Case Report: Cryptococcal meningitis in an apparently immunocompetent patient in Nepal - challenges in diagnosis and treatment (original) (raw)
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Wellcome Open Research
A 50 year old woman from Nepal had clinical features suggestive of meningitis. Cerebrospinal fluid (CSF) analysis was normal except for the presence of cryptococcal antigen. The inclusion of test for Cryptococcus in the CSF helped in making the diagnosis of cryptococcal meningitis in our patient who was apparently immunocompetent. Treatment with liposomal amphotericin B could not be started on time due financial constraints. The patient had a stroke and further deteriorated. Liposomal amphotericin B is stocked by the government of Nepal for free supply to patients with visceral leishmaniasis, but the policy does not allow the drug to be dispensed for other infections. The family members of our patient acquired the drug within a few days from a government center using their political connections and following administering the treatment the patient improved. This case demonstrates the utility of considering cryptococcal meningitis as a differential diagnosis, and including tests for ...
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...
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.
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.
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.
Indian Journal of Medical Microbiology, 2015
untreated, it is invariably fatal with 30-82% mortality as reported in various studies. [2,3] Although, the incidence of CM has declined in HIV patients who are on anti-retroviral therapy, it remains a leading cause of mortality, especially in the developing countries. Studies done in the pre ART era showed HIV infection as a predisposing factor in 43.9% of patients while more recent studies done showed that up to 78.4% of patients with CM are HIV positive. [1,2] Studies from the developed countries show that majority of CM occur in HIV un-infected patients and that the in-hospital mortality was higher among these patients. [1] This may not be the case in developing countries like India with the rapidly increasing incidence of HIV infection. We, therefore, conducted this study to describe the differences in the presentation of CM between HIV-infected and HIV-uninfected patients. Materials and Methods Christian Medical College, Vellore is a 2,700 bedded tertiary care and teaching hospital located in Tamilnadu state of South-India. All adult patients (age > 15 years) who were admitted with microbiologically confi rmed cryptococcal meningitis (CSF fungal culture and/or a positive India ink test and/or positive cryptococcal antigen test) between the period of January 2005 to May 2013 were included in this descriptive study. Individual patient details on clinical presentation, co-morbid illnesses, HIV infection related clinical, immunological and anti-retroviral treatment details, CM treatment, and outcome were collected. Microbiological results on appropriate body fl uids (CSF, blood, and bone
Cryptococcal Meningitis: Diagnosis and Management Update
Current Tropical Medicine Reports, 2015
Recent advances in the diagnosis and management of cryptococcal meningitis are promising and have been improving long-term survival. Point of care testing has made diagnosing cryptococcal meningitis rapid, practical, and affordable. Targeted screening and treatment programs for cryptococcal antigenemia are a cost-effective method for reducing early mortality on antiretroviral therapy (ART). Optimal initial management with amphotericin and flucytosine improves survival against alternative therapies, although amphotericin is difficult to administer and flucytosine is not available in middle-or low-income countries, where cryptococcal meningitis is most prevalent. Controlling increased intracranial pressure with serial therapeutic lumbar punctures has a proven survival benefit. Delaying ART initiation for 4 weeks after the diagnosis of cryptococcal meningitis is associated with improved survival. Fortunately, new approaches have been leading the way toward improving care for cryptococcal meningitis patients. New trials utilizing different combinations of antifungal therapy are reviewed, and we summarize the efficacy of different regimens.
HIV/AIDS (Auckland, N.Z.), 2021
Background Cryptococcal meningitis is a leading cause of mortality in advanced HIV disease. A positive cerebrospinal fluid cryptococcal antigen (CrAg) test defines cryptococcal meningitis. Herein, we present a patient with serum and cerebrospinal fluid CrAg negative cryptococcal meningitis, despite a positive cerebrospinal fluid India ink examination and quantitative culture. Case Details A 56-year-old HIV-positive Ugandan woman, with an undetectable HIV RNA viral load and CD4+ T-cell count of 766 cells per microlitre presented with signs and symptoms consistent with cryptococcal meningitis. Her serum and cerebrospinal fluid CrAg tests were negative despite having a positive cerebrospinal fluid India ink and quantitative culture. On day 1, she was commenced on intravenous amphotericin B deoxycholate (1mg/kg) for 3 days (considering 10 CFU growth of Cryptococcus spp) in combination with oral flucytosine (100mg/kg) for 7 days and then fluconazole 1200mg once daily for the next 11 days...
Cryptococcal Meningitis in a Newly Diagnosed AIDS Patient: A Case Report
West African Journal of Medicine, 2010
BACKGROUND: Cryptococcus neoformans is a very important cause of fungal meningitis in immunosuppressed patients OBJECTIVE: To describe a case of cryptococcal meningoencephalitis in an HIV/AIDS patient from the University of Ilorin Teaching Hospital. METHODS: An 18-year-old male student presented with cough, weight loss, and fever. He was clinically assessed and had full laboratory investigations including cerebrospinal fluid CSF and then started on chemotherapy. Both the clinical and neurological evaluation of the patient was described along with the laboratory analyses of his CSF. Outcome of how he was managed was also reported. RESULTS: Cryptococcus neoformans presented as an AIDS defining fungal infection for the first time in this 18 year old undergraduate who was infected probably from transfusion of unscreened blood He had advanced HIV infection (CD4+ count of 29cells/ul) and severe cryptococcal meningoencephalitis. He was unsuccessfully managed with fluconazole, a second choice drug for this condition, amphotericin B being not available. CONCLUSION: Nigerians should have access to effective blood transfusion services at all public and private hospitals across the country. The National Essential Drug list should be expanded to include drugs such as amphotericin B which hitherto were considered exotic. WAJM 2009; 28(5): 343-346.