Análise clínica e epidemiológica da infecção por criptococose em pacientes do hospital de referência em doenças tropicais de Teresina, Brasil

Danilo Rafael da Silva Fontinele; Rafael dos Santos Nunes; Luiz Henrique Carvalho Silva; Liline Maria Soares Martins; Bodo Wanke

doi:10.47456/rbps.v24i2.36612

Authors

Danilo Rafael da Silva Fontinele
Rafael dos Santos Nunes UESPI - UNIVERSIDADE ESTADUAL DO PIAUÍ
Luiz Henrique Carvalho Silva
Liline Maria Soares Martins
Bodo Wanke

DOI:

https://doi.org/10.47456/rbps.v24i2.36612

Keywords:

HIV, Cryptococcosis, Antiretroviral Therapy, Fluconazole, Amphotericin B

Abstract

Introduction: Cryptococcosis is an invasive mycosis commonly associated with the infection of immunosuppressed HIV+ patients. Objective: To characterize the clinical and epidemiology of infections by Cryptococcus spp. in a tropical disease hospital for the past five years. Methods: This is a descriptive and retrospective research with a quantitative approach. Results: Of the 40 patients, 90% developed cryptococcal meningitis. The examination with India ink was positive in 23 patients. The CrAg method was positive in 29 respondents, being the most used for diagnosis. Cryptococcus infection was more determinant for the development of cryptococcal meningitis, and infection in the Central Nervous System (CNS) was the most common clinical form. Fluconazole and amphotericin B were used in more than 70% of cases. Conclusion: Since half of the patients who died were HIV+, the use of ART and tracking of fungal infection by CrAg can contribute to a reduction in mortality in this population.

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References

Srikanta D, Santiago-Tirado FH, Doering TL. Cryptococcus neoformans: historical curiosity to modern pathogen. Yeast [internet]. 2014 feb;31(2):47-60. Available from: http://doi.wiley.com/10.1002/yea.2997

Alves GS, Freire AK, Bentes AS, Pinheiro JF, Souza JV, Wanke B et al. Molecular typing of environmental cryptococcus neoformans/C. gattii species complex isolates from Manaus, Amazonas, Brazil. Mycoses. 2016;59(8):509-15.

Maziarz EK, Perfect JR. Cryptococcosis. Infect Dis Clin North Am [internet]. 2016 mar;30(1):179-206. Available from: https://linkinghub.elsevier.com/retrieve/ pii/S0891552015000951

Marr KA, Sun Y, Spec A, Lu N, Panackal A, Bennett J et al. A multicenter, longitudinal cohort study of Cryptococcosis in human immunodeficiency virus-negative people in the United States. Clin infect dis [internet]. 2020 jan 2;70(2):252-61. Available from: https://academic.oup. com/cid/article/70/2/252/5374489

El Fane M, Badaoui L, Ouladlahsen A, Sodqi M, Marih L, Chakib A et al. La cryptococcose au cours de l’infection à VIH. J Mycol Med [Internet]. 2015 dec;25(4):257- 62. Available from: http://dx.doi.org/10.1016/j. mycmed.2015.09.008

Bentes AS, Wanke B, Lazéra MS, Freire AK, Silva Júnior RM, Rocha DF et al. Cryptococcus gattii VGII isolated from native forest and river in Northern Brazil. Brazilian J Microbiol [internet]. 2019 apr 9;50(2):495-500. Avai-lable from: http://link.springer.com/10.1007/s42770-019- 00066-6

Schmiedel Y, Zimmerli S. Common invasive fungal diseases: an overview of invasive candidiasis, aspergillosis, cryptococcosis, and pneumocystis pneumonia. Swiss Med Wkly [internet]. 2016 feb. 22;146(february):w14281. Available from: http://doi.emh.ch/smw.2016.14281

Kon AS. Rev Sociedade Bras de Medicina Tropical. Consenso em criptococose - 2008. 2008;41(5):524-44.

Chang CC, Sorrell TC, Chen SC. Pulmonary cryptococcosis. Semin Respir Crit Care Med. 2015;36(5):681-91.

Montagna MT, De Donno A, Caggiano G, Serio F, De Giglio O, Bagordo F et al. Molecular characterization of cryptococcus neoformans and Cryptococcus gattii from environmental sources and genetic comparison with clinical isolates in Apulia, Italy. Environ Res [internet]. 2018 jan.;160(june 2017):347-52. Available from: http:// dx.doi.org/10.1016/j.envres.2017.09.032

Ramírez-Ramos C, Galindo J, Correa S, Giraldo- Bahamon G, Rivera J, Solano J et al. Meningitis criptocóccica en pacientes sin infección por VIH: presentación de dos casos y revisión de la literatura. Rev Chil infectología [internet]. 2018;35(6):716-21. Available from: http:// www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716- 10182018000600716&lng=en&nrm=iso&tlng=en

Trilles L, Lazéra MD, Wanke B, Oliveira RV, Barbosa GG, Nishikawa MM et al. Regional pattern of the molecular types of Cryptococcus neoformans and

Cryptococcus gattii in Brazil. Mem Inst Oswaldo Cruz [internet]. 2008 aug;103(5):455-62. Available from: http:// www.scielo.br/scielo.php?script=sci_arttext&pid=S0074- 02762008000500008&lng=en&tlng=en

Anzai MC, Lazéra MS, Wanke B, Trilles L, Dutra V, De Paula DA et al. Cryptococcus gattii VGII in a plathymenia reticulata hollow in Cuiabá, Mato Grosso, Brazil. Mycoses. 2014;57(7):414-8.

Deng H, Zhang J, Li J, Wang D, Pan L, Xue X. Clinical features and radiological characteristics of pulmonary cryptococcosis. J Int Med Res. 2018;46(7):2687-95.

Bruner KT, Franco-Paredes C, Henao-Martínez AF, Steele GM, Chastain DB. Cryptococcus gattii complex infections in HIV-infected patients, southeastern United States. Emerg Infect Dis [internet]. 2018 nov;24(11):1.998- 2.002. Available from: http://wwwnc.cdc.gov/eid/ article/24/11/18-0787_intro.htm

Souto AC, Bonfietti LX, Ferreira-Paim K, Trilles L, Martins M, Ribeiro-Alves M et al. Population genetic analysis reveals a high genetic diversity in the Brazilian Cryptococcus Gattii vgii population and shifts the global origin from the Amazon Rainforest to the semi-arid desert in the Northeast of Brazil. Reynolds TB (editor). PLoS Negl Trop Dis [internet]. 2016 aug. 16;10(8):e0004885. Available from: https://dx.plos.org/10.1371/journal. pntd.0004885

Veltman JA, Bristow CC, Klausner JD. Meningitis in HIV-positive patients in sub-Saharan Africa: a review. J Int AIDS Soc [internet]. 2014 jan. 17(1):191-84. Available from: http://doi.wiley.com/10.7448/IAS.17.1.19184

Rajasingham R, Smith RM, Park BJ, Jarvis JN, Govender NP, Chiller TM et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis [internet]. 2017 aug. 17(8):873- 81. Available from: http://dx.doi.org/10.1016/S1473- 3099(17)30243-8

Pedroso RD, Candido RC. Diagnóstico laboratorial da criptococose. Newslab [internet]. 2006;(1):94- 102. Available from: http://www.newslab.com.br/ed_ anteriores/77/art03/art03.pdf

Chammard TB, Temfack E, Lortholary O, Alanio A. Diagnostic and therapeutic strategies in cryptococcosis: impact on outcome. Mem Inst Oswaldo Cruz [internet]. 2018 may 7;113(7):1-6. Available from: http://www. scielo.br/scielo.php?script=sci_arttext&pid=S0074- 02762018000700207&lng=en&tlng=en

Silva MA, Gagliani LH. Diagnóstico e prevalência da meningite criptococócica em pacientes portadores da síndrome da imunodeficiência adquirida - Sida. Rev UNILUS Ensino e Pesquisa. 2014;11(22):23-44.

Vianna CM, Mosegui GB. Cost-effectiveness analysis and budgetary impact of the cryptococcal antigen lateral flow assay (CRAG-LFA) implementation for the screening and diagnosis of cryptococcosis in asymptomatic people living with HIV in Brazil. Rev. Inst. Med. Tropical S. P. [internet]. 2021;63. Available from: http://www. scielo.br/scielo.php?script=sci_arttext&pid=S0036- 46652021000100230&tlng=en

World Health Organization. HIV prevention, testing, treatment, service delivery and monitoring [internet]. 2021. Available from: http://apps.who.int/bookorders.

United States Department of Health and Human Services. Diagnosis and testing for C. gattii Infection [internet]. United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 2015 [cited 2021 jun. 8]. Available from: https://www.cdc.gov/fungal/diseases/ cryptococcosis-gattii/diagnosis.html

Mourad A, Perfect JR. The war on cryptococcosis: a rreview of the antifungal arsenal. Mem Inst Oswaldo Cruz [internet]. 2018 feb 19;113(7):1-7. Available from: http:// www.scielo.br/scielo.php?script=sci_arttext&pid=S0074- 02762018000700202&lng=en&tlng=en

Chen SC, Korman TM, Slavin MA, Marriott D, Byth K, Bak N et al. Antifungal therapy and management of complications of cryptococcosis due to Cryptococcus Gattii. Clin Infect Dis. 2013;57(4):543-51.

Stone NR, Rhodes J, Fisher MC, Mfinanga S, Kivuyo S, Rugemalila J et al. Dynamic ploidy changes drive fluconazole resistance in human cryptococcal meningitis. J Clin Invest [internet]. 2019 jan. 28;129(3):999-1.014. Available from: https://www.jci.org/articles/view/124516

Tenforde MW, Shapiro AE, Rouse B, Jarvis JN, Li T, Eshun-Wilson I et al. Treatment for HIV-associated cryptococcal meningitis. Cochrane Database Syst Rev [internet]. 2018 jul. 25;2018(7). Available from: http:// doi.wiley.com/10.1002/14651858.CD005647.pub3

Baddley JW, Thompson GR, Riley KO, Moore MK, Moser SA, Pappas PG. Factors associated with ventriculoperitoneal shunt placement in patients with cryptococcal meningitis. Open Forum Infect Dis. 2019;6(6):10-5.

Rolfes MA, Hullsiek KH, Rhein J, Nabeta HW, Taseera K, Schutz C et al. The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis. Clin Infect Dis [internet]. 2014 dec. 1;59(11):1.607-14. Available from: https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciu596