Cryptococcosis in apparently immunocompetent patients (original) (raw)

Cryptococcal Meningitis in Immunocompetent Patient-Case Report

Cryptococcal Meningitis (CM) is a rare infection in immunocompetent patients. A kind of central nervous system infection caused by encapsulated yeast-like fungus Cryptococcus neoformans. A 59-year-old man presented to the Neurology Department of Nova Iguacu General Hospital, complaining has felt "muddled" recently and feeling diaphragmatic spasm without any apparent cause. In addition, at neurological examination, the patient was slightly confused and during the mini-mental state examination he scored less than 20 points, feeling "slowed down", no cranial nerve dysfunction, "rigidity of gait as well as of hand movements, more pronounced on the right one, pyramidal signs bilaterally were more intensely noted on the left". His MRI, lumbar puncture, fungal isolation and Nakin Ink were positive to Cryptococcosis while, in turn, HIV tests I and II were both negative. The treatment was started with Amphotericin B 50 mg IV, once a day, plus Dexamethashone. From our clinical case, we decided to do a brief review about Cryptococcoal Meningitis in immunocompetents and Cryptococcoma, researching at MedLine and Pubmed, using terms "Cryptococcal meningitis", "Cryptococcal meningitis in immunocompetent" and "Cryptococcomas". It is concluded that CM in immunocompetents is uncommon, but an important cause of non-acute meningitis, that should be included in the range of causes of preventable blindness. In this sense, this article purposes advertise clinicians and specialists, to recognize the clinical manifestation and diagnosis of cryptococcal meningitis in immunocompetents, trying to avoid a later diagnosis and the following complications.

Cryptococcal infection in patients with clinically diagnosed meningitis in a tertiary care center

Neurology India, 2003

A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-and-a-half years was carried out to determine the prevalence of cryptococcal infection, its associated risk factors and therapeutic outcome. Fifty-four (16.6%) patients with cryptococcal meningitis were identified by smear examination, culture and/or cryptococcal antigen latex agglutination test. Records of 45 cryptococcal meningitis patients were available; 18 (40%) of them were apparently healthy immunocompetent individuals, 13 (28.9%) had human immunodeficiency virus (HIV) infection, 9 (20%) were renal transplant recipients, 4 (8.9%) were diabetic and 1 (2.2%) had systemic lupus erythematosus. Ten (22.2%) patients died and 11 (24.4%) patients (all HIV-positive) left against medical advice. The present study indicates that cryptococcal infection is associated with high mortality. Presenting symptoms being indistinguishable from other causes of central nervous system infection, all pati...

Clinical and mycological profile of cryptococcosis in a tertiary care hospital

Indian Journal of Medical Microbiology, 2007

This study examined the extent of cryptococcosis in clinically diagnosed cases of meningitis in HIV-1 seropositive and apparently immunocompetent patients. One hundred and forty-six samples, obtained from 126 chronic meningitis patients comprised of cerebrospinal ß uid (CSF), blood, sputum and urine. The samples were processed by standard microbiological procedures. Cryptococcal isolates were identiÞ ed by microscopy, cultural characteristics, melanin production on niger seed agar and hydrolysis of urea. The isolates were further speciated on cannavanine glycine bromothymol blue (CGB) media. Cryptococcal antigen detection of CSF samples was performed by latex agglutination test (LAT). Minimum inhibitory concentration (MIC) of amphotericin B for the isolates was also tested. Cryptococcosis was diagnosed in 13 patients (eight HIV-1 seropositive and Þ ve apparently immunocompetent). Cryptococcus neoformans var. neoformans was the predominant isolate. Cryptococcal antigen was detected in all, whereas microscopy could detect yeast cells in nine patients. The isolates were sensitive to amphotericin B. CD4 cell counts ranged from 8 to 96/cu mm. The study concludes that all CSF samples with clinical diagnosis of subacute and chronic meningitis should be subjected to tests for detection of Cryptococcus in clinical laboratory irrespective of the immune status.

Cryptococcal Meningitis in Immunocompetent Patient

Journal of Ayub Medical College, Abbottabad : JAMC

Cryptococcal meningitis (CM) is life threatening fungal infection of central nervous system (CNS). Although it is commonly associated with immunosuppression but rarely it can occur in immune competent patient. We report a case of 21 year old non HIV infected girl. Based on initial diagnoses of tuberculosis Bacillus meningitis (TBM), she was started on anti-tuberculosis treatment (ATT). However failure to respond to treatment prompted a quest for alternative diagnosis. A final Diagnosis of CM was confirmed on latex agglutination antigen detection on cerebrospinal fluid (CSF) analysis. The patient responded well to antifungal treatment. Initially diagnosis was missed due to common occurrence of tuberculosis infection in Pakistan and resemblance of its symptomatology and magnetic resonance imaging (MRI) findings with CNS cryptoccocal infection.

Correlation between serum cryptococcal antigen titre and meningitis in immunocompetent patients

Journal of medical microbiology, 2018

The aim of this paper was to determine the correlation between serum cryptococcal antigen and a diagnosis of cryptococcal meningitis in the immunocompetent cohort. A retrospective multicentre analysis of immunocompetent patients diagnosed and treated for cryptococcal meningitis between January 2000 and December 2017 was performed. Sixty-seven of the 143 cases of cryptococcosis occurred in immunocompetent patients. The serum cryptococcal antigen titre was significantly higher in the meningitis group [1 : 256 (IQR: 64-1024)] compared with that for non-meningitis patients [1 : 64 (IQR: 8-256)], P=0.012. The relative risk of meningitis with a serum cryptococcal antigen (CRAG) >1 : 64 was 1.8 (95 % CI: 1.15-2.82). This study demonstrates a clear correlation between serum cryptococcal antigen titre and meningitis. While the serum titre is not definitive for meningitis, in resource-limited settings or cases where lumbar puncture may be contraindicated, this evidence may aid diagnosis an...

Fatal Cryptococcal Meningitis in a Non-Hiv Patient: A Case Report

International Journal of Biology, Pharmacy and Allied Sciences, 2021

Cryptococcal infections are fungal infections most commonly seen in immunocompromised patients. Cryptococcus neoformans is a saprophyte usually found in soil contaminated with pigeon droppings. Suspicion to diagnose begins with clinical symptoms that can be non-specific such as fevers and headaches. We present a case of Cryptococcus meningitis (CM) in a patient with cardiopulmonary arrest. A 55 year old male patient came with history of headache with fever since last 3 months. He also had neck regidity for last 3 months. The patient was admitted as a case of Cryptococcal meningitis based on clinical laboratory and radiological features. Investigations were done to rule out other immune system disorders. He was treated with Amphotericine B (IV) and Fluconazole orally for 2 weeks. Culture of CSF was done which showed Cryptococcus neoformans. As a conclusion, Cryptococcus might affect non-HIV patients regardless to their immune system.

Fatal cryptococcal meningitis in a non-HIV patient

International journal of health sciences

Cryptococcal infections (Cryptococcosis) are fatal fungal infections typically caused by Cryptococcus neoformans, a saprophyte frequently found in soil contaminated with pigeon droppings and frequently seen in immunocompromised (specifically HIV Positive) individuals. Now a day’s awareness is emerging on cryptococcal disease among non-immunocompromised patients also. We present a case of Cryptococcus meningitis (CM) in a patient with cardiopulmonary arrest. A 55 year old male patient came with history of headache and fever with neck rigidity since last 3 months. The patient was admitted as a case of CM based on clinical findings and radiological features. Investigations were done to rule out other disorders of the immune system. He was treated with Amphotericine B (IV) and Fluconazole orally for 2 weeks. Culture of CSF was done which showed presence of Cryptococcus neoformans. It is concluded from the findings that Cryptococcus may also affect non-HIV patients regardless to their i...