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

Farhang Babamahmoodi; Kobra   Gerizade firozjaii; Masoumeh Bayani; Tahereh  Shokohi; Jamshid  Yazdani; Amir Mohammad  Beyzaee; Fatemeh  Ahangarkani

doi:10.18502/cmm.6.4.5330

Farhang Babamahmoodi Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
Kobra Gerizade firozjaii Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
Masoumeh Bayani Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
Tahereh Shokohi Invasive Fungi Research Center, communicable diseaes institue,Mazandaran University of Medical Sciences, Sari, Iran.
Jamshid Yazdani Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
Amir Mohammad Beyzaee Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
Fatemeh Ahangarkani Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran

DOI: https://doi.org/10.18502/cmm.6.4.5330

Keywords: Cryptococcal meningitis Cryptococcus species HIV Iran

Abstract

Background and Purpose:Cryptococcalmeningitis (CM) is a serious fungal infection that especially affectspatients with human immunodeficiency virus (HIV). In this regard,the present retrospective study aimed to analyze the clinical and laboratory features and therapeutic outcomes of patients with CM admitted to two teaching referral centersin the north of Iran during 2011-19.

Materials and Methods:This study was performed onall the hospitalized patients diagnosed with CM in two therapeutic centers of infectious diseases in the north of Iran. The required data,such as demographic characteristics and clinical and paraclinical features of 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 on the results,75% of the patients were male. Moreover,the average age of the subjects was 40.33± 8.93 years old and 66.6%ofthem(n=8) were HIV-positive. Other underlying diseases among HIV-positive patients included infection 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 symptoms among 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 difference was observed between the groups of HIV-positive and HIV-negative patients regarding the period between the onset of symptoms and diagnosis of CM,the length of hospital stay,and the duration of antifungal medication consumption. In total,three patients (25%) expired,and six patients recovered. The CM recurred in two HIV-negative and oneHIV-positive subjects;the two HIV-negative patients were treated,whilethe HIV-positive patient expired due to this recurrence.

Conclusion:Clinical features and cerebrospinal fluid parameters were not different in HIV-positive and HIV-negative participants. Despite the fact thatCM is not common in Iran, due to the increasing number of immunosuppressive patients, the differential diagnosis of CM should be considered for patients with signs and symptoms of infection in the central nervous system.