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Aims: To determine the prevalence of cryptococcal infection among HIV hospitalized patients, to evaluate clinical characteristics and outcomes in Latvia.
Study Design: Cross-sectional study.
Place and Duration of Study: Riga Eastern Clinical University Hospital, Latvian Center of Infectology, between January 2014 and February 2017.
Methodology: We conducted the study reporting demographics, epidemiological (age, sex, clinical aspects, paraclinical results (cryptococcal antigen in cerebrospinal fluid, serum, urine, cryptococcal DNA, HIV RNA and lymphocyte T CD4+ count), treatment and outcome aspects. We analyze 69 patients (71% men, 29% women) with HIV infection and cryptococcosis.
Results: 69 cases of cryptococcosis were confirmed for 699 HIV infected hospitalized patients tested, giving a prevalence of 9.9%. 38% (n=26/69) of patients were with clinical signs of infection with the central nervous system involvement, 19% (13/69) patients had pulmonary involvement.
Other 43% (n=30/69) of patients had disseminated non-CNS disease (elevated serum cryptococcal Ag or DNA). Most patients had advanced HIV disease (Median lymphocyte T CD4+ count=48, 5 cells/uL, (1-1041), the average was 112, 9 cells/ uL (SD 184.98). 87% (n=59/68) of patients had lymphocyte T CD4+cell count < 200 cells/μL Only 25% (n=14) of the patients known to have HIV infection (n=56/69) were receiving antiretroviral therapy at the time of presentation. Overall mortality rate was 59% (n=41/69).
Conclusion: Prevalence of cryptococcal antigenemia was 9.9%, indicating that the prevalence of cryptococcal infection among HIV patients in Latvia may be high enough to consider targeted screening.HIV positive patients have high mortality (35%) following cryptococcal infection which persists beyond their initial hospitalization. Follow-up studies of late mortality would be beneficial.
Centers for Disease Control and Prevention [homepage on the Internet]. C. neoformans infection statistics.
Available:https://www.cdc.gov/fungal/diseases/cryptococcosis neoformans/statistics.html. (Page last reviewed: October 9, 2018)
Mirza SA, Phelan M, Rimland D, Graviss E, Hamill R, Brandt ME, et al. The changing epidemiology of cryptococcosis: An update from population-based active surveillance in 2 large metropolitan areas, 1992-2000. Clin Infect Dis. 2003;36(6): 789-94.
Kaplan JE, Hanson D, Dworkin MS, Frederick T, Bertolli J, Lindegren ML, et al. Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy. Clin Infect Dis. 2000;30(Suppl 1):S5-14.
DOI: 10.1086/313843. PMID: 10770911
Rajasingham R, Smith RM, Park BJ, Jarvis JN, Govender NP, Chiller TM, et al. Global burden of disease of HIV-associated cryptococcal meningitis: An updated analysis. Lancet Infect Dis. 2017;17(8): 873-881.
DOI:10.1016/S1473-3099(17)30243-8 [PMID: 28483415 PMCID: PMC5818156]
Spec A, Mejia-Chew C, Powderly WG, Cornely OA. EQUAL Cryptococcus Score. A European confederation of medical mycology score derived from current guidelines to measure quality of clinical cryptococcosis management. Open Forum Infect Dis. 2018;5(11):299.
Jarvis JN, Lawn SD, Vogt M, Bangani N, Wood R, Harrison TS. Screening for Cryptococcal Antigenaemia in Patients Accessing an Antiretroviral Treatment Program in South Africa. Clin Infect Dis. 2009;48(7):856–862.
De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, et al. Revised definitions of invasive fungal disease from the european organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813-21.
[PMID: 18462102 PMCID: PMC2671227]
SPSS Inc. Released. SPSS for Windows, Version 16.0. Chicago, SPSS Inc; 2007.
Latvian Central Statistical Administration. Available: www.csb.gov.lv
Centre for Disease Prevention and Control of Latvia.
World Health Organization [homepage on the Internet]. Geneva: World Health Organization. HIV/ AIDS Surveillance in Europe; 2018.
European Center for Disease Prevention and Control [homepage on the Internet]. HIV/ AIDS Surveillance in Europe 2018. European Center for Disease Prevention and Control (ECDC); 2018.
World Health Organization [homepage on the Internet]. World Health Organization. Cryptococcal disease: what's new and important; 2018.
Katchanov J, Jefferys L, Tominski D, Wöstmann K, Slevogt H, Arastéh K, Stocker H . Cryptococcosis in HIV-infected hospitalized patients in Germany: Evidence for routine antigen testing. J Infect. 2015;71(1):110-6.
World Health Organization [homepage on the Internet]. World Health Organization. Guidelines on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children. 2018;62.
European AIDS Clinical Society [homepage on the Internet]. EACS. European AIDS Clinical Society .European AIDS Clinical Society guidelines; 2018. Available:http://www.eacsociety.org/guidelines/eacs-guidelines/eacs-guidelines.html
Williams DA, Kiiza T, Kwizera R, Kiggundu R, Velamakanni S, Meya DB, et al. Evaluation of Fingerstick cryptococcal antigen lateral flow assay in hiv-infected persons: A Diagnostic Accuracy Study. Clin Infect Dis. 2015;61(3):464–7.
[PMID: 25838287 PMCID: PMC4503809]