HIV-associated cryptococcal meningitis

JN Jarvis, TS Harrison - Aids, 2007 - journals.lww.com
Aids, 2007journals.lww.com
While the incidence of cryptococccal meningitis in the developed world has declined with
widespread, early antiretroviral therapy (ART), cryptococcal disease remains a major
opportunistic infection and leading cause of mortality in patients infected with HIV in much of
the developing world. Most HIV-related cases are caused by Cryptococcus neoformans var.
grubii (serotype A), while var. neoformans (serotype D) is responsible for a proportion,
especially in Europe, and there are a small number of Cryptococcus gatti infections (formerly …
While the incidence of cryptococccal meningitis in the developed world has declined with widespread, early antiretroviral therapy (ART), cryptococcal disease remains a major opportunistic infection and leading cause of mortality in patients infected with HIV in much of the developing world. Most HIV-related cases are caused by Cryptococcus neoformans var. grubii (serotype A), while var. neoformans (serotype D) is responsible for a proportion, especially in Europe, and there are a small number of Cryptococcus gatti infections (formerly C. neoformans serotypes B and C)[1, 2]. The last includes a small number of cases in HIV-infected individuals forming part of an unprecedented outbreak of C. gattii infections, predominantly in apparently immunocompetent patients, on Vancouver Island, Canada [3, 4].
C. neoformans is distributed worldwide. An ubiquitous environmental saphrophyte, it is found in soil contaminated with pigeon droppings and has also been isolated from the heartwood of several tree species in South America [5] and India [6], and from the homes of African HIV-seropositive patients [7, 8]. Exposure may be common [9], although the exact circumstances are usually unclear. Inhalation of small, thinly encapsulated yeasts, or basidiospores [10], may lead to an initial pulmonary infection, which, depending on host immune response and the number and virulence of the organisms, is cleared, contained within granulomata as a latent infection or disseminates. The minority in whom disease disseminates typically have defects in T cell function, through
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