The study of almost 300 autopsies carried out in Mozambique and Brazil shows that 57% were positive for HIV and, of these, 10% died from infection with cryptococcus. For the majority of patients the infection was not suspected and 75% of them died in the first week after entering the hospital.
Cryptococcal meningitis causes approximately one in ten deaths in patients with HIV, according to an autopsy study carried out in Mozambique and Brazil and coordinated by the Barcelona Institute of Global Health (ISGlobal), a center promoted by “la Caixa”.
Cryptococcus is an opportunistic fungus found in the environment that can cause serious infections, especially in people with a weak immune system. In fact, cryptococcal meningitis is the second cause of death in people with HIV, after tuberculosis. It is estimated that in 2014, cryptococcal meningitis caused more than 130,000 deaths in sub-Saharan Africa.
The two species that usually cause infections in humans are Cryptococcus neoformans and Cryptococcus gatti , which was described relatively recently. Although C. neoformans seems to predominate in patients with HIV, relatively little is known about the epidemiology and clinical presentation of C. gatti infections, particularly in Africa.
In this study, which was carried out under the CADMIA project, the authors determined deaths due to cryptococcus in a series of autopsies performed in two hospitals located in areas with high prevalence of HIV: Mozambique and the Brazilian Amazon. In addition, they made a detailed characterization of fatal cryptococcosis.
Deaths in the first week
Of the 284 complete diagnostic autopsies performed (223 in Maputo, Mozambique and 61 in Manaus, Brazil), 163 (57%) were positive for HIV, and 16 of these patients (10%) died of cryptococcal infection.
C. neoformans was responsible for two thirds of these infections, while the rest was caused by C. gatti, which was also detected in the only patient negative for HIV who died from cryptococcosis. “This is the first study to document infections by C. gatti in Mozambique,” explains Juan Carlos Hurtado, first author of the study.
The analysis of the symptoms and the clinical management of these cases revealed that, for the majority of patients, cryptococcal infection was not suspected and that 75% of them died in the first week after entering the hospital.
“Our study highlights that even today, cryptococcal mortality in patients with HIV is very important, and supports the current recommendations for screening and preventive treatment for cryptococcus,” adds Miguel J. Martínez, ISGlobal researcher and coordinator of the study.