Clinical features and para-clinical findings of cryptococcal meningitis in the North of Iran during 2011-19

Abstract

Background and Purpose:Cryptococcalmeningitis (CM) is a serious fungal infection that especially affectspatients with human immunodeficiency virus (HIV). In this regard,the presentretrospective study aimed to analyze the clinical and laboratory features and therapeutic outcomes of patients with CM admitted totwo teaching referral centersin the north of Iran during 2011-19. Materials and Methods:This studywas performed onall the hospitalized patients diagnosedwith CM in two therapeutic centers of infectious diseases in the north of Iran. The required data,such as demographic characteristicsandclinical and paraclinical featuresof patients,were extracted and entered in the information forms. Finally, the collected data were analyzed inSPSSsoftware(version16). Results:For the purpose of the study, records of 12confirmed CM patients were evaluatedin this research. Based onthe results,75% ofthepatients were male.Moreover,the average age of the subjectswas 40.33± 8.93 years oldand 66.6%ofthem(n=8) were HIV-positive. Other underlying diseases among HIV-positive patients includedinfection with hepatitis C virus (25%) and a history of tuberculosis (25%). In total, threeHIV-negative patients suffered from Hodgkin lymphoma (25%), sarcoidosis (25%),and asthma (25%) and one patient (25%) had no underlying disease. Headache (75%), weakness,and fatigue (75%) were the most common symptomsamong the participants. The cluster of differentiation 4count in all HIV-positive patients was less than 100 cells/μl. There was no significant difference between symptoms in HIV-positive and HIV-negative patients. Besides, no significant differencewas observedbetween the groups of HIV-positive and HIV-negative patientsregardingthe period betweentheonset of symptoms and diagnosisof CM,the length of hospital stay,and the duration of antifungal medicationconsumption. In total,threepatients (25%) expired,and six patients recovered. The CM recurred in two HIV-negative and oneHIV-positivesubjects;the two HIV-negativepatientswere treated,whilethe HIV-positivepatientexpired due to thisrecurrence. Conclusion:Clinical features and cerebrospinal fluid parameters were not different in HIV-positive and HIV-negative participants. Despite the fact thatCM is not commoninIran, due to the increasing number of immunosuppressive patients, the differential diagnosis of CM should be considered forpatients with signs and symptoms of infection in the central nervous system.

Keywords

• cryptococcal meningitis
• cryptococcus species
• hiv
• iran