Long-term outcome of AIDS-associated cryptococcosis in the era of combination antiretroviral therapy

Lortholary, Olivier; Poizat, Gwendoline; Zeller, Valérie; Neuville, Ségolène; Boibieux, A.; Alvarez, Muriel; Dellamonica, P.; Botterel, Françoise; Dromer, Françoise; Chêne, Geneviève

doi:10.1097/01.aids.0000252060.80704.68

Cited by 183 publications

(124 citation statements)

References 40 publications

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“…29 A progressive decline of cryptococcosis and other opportunistic infections rates in most places where ART is available has been observed, especially in patients with good compliance, which permits to evaluate its true impact on AIDS mortality rates. 6,9,30,31 Despite ART availability in public health services in Brazil since 1997, the prevalence of cryptococcosis is 6-12% and the associated mortality rate is currently 55%. [32][33][34] This mycosis was considered the second most important cause of mortality among systemic mycoses according to Brazilian study based on public health registers.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Torres

Etchebehere

Adad

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (P = 0.0047), intracranial increased pressure (P = 0.047), and severe malnutrition (P = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.

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Section: Discussionmentioning

confidence: 99%

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Torres

Etchebehere

Adad

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…22 The age ranges as well as the viral HIV load and the CD4 + and CD8 + cell counts were similar. In other studies, a low CD4 + cell count was one of the factors predisposing to recurrent cryptococcosis, 23 and death was related to a high HIV viral load. 24 Clinically, refractory and/or relapsing cryptococcosis was characterized by a disseminated infection represented by a higher prevalence of cryptococcemia and of expansive injury in the brain parechyma, as well as high lethality.…”

Section: Discussionmentioning

confidence: 86%

Refractory and/or Relapsing Cryptococcosis Associated with Acquired Immune Deficiency Syndrome: Clinical Features, Genotype, and Virulence Factors of Cryptococcus spp. Isolates

Nascimento¹,

Vitali²,

Tonani³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Refractory and relapsing crytocococcosis in acquired immune deficiency syndrome (AIDS) patients have a poor prognosis. The risk factors for this complicated infection course were evaluated by comparing refractory and/or relapsing cryptococcosis in human immunodeficiency virus-coinfected patients (cohort 1) with another group of AIDS patients who adequately responded to antifungals (cohort 2). Except for one isolate of Cryptococcus gattii from a cohort 2 case, all other isolates were identified as Cryptococcus neoformans var. grubii, sex type α, genotype VNI, including Cryptococcus reisolated from the relapse or in the refractory state. No differences were observed with respect to Cryptococcus capsule size and in the melanin and phospholipase production. The cohort 1 patients presented higher prevalence of cryptococcemia, cerebral dissemination, chronic liver disease, and leucopenia, and have increased death rate. Apparently, the refractory and/or relapsing cryptococcosis in the AIDS patients were more related to the host and the extent of the infection than to the fungal characteristics.

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“…Cryptococcosis is a life-threatening infection caused by Cryptococcus neoformans and C. gattii (4)(5)(6). Current diagnostic procedures of cryptococcosis, whether direct or indirect, have limitations.…”

Section: Discussionmentioning

confidence: 99%

Rapid detection of cryptococcal antigen by a flow assay

et al. 2017

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SummaryCryptococcosis is a life-threatening infection caused by Cryptococcus neoformans and C. gattii. Tests for quick detection of the cryptococcal antigen are needed. This study compares the performance of a lateral flow assay (LFA) to the latex agglutination method. Thirty-five cryopreserved positive samples (sera and cerebrospinal fluids) plus three negative sera for control have been examined. LFA does not need high-temperature incubation or enzyme pre-treatment. All the results, except for one serum, agree with previous obtained with latex agglutination method. LFA has an important clinical utility for its rapidity and sensitivity, and it also can be used as a point-of-care test.

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Long-term outcome of AIDS-associated cryptococcosis in the era of combination antiretroviral therapy

Abstract: Overall survival after cryptococcosis has dramatically improved at the cART era. Immune restoration and low serum cryptococcal antigen titres are associated with lower cryptococcosis relapse rates.

Cited by 183 publications

References 40 publications

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Refractory and/or Relapsing Cryptococcosis Associated with Acquired Immune Deficiency Syndrome: Clinical Features, Genotype, and Virulence Factors of Cryptococcus spp. Isolates

Rapid detection of cryptococcal antigen by a flow assay

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