scholarly journals A fatal case of meningitis caused by Cryptococcus neoformans var. grubii in an immunocompetent male

2010 ◽  
Vol 5 (01) ◽  
pp. 071-074 ◽  
Author(s):  
Prashant Gupta ◽  
Shruti Malik ◽  
Vineeta Khare ◽  
Gopa Banerjee ◽  
Anurag Mehrotra ◽  
...  
Keyword(s):  
Developing Countries ◽  
Cryptococcus Neoformans ◽  
Cryptococcal Meningitis ◽  
Fatal Case ◽  
Immunocompromised Patients ◽  
Course Of Illness ◽  
Cryptococcal Infection ◽  
Immunocompetent Patients

The incidence of cryptococcal infection is high in developing countries such as India. Cryptococcal meningitis is considered rare in immunocompetent patients and is mainly a disease of immunocompromised patients. Prognosis in immunocompetent patients is generally considered good. We report a fatal case of cryptococcal meningitis in an immunocompetent male caused by Cryptococcus neoformans var. grubii. Whether the patient is immunocompromised or immunocompetent, the outcome of the disease can be severe unless the disease is diagnosed early in the course of illness.

scholarly journals 1404. The FilmArray Meningitis/Encephalitis (FA ME) May Be of Higher Yield in the Immunocompromised Patient Population

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S511-S511
Author(s):  
Nirja Mehta ◽  
Jesse T Jacob ◽  
Christina Dean ◽  
Zanthia Wiley ◽  
Eileen Burd ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Chart Review ◽  
Hematologic Malignancy ◽  
False Negative ◽  
Small Sample ◽  
Cns Infection ◽  
Steady Increase ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Immunocompetent Patients

Abstract Background The FilmArray® Meningitis/Encephalitis (FA ME) panel is a PCR-based assay that rapidly detects 14 pathogens directly from CSF specimens. After the introduction of this assay at our institution, there was a steady increase in requests for use; however, the positivity rate remained stable. We sought to understand the characteristics of the patients most likely to have a positive FA ME panel, with particular interest in the immune status of each patient. Methods A retrospective chart review was conducted on 124 patients with suspected infectious meningitis/encephalitis at a large academic tertiary referral center who received FA ME testing between October 2016 and November 2018. Patients were considered immunocompromised if they had received chemotherapy, were solid-organ transplant recipients, or were diagnosed with HIV, autoimmune diseases on immunosuppressants, uncontrolled diabetes, cirrhosis, or hematologic malignancy. Clinical CNS infection was determined using chart review based on culture, serologic, or molecular data. Results 60 (48%) patients were immunocompromised and 64 (52%) patients were immunocompetent. Clinical CNS infection occurred in ~25% of immunocompetent (17, 26%) and immunocompromised (17, 28%) patients. However, only 6 immunocompetent patients were found to have a positive FA ME; this accounts for only 35% of the total number of positive FA ME assays during this study period (P = 0.08). Notably, 4 out of 6 patients with cryptococcal meningitis had false-negative results on the FA ME. Conclusion In spite of the relatively small sample size, there was a trend toward significance in the accurate yield of the FA ME panel in the immunocompromised population compared with the immunocompetent. Our immunocompromised patients appear to be more likely to have an infection which is tested for on the panel. The rates of confirmed CNS infections in both populations were very similar, indicating that immunocompromised patients may benefit more from use of this assay. In our study, immunocompetent patients were more likely to have West Nile infection, for example, which is not on the panel. Additionally, had cryptococcal meningitis been accurately diagnosed by the FA ME, an even greater number of immunocompromised patients would have had a positive FA ME. Disclosures All authors: No reported disclosures.

scholarly journals The virulence of the Cryptococcus neoformans VNIa-5 lineage is highly plastic and associated with isolate background

2020 ◽  
Author(s):  
Trieu Phan Hai ◽  
Thanh Lam Tuan ◽  
Duong Van Anh ◽  
Trinh Nguyen Mai ◽  
Lan Nguyen Phu Huong ◽  
...  
Keyword(s):  
Cryptococcus Neoformans ◽  
Culture Filtrate ◽  
Secreted Proteins ◽  
Immunocompromised Patients ◽  
Present Evidence ◽  
Sterile Culture ◽  
Virulence Phenotype ◽  
Almost All ◽  
Highly Virulent ◽  
Immunocompetent Patients

AbstractCryptococcus neoformans most frequently causes disease in immunocompromised patients. However, in Vietnam and east Asia, disease is frequently reported in apparently immunocompetent patients. We have previously shown that almost all such disease is due to a specific lineage of C. neoformans – VNIa-5. However, in HIV-infected patients, infections due to this lineage are not associated with worse outcomes. Here, we demonstrate that the VNIa-5 lineage presents different virulence phenotypes depending on its source. Isolates derived from immunocompetent patients are more virulent than those from HIV-infected patients or the environment. Moreover, the virulence phenotype is plastic – sterile culture filtrate from highly virulent VNIa-5 strains can induce increased virulence in less virulent VNIa-5 isolates, which in turn can then induce increased virulence in their low virulence states. We present evidence that this phenomenon is driven by secreted proteins associated with extra-cellular vesicles.

scholarly journals Possibility of diagnosing meningitis by gas chromatography: cryptococcal meningitis

1976 ◽  
Vol 3 (3) ◽  
pp. 239-245
Author(s):  
D Schlossberg ◽  
J B Brooks ◽  
J Shulman
Keyword(s):  
Gas Chromatography ◽  
Cerebrospinal Fluid ◽  
Liquid Chromatography ◽  
Cryptococcus Neoformans ◽  
Electron Capture ◽  
Cryptococcal Meningitis ◽  
Viral Infections ◽  
Viral Meningitis ◽  
Gas Liquid Chromatography ◽  
Cryptococcal Infection

Cerebrospinal fluid (CSF) from eight patients with cryptococcal meningitis, from ten patients with viral meningitis, and from four control patients without meningitis were analyzed by electron-capture gas-liquid chromatography (EC-GLC). All cryptococcal specimens had similar EC-GLC profiles, and these differed from those of the controls. Viral EC-GLC patterns were different from those obtained with specimens from the patients with cryptococcal infection and from the controls. In addition, specimens from patients with various types of viral infections gave profiles that differed from each other. Two normal CSFs were inoculated with Cryptococcus neoformans; aliquots of these cultures showed an EC-GLC pattern very similar to that seen in CSF of patients with cryptococcal meningitis. The EC-GLC procedure is rapid, reproducible, and easy to perform and may hold promise as an additional aid in the diagnosis of cryptococcal infection.

scholarly journals Disseminated Cryptococcosis Incorrectly Managed: a Case Report

2019 ◽  
pp. 28-31
Author(s):  
Adil Maleb ◽  
Aziza Hami ◽  
Yassine Ben Lahlou ◽  
Somiya Lamrabat ◽  
Safaa Rifai ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Blood Culture ◽  
Fungal Infection ◽  
Fatal Outcome ◽  
Microbiological Analysis ◽  
Immunocompromised Patients ◽  
Bacteriological Examination ◽  
Cryptococcal Infection ◽  
Immunocompetent Patients

Disseminated cryptococcosis is a rare fungal infection, which mainly occurs in immunocompromised patients, and the diagnosis is difficult. Therefore, it is less likely to be considered in immunocompetent patients. Here, we present a case of fatal cryptococcal infection of the pleural fluid and ascites in a patient seronegative for HIV. The patient was a 45-year old man who was followed for Crohn's disease and treated with steroids and an immunosuppressant (azathioprine). The culture of pleural and ascites fluids showed the presence of yeasts colonies identified as Cryptococcus neoformans. Bacteriological examination of the blood culture or cerebrospinal fluid (CSF) was not prescribed. The HIV serology was negative. At the fourth day of treatment, the patient died because of the deterioration of neurological and hepatocellular functions. The main diagnostic problems that led to this fatal outcome were non-suspicion of an at-risk patient, lack of microbiological analysis of the blood or CSF, and inadequate antifungal therapy.

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.

Treatment of Non-HIV Cryptosporidial Diarrhea with Azithromycin

1995 ◽  
Vol 29 (10) ◽  
pp. 991-993 ◽  
Author(s):  
Robert E Bessette ◽  
Guy W Amsden
Keyword(s):  
High Dose ◽  
Immunocompromised Patients ◽  
Excessive Weight Loss ◽  
The Past ◽  
Excessive Weight ◽  
Case Summary ◽  
Effective Option ◽  
Stool Cultures ◽  
Immunocompetent Patients

Objective: To report a patient with non-HIV-related cryptosporidial diarrhea who was treated effectively with a regimen of high-dose azithromycin therapy. Case Summary: A 42-year-old immunocompetent man contracted cryptosporidiosis from an ailing calf that he had purchased. He finally was admitted to the hospital because of excessive weight loss and profuse diarrhea. The patient was started on a course of high-dose azithromycin therapy and symptoms resolved within 48 hours. Follow-up stool cultures were negative for the parasite. Discussion: Although usually associated with immunocompromised patients, cryptosporidiosis occurs in immunocompetent hosts in a significant portion of the reported cases each year. Although self-limiting in most cases in this population, the disease can be severe at times and require treatment. Paromomycin therapy has been used in the past with good results. Although macrolides have had erratic effects against this parasite in the past, azithromycin (an azalide) demonstrated good efficacy in this patient. Conclusions: Azithromycin has demonstrated that it may be an effective option for the treatment of cryptosporidiosis in immunocompetent patients. Studies involving its use in immunocompromised patients are currently underway.

scholarly journals Prostatic tuberculosis: case report

2008 ◽  
Vol 126 (4) ◽  
pp. 227-228 ◽  
Author(s):  
Daniel Sáenz-Abad ◽  
Santiago Letona-Carbajo ◽  
José Luis de Benito-Arévalo ◽  
Isabel Sanioaquín-Conde ◽  
Francisco José Ruiz-Ruiz
Keyword(s):  
Computed Tomography ◽  
Mycobacterium Tuberculosis ◽  
Case Report ◽  
Urine Culture ◽  
Immunocompetent Patient ◽  
Immunocompromised Patients ◽  
Tuberculosis Case ◽  
Immunocompetent Patients

CONTEXT: Tuberculosis of the prostate has mainly been described in immunocompromised patients. However, it can exceptionally be found as an isolated lesion in immunocompetent patients. CASE REPORT: We report a case of prostatic tuberculosis in a young, healthy and immunocompetent patient with unremarkable findings from intravenous urographic examination. Computed tomography showed an abscess in the prostate and Mycobacterium tuberculosis was isolated in a urine culture. Treatment with isoniazid, rifampin and pyrazinamide was successful.

scholarly journals Primary Cutaneous Cryptococcosis in an Immunocompetent 6-Year-Old Female

2018 ◽  
Vol 2 (4) ◽  
pp. 240-242
Author(s):  
Mitchell Hobbs ◽  
Joy King ◽  
Rana El Feghaly ◽  
Robert Brodell
Keyword(s):  
Cryptococcus Neoformans ◽  
Skin Lesions ◽  
Immunocompetent Patient ◽  
Immunocompromised Patients ◽  
Oral Fluconazole ◽  
Healthy Female ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Cutaneous Cryptococcosis ◽  
Superficial Culture

A 6-year-old otherwise healthy female presented to the ED with a right eyebrow lesion for one month.  Previous I&D attempts and empiric antibiotic treatment had failed to improve the lesion.  Following dermatology referral, superficial culture resulted with growth of Cryptococcus neoformans after which completion of oral fluconazole treatment resolved the lesion.  Though Cryptococcus neoformans infections commonly plague immunocompromised patients, primary cutaneous cryptococcosis in the immunocompetent patient is a rare but documented infection with a paucity of reported pediatric cases, and frontline physicians should be aware of such a diagnosis in the setting of persistent skin lesions without response to more commonly utilized therapies.

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