Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study

Abstract

Cryptococcal meningoencephalitis (CM) remains the most prevalent invasive fungal infection worldwide. The main objective of this study was to describe the prevalence of CM and cryptococcal infection in HIV-infected patients in Madagascar. The secondary objectives were to assess the adjusted prevalence of CM according to clinical presentation and patient characteristics, to determine crude 90-day survival according to cryptococcal antigen (CrAg) status and CM, and to identify the genotypes of Cryptococcus clinical isolates. This cross-sectional study was carried out at two urban hospitals in Antananarivo (central highlands) and Toamasina (east coast) between November 2014 and December 2016. Consecutive HIV-infected adults presenting with CD4 cell counts �200/μl were enrolled. Lateral flow immunoassays of CrAg were performed on serum for all patients, and on cerebrospinal fluid for patients with CM symptoms. MALDI-ToF MS, ITS sequencing, and determinations of the molecular and mating types of the isolates were performed. Fluconazole is the only drug for CM treatment available in Madagascar. Patients were treated orally, with high doses (1200 mg/day) for 10-12 weeks and then with 200 mg/day. Minimum inhibitory concentrations were determined for amphotericin B, flucytosine, voriconazole and fluconazole in E-tests. Overall prevalence was 13.2% (95% CI 7.9-20.3) for cryptococcal infection and PLOS Neglected Tropical Diseases | https://doi.

Microbiological, Epidemiological, and Clinical Characteristics of Patients With Cryptococcal Meningitis at a Tertiary Hospital in China: A 6-Year Retrospective Analysis

“…The genus Cryptococcus usually invades the central nervous system (CNS) and results in cryptococcal meningitis and then a high mortality rate (Lahiri et al, 2019). In addition, meningitis by C. neoformans species complex occurred more frequently than that by C. gattii species complex (Yuchong et al, 2012;Hagen et al, 2015;Smith et al, 2015;Ferreira-Paim et al, 2017;Thanh et al, 2018;Rakotoarivelo et al, 2020), and this might be explained by that the former is globally distributed, while the latter seems to be geographically restricted (Kidd et al, 2007;Chen et al, 2014;Smith et al, 2015;Firacative et al, 2016;May et al, 2016;Souto et al, 2016). Furthermore, both amphotericin B and fluconazole remain the mainstay treatment in cryptococcal meningitis (Yao et al, 2014;Beardsley et al, 2019).…”

Infections due to Rare Cryptococcus Species. A Literature Review

“…Subsequently, these species showed negative agglutination tests (negative capsule antigen) and no studies were performed using the newest lateral flow devices able to detect Cryptococcus capsular antigens. This false negative capsular antigen detection was also described for some C. gattii isolates [53][54][55]. Another important point to consider is the inability of most of the rare Cryptococcus spp.…”

Prevalence of Anaemia and Pulmonary Mycoses in Immunocompromised Subjects: A Review of Nigeria Perspective

“…People with immuno-compromised system are vulnerable to secondary infections and malignancies that are generally termed as opportunistic infections [1,2]. Individuals susceptible to pulmonary mycoses include those with immuno-suppressive illnesses like HIV/AIDS [1][2][3][4][5], diabetes [6-8], tuberculosis [3,9,10], cancer [7], chronic obstructive pulmonary diseases(COPD), immune-modulator therapy for the prevention of rejection in solid organ and hemaetopoietic cell transplantation [7,11,12]. Fungal infections of the lung are among the most feared infections in immuno-compromised patients.…”

“…Fungi like Aspergillus species, Candida species, Cryptococcus species are common ubiquitary opportunistic pathogens affecting the lung, especially in immuno-compromised people [1][2][3][4][5]7,9,10,13]. The Aspergillus species forms a genus of ubiquitous, molds present in soil, air, various types of organic debris, water, indoor environment and many other sites; forming commonest pathogens responsible for mycoses in immuno-suppressive individuals [1][2][3][4]7,[9][10][11][12][13]. Aspergillus species caused pulmonary aspergillosis; especially in immuno-compromised subjects [14][15][16].…”

“…HIV is a multi-systemic infection that suppresses haematopoietic system [13,17]. HIV/AIDS is a global pandemic disease [1][2][3]18] contributing to health burden in developing countries [1][2][3]. Diabetes mellitus continues to be a global health problem with over 80% of affected people living in low-middle income countries (LMICs) where tuberculosis is widespread [2,[6][7][8].…”