Clinical Profile of 24 AIDS Patients with Cryptococcal Meningitis in the HAART Era: A Report from an Infectious Diseases Tertiary Hospital in Western Romania

Iosif Marincu; Cosmin Citu; Iulia Vidican; Felix Bratosin; Mihai Mares; Oana Suciu; Stefan Frent; Adrian Vasile Bota; Madalina Timircan; Melania Lavinia Bratu; Mirela Loredana Grigoras

doi:10.3390/diagnostics12010054

Clinical Profile of 24 AIDS Patients with Cryptococcal Meningitis in the HAART Era: A Report from an Infectious Diseases Tertiary Hospital in Western Romania

Diagnostics (Basel). 2021 Dec 28;12(1):54. doi: 10.3390/diagnostics12010054.

Authors

Affiliations

¹ Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
² Department of Psychology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.

Abstract

Management of cryptococcal infections among patients suffering from acquired immunodeficiency syndrome (AIDS) represents a medical challenge. This retrospective study aims to describe the disease management and outcomes among 24 AIDS patients who suffered from Cryptococcus neoformans meningitis. The parameters evaluated from our patients' database records include epidemiological data, clinical manifestations, biochemical and microbiological analysis of patients' cerebrospinal fluid (CSF), treatment profiles, and disease outcomes. All patients included in the study had a lymphocyte count of less than 200 CD4/mm³. Of the 24 patients included in this study, five had been diagnosed with HIV infection since childhood, after receiving HIV-infected blood transfusions. The most prominent symptom was fatigue in 62.5% of patients, followed by nausea/vomiting and headache. Seven patients had liver cirrhosis due to hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, while Kaposi sarcoma and cerebral toxoplasmosis were found in two patients. Six out of 24 patients died due to bacterial sepsis and acute respiratory distress syndrome (ARDS). High intracranial pressure was the strongest predictive factor for mortality (OR = 2.9), followed by ARDS (OR = 1.8), seizures at disease onset (OR = 1.4), and diabetes mellitus (OR = 1.2). Interestingly, patients younger than 40 years old had a significantly lower survival rate than that of the older patients. Before developing Cryptococcal meningitis, all patients had low adherence to the early ART treatment scheme and skipped the follow-up visits. All patients received a combination of amphotericin B and flucytosine as induction therapy, adding fluconazole for maintenance. Simultaneously, AIDS HAART was initiated at diagnosis of the cryptococcal infection. A combined regimen of antifungals and highly active antiretroviral therapy showed improved patient recovery with minor side effects.

Keywords: AIDS; Cryptococcus neoformans; HAART; HIV; amphotericin B; cryptococcal meningitis; flucytosine.