Objective: Cryptococcus ne oformansis an encapsulated yeastfound ubiquitously in theenvironment, considered important in immunocompromised individuals with HIV. Non-HIV susceptible groups include malignancies, long-term use of corticos-teroids, solid organ transplantation, sarcoidosis, immunosuppressive therapy, and cirrhosis. Cryptococcal infections are rising in HIV-negative cirrhotic patients, accounting for 6-21% of the systemic infections. Chronic liver disease (CLD) is a neglected risk factor for fungal infections.To analyze epidemiology, risk factors, and antifungal susceptibility profile of HIV-negative liver disease patients. Material Methods: The retrospective study was conducted in tertiary care hepatobiliary center in New Delhi, India from January 2017 to March 2022 after ethical approval. Demographic data, laboratory data, and clinical history of the patients admitted with liver disease and suspected cryptococcal infections were obtained from Hospital records for epidemiology and risk factor analysis.Blood, CSF, serum, urine, and body fluid (Ascitic fluid, peritoneal fluid, pleural fluid, MiniBAL) samples were processed for fungal culture on SDA and SDA with cyclohexamide.Blood and body fluid were also inoculated in an automated blood culture system (BacT/ALERT 3D bioMérieux).Samples were processed for gram stain, India ink, and Cryptococcal anti-gen. Identification was done by an automated identification system (VITEK 2 compact bioMérieux). The micro-broth dilution method (Sensititre YeastOne colorimetric plate, Thermo Fisher Scientific, MA, United States) was used to determine the sus-ceptibility of all Cryptococcus strains to the six antifungal drugs, fluconazole, 5-fluorocytosine, amphotericin B, itraconazole, posaconazole, and voriconazole. The results were reported as wild-type (WT) or non-wild-type (non-WT) in accordance with the epidemiological cut off value (ECV) set for Cryptococcus spp. (Espinel-Ingr off et al., 2012a, b; CLSI, 2018). Results: Weanalyzed 30patients of suspectedcryptococcal infection andobtained 40C.ne oformans isolatesfrom different samples from these patients. Out of 40 samples, C ne oformans was isolated from blood (25,62.5%), urine (6,15%), ascitic fluid (4,10%), mini-BAL (2,5%), bone marrow (1,2.5%), CSF (1,2.5%), pleural fluid (1,2.5%). All samples were positive for Cryptococcal antigen. India ink positivity was observed in 56%. Alcoholic liver disease was the most common risk predictive factor seen in 30% of patients.Hepatitis B and C-associated with CLD was seen in 20%.Other risk predictive factors were AKI (70%), diabetes mellitus (20%), TB (10%), autoimmune hepatitis (6.6%), autoimmune disease (autoimmune hemolytic anemia, Sjogren syndrome) (6.6%), Sarcoidosis (3.3%), Hepatocellular carcinoma (3.3%), HIV (3.3%). Hepatic encephalopathy was seen in 70% of patients which mimics the symptoms of C. meningitis.7.5% (3/40), 5% (2/40), 2.5% (1/40), 7.5% (3/40), and 2.5% (1/40) of C. ne oformans strains were non-WT to fluconazole, 5-fluorocytosine, amphotericin B, posaconazole, and itraconazole, respectively, but all strains were WT to voriconazole. Overall mortality was 66.6%. Conclusion: Above study shows that liver diseases are an important risk factor for cryptococcal infection owing to im-munosuppressed state, use of steroids, and associated comorbidities like DM, TB, AKI, autoimmune disease, Sarcoidosis, hep-atocellular carcinoma. Therefore, it is necessary to investigate and be vigilant about the isolation of Cryptococcus. The use of appropriate antifungals can improve clinical outcomes. As there is increasing resistance to amphotericin B, 5-fluorocytosine, azoles; antifungal susceptibility testing should be done. Cryptococcal antigen detection can be useful in non-CSF samples as well.
CITATION STYLE
Patel, D., Kale, P., Khillan, V., & Sarin, S. K. (2022). P406 Rise in HIV negative Cryptococcal infection in liver disease patient: epidemiology, risk factor, antifungal susceptibility profile from tertiary care hepatobiliary center. Medical Mycology, 60(Supplement_1). https://doi.org/10.1093/mmy/myac072.p406
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