Cryptococcus is an opportunistic fungus found in the environment that, in people with a weak immune system, can cause serious infections. In fact, after tuberculosis, cryptococcal meningitis is the second cause of death in people with HIV. It is estimated that in 2014 this bacterium caused more than 130,000 deaths in sub-Saharan Africa. Being Cryptococcus neoformans and Cryptococcus gatti, and although C. neoformans seems to predominate in the affectation of patients with HIV, relatively little is still known about the epidemiology and clinical presentation of C. gatti infections, especially in Africa.
In this study, which was carried out within the framework of 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.
Of the 284 complete diagnostic autopsies that were carried out between Mozambique and Brazil, more than half (163) 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 symptoms and the clinical management of these cases revealed that, in the majority of patients, there was no suspicion of cryptococcal infection and that 75% of them died in the first week after admission to 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.