Purpose:
To describe the ophthalmological characteristics, clinical course and visual
prognosis of HIV-AIDS patients with cryptococcal meningitis. Methods: Retrospective
study conducted in HIV-AIDS diagnosed outpatients treated at Dos de Mayo Hospital, from 2004 to
2014. Descriptive statistics were obtained for age, gender, associated diseases,
CD4 T cell counts, antiretroviral therapy (ART), cryptococcal meningitis
symptoms, relapses and visual complaints data. Diagnosis was based in CSF
analysis, Chinese dye and culture. CSF opening pressure was recorded.
Descriptive statistics were performed. Results: 18 cases were studied. 16 men
and 2 women. The range of age was 24 - 51 and median 33 years. Three patients
had been treated with ART. Tuberculosis was the most frequent associated
disease IN 5 cases (27.8%). Cryptoccocal meningitis relapses were present in 5 (27.8%). CD4 count below 50 was the most prevalent in 11
(61%). Thirteen had ocular symptoms, low visual acuity was present in the half
of cases and diplopia in 2 (11.1%). 13
(72.2%) coursed with headache. In eleven cases, the CSF opening
pressures had been reported, and the
range was 18 - 350 mm H2O, mean 67-6. CSF culture was obtained in 11
patients, it was positive in 7 (38.9%). Indian ink was positive in 16 (88.9%). Conclusion:
There was no blindness related with cryptococcal meningitis despite the higher
values of CSF opening pressure reported.
Cite this paper
Díaz, M. and Yánez, B. (2018). Ocular Findings of Cryptococcal Meningitis in HIV-AIDS Patients. Open Access Library Journal, 5, e4818. doi: http://dx.doi.org/10.4236/oalib.1104818.
Mirza, S.A., Phelan, M., Rimland, D., Graviss, E., Hamill, R., et al. (2003) The Changing Epidemiology of Cryptococcosis: An Update from Population Based Active Surveillance in 2 Large Metropolitan Areas, 1992-2000. Clinical Infectious Diseases, 36, 789-794. https://doi.org/10.1086/368091
Park, B.J., Wannemuehler, K.A., Marston, B.J., Govender, N., Pappas, P.G., et al. (2009) Estimation of the Current Global Burden of Cryptococcal Meningitis among Persons Living with HIV/AIDS. AIDS, 23, 525-530.
Olivares, L.R., Martínez, K.M., Cruz, R.M., Rivera, M.A., Meyer, W., et al. (2009) Genotyping of Mexican Cryptococcus neoformans and C. gattii Isolates by PCR-Fingerprinting. Medical Mycology, 47, 713-721. https://doi.org/10.3109/13693780802559031
Vidal, J.E., de Oliveira, P.A.C., Dauar, R.F. and Boulware, D.R. (2013) Strategies to Reduce Mortality and Morbidity Due to AIDS-Related Cryptococcal Meningitis in Latin America. Brazilian Journal of Infectious Diseases, 17, 353-362.
Quinet-Leiman, B.C. and Jorge-Koifman, R. (2009) Official Information Systems for Cryptococcal Meningitis, State of Rio de Janeiro, Southeastern Brazil. Revista de Saúde Pública, 43, 1-4.
Cunha Colombo, E.R., Mora, D.J. and Silva-Vergara, M.L. (2011) Immune Reconstitution Inflammatory Syndrome (IRIS) Associated with Cryptococcus neoformans Infection in AIDS Patients. Mycoses, 54, e178-e182. https://doi.org/10.1111/j.1439-0507.2010.01870.x
Johnston, S.R., Corbett, E.L., Foster, O., Ash, S. and Cohen, J. (1992) Raised Intracranial Pressure and Visual Complications in AIDS Patients with Cryptococcal Meningitis. Journal of Infection, 24, 185-189. https://doi.org/10.1016/0163-4453(92)92954-H
Graybill, J.R., Sobel, J., Saag, M., van Der Horst, C., Powderly, W., et al. (2000) Diagnosis and the NIAID Mycoses Study Group and AIDS Cooperative Treatment Groups. Clinical Infectious Diseases, 30, 47-54.
Kestelyn, P., Taelman, H., Bogaerts, J., Kagame, A., Abdel Aziz, M., et al. (1993) Ophthalmic Manifestations of Infections with Cryptococcus neoformans in Patients with the Acquired Immunodeficiency Syndrome. American Journal of Ophthalmology, 116, 721-727. https://doi.org/10.1016/S0002-9394(14)73472-5
Babu, K., Murthy, K.R. and Rajagopalan, N. (2008) Primary Bilateral Multifocal Choroiditis as an Initial Manifestation of Disseminated Cryptococcosis in a HIV-Positive Patient. Ocular Immunology and Inflammation, 16, 191-193.
Denning, D.W., Armstrong, R.W., Fishman, M. and Stevens, D.A. (1991) Endophtalmitis in a Patient with Disseminated Cryptoccocosis and AIDS Who Was Treated with Itraconazole. Clinical Infectious Diseases, 13, 1126-1130. https://doi.org/10.1093/clinids/13.6.1126
Rex, J.H., Larsen, R.A., Dismukes, W.E., Cloud, G.A. and Bennett, J.E. (1993) Catastrophic Visual Loss Due to Cryptococcus neoformans Meningitis. Medicine, 72, 207-224. https://doi.org/10.1097/00005792-199307000-00001
Corti, M., Solari, R., Cangelosi, D., Domínguez, C., Yampolsky, C., et al. (2010) Sudden Blindness Due to Bilateral Optic Neuropathy Associated with Cryptococcal Meningitis in an AIDS Patient. Revista Iberoamericana de Micología, 27, 207-209. https://doi.org/10.1016/j.riam.2010.09.002
Duggan, J. and Walls, H.M. (2012) Ocular Complications of Cryptococcal Meningitis in Patients with HIV: Report of Two Cases and Review of the Literature. Journal of the International Association of Providers of AIDS Care (JIAPAC), 11, 283-288. https://doi.org/10.1177/1545109712448537
Pappalardo, M.C. and Melhem, M.S. (2003) Cryptococcosis: A Review of the Brazilian Experience for the Disease. Revista do Instituto de Medicina Tropical de S?o Paulo, 45, 299-305. https://doi.org/10.1590/S0036-46652003000600001
Békondi, C., Bernede, C., Passone, N., Minssart, P., Kamalo, C., et al. (2006) Primary and Opportunistic Pathogens Associated with Meningitis in Adults in Bangui, Central African Republic, in Relation to Human Immunodeficiency Virus Serostatus. International Journal of Infectious Diseases, 10, 387-395. https://doi.org/10.1016/j.ijid.2005.07.004
Campos, P. and Rojas, R. (1994) Complicaciones infecciosas del sistema nervioso central en el SIDA. In: Sanchez, J., Mazzoti, G., Cuellar, L., Campos, P. and Gottuzzo, E., Eds., SIDA, epidemiología diagnóstico, tratamiento y control de la infección VIH SIDA, OMS/OPS MINSA, Perú, 141-149.
Canelo, C., Navarro, A., Guevara, M., Urcia, F., Zurita, S., et al. (1999) Determinación de la Variedad de Cepas de Cryptococcus Neoformans aisladas de pacientes con SIDA. Revista Peruana de Medicina Experimental y Salud Publica, 16, 44-47.
Mónaco, L.S. and Tamayo, A.(2008) Criptococcosis en pacientes SIDA: Estudio de casos en el Hospital Paroissien en el período 1996-2007. Revista Argentina de Microbiología, 40, 218-221.
Ordó?ez, N. and Casta?eda, E. (1994) Serotipificación de aislamientos clínicos y del medio ambiente de Cryptococcus neoformans en Colombia. Biomedica, 14, 131-139. https://doi.org/10.7705/biomedica.v14i3.2096
Lee, S.C., Dickson, D.W. and Casadevall, A. (1996) Pathology of Cryptococcal Meningoencephalitis: Analysis of 27 Patients with Pathogenetic Implications. Human Pathology, 27, 839-847. https://doi.org/10.1016/S0046-8177(96)90459-1
Bicanic, T., Brouwer, A.E., Meintjes, G., Rebe, K., Limmathurotsakul, D., et al. (2009) Relationship of Cerebrospinal Fluid Pressure, Fungal Burden and Outcome in Patients with Cryptococcal Meningitis Undergoing Serial Lumbar Punctures. AIDS, 23, 701-706.