Cryptococcal meningitis in Chinese patients with systemic lupus erythematosus

Zhong, Yi; Li, Min; Liu, Jia; Zhang, Weixi; Peng, Fuhua

doi:10.1016/j.clineuro.2015.01.023

Cited by 12 publications

(12 citation statements)

References 32 publications

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“…C. neoformans is the predominant species to cause cryptococcosis in our study. Our results were in consistent with other studies conducted in the same or nearby regions, which reported that C. neoformans are responsible for 66.7% and 100% of the cryptococcosis [8,21].…”

Section: Discussionsupporting

confidence: 93%

Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study

et al. 2020

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Background: Cryptococcal infection is a life-threatening complication in patients with connective tissue disease (CTD). This retrospective study was performed to explore the clinical features and associated factors of cryptococcosis in patients with CTD from southern China. Methods: Demographic and clinical data were collected between 2007 and 2018. Associated factors were analyzed by logistic regression analysis. Results: A total of 6809 inpatients with CTD were included. Cryptococcosis was diagnosed in 30 patients (prevalence, 0.4%). Cryptococcosis was predominant in patients with ANCAassociated vasculitis (AAV) (prevalence, 6/530, 1.1%). Lung was commonly involved (18/30, 60.0%), followed by meninges (6/30, 20.0%), blood stream (5/30, 16.7%) and disseminated cryptococcosis (1/30, 3.3%). Infiltrates (10/18, 55.6%) and small nodules (8/18, 44.4%) were the main radiographic manifestation of pulmonary cryptococcosis (PC). The positive rate of serum cryptococcal antigen (CrAg) in patients with PC was 88.2%. Cryptococcus spp. were found in 75% (3/4) patients who underwent lung biopsy. Most of the patients with cryptococcal meninges (CM) had elevated cerebrospinal fluid (CSF) opening pressure (6/7, 85.7%) and decreased CSF glucose level (5/7, 71.4%). Positive blood culture confirmed the diagnosis of cryptococcal sepsis (CS). Three patients died (10.0%), including one with CM and two with PC. Multivariate logistic regression analysis showed that accumulated dose of glucocorticoid (GC) odds ratio (OR) = 1.42, 95% confidence interval (CI) 1.08-1.87, P = 0.01 was associated with cryptococcosis in patients with CTD. Conclusions: Cryptococcosis developed in various organs. Typical radiological manifestation accompanied with positive serum CrAg were helpful clues for diagnosis. Lumbar puncture was a critical diagnostic method to distinguish CM. The accumulated dose of GC was associated with cryptococcosis in patients with CTD. Background Infection is one of the major threats to patients with connective tissue disease (CTD) because of the immune disturbance and immunosuppressive therapy [1 ,2 ]. As one of the opportunistic infections, invasive fungal disease (IFD) is a matter of concern in immunocompromised hosts. Our previous study found that approximately 1.1% of the lupus patients develops IFD [3]. Aspergillus spp., Candida spp. and Cryptococcus spp. are the common causative agents. However, due to the limitation of sample

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Section: Discussionsupporting

confidence: 93%

Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study

et al. 2020

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“…2 There have been a few case reports worldwide of pediatric patients with SLE diagnosed with cryptococcal infection. 3 Cryptococcus neoformans first enters the body via inhalation into the respiratory tract. It can cause meningoencephalitis by entering the central nervous system through hematogenous dissemination.…”

Section: Discussionmentioning

confidence: 99%

“…However, CSF indices may be normal in culture-proven cryptococcal or antigen-positive cryptococcal meningitis, as seen in this patient. 3 The opening pressure may be extremely high although this is observed most often in patients with AIDS. 4 In this case, an opening pressure was not measured.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Meningitis in a Teenage Boy with Systemic Lupus Erythematosus

Ruan

Abraham

TeKippe

et al. 2016

J Pediatr Infect Dis

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There are approximately 1 million new cases of cryptococcal meningitis each year and most cases occur among people with human immunodeficiency virus/acquired immunodeficiency syndrome. There have been rare case reports worldwide of pediatric patients with systemic lupus erythematosus (SLE) diagnosed with the cryptococcal infection. We present a teenage boy with SLE and severe lymphopenia who developed cryptococcal meningitis to demonstrate the importance of considering this diagnosis in the absence of characteristic neurological signs and symptoms.

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“…It is estimated that 18 to 67% of SLE patients have central nervous system (CNS) involvement. 4 Infections account for 20–55% of morbidity and mortality in SLE, 5 with the CNS being responsible for 3% of these infections. 5,6 Nevertheless, in up to 81% of NPSLE patients do not have any other systemic SLE activity.…”

Section: Introductionmentioning

confidence: 99%

“…4 Infections account for 20–55% of morbidity and mortality in SLE, 5 with the CNS being responsible for 3% of these infections. 5,6 Nevertheless, in up to 81% of NPSLE patients do not have any other systemic SLE activity. 4 The most common agents are Mycobacterium tuberculosis followed by Cryptococcus neoformans .…”

Section: Introductionmentioning

confidence: 99%

The role of infections in neuropsychiatric lupus

Ribeiro

Signorelli

2017

Lupus

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Opportunistic infections can cause manifestations that resemble neuropsychiatric systemic lupus erythematosus and they can also trigger lupus flares. Therefore, central nervous system infections as differential diagnosis in neuropsychiatric systemic lupus erythematosus may be difficult, leading to delayed diagnosis and specific treatment. Central nervous system infection in systemic lupus erythematosus is not common but, if left misdiagnosed and not treated promptly, can be fatal. Complementary diagnosis tests are generally non-specific and disappointing. Caution with immunosuppressive drug treatment should be emphasized while an opportunistic infection cannot be ruled out. In this review, we discuss the various types of central nervous system infections reported in systemic lupus erythematosus patients, highlighting the importance of their early recognition in order to improve morbidity and mortality. Prevention with vaccination is a recommended approach.

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Cryptococcal meningitis in Chinese patients with systemic lupus erythematosus

Cited by 12 publications

References 32 publications

Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study

Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study

Cryptococcal Meningitis in a Teenage Boy with Systemic Lupus Erythematosus

The role of infections in neuropsychiatric lupus

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