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New recommendations against a major opportunistic infection -- cryptococcosis

and its evolution (prognostic factors), this study enrolled 230 patients infected (HIV+) or not (HIV-) by HIV.

It demonstrates that the disease is more severe in men than women, suggesting influence of sex hormones. It is also more severe in HIV+ than in HIV- individuals. In terms of mortality, it is those patients suffering from a haematological malignancy (such as lymphoma or chronic leukaemia) in which cryptococcosis is the most serious. The study also demonstrates that between the two serotypes of C. neoformans present in France (A and D), serotype A is associated with a more severe presentation and evolution of the disease. Finally, the patients having neurological defects and/or abnormal consciousness, or abnormal neuroimaging at the time of diagnosis, have a worsened prognosis for survival.

Along with these different factors, the researchers studied the impact of the initial "fungal load" (the quantity of fungi in the organism) and the evolution of cryptococcosis according to the particular antifungal drugs used.

In light of all of the factors analysed, the authors advocate that all patients in whom a diagnosis of cryptococcosis has been established should have an assessment of their fungal load to evaluate the severity of the disease.

According to the researchers, this systematic assessment should include a cerebrospinal fluid culture, a blood culture, a urine culture, and a determination of the quantity (titration) of the circulating antigen of Cryptococcus.

"For patients who have a very high fungal load, we recommend starting an initial therapy combining two antifungals, a treatment that is currently only recommended in cases of meningitis and severe pneumonia", concludes Dromer.

The authors stress that the three-month mortality rate from cryptococcosis remains 15-20% in Western countries, and that this is much higher in Africa and Asia: this greatly justifies improving the therapeutic management
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Source:CNRS


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