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Cryptococcosis in Denmark: an analysis of 28 cases in 1988-1993
J D Knudsen1, L Jensen, T L Sørensen
1Division of Microbiology, Statens Serum Institut, Copenhagen, Denmark.
Abstract:
A total number of 31 events of systemic cryptococcal infection in 28 patients was identified in a nation-wide survey over 6 years from 1988 to the end of 1993. All medical records were reviewed, 24 of the patients were HIV-infected. Meningitis was diagnosed in 25 patients, and fungemia in 8 patients. The most frequent symptom was headache followed by fever. The median duration in days of fever, headache, and other neurological signs/symptoms before diagnosis was 12, 8 and 2 days, respectively, and, after diagnosis and start of treatments 7, 11 and 12 days, respectively. There was a significant correlation between the duration of headache and the duration of neurological signs/symptoms but not between headache and fever. More than 50% of the patients died within 5 months after the diagnosis. In 39% of the cases, the patients were orally treated with various antifungal drugs before the diagnosis. The rate of cryptococcosis (cumulative) in Danish AIDS patients was estimated to be 1.7%. The HIV-positive patients were, at the time of the cryptococcal diseases, profoundly immunocompromised, with a median CD4+ cell count of 18 (range: 0-78)/microliters. From 24 patients at least 1 isolate of Cryptococcus neoformans was typed, all being var. neoformans, identical with serotype A/D.
Insights
Systemic cryptococcal infections, particularly cryptococcal meningitis, significantly impact HIV-infected individuals. Early diagnosis and treatment are crucial, as over 50% of patients died within five months.
Area of Science:
- Infectious Diseases
- Mycology
- Epidemiology
Background:
- Cryptococcal infection is a serious opportunistic infection, especially in individuals with compromised immune systems.
- This study investigates the epidemiology and clinical features of systemic cryptococcal infections in Denmark.
Observation:
- A nationwide survey identified 31 cases of systemic cryptococcal infection in 28 patients over six years (1988-1993).
- 24 out of 28 patients were infected with the Human Immunodeficiency Virus (HIV).
- Cryptococcal meningitis was diagnosed in 25 patients, and fungemia in 8 patients.
Findings:
- Headache and fever were the most frequent symptoms, with median durations before diagnosis of 8 and 12 days, respectively.
- A significant correlation was observed between headache duration and neurological signs/symptoms.
- Over 50% of patients died within five months of diagnosis; 39% received prior antifungal treatment.
- The cumulative incidence of cryptococcosis in Danish AIDS patients was estimated at 1.7%.
- HIV-positive patients had a median CD4+ cell count of 18 cells/microliter, indicating profound immunosuppression.
Implications:
- Findings highlight the high mortality associated with cryptococcal infections in immunocompromised individuals.
- Emphasizes the need for prompt diagnosis and effective management strategies for cryptococcosis in HIV patients.
- Underscores the importance of monitoring and early intervention for opportunistic infections in immunocompromised populations.