Cryptoccoccal meningitis in post-covid 19 patient in the city of manaus: Case report

Cryptococcosis is a cosmopolitan and opportunistic mycosis, caused mainly by the etiological agent Cryptococcus neoformans, through the inhalation of fungal structures, especially in bird feces. The aim of this study was to report a reported case of cryptococcal meningitis in an immunosuppressed patient due to previous COVID-19 infection in the city of Manaus-AM, as well as to implement health education actions to prevent cryptococcosis in the region of the disease. Information about the case was obtained through access to the database of the Information System for Notifiable Diseases (SINAN), made available by the Center for Control of Zoonoses Dr. Carlos Durand (CCZ), an agency belonging to the Municipal Health Department of Manaus (SEMSA). The case patient, male, presented symptoms such as headache, fever, vomiting, seizures, neck stiffness, petechiae and hemorrhagic suffusions, hearing loss and signs of Kernig and Brudzinski. In a zoosanitary visit to the site of the injury, the presence of pigeon excreta on the walls of the residence was found, and cleaning was carried out without the use of personal protective equipment (PPE’s). The contact with the residents evidenced the lack of information about the zoonosis addressed, including the risk of transmission of cryptococcosis by pigeons, facts that make necessary more sanitary actions on zoonoses among the population of Manaus.

Herpes Zoster in Immunosuppressed Patients

Herpes zoster (HZ) is a disease caused by the activation of the virus in the latent phase. The name of the virus is varicella-zoster virus (VZV). This virus remains in the dorsal root ganglia, the collection of neuronal cell bodies. It is known as reactivation because it is a secondary infection. The main or the old infection is chickenpox; it generally occurs in the early stages of life. This secondary infection is caused in the later stages of life in old age patients; if the patient is immunocompromised, this type of infection can cause death or make the patient unconscious. But in the world, many people have a variety of standard or uncommon signs and symptoms of this disease based on their body, diet, area, or even genetic features. This Herpes Zoster acts on the immune response called cell-mediated immunity and decreases it rapidly with the advance of age of the person. In the coming years, the incidences of this disease are gradually increasing because of the weakening of the immune system. The incidences also happened in people with defective immunity of cell-mediated type or due to the abuse of certain drugs. The herpes zoster is caused to the immunosuppressed patient more quickly than the average population. As there is no immune system to defend the body, some secondary infections can also be induced in these conditions and lead to death. This multiple infection can make a differential diagnosis. This review explains and understands the herpes zoster virus causing different complications in the body and other clinical things related to immunocompromised patients.

Fasciitis by Lactococcus garvieae on an immunosuppressed patient by Diabetes Mellitus

Lactococcus garvieae, a gram-positive anaerobe facultative coccus, is a well-known pathogen in the aquaculture and cattle sector, being extremely rare for human beings. There are some case reports of infections caused by this microorganism, however, there are no fasciitis cases up to date. This is a case of a 24-year-old patient with uncontrolled diabetes mellitus and previous COVID-19 pneumonia without sequelae, admitted to the emergency room for a case compatible with fasciitis. Three cultures for L. garvieae were obtained from surgical debridement and microbiological studies were performed using automated VITEK-2 equipment. No posterior complications were documented. The patient went through a skin graft with a favorable response without evidence of clinical relapse.

Emergence of SARS-CoV-2 resistance mutations in a patient who received anti-SARS-COV2 spike protein monoclonal antibodies: a case report

Background To manage severe or potentially severe cases of CoronaVirus Disease 2019 (COVID-19), therapeutic monoclonal antibodies targeting Spike protein of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) have been designed. It has been noted in vitro that upon exposure to these treatments, mutations could be selected. Case presentation We here report the case of an immunosuppressed patient infected with a B.1.1.7 variant, who received a combination of monoclonal antibodies, and subsequently selected mutations K417N, E484K and Q493R on Spike protein of SARS-CoV-2. Conclusions Our case raises the importance of monitoring SARS-CoV-2 mutations in patients receiving monoclonal antibodies and having persistent excretion of the virus, in order to offer optimal management of their infection, and strengthen prevention measures to avoid subsequent transmission of these selected variants.

Brain paracoccidioidomycosis in an immunosuppressed patient with systemic lupus erythematosus

Background: Brain paracoccidioidomycosis (PCM) or neuroparacoccidioidomycosis (NPCM) is a fungal infection of the central nervous system (CNS) caused by Paracoccidioides brasiliensis, a dimorphic fungus. The CNS involvement is through bloodstream dissemination. The association between NPCM and systemic lupus erythematous (SLE) is rare. However, SLE patients are under risk of opportunistic infections given their immunosuppression status. Case Description: The aim of this case report is to present a 37-year-old female with diagnosis of SLE who presented with progressive and persistent headache in the past 4 months accompanied by the right arm weakness with general and neurologic examination unremarkable. The computerized tomography of the head showed left extra-axial parietooccipital focal hypoattenuation with adjacent bone erosion. The brain magnetic resonance imaging reported left parietooccipital subdural collection associated with focal leptomeningeal thickening with restriction to diffusion and peripheral contrast enhancement. The patient underwent a left craniotomy and dura mater biopsy showed noncaseous granulomatosis with multinucleated giant cells with rounded birefringent structures positive for silver stain, consistent with PCM. Management with itraconazole 200 mg daily was started with a total of 12 months of treatment, with patient presenting resolution of headache and right arm weakness. Conclusion: The diagnosis of NPCM is challenging and a high degree of suspicious should be considered in patients with persistent headache and immunosuppression.

Cryptococcal Meningoencephalitis in an Immunosuppressed Patient with Chronic Lymphocytic Leukemia

Cryptococcal meningoencephalitis, an invasive fungal infection caused by an encapsulated fungus Cryptococcus neoformans should be suspected in immune compromised individuals with defective cell-mediated immunity and patients on immunosuppressive drugs with recent development of fever, confusion and loss of consciousness. A rapid diagnosis is fundamental for decreasing morbidity and mortality from cryptococcal disease. Cerebrospinal fluid (CSF) study and simple stain like India Ink Stain can be performed for diagnosis of cryptococcal meningoencephalitis. Here, we report a case of cryptococcal meningoencephalitis in chronic lymphocytic leukemia (CLL) patient on immunosuppressive drugs diagnosed by CSF study and India ink stain which responded dramatically with antifungal agents after diagnosis. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 87-89