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Usefulness of Yeast Cell Counting and Lack of Clinical Correlation of the Antifungal Susceptibility Testing Results in Management of Aids-associated Cryptococcal Meningitis

  • Clinical Mycology Lab Issues (S Cordoba, Section Editor)
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Abstract

Purpose of Review

Cryptococcal meningitis is one of the most seriously opportunistic infections in people living with HIV. We evaluated clinical and laboratorial features (minimum inhibitory concentrations for fluconazole, initial fungal burden in cerebrospinal fluid) and risk factors associated with in-hospital mortality.

Recent Findings

There is no good evidence for the use of minimum inhibitory concentrations for fluconazole in routine practice for the management of cryptococcosis patients. Counting yeast cells at cerebrospinal fluid can predict positive culture by not death.

Summary

Data from 46 cryptococcal meningitis patients were reviewed, retrospectively. Patients who presented yeast cell count greater than 400 yeast cells/μ in their initial cerebrospinal fluid sample were associated with higher mortality (p = 0.014); moreover, the yeast cell count is an easy and cheap assay, with high values possibly associated to poor prognosis. Additionally, we verified no significant differences between fluconazole susceptibility profile, molecular type, clinical presentation, cytological analyses, time to sterilize the cerebrospinal fluid, agent recovering out of central nervous system, previous diagnosis of cryptococcal meningitis or usage of fluconazole, and overall mortality.

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Acknowledgments

We would like to thank Jane Atobe and Simone Aparecida de Souza from the laboratory group of the IIER. Molecular-type standard strains were kindly provided by the Mycology Laboratory of the Instituto Nacional de Infectologia Evandro Chagas—Fundação Oswaldo Cruz.

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Author notes

  1. Oscar José Chagas

    Present address: Serviço de Assistência Especializado em DST/AIDS, Prefeitura do Município de São Paulo, Alameda Cleveland, no 374, São Paulo, 01812-000, SP, Brazil

  2. Oscar José Chagas and Renata Buccheri contributed equally to this work.

Authors and Affiliations

  1. Instituto de Infectologia Emílio Ribas, Avenida Dr. Arnaldo, no 165, São Paulo, 01246-900, SP, Brazil

    Oscar José Chagas, Renata Buccheri, Rosa Marcusso & Daniel Wagner Santos

  2. Instituto Adolfo Lutz, Avenida Dr. Arnaldo, no 355, São Paulo, 01246-000, Brazil

    Márcia de Souza Carvalho Melhem, Walderez Szeszs, Marilena dos Anjos Martins & Lidiane de Oliveira

  3. Science Graduate Program Secretary of Health, Federal University of Mato Grosso do Sul, Cidade Universitária s/n Unidade 9, Campo Grande, 79070-900, MS, Brazil

    Márcia de Souza Carvalho Melhem

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Oscar José Chagas, Renata Buccheri, Márcia de Souza Carvalho Melhem, Walderez Szeszs, Marilena dos Anjos Martins, Lidiane de Oliveira, Rosa Marcusso and Daniel Wagner Santos declare no conflicts of interest relevant to this manuscript.

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Chagas, O.J., Buccheri, R., de Souza Carvalho Melhem, M. et al. Usefulness of Yeast Cell Counting and Lack of Clinical Correlation of the Antifungal Susceptibility Testing Results in Management of Aids-associated Cryptococcal Meningitis. Curr Fungal Infect Rep 14, 1–8 (2020). https://doi.org/10.1007/s12281-020-00368-5

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