RESUMO
BACKGROUND: Cryptococcal meningitis (CM) is an inflammatory mycosis of the central nervous system caused by meninge infection or brain parenchyma with Cryptococcus species. It is associated with high morbidity and mortality, and patients with acquired immune deficiency syndrome are particularly susceptible. There have been increasing reports of CM in HIV-negative patients in China over the last few years. CASE PRESENTATION: A 31-year-old healthy Chinese male presented with fever and gradually developed headache, projectile vomiting, and other manifestations that were later confirmed as Cryptococcus gattii meningoencephalitis. However, multiple disease changes occurred during the course of treatment, and the regimen was accordingly modified after the diagnosis of post-infectious inflammatory response syndrome (PIIRS). The patient eventually recovered. CONCLUSION: There has been a growing trend in the incidence of C. gattii meningoencephalitis in HIV-negative patients. It shows rapid onset and severe prognosis. This case report can provide a reference to treat PIIRS following CM in HIV-negative patients.
Assuntos
Cryptococcus gattii , Inflamação , Meningite Criptocócica , Meningoencefalite , Humanos , Masculino , Adulto , Meningoencefalite/complicações , Meningoencefalite/diagnóstico por imagem , Meningoencefalite/tratamento farmacológico , Infecções por HIV , Inflamação/etiologia , Imageamento por Ressonância Magnética , Meningite Criptocócica/complicações , Meningite Criptocócica/diagnóstico por imagem , Meningite Criptocócica/tratamento farmacológicoRESUMO
The hyper IgM syndromes are a rare group of primary immunodeficiency. The X-linked Hyper IgM syndrome (HIGM), due to a gene defect in CD40L, is the commonest variant; it is characterized by an increased susceptibility to a narrow spectrum of opportunistic infection. A few cases of HIGM patients with Cryptococcal meningoencephalitis (CM) have been described in the literature. Herein we report the case of a young male diagnosed in infancy with HIGM who developed CM complicated by a post-infectious inflammatory response syndrome (PIIRS), despite regular immunoglobulin replacement therapy and appropriate antimicrobial prophylaxis. The patient was admitted because of a headache and CM was diagnosed through detection of Cryptococcus neoformans in the cerebrospinal fluid. Despite the antifungal therapy resulting to negative CSF culture, the patient exhibited persistent headaches and developed diplopia. An analysis of inflammatory cytokines on CSF, as well as the brain MRI, suggested a diagnosis of PIIRS. Therefore, a prolonged corticosteroids therapy was started obtaining a complete resolution of symptoms without any relapse.
Assuntos
Síndrome de Imunodeficiência com Hiper-IgM Tipo 1/complicações , Meningite Criptocócica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Corticosteroides/uso terapêutico , Humanos , Masculino , Meningite Criptocócica/diagnóstico por imagem , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/imunologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Adulto JovemAssuntos
Cistos/complicações , Cistos/diagnóstico por imagem , Hospedeiro Imunocomprometido , Meningite Criptocócica/complicações , Meningite Criptocócica/diagnóstico por imagem , Esclerose Múltipla/imunologia , Adulto , Antifúngicos/uso terapêutico , Fluconazol/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Meningite Criptocócica/tratamento farmacológico , Esclerose Múltipla/tratamento farmacológico , Púrpura Trombocitopênica/tratamento farmacológico , Púrpura Trombocitopênica/imunologia , Resultado do TratamentoRESUMO
BACKGROUND: This case report emphasizes that cryptococcal meningitis could be uncommonly presented to otolaryngologists as sudden onset of hearing loss, especially in patients with underlying diseases that could cause immunocompromise, and highlights the importance of differentiated diagnosis on sudden hearing loss before steroid therapy. It also demonstrates that prompt and sufficient fungicidal therapy with appropriate supportive treatment is crucial for a good prognosis on cryptococcal meningitis. CASE PRESENTATION: A diabetic adult with untreated chronic hepatitis B was admitted complaining of sudden onset of left-sided hearing loss, following unexpected aggravating headache with meningeal signs after hospitalization with days of intratympanic steroid therapy. Cryptococcal meningitis was confirmed through lumbar puncture showing positive India ink staining and microbial culture of the cerebrospinal fluid (CSF). Fortunately, the patient recovered after prompt and adequate fungicidal therapy plus appropriate supportive treatment at last, though persistent hearing loss remained. CONCLUSIONS: Cryptococcal meningitis could be presented in a very concealed way as sudden hearing loss, especially in patients with underlying diseases that could cause immunosuppression. Differentiated diagnosis on sudden hearing loss before steroid therapy is important.
Assuntos
Perda Auditiva Súbita/microbiologia , Meningite Criptocócica/complicações , Meningite Criptocócica/diagnóstico por imagem , Antifúngicos/uso terapêutico , Complicações do Diabetes , Diabetes Mellitus , Diagnóstico Diferencial , Perda Auditiva Súbita/diagnóstico , Hepatite B Crônica/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite Criptocócica/líquido cefalorraquidiano , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-IdadeRESUMO
There are still no unified guidelines of surgical treatment and timing for human immunodeficiency virus (HIV)-negative patients with cryptococcal meningitis (CM).The clinical data and follow-up data were collected from HIV-negative CM patients in Xiangya Hospital of Central South University from January 2009 to November 2018, and 42 patients who were treated with surgical intervention were enrolled in the present study. These 42 patients were divided into ventriculoatrial (VA) group, ventriculoperitoneal group, external ventricle drainage (EVD) group, hydrocephalus (HYC) group, non-HYC group, EVD group, and non-EVD group (VA/ ventriculoperitoneal) according to different surgical procedures. Statistical analyses were conducted using SPSS (version 19.0, Chicago, IL).Signs of headache, fever, and loss of consciousness in the VA group were significantly improved compared with the EVD group at 1 week after operation (Pâ<â.05). The mortality rate of the VA group was significantly lower than that of the EVD group (Pâ<â.05). Moreover, male patients were more prone to have HYC (Pâ<â.05). Younger patients tended to develop HYC (Pâ<â.05). Cerebrospinal fluid sugar in the non-HYC group was significantly lower compared with the HYC group (Pâ<â.05). Time of CM-to-operation in the non-HYC group was markedly shorter compared with the HYC group (Pâ<â.01).VA procedure could be one of the first choices for the treatment of uncontrollable intracranial hypertension caused by CM. Severe uncontrollable headache, loss of consciousness, and cerebral hernia were indications of emergency surgery. Repeated headache, hearing impairment, and especially progressive loss of vision were indications of early surgery to avoid permanent damage to nerve functions of HIV-negative CM patients.
Assuntos
Soronegatividade para HIV , Meningite Criptocócica/cirurgia , Duração da Cirurgia , Adolescente , Adulto , Idoso , Criança , China , Feminino , Humanos , Masculino , Meningite Criptocócica/diagnóstico por imagem , Meningite Criptocócica/mortalidade , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Cryptococcal meningitis (CM) is the most common fungal infection of the central nervous system and has high morbidity and mortality. Almost studies about prognostic factors have largely focused on the immunocompromised population rather than immunocompetent patients. So that we sought to conduct a retrospective study to determine prognostic factors which predict the outcomes in immunocompetent patients with CM. METHODS: We retrospectively collected and analyzed the demographic and clinical data of 76 apparently immunocompetent patients with cryptococcal meningitis from January 2003 to June 2019 in China. The clinical outcome was graded by the Glasgow outcome scale (GOS) at discharge, and patients were divided into good (score of 5) and unfavorable (score of 1-4) outcome groups, potential prognostic factors were analyzed. RESULTS: Non-parametric test confirmed that unfavorable outcome was associated with lower glucose level of CSF(P = 0.001), and Pearson's χ2 analysis confirmed that unfavorable outcome was associated with opening pressure of CSF(>300mmH20, P = 0.038), impaired consciousness (P = 0.001), hydrocephalus(P = 0.045), and Shunt surgery (P = 0.045), and then multiple logistic regression analysis confirmed that impaired consciousness(P = 0.015) and lower glucose concentration of CSF(P = 0.012) increased the likelihood of unfavorable outcome in CM patients. CONCLUSION: Impaired consciousness and decreased glucose concentration of CSF were independently prognostic factors which predict the unsatisfactory outcome in immunocompetent patients with CM.
Assuntos
Estado de Consciência , Glucose/líquido cefalorraquidiano , Meningite Criptocócica/etiologia , Adulto , China , Feminino , Humanos , Hidrocefalia/etiologia , Hospedeiro Imunocomprometido , Masculino , Meningite Criptocócica/diagnóstico por imagem , Meningite Criptocócica/terapia , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
We report a 55-year-old man with Cryptococcus neoformans meningitis who showed refractory deterioration twice with an increased cerebrospinal fluid cryptococcal antigen titer during the course of treatment. Although the initial deterioration was temporarily improved by placement of a ventriculoperitoneal shunt, he experienced deterioration again. However, he improved after administration of systemic corticosteroids. The present case suggests that systemic corticosteroid can be a choice of treatment to rescue immunocompetent patients with Cryptococcus neoformans meningitis and severe deterioration, even if cerebrospinal fluid analysis shows an increased cryptococcal antigen titer.
Assuntos
Corticosteroides/uso terapêutico , Antígenos de Fungos/efeitos dos fármacos , Meningite Criptocócica/tratamento farmacológico , Encéfalo/diagnóstico por imagem , Cryptococcus neoformans , Humanos , Masculino , Meningite Criptocócica/diagnóstico por imagem , Pessoa de Meia-Idade , Próteses e Implantes , Derivação VentriculoperitonealRESUMO
Disease caused by Cryptococcus gattii typically manifests as meningoencephalitis or pulmonary nodules. Endobronchial lesions are rare, and most cases are caused by Cryptococcus neoformans. We describe here a case of endobronchial disease in a child caused by C gattii. The disease spectrum in this patient was notable for the discovery of anti-granulocyte macrophage colony-stimulating factor autoantibodies.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Autoanticorpos/sangue , Brônquios/microbiologia , Broncopatias/microbiologia , Cryptococcus gattii/isolamento & purificação , Fator Estimulador de Colônias de Granulócitos e Macrófagos/imunologia , Meningite Criptocócica/diagnóstico por imagem , Obstrução das Vias Respiratórias/diagnóstico , Animais , Antifúngicos/uso terapêutico , Encéfalo/diagnóstico por imagem , Brônquios/patologia , Broncopatias/diagnóstico , Broncopatias/terapia , Broncoscopia , Criança , Criptococose/complicações , Criptococose/diagnóstico por imagem , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imageamento por Ressonância Magnética , Meningoencefalite/diagnóstico por imagem , Meningoencefalite/microbiologia , Phascolarctidae/microbiologiaRESUMO
We report two cases of cryptococcosis, associated with anti-granulocyte-macrophage colony-stimulating factor antibodies. We review this recently identified acquired form of autoimmune immune deficiency and discuss the potential applications of granulocyte-macrophage colony-stimulating factor antibody testing by enzyme-linked immunosorbent assay.
Assuntos
Autoanticorpos/imunologia , Criptococose/diagnóstico , Criptococose/imunologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/imunologia , Adulto , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Autoanticorpos/sangue , Encéfalo/diagnóstico por imagem , Criptococose/tratamento farmacológico , Cryptococcus neoformans , Ensaio de Imunoadsorção Enzimática , Humanos , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/imunologia , Imageamento por Ressonância Magnética , Masculino , Meningite Criptocócica/diagnóstico por imagem , Meningite Criptocócica/imunologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Following a fatal case of Cryptococcus neoformans meningitis in a child with X-linked hyper-immunoglobulin M syndrome (XHIGM), we evaluated the fungal isolate in an experimental infection in a mouse model with respect to microbiology, epidemiology, virulence and response to therapy. The minimum inhibitory concentrations for antifungals in the susceptibility test were 0.5mg/L for amphotericin B, 4.0mg/L for fluconazole and 0.12mg/L for voriconazole. Evaluation of pathogenicity by means of an experimental infection in BALB/c mice showed that fungus isolated from the blood and cerebrospinal fluid of the child was able to disseminate, reaching the spleen, lungs and brain, where it caused significant macroscopic alterations in the size and texture of each organ. Treatment of infected mice with amphotericin B reduced the fungal load in the spleen and lungs, but not in the brain.
Assuntos
Cryptococcus neoformans/isolamento & purificação , Cryptococcus neoformans/patogenicidade , Síndrome de Imunodeficiência com Hiper-IgM Tipo 1/complicações , Síndrome de Imunodeficiência com Hiper-IgM Tipo 1/microbiologia , Meningite Criptocócica/diagnóstico por imagem , Meningite Criptocócica/microbiologia , Anfotericina B/farmacologia , Animais , Antifúngicos/farmacologia , Pré-Escolar , Cryptococcus neoformans/efeitos dos fármacos , Modelos Animais de Doenças , Evolução Fatal , Humanos , Síndrome de Imunodeficiência com Hiper-IgM Tipo 1/diagnóstico , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Testes de Sensibilidade Microbiana , Tomografia Computadorizada por Raios XRESUMO
This report describes a 30-year-old immunocompetent male with new-onset seizures, later found on imaging to have 2 enhancing lesions in the brain. The patient underwent a left parietal craniectomy with resection of one of the masses, which demonstrated focal areas of necrosis and many small cystic structures positive for periodic acid-Schiff and Gomori's methenamine silver special stain. Numerous laboratory examinations, including HIV test, rapid plasma reagin, toxoplasma immunoglobulin G and immunoglobulin M, Lyme, cytomegalovirus, tuberculosis, cysticercosis, and Echinococcus serology, were all negative. Despite negative cerebrospinal fluid (CSF) culture and several negative CSF antigen tests, continued investigation, and follow-up, CSF antigen testing ultimately revealed Cryptococcus as the causative agent. In light of the mysterious and unusual presentation, the authors discuss potential infectious differential diagnoses in patients with atypical clinical presentation, laboratory tests, and surgical pathology.
Assuntos
Meningite Criptocócica/complicações , Convulsões/microbiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/microbiologia , Encéfalo/cirurgia , Cryptococcus , Diagnóstico Tardio , Humanos , Imunocompetência , Imageamento por Ressonância Magnética , Masculino , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/diagnóstico por imagem , Meningite Criptocócica/cirurgia , Neuroimagem , Convulsões/diagnóstico por imagem , Convulsões/etiologia , Tomografia Computadorizada por Raios XAssuntos
Infarto Encefálico/etiologia , Letargia/etiologia , Meningite Criptocócica/complicações , Tálamo/diagnóstico por imagem , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Infarto Encefálico/diagnóstico por imagem , Flucitosina/uso terapêutico , Humanos , Letargia/diagnóstico por imagem , Masculino , Meningite Criptocócica/diagnóstico por imagem , Meningite Criptocócica/tratamento farmacológicoRESUMO
BACKGROUND: The elderly, and especially those with an immuno-compromised status, are vulnerable to infectious diseases. The purpose of this study was to examine the clinical characteristics and therapeutic outcomes of cryptococcal meningitis (CM) in elderly patients in Taiwan. METHODS: Ninety-nine adult patients with CM were identified during a 15-year study period (2002-2016), of whom 38 elderly (≥ 65 years) patients (16 men and 22 women, median age 72.9 years; range 65-86 years) were included for analysis. The clinical characteristics and therapeutic outcomes of these patients were analyzed and compared to non-elderly adult patients (< 65 years) with CM. RESULTS: Among the 38 patients, diabetes mellitus was the most common underlying condition (15), followed by adrenal insufficiency (7), malignancy (6), hematologic disorders (5), chronic obstructive pulmonary disease (5), autoimmune diseases (3), liver cirrhosis (3) and acquired immunodeficiency syndrome (1). Altered consciousness (29), fever (21) and headache (17) were the leading clinical manifestations. Positive cerebrospinal fluid and blood cultures for Cryptococcus (C.) neoformans were found in 26 and 9 patients, respectively. There were significant differences in gender, altered consciousness and recent cerebral infarction between the elderly and non-elderly groups. The elderly group had a high mortality rate (36.8%, 14/38), and the presence of cryptococcemia was the most significant prognostic factor. CONCLUSIONS: This study offers a preliminary view of the clinical characteristics of CM in the elderly. The results suggest that elderly patients (≥ 65 years) are more vulnerable to CM than adults aged < 65 years. Compared to the non-elderly group, the elderly group had female predominance, higher rates of altered consciousness and recent cerebral infarction as the clinical presentation. The presence of cryptococcemia was a significant prognostic factor in the elderly group. This study is limited by the small number of patients, and further large-scale studies are needed to better delineate this specific infectious syndrome.
Assuntos
Hospitalização/tendências , Meningite Criptocócica/diagnóstico por imagem , Meningite Criptocócica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infarto Cerebral/sangue , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico por imagem , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Meningite Criptocócica/sangue , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVE: Cryptococcal meningitis carries a high mortality, and survivors are left with considerable neurologic sequelae and marked disability. We lack a clear understanding of the pathogenesis of neurologic sequelae and description of stroke features in this population. We aim to describe clinical and radiographic features and predictors of stroke in a cohort of patients with cryptococcal meningitis. METHODS: We collected key information on patients diagnosed with cryptococcal meningitis at the University of Colorado Hospital between 2000 and 2018 (nâ¯=â¯42). Of those, 32 had neuroimaging studies available. Bivariate and risk ratio estimates regression models were performed to identify predictors of stroke. RESULTS: We found a 26% ischemic stroke complication rate in individuals with cryptococcal meningitis. Most strokes were acute (75%), lacunar (100%), multiple (88%), bilateral (63%), and involving the basal ganglia (75%). Presence of malignancy (38% versus 8%, P = .085) was higher in stroke in individuals with cryptococcal meningitis, although not statistically significant. Every unit decrease in hemoglobin and serum sodium were predictors for 1.35 and 1.14 times increase in the risk of ischemic stroke, respectively. The presence of hyponatremia carried a RR of 5.7 (95% confidence interval, 1.7-34, P = .005). Cryptococcal meningitis lead to death in 19% of patients and a considerable rate of neurologic sequela among survivors. CONCLUSIONS: Cryptococcal meningitis carries a high risk of lacunar stroke, particularly in the basal ganglia. Cryptococcal meningitis-associated stroke is common and frequently associated with neurologic disability among survivors. We need to understand the possible role of malignancy, anemia, and hyponatremia in the onset of ischemic stroke.
Assuntos
Imageamento por Ressonância Magnética , Meningite Criptocócica/diagnóstico por imagem , Acidente Vascular Cerebral Lacunar/diagnóstico por imagem , Adulto , Idoso , Colorado , Avaliação da Deficiência , Feminino , Humanos , Masculino , Meningite Criptocócica/complicações , Meningite Criptocócica/microbiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral Lacunar/microbiologia , Fatores de TempoAssuntos
Cryptococcus neoformans , Cistos/diagnóstico por imagem , Encefalite Infecciosa/diagnóstico por imagem , Imageamento por Ressonância Magnética , Meningite Criptocócica/diagnóstico por imagem , Adulto , Cistos/complicações , Feminino , Humanos , Encefalite Infecciosa/complicações , Imageamento por Ressonância Magnética/métodos , Meningite Criptocócica/complicaçõesRESUMO
BACKGROUND: The incidence of cryptococcal meningitis among immunocompetent patients increases, especially in China and imaging plays an important role. The current study was to find the correlation between magnetic resonance imaging (MRI) manifestation and clinical severity in nonhuman immunodeficiency virus patients with cryptococcal infection of central nervous system (CNS). METHODS: A total of 65 patients with CNS cryptococcal infection from August 2014 to October 2016 were retrospectively included in this study. All the patients had MRI data and clinical data. The patients were divided into two groups according to whether the patients were confirmed with identifiable underlying disease. Comparison and correlation of MRI and clinical data in both groups were investigated using independent sample t- test, Chi-square test, Mann-Whitney test and Spearman rank correlation analysis. RESULTS: In all 65 patients, 41 cases (41/65, 63.1%; Group 1) had normal immunity and 24 cases (24/65, 36.9%; Group 2) had at least one identifiable underlying disease. Fever, higher percentage of neutrophil (NEUT) in white blood cell (WBC), and increased cell number of cerebral spinal fluid (CSF) were much common in patients with underlying disease (Group 1 vs. Group 2: Fever: 21/41 vs. 21/24, χ2 = 8.715, P = 0.003; NEUT in WBC: 73.15% vs. 79.60%, Z = -2.370, P = 0.018; cell number of CSF: 19 vs. 200, Z = -4.298, P < 0.001; respectively). Compared to the patients with normal immunity, the lesions are more common in the basal ganglia among patients with identifiable underlying disease (Group 1 vs. Group 2: 20/41 vs. 20/24, χ2 = 7.636, P = 0.006). The number of the involved brain areas in patients with identifiable underlying disease were well correlated with the number of cells and pressure of CSF (r = -0.472, P = 0.031; r = 0.779, P = 0.039; respectively). CONCLUSIONS: With the increased number of the involved brain areas in patients with identifiable underlying disease, the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.
Assuntos
Encefalite/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Meningite Criptocócica/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
We report a 45-year-old male with AIDS who had a Cryptococcus neoformans central nervous system infection. He was treated with amphotericin B deoxycholate subsequently changed to voriconazole due to systemic toxicity of the former. Plasma levels of voriconazole were insufficient with a standard dose (0.7 μg/mL), therefore, the dose was increased thereafter to reach appropriate levels (4.5 μg/mL). Anti-retroviral therapy was started five weeks after voriconazole initiation with non-interacting drugs and he was discharged after a favorable evolution. He was re-admitted three months later due to seizures; a brain magnetic resonance showed new sub-cortical nodules. After excluding alternative causes and demonstrating fungal eradication, an immune reconstitution inflammatory syndrome (IRIS) event was suspected and treated with a short course of steroids. His evolution was satisfactory.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Anfotericina B/efeitos adversos , Meningite Criptocócica/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Ácido Desoxicólico/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Voriconazol/administração & dosagem , Antifúngicos/efeitos adversos , Anfotericina B/administração & dosagem , Meningite Criptocócica/diagnóstico por imagem , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Ácido Desoxicólico/administração & dosagem , Combinação de Medicamentos , Antifúngicos/administração & dosagemRESUMO
Cryptococcus gattii traditionally infects immunocompetent hosts and causes devastating pulmonary or central nervous system disease. However, this infection rarely occurs in patients infected with HIV. We report 3 cases of HIV-associated C. gattii complex infections in the southeastern United States. Detection of C. gattii in HIV-infected patients in this region warrants increased awareness of this threat to ensure appropriate diagnosis and treatment to optimize patient outcomes.
Assuntos
Cryptococcus gattii/isolamento & purificação , Infecções por HIV/diagnóstico por imagem , HIV/isolamento & purificação , Meningite Criptocócica/diagnóstico por imagem , Adulto , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Masculino , Meningite Criptocócica/complicações , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/microbiologia , Pessoa de Meia-Idade , Sudeste dos Estados Unidos , Tomografia Computadorizada por Raios XRESUMO
Cryptococcal meningitis (CM) is the most common type of fungal meningitis. The clinical symptoms of CM are nonspecific, and neuroimaging characteristics are variable. Herein, we present a case of a senile female with CM that was once misdiagnosed as cerebral infarction. Her condition worsened and she developed hydrocephalus. No apparent predisposing factors of CM were reported in this patient. The diagnosis of CM was definitely made after India ink staining of cerebrospinal fluid was positive. This case indicates that clinicians should bear cryptococcal infection in mind when the symptoms are nonspecific and neuroimaging findings are atypical.