scholarly journals Central Nervous System Vasculitis for Cryptococcosis in an Immunocompetent Patient

Diseases ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 75 ◽  
Author(s):  
Dan Zimelewicz Oberman ◽  
Liliana Patrucco ◽  
Carolina Cuello Oderiz
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cryptococcus Neoformans ◽  
Cryptococcal Meningitis ◽  
Fungal Pathogen ◽  
Immunocompetent Patient ◽  
Central Nervous System Vasculitis ◽  
Diagnostic Challenge ◽  
Threatening Condition ◽  
Life Threatening

Cryptococcal meningitis is a life-threatening condition caused by a fungal pathogen, Cryptococcus neoformans, that can infect both immunosuppressed and immunocompetent hosts. It is an important cause of morbidity and mortality in severely immunodeficient patients. However, in an immunocompetent patient it represents a diagnostic challenge, mainly because it is extremely rare, but also because of its nonspecific clinical manifestation. Neurovascular involvement in cryptococcal meningitis is rare and not well known and only few reports have described this association. We describe a cryptococcal meningitis in an immunocompetent patient associated with central nervous system vasculitis.

scholarly journals Identification of Genes from the Fungal Pathogen Cryptococcus neoformans Related to Transmigration into the Central Nervous System

PLoS ONE ◽  
2012 ◽  
Vol 7 (9) ◽  
pp. e45083 ◽  
Author(s):  
Hsiang-Kuang Tseng ◽  
Chang-Pan Liu ◽  
Michael S. Price ◽  
Ambrose Y. Jong ◽  
Jui-Chih Chang ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cryptococcus Neoformans ◽  
Fungal Pathogen ◽  
The Central Nervous System

scholarly journals The Role of Catheter Angiography in the Diagnosis of Central Nervous System Vasculitis

2016 ◽  
Vol 5 (3-4) ◽  
pp. 194-208 ◽  
Author(s):  
Randall C. Edgell ◽  
Ahmed E. Sarhan ◽  
Jazba Soomro ◽  
Collin Einertson ◽  
Joanna Kemp ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Decision Making ◽  
Case Series ◽  
Low Frequency ◽  
Catheter Angiography ◽  
Central Nervous System Vasculitis ◽  
Diagnostic Challenge ◽  
Pubmed Database ◽  
Angiographic Findings

Background: Central nervous system vasculitis (CNSV) is a rare disorder, the pathophysiology of which is not fully understood. It involves a combination of inflammation and thrombosis. CNSV is most commonly associated with headache, gradual changes in mental status, and focal neurological symptoms. Diagnosis requires the effective use of history, laboratory testing, imaging, and biopsy. Catheter angiography can be a powerful tool in the diagnosis when common and low-frequency angiographic manifestations of CNSV are considered. We review these manifestations and their place in the diagnostic algorithm of CNSV. Summary: We reviewed the PubMed database for case series of CNSV that included 5 or more patients. Demographic and angiographic findings were collected. Angiographic findings were dichotomized between common and low-frequency findings. A system for incorporating these findings into clinical decision-making is proposed. Key Message: CNSV is a diagnostic challenge due to the absence of a true gold standard test. In the absence of such a test, catheter angiography remains a central piece of the diagnostic puzzle when appropriately employed and interpreted.

scholarly journals Central nervous system vasculitis in a patient with HIV infection: a diagnostic challenge

2017 ◽  
Vol 75 (12) ◽  
pp. 897-898 ◽  
Author(s):  
Nícolas de O. Amui ◽  
Roberta G. F. Silva ◽  
Danilo M. C. Costa ◽  
Orlando G. P. Barsottini ◽  
José Luiz Pedroso ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Hiv Infection ◽  
Central Nervous System Vasculitis ◽  
Diagnostic Challenge

scholarly journals Isolated cryptococcal osteomyelitis in an immunocompetent patient

2011 ◽  
Vol 5 (09) ◽  
pp. 669-673 ◽  
Author(s):  
Irfan Qadir ◽  
Farheen Ali ◽  
Umair Zafar Malik ◽  
Masood Umer
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cryptococcus Neoformans ◽  
Complete Recovery ◽  
Immunocompetent Patient ◽  
The Central Nervous System ◽  
Hiv Negative

Cryptococcosis is a rare infection in HIV-negative individuals. While the lungs and the central nervous system are most commonly infected, skeletal cryptococcosis is uncommon and isolated osteomyelitis due to Cryptococcus neoformans is quite rare. To our knowledge, only 47 cases of isolated cryptococcal osteomyelitis have been reported from 1974 to 2005. We report a case of isolated cryptococcal osteomyelitis in an immunocompetent patient, who received 12 weeks of fluconazole with complete recovery.

scholarly journals Central Nervous System Tuberculosis: An Imaging-Focused Review of a Reemerging Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Morteza Sanei Taheri ◽  
Mohammad Ali Karimi ◽  
Hamidreza Haghighatkhah ◽  
Ramin Pourghorban ◽  
Mohammad Samadian ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Correct Diagnosis ◽  
Miliary Tuberculosis ◽  
Imaging Characteristics ◽  
Threatening Condition ◽  
Life Threatening ◽  
Neurological Conditions ◽  
Cns Tuberculosis ◽  
Made In

Central nervous system (CNS) tuberculosis is a potentially life threatening condition which is curable if the correct diagnosis is made in the early stages. Its clinical and radiologic manifestations may mimic other infectious and noninfectious neurological conditions. Hence, familiarity with the imaging presentations of various forms of CNS tuberculosis is essential in timely diagnosis, and thereby reducing the morbidity and mortality of this disease. In this review, we describe the imaging characteristics of the different forms of CNS tuberculosis, including meningitis, tuberculoma, miliary tuberculosis, abscess, cerebritis, and encephalopathy.

scholarly journals Anti-neutrophil cytoplasmic antibody–associated vasculitis complicated with diffuse alveolar haemorrhage and central nervous system vasculitis

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110118
Author(s):  
Takashi Nawata ◽  
Kaori Murakawa ◽  
Kosaku Shiragami ◽  
Masaki Shibuya ◽  
Makoto Kubo ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Systemic Vasculitis ◽  
Alveolar Haemorrhage ◽  
Simultaneous Occurrence ◽  
Cerebral Stroke ◽  
Diffuse Alveolar Haemorrhage ◽  
Central Nervous System Vasculitis ◽  
Rare Presentation ◽  
Life Threatening

Diffuse alveolar haemorrhage and central nervous system vasculitis are life-threatening complications of anti-neutrophil cytoplasmic antibody-associated vasculitis. The simultaneous occurrence of diffuse alveolar haemorrhage and central nervous system vasculitis is a rare presentation of antibody-associated vasculitis. Its diagnosis by histopathology is difficult because biopsy is difficult to perform, and urgent treatment is needed. We report a case of a Japanese man with diffuse alveolar haemorrhage and central nervous system vasculitis associated with antibody-associated vasculitis. New classification criteria may be needed for diffuse alveolar haemorrhage and central nervous system vasculitis associated with systemic vasculitis. When antibiotic-resistant atypical bilateral pneumonia is noted in the acute phase of a cerebral stroke, with elements suggestive of vasculitis, clinicians should be aware that diffuse alveolar haemorrhage and central nervous system vasculitis may occur simultaneously.

Cryptococcal arthritis in an immunocompetent migrant

2020 ◽  
Vol 27 (4) ◽  
Author(s):  
Alexandra Mokrzycki ◽  
Vanina Meyssonnier ◽  
Beate Heym ◽  
Thomas Aubert ◽  
Antoine Mouton ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Medical Treatment ◽  
Cryptococcus Neoformans ◽  
Immunocompetent Patient ◽  
Total Recovery ◽  
The Central Nervous System ◽  
Immunocompetent Patients

Cryptococcosis is a rare infection in immunocompetent patients. While the lungs and the central nervous system are most often involved, skeletal cryptococcosis is uncommon. We report a case of isolated osteoarthritis of the ankle due to Cryptococcus neoformans in a 24-year-old immunocompetent patient, who underwent surgical and medical treatment with total recovery at 6 months.

scholarly journals CARD9 Is Required for Classical Macrophage Activation and the Induction of Protective Immunity against Pulmonary Cryptococcosis

mBio ◽  
2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Althea Campuzano ◽  
Natalia Castro-Lopez ◽  
Amanda J. Martinez ◽  
Michal A. Olszewski ◽  
Anutosh Ganguly ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Immune Cells ◽  
Fungal Pathogen ◽  
Protective Immunity ◽  
Macrophage Activation ◽  
Lectin Receptors ◽  
Content Type ◽  
Life Threatening ◽  
Deficient Mice

ABSTRACT Caspase recruitment domain-containing protein 9 (CARD9) is a critical adaptor molecule triggered by the interaction of C-type lectin receptors (CLRs) with carbohydrate motifs found in fungi. Consequently, clinical and animal studies indicate that CARD9 is an important regulator of protective immunity against fungal pathogens. Previous studies suggest that CARD9 is important for the induction of protection against Cryptococcus neoformans, an opportunistic fungal pathogen that causes life-threatening infections of the central nervous system in immunocompromised patients. However, the effect of CARD9 deficiency on the induction of protective immune responses against C. neoformans is unknown. Immunization with a C. neoformans mutant that overexpresses the transcription factor zinc finger 2, denoted LW10, results in protection against an otherwise lethal challenge with wild-type (WT) C. neoformans. Our results showed that CARD9 is essential for the induction of vaccine-mediated immunity against C. neoformans infection. We observed significant decreases in interleukin-17 (IL-17) production and significant increases in Th2-type cytokine (IL-4, IL-5, and IL-13) production in CARD9-deficient mice after inoculation with strain LW10. While leukocyte infiltration to the lungs of CARD9-deficient mice was similar in LW10 and WT C. neoformans-infected mice, macrophages derived from CARD9-deficient mice inherently skewed toward an M2 activation phenotype, were unable to contain the growth of LW10, and failed to produce nitric oxide in response to infection with LW10 or stimulation with lipopolysaccharide. These results suggest that CARD9-mediated signaling is required for M1 macrophage activation and fungicidal activity necessary for the induction of vaccine-mediated immunity against C. neoformans. IMPORTANCE Cryptococcus neoformans is a fungal pathogen that is found throughout the environment and can cause life-threatening infections of the lung and central nervous system in severely immunocompromised individuals. Caspase recruitment domain-containing protein 9 (CARD9) is a critical molecule that is activated after interactions of C-type lectin receptors (CLRs) found on the surfaces of specific immune cells, with carbohydrate structures associated with fungi. Patients with defects in CARD9 are significantly more susceptible to a multitude of fungal infections. C. neoformans contains several carbohydrate structures that interact with CLRs on immune cells and activate CARD9. Consequently, these studies evaluated the necessity of CARD9 for the induction of protective immunity against C. neoformans infection. These results are important, as they advance our understanding of cryptococcal pathogenesis and host factors necessary for the induction of protective immunity against C. neoformans.

scholarly journals Dissemination of Cryptococcus neoformans via localised proliferation and blockage of blood vessels

2017 ◽  
Author(s):  
Josie F Gibson ◽  
Robert J Evans ◽  
Aleksandra Bojarczuk ◽  
Richard Hotham ◽  
Anne K Lagendijk ◽  
...  
Keyword(s):  
Blood Vessel ◽  
Cryptococcus Neoformans ◽  
Blood Vessels ◽  
Cryptococcal Meningitis ◽  
Fungal Pathogen ◽  
Vascular Damage ◽  
Cryptococcal Infection ◽  
Vessel Damage ◽  
Junction Protein ◽  
Life Threatening

AbstractCryptococcus neoformans is an opportunistic fungal pathogen that can cause life-threatening cryptoccocal meningitis, predominantly within immunocompromised individuals. Cortical infarcts are observed in as many as 30% of cryptococcal meningitis cases, being particularly common in severe infection. Limited clinical case studies suggest infarcts are secondary to vasculitis and blood vessel damage caused by cryptococcal infection. However, the cause of infarcts in cryptococcal infection has not been determined. To examine potential causes of vascular damage and cryptococcal dissemination in cryptococcal infection, the zebrafish C. neoformans infection model was used. We demonstrate that spread of cryptococci from the vasculature occurs at sites where cryptococci grow within the blood vessels, originating from a single or small number of cryptococci. We find that cryptococcal cells become trapped within the vasculature and can proliferate there resulting in vasodilation. Localised cryptococcal growth in the vasculature is also associated with sites of dissemination – in some cases simultaneously with a loss of blood vessel integrity. Using a cell-cell junction protein reporter (VE-cadherin) we identified sites dissemination associated with both intact blood vessels and where vessel rupture occurred. Thus, we have identified a mechanism for blood vessel damage during cryptococcal infection that may represent a cause of the vascular damage and cortical infarction observed in cryptococcal meningitis.Author summaryHuman infection by the fungal pathogen, Cryptococcus neoformans, can lead to life-threatening cryptococcal meningitis. In severe cases of cryptococcal meningitis, a lack of blood supply can cause tissue death and a resulting area of dead tissue (infarct) in the brain. Although vasculature inflammation in known to occur in cryptococcal meningitis, the cause of infarcts in unknown. Using a zebrafish model of cryptococcal infection, the growth and dissemination of fungal cells was observed over time. We show that cryptococcal cells become trapped and proliferate in the vasculature, resulting in cryptococcoma that damage the blood vessels. We propose that vessel damage results from increased blood pressure caused by cryptococci blocking blood vessels suggesting that the vascular damage that ensues on cryptococcoma formation may in turn be a cause of infarct formation seen in cryptococcal meningitis.

DIAGNOSTIC VALUE OF SPECIFIC ANTIBODY SYNTHESIS IN BRAIN OF PATIENTS WITH NEUROINFECTIONS

2019 ◽  
Vol 72 (8) ◽  
pp. 1437-1441
Author(s):  
Pavel Dyachenko ◽  
Igor Filchakov ◽  
Anatoly Dyachenko ◽  
Victoria Kurhanskaya
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Manifestations ◽  
Diagnostic Value ◽  
Diagnostic Challenge ◽  
Specific Antibodies ◽  
Intrathecal Synthesis ◽  
Varicella Zoster ◽  
Mrz Reaction ◽  
Wide Range

Introduction: Viral encephalitis accounts for 40-70% of all cases worldwide, central nervous system infections pose a diagnostic challenge because clinical manifestations are not typically pathognomonic for specific pathogens, and a wide range of agents can be causative. The aim: To assess the diagnostic value of intrathecal synthesis of specific antibodies in patients with inflammatory lesions of the central nervous system. Materials and methods: Within the framework of the study, two groups of 90 people in each were formed from the patients with neuroinfections admitted to our Center. Intrathecal synthesis (ITS) of total (unspecific) IgG in members of one of group (group of compare) was determined. Brain synthesis of specific antibodies (Ab) to some neurotropic pathogens (herpes simplex virus 1/2, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, rubella virus, Borrelies) was studied in the second group of patients (group of interest). There were no statistically significant differences between groups by gender and age. Encephalitis and encephalomyelitis prevailed among patients of both groups Results: ITS of total IgG was established in 30 (33.3 ± 6.1 %) patients of the first group with IgG index more than 0.6 indicating on inflammatory process in CNS and no marked changes of CSF. ITS of specific Ab was determined in 23 of 90 (25.6 ± 4.6 %) patients included into group of interest. In more than half of cases Ab to several infectious agents were detected simultaneously. ITS of various specificity, in particular, to measles and rubella viruses, and VZV, known as MRZ-reaction, is characteristic of some autoimmune lesions of CNS, multiple sclerosis first of all. In fact, further research of 5 patients with MRZ-reaction confirmed their autoimmune failure of CNS. Detection of ITS in the CSF samples didn’t depend on concentration of specific Ab in serum and CSF and wasn’t followed by HEB dysfunctions which were observed with the same frequency in patients with or without ITS (13.0 % and 13.6 % respectively). Conclusion: Specific Ab synthesis to several neurotropic pathogens in the CSF of significant part of examined patients was established. Thus, diagnostic value of ITS of specific immunoglobulins seems to be limited to cases in which autoimmune damage of the CNS is suspected.

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