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Cryptococcus neoformans: Brain Preference, Gender Bias, and Interactions with Mycobacterium tuberculosis and

Ruxandra Moroti1,2, Adriana Hristea1,2, Georgiana Neagu2

  • 1Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.

Microorganisms
|March 27, 2025
PubMed

Insights

Central nervous system cryptococcosis (Crypto-CNS) in HIV-positive patients predominantly affects men and can be worsened by tuberculosis. Toxoplasma gondii (T. gondii) coinfection may increase mortality at critically low immune levels.

Area of Science:

  • Infectious Diseases
  • Neuroscience
  • Immunology

Background:

  • Cryptococcus neoformans is a leading cause of fungal meningoencephalitis, particularly in immunocompromised individuals.
  • HIV-positive patients are highly susceptible to Cryptococcus neoformans infections, leading to significant morbidity and mortality.
  • Understanding the factors influencing Cryptococcus neoformans brain tropism and coinfections is crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate the brain tropism of Cryptococcus neoformans in immunosuppressed patients.
  • To explore gender predilection and interactions with opportunistic neurotropic microorganisms, including Mycobacterium tuberculosis and Toxoplasma gondii.
  • To analyze the clinical, immunobiological, and imaging characteristics of central nervous system cryptococcosis (Crypto-CNS) in HIV-positive patients.

Main Methods:

  • Retrospective analysis of 42 HIV-positive patients diagnosed with Crypto-CNS between 2010-2019.
  • Examination of demographic, clinical, immunobiological, and imaging data, including CD4 counts and comorbidities.
  • Assessment of coinfections with Mycobacterium tuberculosis and Toxoplasma gondii.

Main Results:

  • Male predominance (3.6:1) observed in Crypto-CNS patients, with a mean age of 33.3 years.
  • Severe immunosuppression (CD4 <200 cells/mm³) was universal; 27.7% had concurrent tuberculosis.
  • Toxoplasma gondii seropositivity was associated with lower CD4 counts and increased in-hospital mortality, alongside high intracranial pressure.

Conclusions:

  • Crypto-CNS in HIV-positive patients primarily affects men and is associated with tuberculosis coinfection.
  • Toxoplasma gondii may offer some protection at lower immune levels but increases mortality when immunity is critically compromised.
  • High intracranial pressure and low CD4 counts are significant factors associated with mortality in these patients.
Keywords:
Cryptococcus neoformansHIV infectionMycobacterium tuberculosisToxoplasma gondiicentral nervous system coinfectionsdopaminemale sexmicrobial interactionsmortalitytestosterone

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