title: Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil.
abstract: Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (P = 0.0047), intracranial increased pressure (P = 0.047), and severe malnutrition (P = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.
authors.affiliation: Infectious Diseases Unit, Triângulo Mineiro Federal University, Minas Gerais, Brazil.
authors.forename: Rafael Garcia
authors.initials: RG
authors.lastname: Torres
authors.affiliation: Discipline of Special Pathology, Triângulo Mineiro Federal University, Minas Gerais, Brazil.
authors.forename: Renata Margarida
authors.initials: RM
authors.lastname: Etchebehere
authors.affiliation: Discipline of Special Pathology, Triângulo Mineiro Federal University, Minas Gerais, Brazil.
authors.forename: Sheila Jorge
authors.initials: SJ
authors.lastname: Adad
authors.affiliation: Discipline of Special Pathology, Triângulo Mineiro Federal University, Minas Gerais, Brazil.
authors.forename: Adilha Rua
authors.initials: AR
authors.lastname: Micheletti
authors.affiliation: Infectious Diseases Unit, Triângulo Mineiro Federal University, Minas Gerais, Brazil.
authors.forename: Barbara de Melo
authors.initials: BM
authors.lastname: Ribeiro
authors.affiliation: Infectious Diseases Unit, Triângulo Mineiro Federal University, Minas Gerais, Brazil.
authors.forename: Leonardo Eurípedes Andrade
authors.initials: LE
authors.lastname: Silva
authors.affiliation: Infectious Diseases Unit, Triângulo Mineiro Federal University, Minas Gerais, Brazil.
authors.forename: Delio Jose
authors.initials: DJ
authors.lastname: Mora
authors.affiliation: Infectious Diseases Unit, Triângulo Mineiro Federal University, Minas Gerais, Brazil.
authors.forename: Kennio Ferreira
authors.initials: KF
authors.lastname: Paim
authors.affiliation: Infectious Diseases Unit, Triângulo Mineiro Federal University, Minas Gerais, Brazil. marioleon.dip@mednet.com.br.
authors.forename: Mario León
authors.initials: ML
authors.lastname: Silva-Vergara
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000473:pathology; D000328:Adult; D001344:Autopsy; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D003453:Cryptococcosis / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies