Article (Scientific journals)
Comparison of clinical and biological characteristics of HIV infected patients presenting Cryptococcus neorformans versus C. curvatus /C. laurentii meningitis
Zono, Bive; MOUTSCHEN, Michel; SITUAKIBANZA, Hippolyte et al.
2021In BMC Infectious Diseases, 21 (1), p. 1-10
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Keywords :
Cryptococcus neoformans; Cryptococcus curvatus; Cryptococcus laurentii; Meningitis; HIV; Clinical characteristic; biological characterization; Kinshasa; DRC
Abstract :
[en] 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.
Research center :
CIRM - Centre Interdisciplinaire de Recherche sur le Médicament - ULiège
Disciplines :
Laboratory medicine & medical technology
Immunology & infectious disease
Author, co-author :
Zono, Bive  ;  Université de Liège - ULiège > Doct. sc. bioméd. & pharma. (paysage)
MOUTSCHEN, Michel  ;  Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service des maladies infectieuses - médecine interne
SITUAKIBANZA, Hippolyte;  Université de Kinshasa > Médecine interne/médecine tropicale > maladies infectieuses
SACHELI, Rosalie  ;  Centre Hospitalier Universitaire de Liège - CHU > Unilab > Laboratoire CNR
MUENDELE, Gaultier;  Centre Hospitalier Mère et Enfant de NGABA > Médecine Interne > Prise en charge VIH
KABUTUTU, Pius;  Université de Kinshasa > Sciences de base > Biologie Moléculaire
BIAKABUSWA, Adolphe;  Centre Médical et évangélique Révérend LUYINDU > Médecine Interne > Prise en charge VIH
LANDU, Nicole;  Centre Médical et évangélique Révérend LUYINDU > Médecine Interne > Prise en charge VIH
MVUMBI, Georges;  Université de Kinshasa > Sciences de base > Biologie Moléculaire
Hayette, Marie-Pierre ;  Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Bact., mycologie, parasitologie, virologie, microbio.
Language :
English
Title :
Comparison of clinical and biological characteristics of HIV infected patients presenting Cryptococcus neorformans versus C. curvatus /C. laurentii meningitis
Alternative titles :
[fr] Comparaison des caractéristiques cliniques et biologiques des personnes vivant avec le VIH présentant une méningite à Cryptococcus neoformans versus C. curvatus/C. laurentii
Publication date :
15 November 2021
Journal title :
BMC Infectious Diseases
eISSN :
1471-2334
Publisher :
BioMed Central, United Kingdom
Volume :
21
Issue :
1
Pages :
1-10
Peer reviewed :
Peer Reviewed verified by ORBi
Additional URL :
Name of the research project :
Cryptococcose chez les personnes vivant avec le VIH à Kinshasa (RDC): étude épidémiologique et moléculaire
Funders :
ARES CCD - Académie de Recherche et d'Enseignement Supérieur. Coopération au Développement [BE]
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since 06 January 2022

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