Cryptococcosis in HIV – Infected Hospitalized Patients in Latvia

Abstract

Aims: To determine the prevalence of cryptococcal infection among HIV hospitalized patients, to evaluate clinical characteristics and outcomes in Latvia.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Riga Eastern Clinical University Hospital, Latvian Center of Infectology, between January 2014 and February 2017.
 Methodology: We conducted the study reporting demographics, epidemiological (age, sex, clinical aspects, paraclinical results (cryptococcal antigen in cerebrospinal fluid, serum, urine, cryptococcal DNA, HIV RNA and lymphocyte T CD4+ count), treatment and outcome aspects. We analyze 69 patients (71% men, 29% women) with HIV infection and cryptococcosis.
 Results: 69 cases of cryptococcosis were confirmed for 699 HIV infected hospitalized patients tested, giving a prevalence of 9.9%. 38% (n=26/69) of patients were with clinical signs of infection with the central nervous system involvement, 19% (13/69) patients had pulmonary involvement.
 Other 43% (n=30/69) of patients had disseminated non-CNS disease (elevated serum cryptococcal Ag or DNA). Most patients had advanced HIV disease (Median lymphocyte T CD4+ count=48, 5 cells/uL, (1-1041), the average was 112, 9 cells/ uL (SD 184.98). 87% (n=59/68) of patients had lymphocyte T CD4+cell count < 200 cells/μL Only 25% (n=14) of the patients known to have HIV infection (n=56/69) were receiving antiretroviral therapy at the time of presentation. Overall mortality rate was 59% (n=41/69).
 Conclusion: Prevalence of cryptococcal antigenemia was 9.9%, indicating that the prevalence of cryptococcal infection among HIV patients in Latvia may be high enough to consider targeted screening.HIV positive patients have high mortality (35%) following cryptococcal infection which persists beyond their initial hospitalization. Follow-up studies of late mortality would be beneficial.

Morbidity and mortality in the modern antiretroviral treatment era in a tertiary teaching hospital in Durban, South Africa.

“…Similarly, the same ndings were also found in Latvia. 28 and in Uganda. 35 This may result as most of the HIV infected patients included in this study had lack of information about preventive therapy among those with low CD4 cell counts.…”