Résumé

<h3 style="margin-left:0px;"><strong>Background</strong></h3><p>Cryptococcal meningitis is mainly caused by <i>Cryptococcus neoformans/C. gattii</i> complex. We compared the clinical, biological, and antifungal susceptibility profiles of isolates from HIV-Infected Patients (HIVIP) with <i>C. neoformans</i> (<i>Cn</i>) versus <i>C. curvatus/C. laurentii</i> (<i>Cc/Cl</i>) meningitis.</p><h3 style="margin-left:0px;"><strong>Methods</strong></h3><p>Comparative analytical study were conducted. Apart from patients’ clinical data, the following analysis were performed and the results were compared in both groups: biochemical examination, cryptococcal antigen test, India ink staining, and culture on Cerebral Spinal Fluid (CSF), strains identification by mass spectrometry, ITS sequencing, PCR serotyping and antifungal susceptibility. The main outcome variable was the “species of <i>Cryptococcus</i> identified”, which was compared to other variables of the same type using the Pearson Chi-square test or the Fisher exact test.</p><h3 style="margin-left:0px;"><strong>Results</strong></h3><p>A total of 23 (79.3%) <i>Cn</i> meningitis cases versus 6 (20.7%) <i>Cc/Cl</i> meningitis were retained<i>.</i> <i>Cn</i> meningitis was more frequently associated with headache (100% vs 50%, <i>p</i> = 0.005) than <i>Cc/Cl</i> meningitis and meningeal signs were more frequent in <i>Cn</i> infected patients. Biologically, hypoglycorrhachia and low CD4 count were more observed in <i>Cn</i> group (90% vs 20% of patients, <i>p</i> = 0.01; 45.6 vs 129.8&nbsp;cells/µL, <i>p</i> = 0.02, respectively). A higher proportion of <i>Cn</i> strains (91.3%) showed a low Minimum Inhibitory Concentration (MIC) (&lt; 8&nbsp;mg/L) for fluconazole compared to <i>Cc/Cl</i> strains (66.7%). Also, <i>Cc/Cl</i> strains resistant to 5-flucytosine and amphotericin B were found in 16.7% of cases for each of the two antifungal agents. <i>Cryptococcus</i> detection by routine analysis (India ink, culture, and antigens) was better for <i>Cn</i> samples than <i>Cc/Cl</i>. Except ITS sequencing, which identified all strains of both groups, mass spectrometry and serotyping PCR identified <i>Cn</i> strains better than <i>Cc/Cl</i> (100% vs 80%, <i>p</i> = 0.1; 100% vs 0%, <i>p</i> &lt; 0.0001, respectively). After treatment with amphotericin B, 5-flucytosine, and fluconazole in both groups, the outcome was similar.</p><h3 style="margin-left:0px;"><strong>Conclusions</strong></h3><p>Clinical presentation of <i>Cn</i> meningitis is certainly more severe than that of <i>Cc/Cl</i> meningitis, but <i>Cc/Cl</i> infection should be considered in the management of HIVIP with meningeal syndrome because of the diagnostic difficulty and the high MICs of antifungal agents required for the treatment of meningitis due to these cryptococcal species.</p>