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Clinical-Laboratory Outcome of Cryptococcus sp. Multifocal Choroiditis in Acquired Immunodeficiency Syndrome Patients
Alexandre Paiva1, Ana Luiza Biancardi1, Andre Curi1
1Clinical Research Laboratory of Infectious Diseases in Ophthalmology, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Insights
Cryptococcus infection in Acquired Immunodeficiency Syndrome (AIDS) patients can cause multifocal choroiditis. Multimodal imaging is crucial for diagnosis and monitoring visual outcomes in these cases.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Immunology
Background:
- Acquired Immunodeficiency Syndrome (AIDS) compromises the immune system, increasing susceptibility to opportunistic infections.
- Cryptococcus sp. infection is a significant opportunistic pathogen in AIDS patients.
- Multifocal choroiditis is an ocular manifestation that can occur secondary to Cryptococcus infection in immunocompromised individuals.
Purpose of the Study:
- To describe the clinical and laboratory outcomes of patients with AIDS and multifocal choroiditis caused by Cryptococcus sp.
- To evaluate the role of multimodal imaging in diagnosing and managing this condition.
Main Methods:
- Retrospective review of clinical records of AIDS patients with cryptococcal multifocal choroiditis.
- Inclusion criteria: typical fundus appearance and laboratory confirmation of disseminated cryptococcosis.
- Multimodal evaluation including spectral domain optical coherence tomography, fluorescein angiography (FA), and indocyanine green angiography (ICG).
Main Results:
- Six AIDS patients (mean age 36.5 years, 83% male) were evaluated.
- High HIV viral load (mean 262,959 copies/mm³) and low T-CD4+ cell count (mean 13.33 cells/mL) were observed.
- Indocyanine green angiography (ICG) revealed more numerous and distinct lesions compared to fundus examination and FA.
Conclusions:
- Clinical, laboratory, and multimodal evaluations are essential for diagnosing and managing cryptococcal multifocal choroiditis in AIDS patients.
- Early diagnosis and appropriate treatment are critical for visual outcomes.
- ICG angiography provides valuable insights into lesion characteristics.
Purpose:
This study aims to describe the clinical and laboratory outcomes of patients with Acquired Immunodeficiency Syndrome (AIDS) presenting multifocal choroiditis secondary to Cryptococcus sp. infection.
Methods:
We reviewed the clinical records of AIDS patients diagnosed with cryptococcal multifocal choroiditis at the Laboratory of Infectious Disease in Ophthalmology, Oswaldo Cruz Foundation, from January 2022 to March 2024. Patients meeting the criteria of typical fundus appearance associated with disseminated cryptococcosis laboratory diagnosis were included. Data collected included age, gender, symptoms, plasma HIV viral load, serum T-CD4+ cell count (cells/mm3), initial visual acuity (VA), laboratory methods for cryptococcosis diagnosis, treatment, and final VA. All patients underwent multimodal evaluation including spectral domain optical coherence tomography, fluorescein angiography (FA), and indocyanine green angiography (ICG).
Results:
Six patients were evaluated, comprising five males (83%) and one female (17%), with a mean age of 36.5 years (standard deviation, SD: 10,46). Five patients (83%) presented with meningeal syndrome. Mean HIV plasma viral load was 262.959 copies/mm3 (SD: 209.469), and the mean serum T-CD4 count was 13.33 cells/mL (SD: 14,63). All patients tested positive for serum cryptococcal antigen (CRAG). Four patients (67%) had positive cerebrospinal fluid (CSF) culture and CRAG. Treatment included intravenous Amphotericin B and oral Fluconazole. Among twelve eyes (100%), four (33%) achieved visual recovery, while eight (67%) maintained initial VA. Lesions were more numerous and distinct on ICG compared to fundus examination and FA.
Conclusion:
This study underscores the importance of clinical, laboratory, and multimodal evaluations in AIDS patients presenting with cryptococcal multifocal choroiditis.
