[Pulmonary cryptococcosis during HIV infection. 15 cases]

Area of Science:

• Infectious Diseases
• Pulmonology
• Immunology

Background:

• Pulmonary cryptococcosis (PC) is a serious opportunistic infection in patients with Human Immunodeficiency Virus (HIV).
• PC can be the initial manifestation of Acquired Immunodeficiency Syndrome (AIDS).
• Low CD4+ lymphocyte counts are characteristic in HIV patients with PC.

Purpose of the Study:

• To describe the clinical presentation, diagnostic findings, and treatment outcomes of PC in HIV-infected patients.
• To highlight the role of PC as an AIDS-defining illness.
• To evaluate the effectiveness of antifungal therapies, including fluconazole for suppressive treatment.

Main Methods:

• Retrospective review of medical records of 15 HIV-infected patients diagnosed with PC.
• Analysis of clinical data, including CD4+ counts, chest radiography, bronchoalveolar lavage (BAL) fluid cultures, cerebrospinal fluid (CSF) cultures, and serum cryptococcal antigen.
• Review of antifungal treatment regimens and outcomes.

Main Results:

• PC was the first AIDS-defining illness in 9 out of 15 patients.
• All patients had low CD4+ counts (median 24/m3).
• Chest radiography commonly showed interstitial infiltrates (13/15), with pleural effusion in 5 cases.
• Cryptococcus neoformans was identified in BAL fluid (11/12) and CSF (7/15).
• Serum cryptococcal antigen was positive in all patients.
• Pneumocystis carinii pneumonia co-infection occurred in 4 patients.
• Fluconazole was the primary treatment for 10 patients, with 7 receiving long-term suppressive therapy.

Conclusions:

• Pulmonary cryptococcosis is a frequent and early manifestation of advanced HIV infection.
• Prompt diagnosis using microbiological and serological tests is essential.
• Fluconazole is effective for both initial treatment and long-term suppressive therapy in HIV-infected patients with PC.