Cryptococcal Disease of the CNS in Immunocompetent Hosts: Influence of Cryptococcal Variety on Clinical Manifestations and Outcome

Abstract

We performed a retrospective review of cases of cerebral cryptococcosis among patients admitted to 12 Australian teaching hospitals between 1985 and 1992. Of 118 cases identified, 35 occurred in immunocompetent hosts. When cases due to Cryptococcus neoformans variety neoformans were compared with those due to Cryptococcus neoformans variety gattii, we found that the latter tended to occur in healthy hosts whose residence or job was located in a rural area, and cerebral mass lesions and/or hydrocephalus and pulmonary mass lesions were more common. For a subgroup of patients with infection due to C. neoformans variety gattii, multiple enhancing lesions were observed on cerebral computed tomograms, and papilledema, high CSF and serum cryptococcal antigen titers, and a worse prognosis (despite prolonged amphotericin B therapy and intraventricular shunt insertion) were also noted. No significant difference in clinical course or outcome in terms of variety of C. neoformans was noted for patients with cryptococcal meningitis whose computed tomographic scans appeared normal on presentation.

Phenotypic Switching of Cryptococcus neoformans and Cryptococcus gattii

“…C. gattii infections have been documented more commonly in immunocompetent individuals, whereas a majority of the patients infected with C. neoformans are immunocompromised, often due to HIV infection [10,11]. Furthermore, some reports have suggested that infections due to C. gattii carry a worse prognosis [12].…”

Fatores prognósticos da meningoencefalite criptocócica

“…Embora vários autores tenham identificado fatores de risco para letalidade [5][6][7][8][9][10][11][12][13] , nenhum estudo com esta finalidade foi realizado no Brasil até então. Assim, procuramos identificar variáveis que, presentes até o momento do diagnóstico, pudessem predizer o desfecho da meningoencefalite criptocócica, em um hospital de referência para doenças infecciosas na cidade de Salvador, nordeste do Brasil.…”

Cryptococcal Meningitis: A Clinicopathological Account of Seven Cases Encountered in a Military Setting

“…Reports of Cryptococcal meningitis in association with sarcoidosis, idiopathic CD4 lymphopenia and neoplastic disease is known [10,[11][12][13]. Cryptococcal meningitis can occur in immunocompetent individuals also [14]. The HIV negative patient in this series could not be fully evaluated in this centre as he was transferred ahead soon after diagnosis.…”

“…False positive results are known to occur especially in the presence of rheumatoid factor, systemic lupus erythematosis and sarcoidosis. Such false positive reactions may be neutralised by pre-treatment of the sample with pronase or with 2-β-mercaptoethanol [12,[13][14][15]. Immunological tests, however were not carried out in this study.…”

“…It is a yeast like fungus, round or oval, usually 4-6 um in diameter with double wall and distinct capsule. Reproduction is by budding [13][14][15][16][17]. It exists as a saprobe in nature.…”