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[Cryptococcal meningitis in patients with diabetes and AIDS]
Fernando Antonio Messina1, Ricardo Negroni1, Elena Isabel Maiolo1
1Unidad de Micología, Hospital de Infecciosas F J Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.
Enfermedades Infecciosas Y Microbiologia Clinica
|December 25, 2013
Summary
Diabetic patients with cryptococcal meningitis (an AIDS-related infection) face significantly worse outcomes and higher mortality rates. Longer treatment induction is recommended for these individuals to improve survival.
Area of Science:
- Infectious Diseases
- Endocrinology
- HIV/AIDS Research
Background:
- Cryptococcal meningitis is a life-threatening AIDS-related infection with high mortality.
- Diabetes mellitus (DM) exacerbates infectious disease severity.
- Diabetic individuals with HIV may experience poorer outcomes from opportunistic infections.
Purpose of the Study:
- To compare the clinical outcomes of cryptococcal meningitis in HIV-positive patients with and without diabetes mellitus.
- To assess the impact of diabetes on treatment response and mortality in cryptococcal meningitis.
Main Methods:
- Retrospective review of 182 HIV-positive patients with cryptococcal meningitis.
- Selection of 28 patients with similar characteristics, divided into two groups: 14 with DM (Group A) and 14 without DM (Group B).
Main Results:
- Group A (DM) had significantly lower rates of negative CSF cultures by 10 weeks (21.4%) compared to Group B (78.5%).
- Overall mortality was substantially higher in Group A (85.7%) than in Group B (21.4%).
- All Cryptococcus neoformans isolates were susceptible to amphotericin B and fluconazole in vitro.
Conclusions:
- Diabetes mellitus is associated with poor clinical outcomes and increased mortality in HIV-positive patients with cryptococcal meningitis.
- A prolonged induction treatment phase may be necessary to improve outcomes for diabetic patients.
- Further research into optimized treatment strategies for this vulnerable population is warranted.
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