of the Congo

Cryptococcosis in Africa: What the data tell us

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