Cerebral cryptococcosis regarding two clinical cases and bibliographic review

Abstract

Cryptococcosis is a life-threatening infection, the species complexes Cryptococcus neoformans and Cryptococcus gattii are yeasts with a polysaccharide capsule, metabolize urea and catecholamines; It is transmitted by inhalation of bird droppings, mainly pigeons, and is capable of causing outbreaks in both immunocompromised and immunocompetent hosts. In Latin America, cryptococcal meningitis is a health threat. The initial infection is localized to the lungs and spreads to other organs, such as the central nervous system, where it causes meningoencephalitis and rarely focal granulomatous lesions such as cryptococcomas. The diagnosis must be made early, with serological tests for the cryptococcal polysaccharide capsular antigen. Treatment is divided into induction, consolidation and maintenance. Below, two clinical cases are presented, the first case is a 68-year-old female with a history of tuberculosis 15 years ago; 10 days, with holocranial headache, nausea and vomiting; on physical examination with superficial stupor, nuchal rigidity; kerning sign (+); lumbar puncture with identification of cryptococcal meningitis, induction treatment with fluconazole was started. The second case, a 60-year-old male with a history of acute lymphoblastic leukemia with chemotherapy 1 month ago, suddenly presented with altered consciousness, a lumbar puncture was performed, which reported cryptococcal meningitis by PCR, induction treatment with fluconazole was started; Both patients were admitted to the Intensive Care Unit, however, they had an unfavorable outcome.