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Title: Mortality due to Cryptococcus neoformans and Cryptococcus gattii in low-income settings: an autopsy study.
Author: Hurtado, Juan Carlos
Castillo, Paola
Fernandes, Fabiola
Navarro, Mireia
Lovane, Lucilia
Casas, Isaac
Quintó, Llorenç
Marco, Francesc
Jordao, Dercio
Ismail, Mamudo R.
Lorenzoni, Cesaltina
Palhares, Antonio E. M.
Ferreira, Luiz
Lacerda, Marcus Vinícius Guimarães
Monteiro, Wuelton
Sanz, Ariadna
Letang, Emilio
Marimon, Lorena
Jesri, Susan
Cossa, Anelsio
Mandomando, Inácio
Vila Estapé, Jordi
Bassat Orellana, Quique
Ordi i Majà, Jaume
Menéndez, Clara
Carrilho, Carla
Martínez Yoldi, Miguel Julián
Keywords: Autòpsia
Malalties infeccioses
Communicable diseases
Issue Date: 16-May-2019
Publisher: Nature Publishing Group
Abstract: Cryptococcosis is a major opportunistic infection and is one of the leading causes of death in adults living with HIV in sub-Saharan Africa. Recent estimates indicate that more than 130,000 people may die annually of cryptococcal meningitis in this region. Although complete diagnostic autopsy (CDA) is considered the gold standard for determining the cause of death, it is seldom performed in low income settings. In this study, a CDA was performed in 284 deceased patients from Mozambique (n = 223) and Brazil (n = 61). In depth histopathological and microbiological analyses were carried out in all cases dying of cryptococcosis. We determined the cryptococcal species, the molecular and sero-mating types and antifungal susceptibility. We also described the organs affected and reviewed the clinical presentation and patient management. Among the 284 cases included, 17 fatal cryptococcal infections were diagnosed. Cryptococcus was responsible for 16 deaths among the 163 HIV-positive patients (10%; 95%CI: 6-15%), including four maternal deaths. One third of the cases corresponded to C. gattii (VGI and VGIV molecular types, Bα and Cα strains) and the remaining infections typed were caused by C. neoformans var. Grubii (all VNI and Aα strains). The level of pre-mortem clinical suspicion was low (7/17, 41%), and 7/17 patients (41%) died within the first 72 hours of admission. Cryptococcosis was responsible for a significant proportion of AIDS-related mortality. The clinical diagnosis and patient management were inadequate, supporting the need for cryptococcal screening for early detection of the disease. This is the first report of the presence of C. gattii infection in Mozambique.
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It is part of: Scientific Reports, 2019, vol. 9, p. 7493
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ISSN: 2045-2322
Appears in Collections:Articles publicats en revistes (ISGlobal)
Articles publicats en revistes (Fonaments Clínics)

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