Clinical characteristics of cerebral cryptococcosis in HIV-infected patients: Hospital Nacional de Paraguay years 2012 to 2020

Abstract

Introduction: the clinical picture of HIV infection reflects the progressive immunodeficiency from the initial phases, sometimes asymptomatic to the final, when clinically it corresponds to more advanced stages of immunosuppression, with CD4 T lymphocytes <100cells / μL, the acquired immunodeficiency syndrome, in the one that already appears the defining diseases, one of them the cerebral cryptococcosis.
Objectives: to describe the clinical characteristics of cerebral cryptococcosis in HIV-infected patients admitted to the Medical Clinic Service of the Hospital Nacional - Itauguá, Paraguay from 2012 to 2020.
Methodology: a descriptive, retrospective, cross-sectional observational study was carried out in patients of both sexes older than 18 years.
Results: 35 patients were studied, 69 % were male, with a median age of 43 years. 100 % were without antiretroviral treatment upon admission, 74 % were not known to be infected with HIV, and 26 % had no adherence to treatment. The evolutionary picture on average was 20 days (2 to 90 days), 91 % of the symptoms on admission were neurological, the predominant being headache, which occurred in isolation in 28% and the rest with another neurological symptom . The mean viral load was 867,464 copies / mL, the median CD4 level was 34 cells / mm3 and 100 % <150 cells / mm3. The mean cerebrospinal fluid findings were glucorrhachia 37 mg / dl, protein sprain 174 mg / dl, cellularity 46 % ≤ 6 cells / μl, 98% predominantly mononuclear. All were treated with amphotericin B and maintenance with fluconazole. The median number of days of hospitalization was 30 days and mortality was 26 %, with poor prognosis factors being: late consultation, unknown HIV-infected patients, and higher viral load.
Conclusions: most of the cases could be evidenced in male patients, young adults, in the AIDS stage, 100 % without antiretroviral treatment, and late consultation and high viral load as poor prognostic factors. The suspicion of meningeal cryptococcosis-HIV concomitance is valid in patients with chronic headache even in unknown patients infected with HIV.