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Zono B, Moutschen M, Situakibanza H, Sacheli R, Muendele G, Kabututu P, Biakabuswa A, Landu N, Mvumbi G, Hayette MP. Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis. BMC Infect Dis 2021; 21:1157. [PMID: 34781895 PMCID: PMC8591831 DOI: 10.1186/s12879-021-06849-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
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) (< 8 mg/L) for fluconazole compared to 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 < 0.0001, respectively). After treatment with amphotericin B, 5-flucytosine, and fluconazole in both groups, the outcome was similar. 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.
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Affiliation(s)
- Bive Zono
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo. .,Center for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium.
| | - Michel Moutschen
- Department of Infectious Diseases and General Internal Medicine, University Hospital Center of Liege, Liege, Belgium
| | - Hippolyte Situakibanza
- Infectious Diseases Service, Department of Internal Medicine/Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Rosalie Sacheli
- National Reference Center for Mycosis, University Hospital Center of Liege, Liege, Belgium.,Center for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
| | - Gaultier Muendele
- Advanced HIV Infection Management Unit, Internal Medicine Department, Centre Hospitalier Mère et Enfant de NGABA, Kinshasa, Democratic Republic of Congo
| | - Pius Kabututu
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Adolphe Biakabuswa
- Advanced HIV Infection Management Unit, Internal Medicine Department, Centre Médical et Evangélique Révérend LUYINDU, Kinshasa, Democratic Republic of Congo
| | - Nicole Landu
- Advanced HIV Infection Management Unit, Internal Medicine Department, Centre Médical et Evangélique Révérend LUYINDU, Kinshasa, Democratic Republic of Congo
| | - Georges Mvumbi
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marie-Pierre Hayette
- National Reference Center for Mycosis, University Hospital Center of Liege, Liege, Belgium.,Center for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
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