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Clinical and Mycological Implications of Cryptococcal Meningitis in Iran Publisher



Bashardoust B1, 2 ; Alavi Darazam I3, 5, 7 ; Daie Ghazvini R1 ; Hashemi SJ1 ; Salehi M5 ; Abbasian L4 ; Dehghan Manshadi SA4 ; Abdorahimi M6 ; Mohamadi A1 ; Zamani F5 ; Ardi P1 ; Khodavaisy S1, 5
Authors
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Authors Affiliations
  1. 1. Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran
  7. 7. Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Tehran, Iran

Source: Heliyon Published:2023


Abstract

Cryptococcal meningitis (CM) is an uncommon and severe infection that tends to affect both immunocompromised and immunocompetent hosts. To gain insights into the clinical and epidemiological characteristics of CM in Iran, this study evaluated patients with subacute or chronic meningitis referred to 15 Iranian hospitals. Relevant clinical and epidemiological characteristics of the patients were analyzed. Diagnosis of CM cases was performed by microscopic examination, culture, latex agglutination assay, lateral flow assay, and multiplex PCR on cerebrospinal fluid (CSF) samples. The isolates were processed and subjected to molecular identification and in vitro susceptibility antifungal profile. Among the 272 evaluated patients, 7 (2.6 %) CM cases were diagnosed. Out of seven CM cases, 6 (86 %) were male with a median age of 36 years. The most common neurological signs were headache (100 %), followed by nausea and vomiting (71.4 %). All CSF samples from CM patients exhibited positive results across all mycological tests conducted. The isolates were identified as Cryptococcus neoformans (86 %) and Cryptococcus gattii (14 %). All isolates were susceptible to voriconazole and fluconazole, while resistance was observed with itraconazole (MIC value of 0.5 μg/mL) and amphotericin B (MIC values of 4 and 1 μg/mL). The highest mortality (6/7, 86 %) was observed among patients. While a comprehensive study on this subject is currently lacking in Iran, the data acquired through this research play a crucial role in enhancing the clinical and epidemiological understanding of this infection, particularly within low-income countries. Moreover, these findings will serve as a cornerstone for future international comparative studies in this field. © 2023
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