AEGiS-15IAC: Cryptococcal meningo-encephalitis (CME) in HIV-infected patients

AEGiS-15IAC: Cryptococcal meningo-encephalitis (CME) in HIV-infected patients - still high mortality despite treatment.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Cryptococcal meningo-encephalitis (CME) in HIV-infected patients - still high mortality despite treatment.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. B10178)

Kowalska J, Podlasin RB, Latarska D, Gizinska J
Hospital of Infectious Diseases , Warsaw, Poland

BACKGROUND: Cryptococcosis is the most frequent, life-threatening meningitis in AIDS. It's frequency declined less then other's opportunistic infections after introducing HAART. The mortality and morbidity rates are still high despite treatment.

METHODS: Medical records of 413 HIV-infected patients (pts) hospitalized between 1994 - 2002 at IVth Ward of Hospital of Infectious Disease in Warsaw were retrospectively analyzed.

RESULTS: 8 cases of CME were identified (incidence 2,4/1000pts/year). Establishing the diagnosis of CME was due to positive latex test result for cryptococcal antigen in CSF (7/8) verified by culture/autopsy. In 1 case was diagnosed postmortem. All the pts were white male; mean age was 40,1<31-45>years; mean CD4+ was 55<4-160>. Only two patients were on HAART. In 2 pts CME was first ADI. In others: PCP, MAC, TBC, CMV retinitis, toxoplasmosis, esophageal candidiasis and wasting syndrome were diagnosed previously. All the patients had 14 to 30-day period of symptoms presence. There were no correlation in clinical symptoms. Fever and focal neurological signs were the most common; nuchal rigidity was present only in 1 patient. CSF tests revealed: cytosis<10/mm³ in 5/7 pts and glucose level below 40 mg% in 5/7 pts. High protein level was in 6/7pts. CSF's opening pressure was not measured. Treatment with amphotericine B was introduced in 5/7 pts: amphotericine B with flucytosine in 1and fluconazole alone in 1. Mortality rate due to CME was 50%: due to other reasons 25%. Autopsy revealed coexisting pathology in CNS in 3 cases.

CONCLUSIONS: The absence of clinical findings and apparently normal CSF should not exclude the possibility of CME. Diagnostic LP should be performed always if nonspecific symptoms are present even in absence of neurological findings. Mortality was high and probably connected with late diagnosis due to: limited diagnostic value of clinical findings, coexisting CNS's diseases and lack of monitoring of CSF's pressure.

Keywords: AEGIS, HIV, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Cryptococcus, Cryptococcosis, Encephalitis, Toxoplasmosis, Meningitis, Incidence, Flucytosine, Cytomegalovirus Retinitis, Fluconazole, Candidiasis, Humans, Male, mortality, therapy, pathogenicity, diagnosis

040711
B10178