Title : Therapeutic challenges of cryptococcosis in immunocompetent and people living with hiv in boufarik, Alegria: A retrospective analysis
Cryptococcosis is a fungal potentially fatal infection, especially in its meningeal location. It’s most often due to Cryptococcus neoformans (Cn). Cellular immunosuppression, in particular the advanced stage of HIV infection, is a frequent risk factor for the onset of the disease in Third World countries. We present a retrospective analysis of patients treated for Neuromeningeal Cryptococcosis (NMC) or Antigenemia Alone (AGC); from January 2018 until April 2023, in the infectious diseases department of the Public Hospital Establishment (EPH) Boufarik, Algeria.
Findings: Twenty patients collected. Male were the more affected (65%). The mean age was 43.3 ± 15.7 years. The risk factor associated with cryptococcosis was mainly AIDS ( 95%) with a CD4 count < 100 cells / μl in 63%. No immunosuppression field was found in one patient. NMC was the predominant clinical form (60%), of which, one was associated with chorioretinitis. The therapeutic regimens are guided by national and international recommendations: for NMC the combination of amphotericin B (amphB) + fluconazole (only association available in country) is used in 84% either amphotericin B deoxycholate (30%) or AmphB liposomal (70%); fluconazole 800 mg/d - 1200 mg/d alone in induction therapy was also used (16%). the mean duration of induction therapy was 25.8 ± 13 days. The transition to consolidation regimen is conditioned by tolerance to AmphB, the availability of the drug and the negativity of the CSF culture. However, there is discordance in vitro/in vivo Cn’s antifungal susceptibility with a delay in LCS culture negativation. Pre-emptive treatment (fluconazole 400mg/day) for AgC was prescribed in 37,5%. relapse of CNM is noted in 2 patients after discontinuation of prophylaxis. The association with other opportunistic infections, namely tuberculosis (5), CMV viremia (4) worsened the prognosis. Death affected 35% of patients.
Conclusion: Despite increasing access to retroviral therapies, persons presenting with advanced HIV disease remains commen. Although cryptococcosis remains rare in immunocompetent patients, new molecules and therapeutic strategies must be developed regardless of the underlying terrain.