{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:36:48Z","timestamp":1787971008430,"version":"build-2784847793"},"reference-count":42,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,10,5]]},"abstract":"<jats:p>Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and\/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (<jats:italic>P<\/jats:italic> = 0.0047), intracranial increased pressure (<jats:italic>P<\/jats:italic> = 0.047), and severe malnutrition (<jats:italic>P<\/jats:italic> = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0148","type":"journal-article","created":{"date-parts":[[2016,7,26]],"date-time":"2016-07-26T02:48:37Z","timestamp":1469501317000},"page":"781-785","source":"Crossref","is-referenced-by-count":12,"title":["Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and\/or Diagnosed at Necropsy in a Teaching Hospital in Brazil"],"prefix":"10.4269","volume":"95","author":[{"given":"Rafael Garcia","family":"Torres","sequence":"first","affiliation":[{"name":"1Infectious Diseases Unit, Tri\u00e2ngulo Mineiro Federal University, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata Margarida","family":"Etchebehere","sequence":"additional","affiliation":[{"name":"2Discipline of Special Pathology, Tri\u00e2ngulo Mineiro Federal University, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila Jorge","family":"Adad","sequence":"additional","affiliation":[{"name":"2Discipline of Special Pathology, Tri\u00e2ngulo Mineiro Federal University, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adilha Rua","family":"Micheletti","sequence":"additional","affiliation":[{"name":"2Discipline of Special Pathology, Tri\u00e2ngulo Mineiro Federal University, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara de Melo","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"1Infectious Diseases Unit, Tri\u00e2ngulo Mineiro Federal University, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Eur\u00edpedes Andrade","family":"Silva","sequence":"additional","affiliation":[{"name":"1Infectious Diseases Unit, Tri\u00e2ngulo Mineiro Federal University, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delio Jose","family":"Mora","sequence":"additional","affiliation":[{"name":"1Infectious Diseases Unit, Tri\u00e2ngulo Mineiro Federal University, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kennio Ferreira","family":"Paim","sequence":"additional","affiliation":[{"name":"1Infectious Diseases Unit, Tri\u00e2ngulo Mineiro Federal University, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario Le\u00f3n","family":"Silva-Vergara","sequence":"additional","affiliation":[{"name":"1Infectious Diseases Unit, Tri\u00e2ngulo Mineiro Federal University, Minas Gerais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"AIDS","first-page":"525","article-title":"Estimation of the current global burden of cryptococcal meningitis among persons living with HIV\/AIDS","volume":"23","author":"Park","year":"2009"},{"key":"ref2","series-title":"AIDS","first-page":"531","article-title":"The burden of HIV-associated cryptococcal disease","volume":"23","author":"Harrison","year":"2009"},{"key":"ref3","series-title":"Infect Dis Clin North Am","first-page":"837","article-title":"Cryptococcosis","volume":"16","author":"Perfect","year":"2002"},{"key":"ref4","series-title":"Mem Inst Oswaldo Cruz","first-page":"513","article-title":"Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006","volume":"104","author":"Prado","year":"2009"},{"key":"ref5","series-title":"Clin Infect Dis","first-page":"641","article-title":"Trends in mortality due to invasive mycotic diseases in the United States, 1980\u20131997","volume":"33","author":"McNeil","year":"2001"},{"key":"ref6","series-title":"HIV Med","first-page":"6","article-title":"AIDS-associated cryptococcosis: a comparison of epidemiology, clinical features and outcome in the pre- and post-HAART eras. Experience of a single centre in Italy","volume":"10","author":"Antinori","year":"2009"},{"key":"ref7","series-title":"Mycopathologia","first-page":"71","article-title":"Epidemiology of invasive fungal infections in patients with acquired immunodeficiency syndrome at a reference hospital for infectious diseases in Brazil","volume":"178","author":"de Oliveira","year":"2014"},{"key":"ref8","series-title":"Q J Med","first-page":"511","article-title":"Cryptococcaemia: clinical features and prognostic factors","volume":"95","author":"Jean","year":"2002"},{"key":"ref9","series-title":"PLoS Med","first-page":"e21","article-title":"Determinants of disease presentation and outcome during cryptococcosis: the CryptoA\/D study","volume":"4","author":"Dromer","year":"2007"},{"key":"ref10","series-title":"Neurobehav HIV Med","first-page":"45","article-title":"Prognosis and management of cryptococcal meningitis in patients with human immunodeficiency virus infection","volume":"4","author":"Rhein","year":"2012"},{"key":"ref11","series-title":"J Citol","first-page":"200","article-title":"Disseminated cryptococcosis presenting with generalized lymphadenopathy","volume":"29","author":"Philip","year":"2012"},{"key":"ref12","series-title":"J Sci","first-page":"927","article-title":"Fatal disseminated Cryptococcus as the initial presentation of HIV infection in the era of highly active antiretroviral therapy","volume":"54","author":"Kovarik","year":"2009"},{"key":"ref13","series-title":"PLoS One","first-page":"e33685","article-title":"An autopsy study describing causes of death and comparing clinico-pathological findings among hospitalized patients in Kampala, Uganda","volume":"7","author":"Cox","year":"2012"},{"key":"ref14","series-title":"Pathol Res Pract","first-page":"209","article-title":"Autopsy findings in the acquired immunodeficiency syndrome (AIDS). A report of 395 cases from the south of France","volume":"195","author":"Hofman","year":"1999"},{"key":"ref15","series-title":"Int J Surg Pathol","first-page":"444","article-title":"Histopathological aspects of neurocryptococcosis in HIV-infected patients: autopsy report of 45 patients","volume":"17","author":"Klock","year":"2009"},{"key":"ref16","series-title":"AIDS","first-page":"1159","article-title":"AIDS-defining diseases in 250 HIV-infected patients; a comparative study of clinical and autopsy diagnoses","volume":"6","author":"d'Arminio Monforte","year":"1992"},{"key":"ref17","series-title":"Rev Inst Med Trop Sao Paulo","first-page":"217","article-title":"Agreement between premortem and postmortem diagnoses in patients with acquired immunodeficiency syndrome observed at a Brazilian teaching hospital","volume":"39","author":"Borges","year":"1997"},{"key":"ref18","series-title":"AIDS Res Treat","first-page":"186850","article-title":"Neuropathology of AIDS: an autopsy review of 284 cases from Brazil comparing the findings pre- and post-HAART (highly active antiretroviral therapy) and pre-and postmortem correlation","volume":"2012","author":"Silva","year":"2012"},{"key":"ref19","series-title":"Am J Clin Pathol","first-page":"221","article-title":"Trends in the postmortem diagnosis of opportunistic invasive fungal infections in patients with AIDS: a retrospective study of 1,630 autopsies performed between 1984 and 2002","volume":"132","author":"Antinori","year":"2009"},{"key":"ref20","series-title":"Global AIDS Response Progress Reporting 2015","author":"UNAIDS","year":"2015"},{"key":"ref21","series-title":"Cryptococcus: From Human Pathogen to Model Yeast","first-page":"585","article-title":"Public health importance of cryptocococcal disease: epidemiology, burden and control","author":"Park","year":"2011"},{"key":"ref22","series-title":"AIDS","first-page":"1663","article-title":"Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study","volume":"16","author":"Mocroft","year":"2002"},{"key":"ref23","series-title":"PLoS One","first-page":"e20272","article-title":"Cross-sectional analysis of late HAART initiation in Latin American and Caribbean: late testers and late presenters","volume":"6","author":"Crabtree-Ramirez","year":"2011"},{"key":"ref24","series-title":"J Acquir Immune Defic Syndr","first-page":"615","article-title":"Mortality during the first year of potent antiretroviral therapy in HIV-1-infected patients in 7 sites throughout Latin America and the Caribbean","volume":"51","author":"Tuboi","year":"2009"},{"key":"ref25","series-title":"Ann Intern Med","first-page":"176","article-title":"Prognostic factors in cryptococcal meningitis. A study in 111 cases","volume":"80","author":"Diamond","year":"1974"},{"key":"ref26","series-title":"Pathol Res Pract","first-page":"427","article-title":"The neuropathology and epidemiology of AIDS. A Berlin experience. A review of 200 cases","volume":"191","author":"Mart\u00ednez","year":"1995"},{"key":"ref27","series-title":"Lancet","first-page":"85","article-title":"Value of necropsy in acquired immune deficiency syndrome","volume":"9","author":"Wilkes","year":"1988"},{"key":"ref28","series-title":"J Acquir Immune Defic Syndr","first-page":"459","article-title":"Diagnostic findings in patients with acquired immune deficiency syndrome (AIDS)","volume":"1","author":"Klatt","year":"1988"},{"key":"ref29","series-title":"PLoS One","first-page":"e69288","article-title":"Cost effectiveness of cryptococcal antigen screening as a strategy to prevent HIV-associated cryptococcal meningitis in South Africa","volume":"8","author":"Jarvis","year":"2013"},{"key":"ref30","series-title":"AIDS","first-page":"2183","article-title":"Long-term outcome of AIDS-associated cryptococcosis in the era of combination antiretroviral therapy","volume":"20","author":"Lortholary","year":"2006"},{"key":"ref31","series-title":"Int J Antimicrob Agents","first-page":"449","article-title":"AIDS-associated Cryptococcus infection before and after the highly active antiretroviral therapy era: emerging management problems","volume":"22","author":"Manfredi","year":"2003"},{"key":"ref32","series-title":"Mycopathologia","first-page":"321","article-title":"Clinical, epidemiological and outcome features of patients with cryptococcosis in Uberaba, Minas Gerais, Brazil","volume":"171","author":"Mora","year":"2012"},{"key":"ref33","series-title":"Vigil\u00e2ncia e Epidemiol\u00f3gica da Criptococose","author":"Minist\u00e9rio da Sa\u00fade","year":"2012"},{"key":"ref34","series-title":"Braz J Infect Dis","first-page":"353","article-title":"Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America","volume":"17","author":"Vidal","year":"2013"},{"key":"ref35","series-title":"Pathol Res Pract","first-page":"549","article-title":"Identification of fungal diseases at necropsy","volume":"208","author":"Colombo","year":"2012"},{"key":"ref36","series-title":"Pathol Res Pract","first-page":"811","article-title":"Autopsy findings in AIDS patients from a reference hospital in Brazil: analysis of 92 cases","volume":"199","author":"Cury","year":"2003"},{"key":"ref37","series-title":"Pathol Res Pract","first-page":"767","article-title":"Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru","volume":"202","author":"Eza","year":"2006"},{"key":"ref38","series-title":"Pathol Res Int","first-page":"547618","article-title":"The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of 236 autopsied cases in Mumbai, India","volume":"2011","author":"Lanjewar","year":"2011"},{"key":"ref39","series-title":"Rev Soc Bras Med Trop","first-page":"247","article-title":"Causes of death among patients with acquired immunodeficiency syndrome autopsied at the Tropical Medicine Foundation of Amazonas [in Portuguese]","volume":"41","author":"Souza","year":"2008"},{"key":"ref40","series-title":"N Engl J Med","first-page":"873","article-title":"The vanishing nonforensic autopsy","volume":"358","author":"Shojania","year":"2008"},{"key":"ref41","series-title":"Am J Public Health","first-page":"1695","article-title":"Autopsy rates among patients reported with AIDS","volume":"84","author":"Schable","year":"1994"},{"key":"ref42","series-title":"Med Mycol","first-page":"522","article-title":"Epidemiology of visceral mycoses in autopsy cases in Japan: the data from 1989 to 2009 in the Annual of Pathological Autopsy Cases in Japan","volume":"51","author":"Suzuki","year":"2013"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/4\/article-p781.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/4\/article-p781.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/4\/article-p781.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T21:56:24Z","timestamp":1723067784000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/4\/article-p781.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,5]]},"references-count":42,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.16-0148","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,5]]}}}