medigraphic.com
Colegio de Medicina Interna de México.

2023, Number 3

<< Back Next >>

Med Int Mex 2023; 39 (3)

Meningeal cryptococcosis in an immunocompetent patient

Bracho-Navarro DF, Cardona-Moica SM, Gómez-Ayala JA, Gómez-Contreras MC

Language: Spanish
References: 10
Page: 548-553
PDF size: 219.65 Kb.


ABSTRACT

Background: Cryptococcosis is the most common cause of fungal meningitis worldwide and has a mortality of about 181,000 cases annually. It affects mainly HIV-positive patients or people with some cellular immune-response compromise. Even though it is an uncommon disease in immunocompetent subjects it may occur in apparently healthy hosts, in whom it must be recognized because the subacute presentation and the late diagnosis can increase morbidity and mortality on this group.
Clinical case: A 67-year-old male patient, apparently immunocompetent, who consulted referring headache, fever and mental status altered. He was diagnosed with meningeal cryptococcosis by microbiological analyses and serum antigens, treated with fluconazole and liposomal amphotericin B and he had an adequate clinical response with no further complications (after finished the treatment) or neurological sequels.
Conclusions: The clinical suspicion of this entity is very important because multiples causes of immunosuppression result in a major predisposition to the disease.


REFERENCES

  1. Bloch KC, Bailin SS. Update on fungal infections of thecentral nervous system: emerging pathogens and emergingdiagnostics. Curr Opin Infect Dis 2019; 32 (3): 277-84. doi:10.1097/QCO.0000000000000541.

  2. Poley M, Koubek R, Walsh L, McGillen B. Cryptococcal meningitisin an apparent immunocompetent patient. J InvestigMed High Impact Case Rep 2019; 7: 232470961983457.doi: 10.1177/2324709619834578.

  3. Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA,Lancaster DJ, et al. Cryptococcosis in human immunodeficiencyvirus–negative patients in the era of effectiveazole therapy. Clin Infect Dis 2001; 33 (5): 690-9. doi:10.1086/322597.

  4. Rajasingham R, Smith RM, Park BJ, Jarvis JN, GovenderNP, Chiller TM, et al. Global burden of disease of HIVassociatedcryptococcal meningitis: an updated analysis.Lancet Infect Dis 2017; 17 (8): 873-81. doi: 10.1016/S1473-3099(17)30243-8.

  5. Williamson PR, Jarvis JN, Panackal AA, Fisher MC, MolloySF, Loyse A, et al. Cryptococcal meningitis: epidemiology,immunology, diagnosis and therapy. Nat Rev Neurol 2017;13 (1): 13-24. doi: 10.1038/nrneurol.2016.167.

  6. Ramírez-Ramos C, Galindo J, Correa S, Giraldo-Bahamon G,Rivera J, Solano J, et al. Meningitis criptocóccica en pacientessin infección por VIH: presentación de dos casos y revisiónde la literatura. Rev Chil Infectol 2018; 35 (6): 716-21.http://dx.doi.org/10.4067/S0716-10182018000600716.

  7. Desalermos A, Kourkoumpetis TK, Mylonakis E. Updateon the epidemiology and management of cryptococcalmeningitis. Expert Opin Pharmacother 2012; 13 (6): 783-9.doi: 10.1517/14656566.2012.658773.

  8. Newsome J, Nguyen D. Cryptococcal meningitis causedby Cryptococcus neoformans in an immunocompetentsoldier. Mil Med 2014; 179 (9): e1059-61. doi: 10.7205/MILMED-D-14-00020.

  9. Louro R, Ferreira R, Pinheiro C, Parada H, Faria D, MonteiroE. Fungal meningitis in an immunocompetent patient. ClinDrug Investig 2013; 33 (S1): 47-50. doi: 10.1007/s40261-012-0021-5.

  10. Poley M, Koubek R, Walsh L, McGillen B. Cryptococcal meningitisin an apparent immunocompetent patient. J InvestigMed High Impact Case Rep 2019; 7: 232470961983457.doi: 10.1177/2324709619834578.




2020     |     www.medigraphic.com