Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis
| Autor: | Nicole Landu, Pius Zakayi Kabututu, Adolphe Biakabuswa, Hippolyte Situakibanza, Bive Zono, Georges Lelo Mvumbi, Rosalie Sacheli, Gaultier Muendele, Marie-Pierre Hayette, Michel Moutschen |
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| Rok vydání: | 2021 |
| Předmět: |
Serotype
medicine.medical_specialty Kinshasa Antifungal Agents Cryptococcus HIV Infections Infectious and parasitic diseases RC109-216 Microbial Sensitivity Tests Meningitis Cryptococcal Gastroenterology symbols.namesake Minimum inhibitory concentration Internal medicine Amphotericin B medicine Humans Meningitis Cryptococcus curvatus Fisher's exact test Cryptococcus neoformans biology business.industry Research Cryptococcus laurentii HIV DRC Cryptococcus gattii Cryptococcosis medicine.disease biology.organism_classification Infectious Diseases Biological characterization symbols Clinical characteristic business Fluconazole medicine.drug |
| Zdroj: | BMC Infectious Diseases BMC Infectious Diseases, Vol 21, Iss 1, Pp 1-10 (2021) |
| ISSN: | 1471-2334 |
| Popis: | Background Cryptococcal meningitis is mainly caused by Cryptococcus neoformans/C. gattii complex. We compared the clinical, biological, and antifungal susceptibility profiles of isolates from HIV-Infected Patients (HIVIP) with C. neoformans (Cn) versus C. curvatus/C. laurentii (Cc/Cl) meningitis. Methods Comparative analytical study were conducted. Apart from patients’ clinical data, the following analysis were performed and the results were compared in both groups: biochemical examination, cryptococcal antigen test, India ink staining, and culture on Cerebral Spinal Fluid (CSF), strains identification by mass spectrometry, ITS sequencing, PCR serotyping and antifungal susceptibility. The main outcome variable was the “species of Cryptococcus identified”, which was compared to other variables of the same type using the Pearson Chi-square test or the Fisher exact test. Results A total of 23 (79.3%) Cn meningitis cases versus 6 (20.7%) Cc/Cl meningitis were retained.Cn meningitis was more frequently associated with headache (100% vs 50%, p = 0.005) than Cc/Cl meningitis and meningeal signs were more frequent in Cn infected patients. Biologically, hypoglycorrhachia and low CD4 count were more observed in Cn group (90% vs 20% of patients, p = 0.01; 45.6 vs 129.8 cells/µL, p = 0.02, respectively). A higher proportion of Cn strains (91.3%) showed a low Minimum Inhibitory Concentration (MIC) (Cc/Cl strains (66.7%). Also, Cc/Cl strains resistant to 5-flucytosine and amphotericin B were found in 16.7% of cases for each of the two antifungal agents. Cryptococcus detection by routine analysis (India ink, culture, and antigens) was better for Cn samples than Cc/Cl. Except ITS sequencing, which identified all strains of both groups, mass spectrometry and serotyping PCR identified Cn strains better than Cc/Cl (100% vs 80%, p = 0.1; 100% vs 0%, p Conclusions Clinical presentation of Cn meningitis is certainly more severe than that of Cc/Cl meningitis, but Cc/Cl infection should be considered in the management of HIVIP with meningeal syndrome because of the diagnostic difficulty and the high MICs of antifungal agents required for the treatment of meningitis due to these cryptococcal species. |
| Databáze: | OpenAIRE |
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