Postgraduate Program in Fungal Biology, Federal University Federal of Pernambuco (UFPE), Recife 50740-570, Pernambuco, Brazil.
Hospital Correia Picanço, Department of Health from the State of Pernambuco, Recife 52060-060, Pernambuco, Brazil.
Viruses. 2023 May 20;15(5):1206. doi: 10.3390/v15051206.
Cryptococcal meningitis is a serious infection of the central nervous system that is predominant in developing countries, caused by fungi of the genus , and which affects immunosuppressed patients, especially those with HIV. Here, we aim to diagnose and characterize the clinical-epidemiological profile of cryptococcosis in patients admitted to two tertiary public hospitals in northeastern Brazil. The study is divided into three moments: (1) the isolation of fungus and diagnosis from biological samples collected between 2017 and 2019, (2) a description of the clinical and epidemiological characteristics of the patients, and (3) the experimental tests related to an in vitro susceptibility antifungal profile. The species were identified by MALDI-TOF/MS. Among the 100 patients evaluated, 24 (24.5%) were diagnosed with cryptococcosis based on positive culture. Clinical-epidemiological analysis showed a slightly higher prevalence in men between 30 and 39 years. When comparing the date of HIV diagnosis and the development of cryptococcosis, it was observed that 50% received the diagnosis of infection by cryptococcosis after or equal to a period of 12 months from being diagnosed with HIV; the other 50% received it within the first 30 days of the HIV diagnosis. Neurocryptococcosis was the most prevalent clinical form, and, at the time of hospital admission, the most common clinical signs were high fever (75%), intense headache (62.50%), and neck stiffness (33.33%). The cerebrospinal fluid showed 100% sensitivity and positivity for direct examination by India ink, and fungal culture. The mortality rate in this study was 46% (11/24), a lower rate than in the other literature. An antifungigram showed that 20 (83.33%) isolates were susceptible to amphotericin B and 15 (62.5%) to fluconazole. Mass spectrometry identified 100% of the isolates as . In Brazil, this infection is not mandatory notifiable. Therefore, although there is little information on the subject, it is obsolete and does not express the reality of the facts, mainly in the northeast region, where this information is insufficient. The data obtained in this research contribute to the epidemiological knowledge of this mycosis in Brazil and will serve as a basis for future globally comparative epidemiological studies.
隐球菌脑膜炎是一种严重的中枢神经系统感染，主要发生在发展中国家，由属真菌引起，影响免疫抑制患者，特别是 HIV 感染者。在这里，我们旨在诊断和描述巴西东北部两家三级公立医院收治的隐球菌病患者的临床流行病学特征。该研究分为三个阶段：（1）从 2017 年至 2019 年采集的生物样本中分离和诊断真菌；（2）描述患者的临床和流行病学特征；（3）与体外抗真菌药敏谱相关的实验检测。通过 MALDI-TOF/MS 对物种进行鉴定。在评估的 100 名患者中，24 名（24.5%）根据阳性培养诊断为隐球菌病。临床流行病学分析显示，30-39 岁男性患病率略高。比较 HIV 诊断日期和隐球菌病的发病日期时，观察到 50%的患者在 HIV 诊断后或 12 个月内被诊断为隐球菌感染；其余 50%的患者在 HIV 诊断的前 30 天内被诊断为隐球菌感染。神经隐球菌病是最常见的临床形式，入院时最常见的临床体征是高热（75%）、剧烈头痛（62.50%）和颈项强直（33.33%）。墨汁直接检查和真菌培养对脑脊液的敏感性和阳性率均为 100%。本研究的死亡率为 46%（11/24），低于其他文献报道。抗真菌药敏谱显示，20 株（83.33%）分离株对两性霉素 B 敏感，15 株（62.5%）对氟康唑敏感。质谱鉴定 100%的分离株为 。在巴西，这种感染不是强制性报告的。因此，尽管有关该主题的信息很少，但它已经过时，不能反映事实的现实情况，尤其是在东北部地区，那里的信息不足。本研究获得的数据有助于了解巴西这种真菌病的流行病学知识，并将为未来的全球比较流行病学研究提供基础。
