Caracterização clínica, epidemiológica e laboratorial e de coinfecções em pacientes com diagnóstico de neurocriptococose admitidos no Hospital Eduardo de Menezes em Belo Horizonte, Minas Gerais

Abstract

Cryptococcal meningitis (CM) is a major opportunistic infection associated with HIV, characterized by high mortality rates, especially in low- and middle-income countries. To evaluate the epidemiological, clinical, and laboratory aspects, as well as factors associated with mortality and the impact of coinfections, a retrospective study was conducted, including 109 laboratory-confirmed cases of cryptococcal meningitis admitted to the Hospital Eduardo de Menezes in Belo Horizonte, Brazil, between 2013 and 2023. Univariate and multivariate analyses were performed to identify factors associated with death and to compare coinfected and non-coinfected patients, in addition to global survival analysis using Kaplan-Meier curves. CM primarily affected men (88%) under 45 years of age, of whom 94.5% were living with HIV (PLHIV). The mean HIV viral load was 43,700 copies/mL, and the mean CD4+ T-lymphocyte count was 62.2 cells/mm3, with 53.2% of patients presenting values below 50 cells/mm3. The most prevalent symptoms were headache (71.5%), weight loss (63.3%), fever (42.2%), and mental confusion (36.7%). Amphotericin B deoxycholate (74.3%) was predominantly used in induction therapy, requiring substitution due to renal toxicity in 55.5% of cases. Overall mortality was 32.1%. Shorter length of stay, mental confusion, lower cerebrospinal fluid (CSF) cell count, shorter induction treatment duration, and the use of amphotericin deoxycholate were associated with death. Coinfections occurred in 34.9% of CM and HIV-infected patients, mainly neurosyphilis and neurotoxoplasmosis. Coinfected patients exhibited a longer length of stay, higher platelet count, higher mean INR, a lower proportion of patients with CD4+ T-lymphocyte count less than 50, and a lower proportion of patients with interruption of HIV treatment. There was no difference in medium-term mortality (60 days), but coinfected patients had significantly higher survival than non-coinfected patients in the first 14 days. The results highlighted that CM maintained a high mortality rate and that coinfections were frequent, underscoring the necessity of including differential diagnoses in the evaluation of immunosuppressed patients, despite coinfection not altering the medium-term outcome.