[Cryptococcal meningoencephalitis. Epidemiology and mortality risk factors in pre- and post-HAART era]

Area of Science:

• Infectious Diseases
• Neurology
• Immunology

Background:

• Cryptococcal meningoencephalitis (CM) is a significant cause of illness and death in individuals with acquired immunodeficiency syndrome (AIDS).
• Despite advances in treatment, CM continues to pose a substantial threat to this vulnerable population.

Purpose of the Study:

• To investigate the clinical characteristics, diagnostic markers, and outcomes of cryptococcal meningoencephalitis in patients with AIDS.
• To identify factors associated with morbidity and mortality in CM cases.

Main Methods:

• A retrospective review of CM cases diagnosed via Cryptococcus neoformans isolation in cerebrospinal fluid at a university hospital.
• Assessment of early (12 weeks) and late (3-18 months) morbidity and mortality.
• Analysis of patient data including CD4+ counts, cryptococcal antigen titers, and initiation of highly active antiretroviral therapy (HAART).

Main Results:

• 32 CM cases were identified among 2,269 AIDS patients (1.41%), with an increasing incidence over time.
• All cases had positive cerebrospinal fluid cryptococcal antigen, with high titers (>1,024) correlating with lower CD4+ counts and disseminated disease.
• The overall mortality rate was 28%, significantly higher in the pre-HAART era, and the relapse rate after a first CM episode was 34%.

Conclusions:

• Severe immunodeficiency, disseminated cryptococcal infection, high CSF antigen titers, and delayed HAART initiation are key determinants of CM morbidity and mortality.
• Effective management requires prompt diagnosis, aggressive antifungal therapy, and timely initiation of HAART.