Characteristics of HIV-associated cryptococcal meningitis in a tertiary Chilean hospital: An observational
Isabel Elicer1, Laura Eugenin2, María Paz Acuña3
1Hospital Dr. Sótero del Río, Clínica Las Condes, Red Salud UC Christus City, Santiago, Chile.
Background:
Central nervous system opportunistic infections can be the first presentation of an HIV infection. Our aim is to describe clinical and laboratory characteristics of HIV-associated Cryptococcal Meningitis (CM), in-hospital outcomes and analyze associations of these parameters with adverse outcomes.
Methods:
Observational study of local cohort of HIV-associated cryptococcal meningitis in a high complexity tertiary urban hospital in Santiago, Chile. Descriptive analysis through chart review of all episodes of HIV-associated CM in adults, from 1995 to 2019. Inclusion criteria were confirmed CM with cerebrospinal fluid culture or India ink in the appropriate clinical context and HIV diagnosis. We selected relevant variables that have been described as predictors of adverse outcomes in the literature and explore associations in our cohort.
Results:
There were 37 HIV associated CM cases, occurring from 2000 to 2019. Majority were men (86 %) with a median age of 35 years. CM was the first HIV manifestation in 32 %. Opening pressure was measured in 10 % of patients at admission. Most CSF parameters were mildly altered, and two patients presented with completely normal CSF findings. Most patients -94,4 %- suffered adverse events secondary to antifungal therapy. Despite of recommendations against their use, steroids were frequently prescribed. Mortality was 18,9 %, and was associated with older age, and more days of headache prior to admission.
Conclusions:
CM clinical presentation and CSF characteristics are variable at presentation, which can lead to delayed diagnosis. Inappropriate use of corticosteroids, antifungal toxicity and suboptimal management of elevated intracranial pressure are key aspects to improve.
Insights
Cryptococcal meningitis (CM) in HIV patients presents variably, often leading to delayed diagnosis. Improving management of intracranial pressure and antifungal toxicity is crucial for better outcomes in these opportunistic infections.
Area of Science:
- Infectious Diseases
- Neurology
- HIV Medicine
Background:
- Opportunistic infections, such as Cryptococcal Meningitis (CM), are often the initial clinical manifestation of Human Immunodeficiency Virus (HIV) infection.
- Understanding the clinical and laboratory features of HIV-associated CM is essential for timely diagnosis and management.
Purpose of the Study:
- To describe the clinical and laboratory characteristics of HIV-associated CM.
- To report in-hospital outcomes.
- To analyze associations between these parameters and adverse outcomes.
Main Methods:
- An observational study of a local cohort of HIV-associated CM patients in Santiago, Chile.
- Descriptive analysis of 37 adult cases from 1995 to 2019 via chart review.
- Inclusion criteria included confirmed CM and HIV diagnosis; relevant variables predicting adverse outcomes were explored.
Main Results:
- 37 cases of HIV-associated CM were identified between 2000 and 2019, predominantly in men (86%) with a median age of 35.
- CM was the first HIV manifestation in 32% of cases. Opening pressure was measured in only 10% of patients.
- High rates of adverse events (94.4%) from antifungal therapy were observed. Mortality was 18.9%, associated with older age and longer headache duration.
Conclusions:
- Clinical presentation and cerebrospinal fluid (CSF) findings in CM are highly variable, potentially delaying diagnosis.
- Key areas for improvement include the inappropriate use of corticosteroids, managing antifungal toxicity, and optimizing treatment for elevated intracranial pressure.
