Keywords
Pregnancy
Prenatal care
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: To review the epidemiological and clinical aspects of cryptococcal meningitis (CM) in pregnant women, with a focus on diagnostic and therapeutic management and complications. Methods: This is an integrative review with a highly sensitive search in the Medline (PubMed), Virtual Health Library (VHL), Web Of Science, Cochrane Library and Embase (Elsevier) databases. To do this, we used the descriptors Meningitis, Cryptococcal and Pregnancy. Results: The inclusion of 13 studies resulted in 24 reports of pregnant women affected by CM, with a mean age of 26.7 years. Half of them were infected in the second trimester (n=12). Most of the pregnant women had positive HIV serology on hospital admission (n=13, 54%). The main clinical findings were headache, nausea, vomiting and symptoms of intracranial hypertension. C. neoformans was responsible for 100% of the infections. The maternal mortality rate was 18.2%, while the fetal/neonatal mortality rate was higher (42.1%). Final considerations: CM is a serious condition in pregnant women, causing high morbidity and mortality. Amphotericin B is the drug of choice, with an induction period of four weeks. The period of consolidation, maintenance and prophylaxis depends on the clinical response and underlying conditions.
References
ABASSI M, et al. Cryptococcal Meningitis: Diagnosis and Management Update. Curr Trop Med Rep, 2015; 2(2): 90-99.
AITKEN GW e SYMONDS EM. Cryptococcal meningitis in pregnancy treated with amphotericin B. A case report. J Obstet Gynaecol Br Emp, 1962; 69: 677-9.
AYE C, et al. Cryptococcosis-the impact of delay to diagnosis. Clin Microbiol Infect, 2016; 22(7): 632-5.
BEARDSLEY J, et al. CryptoDex Investigators. Adjunctive Dexamethasone in HIV-Associated Cryptococcal Meningitis. N Engl J Med, 2016; 374(6): 542-54.
BRIGHT PD, et al. The treatment of a pregnant HIV positive patient with cryptococcal meningitis in Malawi. Case report and review of treatment options. Med Mycol Case Rep, 2017; 19: 9-12.
CHEN CP e WANG KG. Cryptococcal meningitis in pregnancy. Am J Perinatol, 1996; 13(1): 35-6.
CHERIAN J, et al. Shunting in cryptococcal meningitis. J Neurosurg, 2016; 125(1): 177-86.
CORREA EA. Identificação, resistência e sensibilidade de cepas de Cryptococcus neoformans e de Candidas sp., presentes em excretas de pombos no município de Porto Velho, RO – BRASIL. South American Journal of Basic Education, Technical and Technological, 2019; 6(1).
COSTA ML, et al. Cryptococcal meningitis in HIV negative pregnant women: case report and review of literature. Rev Inst Med Trop Sao Paulo, 2009; 51(5): 289-94.
ELY EW, et al. Cryptococcal pneumonia complicating pregnancy. Medicine (Baltimore), 1998; 77(3): 153-67.
FAVALESSA OC, et al. Molecular typing and in vitro antifungal susceptibility of Cryptococcus spp from patients in Midwest Brazil. J Infect Dev Ctries, 2014; 8(8): 1037-43.
FISHER KM, et al. Cryptococcal meningitis: a review for emergency clinicians. Intern Emerg Med, 2021; 16(4): 1031-1042.
FORD N, et al. CD4 Cell Count Threshold for Cryptococcal Antigen Screening of HIV-Infected Individuals: A Systematic Review and Meta-analysis. Clin Infect Dis, 2018; 66(2): 152-159.
HADDOW LJ, et al. Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions. The Lancet infectious diseases, 2010; 10(11): 791-802.
HENAO-MARTÍNEZ AF, et al. Treatment of cryptococcosis in non-HIV immunocompromised patients. Curr Opin Infect Dis, 2018; 31(4): 278-285.
HONG N, et al. Cryptococcosis in HIV-negative Patients with Renal Dialysis: A Retrospective Analysis of Pooled Cases. Mycopathologia, 2017; 182(9-10): 887-896.
JONES JM e CRAIG WA. Cryptococcal meningitis: resolution eight months after antifungal therapy. South Med J, 1983; 76(12): 1567-9.
KHOO CS, et al. Cerebral Lupus and Cryptococcal Meningitis in a Pregnant Woman. J Neurosci Rural Pract, 2020; 11(1): 183-186.
KIGGUNDU R, et al. Unmasking cryptococcal meningitis immune reconstitution inflammatory syndrome in pregnancy induced by HIV antiretroviral therapy with postpartum paradoxical exacerbation. Med Mycol Case Rep, 2014; 29(5): 16-9.
MS. MINISTÉRIO DA SAÚDE. 2019. In: Guia de Vigilância em Saúde: volume único [recurso eletrônico] / Ministério da Saúde, Secretaria de Vigilância em Saúde, Coordenação-Geral de Desenvolvimento da Epidemiologia em Serviços. – 3ª. ed. – Brasília. Disponível em: https ://bvsms.saude.gov.br/ bvs/publica coes/guia_vigilancia_saude_3ed.pdf Acesso em: 22 mar. 2024.
NATH R, et al. Cryptococcus neoformans var. grubii Infection in HIV-Seronegative Patients from Northeast India: Report of Two Cases with Review of Literature. Mycopathologia, 2016; 181(3-4): 315-21.
NAYAK SU, et al. Cryptococcal Meningitis in an HIV-Positive Pregnant Woman. J Int Assoc Physicians AIDS Care (Chic), 2011; 10(2): 79-82.
NUNES JO, et al. Cryptococcal meningitis epidemiology: 17 years of experience in a State of the Brazilian Pantanal. Rev Soc Bras Med Trop, 2018; 51(4): 485-492.
OREFICE RR. Immunology and the immunological response in pregnancy. Best Pract Res Clin Obstet Gynaecol, 2020; 76: 3-12.
OUZZANI M, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev, 2016; 5(1): 210.
Park BJ, et al. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. Aids, 2009; 23(4): 525-530.
PASTICK KA, et al. Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management. Medical mycology, 2020; 58(3): 282-292.
PEREIRA CAP, et al. Cryptococcal meningitis in pregnancy: review of the literature. Report of two cases. Revista do Instituto de Medicina Tropical de São Paulo, 1993; 35: 367-371.
PERFECT JR e BICANIC T. Cryptococcosis diagnosis and treatment: What do we know now. Fungal Genetics and Biology, 2015; 78: 49-54.
PHILPOT CR e LO D. Cryptococcal meningitis in pregnancy. Med J Aust, 1972; 2(18): 1005-7.
PYRGOS V, et al. Epidemiology of cryptococcal meningitis in the US: 1997-2009. PLoS One, 2013; 8(2): 56269.
RAJASINGHAM R, et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis, 2017; 17(8): 873-881.
ROBALO NUNES T, et al. Cryptococcal Meningitis in an HIV-Negative Puerperal Woman. Case Rep Infect Dis, 2021; 6665624.
SANGARÉ I, et al. Prevalence of vulvovaginal candidiasis in pregnancy at three health centers in Burkina Faso. J Mycol Med, 2018; 28(1): 186-192.
SCHUTZ C, et al. Acute Kidney Injury and Urinary Biomarkers in Human Immunodeficiency Virus-Associated Cryptococcal Meningitis. Open Forum Infect Dis, 2017; 4(3): 127.
SLOAN DJ e PARRIS V. Cryptococcal meningitis: epidemiology and therapeutic options. Clin Epidemiol, 2014; 6: 169-82.
URSI ES e GAVÃO CM. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura [Perioperative prevention of skin injury: an integrative literature review]. Rev Lat Am Enfermagem, 2006; 14(1): 124-31.
VIDAL JE, et al. Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America. Braz J Infect Dis, 2013; 17(3): 353-62.
WHO. WORLD HEALTH ORGANIZATION, 2018. Guidelines for The Diagnosis, Prevention and Management of Cryptococcal Disease in HIV-Infected Adults, Adolescents and Children: Supplement to the 2016 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Geneva: World Health Organization; 2018. PMID: 30285342. Disponível em: https ://www.who.int/pu blications/i/item/9789241550277.