Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis

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) menin...

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Autores principales:	Bive Zono, Michel Moutschen, Hippolyte Situakibanza, Rosalie Sacheli, Gaultier Muendele, Pius Kabututu, Adolphe Biakabuswa, Nicole Landu, Georges Mvumbi, Marie-Pierre Hayette
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Cryptococcus neoformans Cryptococcus curvatus Cryptococcus laurentii Meningitis HIV Clinical characteristic Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/2bfe05436bf64e338675bc24904f9448
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spelling	oai:doaj.org-article:2bfe05436bf64e338675bc24904f94482021-11-21T12:42:40ZComparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis10.1186/s12879-021-06849-31471-2334https://doaj.org/article/2bfe05436bf64e338675bc24904f94482021-11-01T00:00:00Zhttps://doi.org/10.1186/s12879-021-06849-3https://doaj.org/toc/1471-2334Abstract 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.Bive ZonoMichel MoutschenHippolyte SituakibanzaRosalie SacheliGaultier MuendelePius KabututuAdolphe BiakabuswaNicole LanduGeorges MvumbiMarie-Pierre HayetteBMCarticleCryptococcus neoformansCryptococcus curvatusCryptococcus laurentiiMeningitisHIVClinical characteristicInfectious and parasitic diseasesRC109-216ENBMC Infectious Diseases, Vol 21, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cryptococcus neoformans Cryptococcus curvatus Cryptococcus laurentii Meningitis HIV Clinical characteristic Infectious and parasitic diseases RC109-216
spellingShingle	Cryptococcus neoformans Cryptococcus curvatus Cryptococcus laurentii Meningitis HIV Clinical characteristic Infectious and parasitic diseases RC109-216 Bive Zono Michel Moutschen Hippolyte Situakibanza Rosalie Sacheli Gaultier Muendele Pius Kabututu Adolphe Biakabuswa Nicole Landu Georges Mvumbi Marie-Pierre Hayette Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis
description	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.
format	article
author	Bive Zono Michel Moutschen Hippolyte Situakibanza Rosalie Sacheli Gaultier Muendele Pius Kabututu Adolphe Biakabuswa Nicole Landu Georges Mvumbi Marie-Pierre Hayette
author_facet	Bive Zono Michel Moutschen Hippolyte Situakibanza Rosalie Sacheli Gaultier Muendele Pius Kabututu Adolphe Biakabuswa Nicole Landu Georges Mvumbi Marie-Pierre Hayette
author_sort	Bive Zono
title	Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis
title_short	Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis
title_full	Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis
title_fullStr	Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis
title_full_unstemmed	Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis
title_sort	comparison of clinical and biological characteristics of hiv-infected patients presenting cryptococcus neoformans versus c. curvatus/c. laurentii meningitis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/2bfe05436bf64e338675bc24904f9448
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Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis

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