Volume 95, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



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 ( = 0.0047), intracranial increased pressure ( = 0.047), and severe malnutrition ( = 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.


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  1. Park BJ, Wannmuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM, , 2009. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS 23: 525530.[Crossref] [Google Scholar]
  2. Harrison TS, , 2009. The burden of HIV-associated cryptococcal disease. AIDS 23: 531532.[Crossref] [Google Scholar]
  3. Perfect JR, Casadevall A, , 2002. Cryptococcosis. Infect Dis Clin North Am 16: 837874.[Crossref] [Google Scholar]
  4. Prado M, Silva MB, Laurenti R, Travassos LR, Taborda CP, , 2009. Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006. Mem Inst Oswaldo Cruz 104: 513521.[Crossref] [Google Scholar]
  5. McNeil MM, Nash SL, Hajjeh RA, Phelan MA, Conn LA, Plikaytis BD, Warnock DW, , 2001. Trends in mortality due to invasive mycotic diseases in the United States, 1980–1997. Clin Infect Dis 33: 641647.[Crossref] [Google Scholar]
  6. Antinori S, Ridolfo A, Fasan M, Magni C, Galimberti L, Milazzo L, Sollima S, Adorni F, Giuliani G, Galli M, Corbellino M, Parravicini C, , 2009. AIDS-associated cryptococcosis: a comparison of epidemiology, clinical features and outcome in the pre- and post-HAART eras. Experience of a single centre in Italy. HIV Med 10: 611.[Crossref] [Google Scholar]
  7. de Oliveira RB, Atobe JH, Souza AS, de Castro Lima Santos DW, , 2014. Epidemiology of invasive fungal infections in patients with acquired immunodeficiency syndrome at a reference hospital for infectious diseases in Brazil. Mycopathologia 178: 7178.[Crossref] [Google Scholar]
  8. Jean SS, Fang CT, Shau WY, Chen YC, Chang SC, Hsueh PR, Hung CC, Luh KT, , 2002. Cryptococcaemia: clinical features and prognostic factors. Q J Med 95: 511518.[Crossref] [Google Scholar]
  9. Dromer F, Mathoulin-Pélissier S, Launay O, Lortholary O, , 2007. Determinants of disease presentation and outcome during cryptococcosis: the CryptoA/D study. PLoS Med 4: e21.[Crossref] [Google Scholar]
  10. Rhein J, Boulware DR, , 2012. Prognosis and management of cryptococcal meningitis in patients with human immunodeficiency virus infection. Neurobehav HIV Med 4: 4561. [Google Scholar]
  11. Philip KJ, Kaur R, Sangeetha M, Masih K, Singh N, Mani A, , 2012. Disseminated cryptococcosis presenting with generalized lymphadenopathy. J Citol 29: 200202.[Crossref] [Google Scholar]
  12. Kovarik CL, Barnard JJ, , 2009. Fatal disseminated Cryptococcus as the initial presentation of HIV infection in the era of highly active antiretroviral therapy. J Sci 54: 927929. [Google Scholar]
  13. Cox JA, Lukande RL, Nelson AM, Mayanja-Kizza H, Colebunders R, Van Marck E, Manabe YC, , 2012. An autopsy study describing causes of death and comparing clinico-pathological findings among hospitalized patients in Kampala, Uganda. PLoS One 7: e33685.[Crossref] [Google Scholar]
  14. Hofman P, Saint-Paul MC, Battaglione V, Michiels JF, Loubière R, , 1999. Autopsy findings in the acquired immunodeficiency syndrome (AIDS). A report of 395 cases from the south of France. Pathol Res Pract 195: 209217.[Crossref] [Google Scholar]
  15. Klock C, Cerski M, Goldani LZ, , 2009. Histopathological aspects of neurocryptococcosis in HIV-infected patients: autopsy report of 45 patients. Int J Surg Pathol 17: 444448.[Crossref] [Google Scholar]
  16. d'Arminio Monforte A, Vago L, Lazzarin A, Boldorini R, Bini T, Guzzetti S, Antinori S, Moroni M, Costanzi G, , 1992. AIDS-defining diseases in 250 HIV-infected patients; a comparative study of clinical and autopsy diagnoses. AIDS 6: 11591164.[Crossref] [Google Scholar]
  17. Borges AS, Ferreira MS, Nishioka S da A, Silvestre MT, Silva AM, Rocha A, , 1997. Agreement between premortem and postmortem diagnoses in patients with acquired immunodeficiency syndrome observed at a Brazilian teaching hospital. Rev Inst Med Trop Sao Paulo 39: 217221.[Crossref] [Google Scholar]
  18. Silva AC, Rodrigues BS, Micheletti AM, Tostes S, Jr Meneses AC, Silva-Vergara ML, Adad SJ, , 2012. Neuropathology of AIDS: an autopsy review of 284 cases from Brazil comparing the findings pre- and post-HAART (highly active antiretroviral therapy) and pre-and postmortem correlation. AIDS Res Treat 2012: 186850. [Google Scholar]
  19. Antinori S, Nebuloni M, Magni C, Fasan M, Adorni F, Viola A, Corbellino M, Galli M, Vago G, Parravicini C, Ridolfo AL, , 2009. Trends in the postmortem diagnosis of opportunistic invasive fungal infections in patients with AIDS: a retrospective study of 1,630 autopsies performed between 1984 and 2002. Am J Clin Pathol 132: 221227.[Crossref] [Google Scholar]
  20. UNAIDS, 2015. Global AIDS Response Progress Reporting 2015. Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data. Available at: http://www.unaids.org/sites/default/files/media_asset/JC2702_GARPR2015guidelines_en.pdf. Accessed February 20, 2015. [Google Scholar]
  21. Park BJ, Lockhart SR, Brandt ME, Chiller TM, Joseph H, , 2011. Public health importance of cryptocococcal disease: epidemiology, burden and control. , ed. Cryptococcus: From Human Pathogen to Model Yeast. Washington, DC: ASM Press, 585593. [Google Scholar]
  22. Mocroft A, Brettle R, Kirk O, Blaxhult A, Parkin JM, Antunes F, Francioli P, D'Arminio Monforte A, Fox Z, Lundgren JD, EuroSIDA Study Group; , 2002. Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study. AIDS 16: 16631671.[Crossref] [Google Scholar]
  23. Crabtree-Ramirez B, Caro-Vega Y, Shepherd BE, Wehbe F, Cesar C, Cortés C, Padgett D, Koenig S, Gotuzzo E, Cahn P, McGowan C, Masys D, Sierra-Madero J, CCASAnet Team; , 2011. Cross-sectional analysis of late HAART initiation in Latin American and Caribbean: late testers and late presenters. PLoS One 6: e20272.[Crossref] [Google Scholar]
  24. Tuboi SH, Schechter M, McGowan CC, Cesar C, Krolewiecki A, Cahn P, Wolff M, Pape JW, Padgett D, Madero JS, Gotuzzo E, Masys DR, Shepherd BE, , 2009. Mortality during the first year of potent antiretroviral therapy in HIV-1-infected patients in 7 sites throughout Latin America and the Caribbean. J Acquir Immune Defic Syndr 51: 615623.[Crossref] [Google Scholar]
  25. Diamond RD, Bennett JE, , 1974. Prognostic factors in cryptococcal meningitis. A study in 111 cases. Ann Intern Med 80: 176181.[Crossref] [Google Scholar]
  26. Martínez AJ, Sell M, Mitrovics T, Stoltenburg-Didinger G, Iglesias-Rozas JR, Giraldo-Velásquez MA, Gosztonyi G, Schneider V, Cervós-Navarro J, , 1995. The neuropathology and epidemiology of AIDS. A Berlin experience. A review of 200 cases. Pathol Res Pract 191: 427443.[Crossref] [Google Scholar]
  27. Wilkes MS, Fortin AII, Felix JC, Godwin TA, Thompson WG, , 1988. Value of necropsy in acquired immune deficiency syndrome. Lancet 9: 8588.[Crossref] [Google Scholar]
  28. Klatt EC, , 1988. Diagnostic findings in patients with acquired immune deficiency syndrome (AIDS). J Acquir Immune Defic Syndr 1: 459465. [Google Scholar]
  29. Jarvis JN, Harrison TS, Lawn SD, Meintjes G, Wood R, Cleary S, , 2013. Cost effectiveness of cryptococcal antigen screening as a strategy to prevent HIV-associated cryptococcal meningitis in South Africa. PLoS One 8: e69288.[Crossref] [Google Scholar]
  30. Lortholary O, Poizat G, Zeller V, Neuville S, Boibieux A, Alvarez M, Dellamonica P, Botterel F, Dromer F, Chêne G, , 2006. Long-term outcome of AIDS-associated cryptococcosis in the era of combination antiretroviral therapy. AIDS 20: 21832191.[Crossref] [Google Scholar]
  31. Manfredi R, Calza L, Chiodo F, , 2003. AIDS-associated Cryptococcus infection before and after the highly active antiretroviral therapy era: emerging management problems. Int J Antimicrob Agents 22: 449452.[Crossref] [Google Scholar]
  32. Mora DJ, Colombo E, Ferreira-Paim K, Andrade-Silva L, Silva-Vergara ML, , 2012. Clinical, epidemiological and outcome features of patients with cryptococcosis in Uberaba, Minas Gerais, Brazil. Mycopathologia 171: 321327.[Crossref] [Google Scholar]
  33. Ministério da Saúde Secretaria de Vigilância em Saúde, Brasil, 2012. Vigilância e Epidemiológica da Criptococose. Available at: http://www.sgc.goias.gov.br/upload/arquivos/2012-05/proposta_ve-criptococose1.pdf. Accessed February 20, 2015. [Google Scholar]
  34. Vidal JE, Penalva de Oliveira AC, Dauar RF, Boulware DR, , 2013. Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America. Braz J Infect Dis 17: 353362.[Crossref] [Google Scholar]
  35. Colombo TE, Soares MM, D'Ávilla SC, Nogueira MC, de Almeida MT, , 2012. Identification of fungal diseases at necropsy. Pathol Res Pract 208: 549552.[Crossref] [Google Scholar]
  36. Cury PM, Pulido CF, Furtado VM, da Palma FM, , 2003. Autopsy findings in AIDS patients from a reference hospital in Brazil: analysis of 92 cases. Pathol Res Pract 199: 811814.[Crossref] [Google Scholar]
  37. Eza D, Cerrillo G, Moore DA, Castro C, Ticona E, Morales D, Cabanillas J, Barrantes F, Alfaro A, Benavides A, Rafael A, Valladares G, Arevalo F, Evans CA, Gilman RH, , 2006. Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru. Pathol Res Pract 202: 767775.[Crossref] [Google Scholar]
  38. Lanjewar DN, , 2011. The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of 236 autopsied cases in Mumbai, India. Pathol Res Int 2011: 547618.[Crossref] [Google Scholar]
  39. Souza SL, Feitoza PV, Andrade RV, Araújo JR, Ferreira LC, , 2008. Causes of death among patients with acquired immunodeficiency syndrome autopsied at the Tropical Medicine Foundation of Amazonas [in Portuguese]. Rev Soc Bras Med Trop 41: 247251.[Crossref] [Google Scholar]
  40. Shojania KG, Burton EC, , 2008. The vanishing nonforensic autopsy. N Engl J Med 358: 873875.[Crossref] [Google Scholar]
  41. Schable B, Chu SY, , 1994. Autopsy rates among patients reported with AIDS. Am J Public Health 84: 16951696.[Crossref] [Google Scholar]
  42. Suzuki Y, Kume H, Togano T, Kanoh Y, Ohto H, , 2013. Epidemiology of visceral mycoses in autopsy cases in Japan: the data from 1989 to 2009 in the Annual of Pathological Autopsy Cases in Japan. Med Mycol 51: 522526.[Crossref] [Google Scholar]

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  • Received : 25 Feb 2016
  • Accepted : 14 Jun 2016
  • Published online : 05 Oct 2016

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