Dataset Information

Trends in Clinico-Epidemiological Profile and Outcomes of Patients with HIV-Associated Cryptococcal Meningitis in Shanghai, China, 2013-2023.

ABSTRACT: The study aimed to analyze changes in the clinical and epidemiological aspects of HIV-associated cryptococcal meningitis (CM) patients and to identify factors influencing their prognosis. Clinical data of patients with HIV-associated CM treated in Shanghai, China between 2013 and 2023 were collected. This study included 279 cases, 2.89% of AIDS patients, showing a yearly decrease in CM prevalence among AIDS patients (p < 0.001). Overall mortality was 10.39% with rates declining from a 2013 peak of 15.38% to 0% in 2023 despite no significant temporal pattern (p = 0.265). Diagnosis took an average of 18 ± 1 days post-symptoms, and admission CD4 counts averaged 29.2 ± 2.5 cells/μL, hinting at a non-significant decline. Frequent symptoms included fever (62.4%), headache (61.6%), fatigue (44.1%), and appetite loss (39.8%), with younger patients more likely to initially show signs of meningeal irritation. Logistic regression analysis underscored the prognostic importance of cerebrospinal fluid (CSF) white blood cell (WBC) count and procalcitonin levels. Over the decade spanning from 2013 to 2023, the incidence and mortality rates of CM among AIDS patients exhibited a downward trend. The average duration from the onset of CM to confirmation of diagnosis remained prolonged. CSF WBC count and procalcitonin levels were associated with unfavorable outcomes.

SUBMITTER: Zhao Z

PROVIDER: S-EPMC11359124 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Trends in Clinico-Epidemiological Profile and Outcomes of Patients with HIV-Associated Cryptococcal Meningitis in Shanghai, China, 2013-2023.

Zhao Zihui Z Song Wei W Liu Li L Qi Tangkai T Wang Zhenyan Z Tang Yang Y Sun Jianjun J Xu Shuibao S Yang Junyang J Wang Jiangrong J Chen Jun J Zhang Renfang R Shen Yinzhong Y

Viruses 20240821 8

The study aimed to analyze changes in the clinical and epidemiological aspects of HIV-associated cryptococcal meningitis (CM) patients and to identify factors influencing their prognosis. Clinical data of patients with HIV-associated CM treated in Shanghai, China between 2013 and 2023 were collected. This study included 279 cases, 2.89% of AIDS patients, showing a yearly decrease in CM prevalence among AIDS patients (<i>p</i> < 0.001). Overall mortality was 10.39% with rates declining from a 201 ...[more]

PMID: 39205307

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Project description:Cryptococcal meningitis, mainly caused by Cryptococcus neoformans/gattii species complexes, is a lethal infection in both immunosuppressive and immunocompetent populations. We characterized 110 Cryptococcus strains collected from Xiangya Hospital of Central South University in China during the 6-year study period between 2013 and 2018, and performed their antifungal susceptibility testing. Furthermore, the clinical features, laboratory and imaging data, treatment strategies and outcomes of the subjects were retrospectively analyzed. Of 110 Cryptococcus strains, C. neoformans species complexes accounted for 96.4% (106/110), including C. neoformans sensu stricto (VNI molecular type, 95.5%, 105/110) and Cryptococcus deneoformans (VNIV molecular type, 0.9%, 1/110), and Cryptococcus deuterogattii (VGII molecular type) accounted for 3.6% (4/110). The strains were further classified into 17 individual sequence types (STs) by using multilocus sequence typing (MLST). 89.1% (98/110) were represented by ST5; seven C. deuterogattii strains and one Cryptococcus deneoformans strain were assigned as ST7 and ST260, respectively. Antifungal minimal inhibitory concentrations above the epidemiological cutoff values (ECVs) were found mainly in C. neoformans species complexes strains (nine for amphotericin B, nine for fluconazole and seven for 5-fluorocytosine). Furthermore, 60.9% (67/110) of the subjects were male, and 40.0% (44/110) did not have underlying diseases. Hepatic diseases (hepatitis/HBV carrier status and cirrhosis) were the most common underlying health conditions (11.8%, 13/110), followed by autoimmune disorders (10.9%, 12/110) and chronic kidney disease (6.36%, 7/110). Only 4.5% (5/110) of the patients were HIV/AIDS positives. For clinical presentation, headache (77.3%, 85/110), fever (47.3%, 52/110), and stiff neck (40.9%, 45/110) were commonly observed. The mortality rate was 35.0% (36/103). In conclusion, our data were characterized by a high prevalence of the Cryptococcal meningitis patients without HIV/AIDS and other underlying health conditions, a relatively high non-wild-type rate of fluconazole and amphotericin B resistance, and low genetic diversity in Cryptococcus strains. The present study will provide evidence for further improvement of the diagnosis and treatment of cryptococcosis in China.

Project description:BackgroundRickettsioses, caused by intracellular bacteria of the genera Rickettsia and Orientia, are transmitted to humans through arthropod vectors such as ticks, fleas, and mites. Over the past two decades, this disease has been recognized as a significant cause of acute febrile illness in Sri Lanka. However, only a limited number of studies have focused on clinico-epidemiological characteristics of patients and immunological diagnostic approaches for disease confirmation.MethodA cross-sectional study was conducted at the Rickettsial Disease Diagnostic and Research Laboratory (RDDRL), University of Kelaniya, Sri Lanka, from 2018 to 2023 from the clinically suspected patients referred for disease confirmation. Clinical, demographic, epidemiological, biochemical, and laboratory data were collected via a questionnaire by reviewing the archived records. The serological finding of the immunofluorescence assay (IFA) conducted for patients samples were retrieved. The patients who were positive for IFA-IgG (> 1:128 as per presumptive confirmation of acute rickettsial illness) were taken as the test group and the negative group was taken as the control group. Data were analyzed using chi-square tests followed by a Correlation analysis between the variables using Pearson correlation.ResultsOut of 1,221 cases, 249 (20.4%) were serologically "confirmed" as positive for rickettsial infection. The test group consisted predominantly of males, similar to the control group. Most cases were males and < 9 years of age followed by 10-19 years. Among the age groups, 10-19 years and 50-59 years, categories indicated a significant positive relationship according to the chi-squared statistics (P < 0.05). A seasonal trend was observed, with higher case numbers reported from January to February. Laboratory findings indicated significant differences between test and control groups in leucopenia (P = 0.005, χ²=7.87), increased neutrophil count (P = 0.0004, χ²=12.71), elevated alanine aminotransferase (P = 0.0001, χ²=14.64), elevated aspartate aminotransferase (P = 0.0001, χ²=18.24), urine occult blood (P = 0.024, χ²=5.09), and raised erythrocyte sedimentation rate (P = 0.034, χ²=4.51). Clinical manifestations showed no major deviations. Notably, eschar was more prevalent in O. tsutsugamushi cases (33.3%) compared to SFG rickettsioses (13.3%).ConclusionThis study highlights the need for improved awareness, diagnostic facilities, and vector control measures to manage rickettsial infections effectively in Sri Lanka. Understanding epidemiological patterns and clinical manifestations is crucial for developing effective surveillance and prevention strategies.Clinical trialNot applicable.

Dataset Information

Trends in Clinico-Epidemiological Profile and Outcomes of Patients with HIV-Associated Cryptococcal Meningitis in Shanghai, China, 2013-2023.

Publications

Trends in Clinico-Epidemiological Profile and Outcomes of Patients with HIV-Associated Cryptococcal Meningitis in Shanghai, China, 2013-2023.

Similar Datasets

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