Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study.
Cryptococcal meningoencephalitis (CM) remains the most prevalent invasive fungal infection worldwide. The main objective of this study was to describe the prevalence of CM and cryptococcal infection in HIV-infected patients in Madagascar. The secondary objectives were to assess the adjusted prevalen...
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ftdoajarticles:oai:doaj.org/article:dc54269acc954d37a0f93fa402971c3f 2023-05-15T15:15:17+02:00 Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study. Rivonirina Andry Rakotoarivelo Mihaja Raberahona Tahinamandranto Rasamoelina Andriamihaja Rabezanahary Fetra Angelot Rakotomalala Tiana Razafinambinintsoa Thomas Bénet Philippe Vanhems Mamy Jean de Dieu Randria Luisa Romanò Massimo Cogliati Muriel Cornet Mala Rakoto Andrianarivelo 2020-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0007984 https://doaj.org/article/dc54269acc954d37a0f93fa402971c3f EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0007984 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007984 https://doaj.org/article/dc54269acc954d37a0f93fa402971c3f PLoS Neglected Tropical Diseases, Vol 14, Iss 1, p e0007984 (2020) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2020 ftdoajarticles https://doi.org/10.1371/journal.pntd.0007984 2022-12-31T04:32:19Z Cryptococcal meningoencephalitis (CM) remains the most prevalent invasive fungal infection worldwide. The main objective of this study was to describe the prevalence of CM and cryptococcal infection in HIV-infected patients in Madagascar. The secondary objectives were to assess the adjusted prevalence of CM according to clinical presentation and patient characteristics, to determine crude 90-day survival according to cryptococcal antigen (CrAg) status and CM, and to identify the genotypes of Cryptococcus clinical isolates. This cross-sectional study was carried out at two urban hospitals in Antananarivo (central highlands) and Toamasina (east coast) between November 2014 and December 2016. Consecutive HIV-infected adults presenting with CD4 cell counts ≤200/μl were enrolled. Lateral flow immunoassays of CrAg were performed on serum for all patients, and on cerebrospinal fluid for patients with CM symptoms. MALDI-ToF MS, ITS sequencing, and determinations of the molecular and mating types of the isolates were performed. Fluconazole is the only drug for CM treatment available in Madagascar. Patients were treated orally, with high doses (1200 mg/day) for 10-12 weeks and then with 200 mg/day. Minimum inhibitory concentrations were determined for amphotericin B, flucytosine, voriconazole and fluconazole in E-tests. Overall prevalence was 13.2% (95% CI 7.9-20.3) for cryptococcal infection and 10.9% (95% CI 6.1-17.5) for CM, among the 129 HIV-infected patients studied. The 90-day mortality rate was 58.8% (10/17) in CrAg-positive patients and 17.9% (20/112) in CrAg-negative patients (p<0.001). The 13 Cryptococcus strains obtained at baseline were all Cryptococcus neoformans var. grubii, genotypes VNI-αA (3 isolates), VNII-αA (4 isolates) or hybrid VNI/VNII-αAAα (6 isolates), suggesting high diversity. Two strains acquired fluconazole resistance after four and five months of exposure, respectively. The prevalence of cryptococcosis is high in Madagascar and this serious condition is life-threatening in HIV-infected ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 14 1 e0007984 |
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Directory of Open Access Journals: DOAJ Articles |
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English |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Rivonirina Andry Rakotoarivelo Mihaja Raberahona Tahinamandranto Rasamoelina Andriamihaja Rabezanahary Fetra Angelot Rakotomalala Tiana Razafinambinintsoa Thomas Bénet Philippe Vanhems Mamy Jean de Dieu Randria Luisa Romanò Massimo Cogliati Muriel Cornet Mala Rakoto Andrianarivelo Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Cryptococcal meningoencephalitis (CM) remains the most prevalent invasive fungal infection worldwide. The main objective of this study was to describe the prevalence of CM and cryptococcal infection in HIV-infected patients in Madagascar. The secondary objectives were to assess the adjusted prevalence of CM according to clinical presentation and patient characteristics, to determine crude 90-day survival according to cryptococcal antigen (CrAg) status and CM, and to identify the genotypes of Cryptococcus clinical isolates. This cross-sectional study was carried out at two urban hospitals in Antananarivo (central highlands) and Toamasina (east coast) between November 2014 and December 2016. Consecutive HIV-infected adults presenting with CD4 cell counts ≤200/μl were enrolled. Lateral flow immunoassays of CrAg were performed on serum for all patients, and on cerebrospinal fluid for patients with CM symptoms. MALDI-ToF MS, ITS sequencing, and determinations of the molecular and mating types of the isolates were performed. Fluconazole is the only drug for CM treatment available in Madagascar. Patients were treated orally, with high doses (1200 mg/day) for 10-12 weeks and then with 200 mg/day. Minimum inhibitory concentrations were determined for amphotericin B, flucytosine, voriconazole and fluconazole in E-tests. Overall prevalence was 13.2% (95% CI 7.9-20.3) for cryptococcal infection and 10.9% (95% CI 6.1-17.5) for CM, among the 129 HIV-infected patients studied. The 90-day mortality rate was 58.8% (10/17) in CrAg-positive patients and 17.9% (20/112) in CrAg-negative patients (p<0.001). The 13 Cryptococcus strains obtained at baseline were all Cryptococcus neoformans var. grubii, genotypes VNI-αA (3 isolates), VNII-αA (4 isolates) or hybrid VNI/VNII-αAAα (6 isolates), suggesting high diversity. Two strains acquired fluconazole resistance after four and five months of exposure, respectively. The prevalence of cryptococcosis is high in Madagascar and this serious condition is life-threatening in HIV-infected ... |
format |
Article in Journal/Newspaper |
author |
Rivonirina Andry Rakotoarivelo Mihaja Raberahona Tahinamandranto Rasamoelina Andriamihaja Rabezanahary Fetra Angelot Rakotomalala Tiana Razafinambinintsoa Thomas Bénet Philippe Vanhems Mamy Jean de Dieu Randria Luisa Romanò Massimo Cogliati Muriel Cornet Mala Rakoto Andrianarivelo |
author_facet |
Rivonirina Andry Rakotoarivelo Mihaja Raberahona Tahinamandranto Rasamoelina Andriamihaja Rabezanahary Fetra Angelot Rakotomalala Tiana Razafinambinintsoa Thomas Bénet Philippe Vanhems Mamy Jean de Dieu Randria Luisa Romanò Massimo Cogliati Muriel Cornet Mala Rakoto Andrianarivelo |
author_sort |
Rivonirina Andry Rakotoarivelo |
title |
Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study. |
title_short |
Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study. |
title_full |
Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study. |
title_fullStr |
Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study. |
title_full_unstemmed |
Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study. |
title_sort |
epidemiological characteristics of cryptococcal meningoencephalitis associated with cryptococcus neoformans var. grubii from hiv-infected patients in madagascar: a cross-sectional study. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2020 |
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https://doi.org/10.1371/journal.pntd.0007984 https://doaj.org/article/dc54269acc954d37a0f93fa402971c3f |
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Arctic |
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Arctic |
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Arctic |
genre_facet |
Arctic |
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PLoS Neglected Tropical Diseases, Vol 14, Iss 1, p e0007984 (2020) |
op_relation |
https://doi.org/10.1371/journal.pntd.0007984 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007984 https://doaj.org/article/dc54269acc954d37a0f93fa402971c3f |
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https://doi.org/10.1371/journal.pntd.0007984 |
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