Epidemiological, clinical and biological profile of neuromeningeal cryptococcosis among people living with in Kinshasa, Democratic Republic of Congo

Bive, Bive Zono; Kamangu, Erick Ntambwe; Situakibanza, Hippolyte; Amaela, Evelyne; Bepouka, Ben; Mbula, Marcel; Kayembe, Jean‐Marie; Mvumbi, Georges Lelo; Hayette, Marie‐Pierre

doi:10.11604/pamj.2020.37.302.20521

Cited by 5 publications

(9 citation statements)

References 5 publications

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“…In our study, the lethality was 43.5%. This lethality is greater than those reported in Kinshasa (34.8%) 19 and Bobo Dioulasso (27.8%), 26 but lower than those observed in other African series (from 71.1% to 83.3%). 32,36,37 These data clearly show the value of early management of patients with NMC.…”

Section: Discussioncontrasting

confidence: 60%

“…Our rate is lower than those of studies carried out in other African countries ranging from 5.6% to 11.43%. [17][18][19][20][21] Two Ivorian studies conducted by Kadjo et al 22,23 had noted a prevalence of 0.6 and 1.1%. These authors found that in ten years, the frequency of this disease has almost halved.…”

Section: Discussion Prevalencementioning

confidence: 99%

“…This makes the clinical diagnosis of NMC problematic. 19,20,23,26 . Headache, fever, stiff neck and vomiting often dominate the symptomatology, most often onset.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…These results are consistent with the data in the literature reporting high proportions of HIV-infected patients with severe immunosuppression. 19,23 It would be useful to point out that in a severely immunosuppressed patient with a CD4 count below 200 / mm 3 , any suspicion of meningitis should lead to a search for NMC.…”

Section: Laboratory Investigationsmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 60%

Section: Discussion Prevalencementioning

confidence: 99%

“…This makes the clinical diagnosis of NMC problematic. 19,20,23,26 . Headache, fever, stiff neck and vomiting often dominate the symptomatology, most often onset.…”

Section: Clinical Featuresmentioning

confidence: 99%

Section: Laboratory Investigationsmentioning

confidence: 99%

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

Katabwa¹,

Mukuku²,

Lwamba³

et al. 2021

JNSK

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“…In this HIV population at high risk of cryptococcosis, we include PLHIV in treatment failure and those on ART but lost to follow-up. Thus, in Kinshasa, the prevalence of NMC has previously been estimated at 8.8%, with a mortality rate of one in three patients [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical epidemiology and high genetic diversity amongst Cryptococcus spp. isolates infecting people living with HIV in Kinshasa, Democratic Republic of Congo

et al. 2022

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Neuromeningeal cryptococcosis (NMC) is a life-threatening opportunistic infection in advanced HIV disease patients (AHDP). It is caused by Cryptococcus spp. complexes and mainly occurs in sub-Saharan Africa. In this study, we performed molecular characterization and antifungal susceptibility profiling of Cryptococcus isolates from AHDP in Kinshasa (DRC). Additionally, we investigated a possible association between NMC severity factors and the Cryptococcus neoformans (Cn) multilocus sequence typing (MLST) profiles. We characterized the isolates using PCR serotyping, MALDI-TOF MS, internal transcribed spacer (ITS) sequencing, and MLST. Susceptibility testing for the major antifungal drugs was performed according to the EUCAST guidelines. Parameters associated with NMC severity, such as hypoglycorrhachia (< 50 mg/dL), increased cerebral spinal fluid opening pressure (> 30 cm H2O), and poor therapeutic outcome were compared with the Cn MLST sequences type (ST). Twenty-three out of 29 Cryptococcus isolates were identified as serotype A using PCR serotyping (79.3%; 95% IC: 65.5–93.1), while six (20.7%; 95% IC: 6.9–34.5) were not serotypable. The 29 isolates were identified by ITS sequencing as follows: Cryptococcus neoformans (23/29, 79.3%), Cutaneotrichosporon curvatus (previously called Cryptococcus curvatus) (5/29, 17.2%), and Papiliotrema laurentii (Cryptococcus laurentii) (1/29, 3.5%). Using the ISHAM MLST scheme, all Cn isolates were identified as molecular type VNI. These comprised seven different STs: ST93 (n = 15), ST5 (n = 2), ST53 (n = 1), ST31 (n = 1), ST4 (n = 1), ST69 (n = 1), and one novel ST that has not yet been reported from other parts of the world and was subsequently assigned as ST659 (n = 2). Of the included strains, only Papiliotrema laurentii was resistant to amphoterin B (1/29, 3.5%), 6.8% (2/29) were resistant to 5-flucytosine (the single Papiliotrema laurentii strain and one Cryptococcus neoformans isolate), and 13.8% (4/29) to fluconazole, including two of five (40%) Cutaneotrichosporon curvatus and two of 23 (8.7%) C. neoformans strains. We found a significative association between poor therapeutic outcome and a non-ST93 sequence type of causative strains (these concerned the less common sequence types: ST53, ST31, ST5, ST4, ST659, and ST69) (87.5% versus 40%, p = 0.02). Molecular analysis of Cryptococcus spp. isolates showed a wide species diversity and genetic heterogenicity of Cn within the VNI molecular type. Furthermore, it is worrying that among included strains we found resistances to several of the commonly used antifungals.

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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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Epidemiological, clinical and biological profile of neuromeningeal cryptococcosis among people living with in Kinshasa, Democratic Republic of Congo

Cited by 5 publications

References 5 publications

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

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

Clinical epidemiology and high genetic diversity amongst Cryptococcus spp. isolates infecting people living with HIV in Kinshasa, Democratic Republic of Congo

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

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