García RJ, Aguirre RK, Sahagún SOE, Ruelas TG, Espinoza CJL

Language: Spanish
References: 12
Page: 222-225
PDF size: 298.38 Kb.

ABSTRACT

Introduction: cryptococcal meningitis is the most common cause of fungal meningitis. Patients with some kind of immunocompromise are the most frequently affected (for example patients with HIV, poorly controlled diabetes or use of immunosuppressors), but these risk factors are not absolutely needed for its appearance. It is still considered a rare disease and the clinical symptoms are nonspecific, a high degree of clinical suspicion is necessary for diagnosis, particularly if the initial manifestations are atypical. Clinical case: a 52-year-old man with clinical record of poorly controlled diabetes. He came for evaluation due to clinical data of an occipital cerebral vascular event (sudden left amaurosis) with subsequent mental status impairment, he was diagnosed with cryptococcosis by Indian ink staining and treated with liposomal amphotericin B. He subsequently developed brain death. Conclusions: clinical suspicion is important in patients with neurological symptoms without an obvious etiology and risk factors for the development of cryptococcosis, since diagnosis and prompt treatment are key to the survival of these patients.

REFERENCES

1. Bloch KC, Bailin SS. Update on fungal infections of the central nervous system: emerging pathogens and emerging diagnostics. Curr Opin Infect Dis. 2019;32(3):277-284. doi: 10.1097/QCO.0000000000000541.

2. Poley M, Koubek R, Walsh L, McGillen B. Cryptococcal meningitis in an apparent immunocompetent patient. J Investig Med 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 immunodeficiency virus–negative patients in the era of effective azole therapy. Clin Infect Dis. 2001;33(5):690-699. doi: 10.1086/322597.

4. Williamson PR, Jarvis JN, Panackal AA, Fisher MC, Molloy SF, 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.

5. Ramírez-Ramos C, Galindo J, Correa S, Giraldo-Bahamon G, Rivera J, Solano J, et al. Meningitis criptocóccica en pacientes sin infección por VIH: presentación de dos casos y revisión de la literatura. Rev Chil Infectol. 2018;35(6):716-721. doi: 10.4067/S0716-10182018000600716.

6. Bracho-Navarro DF, Cardona-Moica SM, Gómez-Ayala JA, Gómez-Contreras MC. Criptococosis meníngea en un paciente inmunocompetente. Med Int Méx. 2023;39(3):548-553.

7. Mwaba P, Mwansa J, Chintu C, Pobee J, Scarborough M, Portsmouth S, et al. Clinical presentation, natural history, and cumulative death rates of 230 adults with primary cryptococcal meningitis in Zambian AIDS patients treated under local conditions. Postgrad Med J. 2001;77(914):769-773.

8. Mishra AK, Vanjare HA, Raj PM. Cryptococcal meningitis presenting as acute onset bilateral cerebellar infarct. J Neurosci Rural Pract. 2017;8:159-160.

9. Zhou W, Lai J, Huang T, Xu Y, Hu S. Cryptococcal meningitis mimicking cerebral infarction: a case report. Clin Interv Aging. 2018;13:1999-2002. doi:10.2147/cia.s181774

10. Lan SH, Chang WN, Lu CH, Lui CC, Chang HW. Cerebral infarction in chronic meningitis: a comparison of tuberculous meningitis and cryptococcal meningitis. QJM. 2001;94(5):247-253.

11. Fugate JE, Lyons JL, Thakur KT, Smith BR, Hedley-Whyte ET, Mateen FJ. Infectious causes of stroke. Lancet Infect Dis. 2014,14(9):869-880. doi: 10.1016/S1473-3099(14)70755-8.

12. Katchanov J, Branding G, Jefferys L, Arastéh K, Stocker H, Siebert E. Neuroimaging of HIV-associated cryptococcal meningitis: comparison of magnetic resonance imaging findings in patients with and without immune reconstitution. Int J STD AIDS. 2016;27(2):110-117. doi: 10.1177/0956462415574633.