Cryptococcal Infection in Advanced HIV-Associated Immunosuppression-Case Series.
5 affiliations
- 1Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
- 2Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.
- 3Emergency Clinical Hospital for Children "St. Maria", 700309 Iasi, Romania.
- 4National Institute for Infectious Diseases "Prof. Dr. Matei Balș", 021105 Bucharest, Romania.
- 5Department of Intensive Care, Clinical Hospital of Emergency "Prof. Dr. Nicolae Oblu", 700309 Iasi, Romania.
Abstract
Background and Clinical Significance: Cryptococcal meningitis remains a life-threatening complication of advanced HIV infection. Its recognition can be challenging when neurological manifestations are nonspecific or cerebrospinal fluid inflammation is limited. This case series illustrates the diagnostic variability and therapeutic challenges encountered in five patients managed at a regional HIV/AIDS center in northeastern Romania. Case Presentation: Five men aged 26-69 years were hospitalized between November 2022 and March 2025 with HIV-associated cryptococcal disease involving the central nervous system. All had profound immunosuppression, with CD4+ T-cell counts of 6-31 cells/mm³. Clinical manifestations included headache, confusion, altered consciousness, and focal neurological deficits. Cerebrospinal fluid opening pressures were elevated, while inflammatory findings ranged from lymphocytic pleocytosis to an almost acellular profile. Microbiological investigations included direct microscopy, fungal culture, and molecular testing, according to availability. In one patient, culture confirmed Cryptococcus neoformans despite negative India ink microscopy and absent documented pleocytosis. Antifungal treatment included liposomal amphotericin B and fluconazole-based regimens, with treatment selection constrained by drug availability and organ dysfunction. Three cases had fatal outcomes during hospitalization. Conclusions: Cryptococcal meningitis should remain a diagnostic consideration in profoundly immunosuppressed patients with neurological symptoms, even when initial microscopy is negative or cerebrospinal fluid inflammation is minimal. These cases emphasize the importance of complementary microbiological investigations, assessment and management of intracranial pressure, reliable access to recommended antifungal regimens, and appropriate timing of antiretroviral therapy.
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BibTeX
@article{loghin2026cryptococcal,
title = {{Cryptococcal Infection in Advanced HIV-Associated Immunosuppression-Case Series.}},
author = {Isabela Ioana Loghin and Ion Cecan and Andrei Vâţă and Anton Knieling and Otilia-Elena Frăsinariu and Victor Daniel Dorobăţ and Vlad Hârtie and Carmen Mihaela Dorobăţ},
journal = {Reports (MDPI)},
year = {2026},
month = oct,
doi = {10.3390/reports9040349},
url = {https://europepmc.org/article/MED/42924801},
note = {CC BY},
}
RIS
TY - JOUR
TI - Cryptococcal Infection in Advanced HIV-Associated Immunosuppression-Case Series.
AU - Isabela Ioana Loghin
AU - Ion Cecan
AU - Andrei Vâţă
AU - Anton Knieling
AU - Otilia-Elena Frăsinariu
AU - Victor Daniel Dorobăţ
AU - Vlad Hârtie
AU - Carmen Mihaela Dorobăţ
PY - 2026
DA - 2026/10/13
JO - Reports (MDPI)
DO - 10.3390/reports9040349
UR - https://europepmc.org/article/MED/42924801
AB - Background and Clinical Significance: Cryptococcal meningitis remains a life-threatening complication of advanced HIV infection. Its recognition can be challenging when neurological manifestations are nonspecific or cerebrospinal fluid inflammation is limited. This case series illustrates the diagnostic variability and therapeutic challenges encountered in five patients managed at a regional HIV/AIDS center in northeastern Romania. Case Presentation: Five men aged 26-69 years were hospitalized between November 2022 and March 2025 with HIV-associated cryptococcal disease involving the central nervous system. All had profound immunosuppression, with CD4+ T-cell counts of 6-31 cells/mm³. Clinical manifestations included headache, confusion, altered consciousness, and focal neurological deficits. Cerebrospinal fluid opening pressures were elevated, while inflammatory findings ranged from lymphocytic pleocytosis to an almost acellular profile. Microbiological investigations included direct microscopy, fungal culture, and molecular testing, according to availability. In one patient, culture confirmed Cryptococcus neoformans despite negative India ink microscopy and absent documented pleocytosis. Antifungal treatment included liposomal amphotericin B and fluconazole-based regimens, with treatment selection constrained by drug availability and organ dysfunction. Three cases had fatal outcomes during hospitalization. Conclusions: Cryptococcal meningitis should remain a diagnostic consideration in profoundly immunosuppressed patients with neurological symptoms, even when initial microscopy is negative or cerebrospinal fluid inflammation is minimal. These cases emphasize the importance of complementary microbiological investigations, assessment and management of intracranial pressure, reliable access to recommended antifungal regimens, and appropriate timing of antiretroviral therapy.
SN - 2571-841X
ER -