Deceptively asymptomatic cryptococcaemia in a renal transplant recipient: the lull before a storm

Sood, Vivek; Pattanashetti, Navin; Ramachandran, Raja; Gupta, Krishan Lal

doi:10.1136/bcr-2018-228115

Cited by 5 publications

(3 citation statements)

References 13 publications

(13 reference statements)

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“…Furthermore, the study revealed high acute high mortality rates in cryptococcemia patients with more than 10% of the patients dying before the availability of culture results [ 6 ]. Few case reports have described cryptococcemia in solid organ transplant patients [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Cryptococcemia in pancreas-kidney transplant patient

Qasem,

Rabbani,

AlKhiami

2023

Medical Mycology Case Reports

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Section: Discussionmentioning

confidence: 99%

Cryptococcemia in pancreas-kidney transplant patient

Qasem,

Rabbani,

AlKhiami

2023

Medical Mycology Case Reports

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“…First of all, inflammatory changes in the vascular endothelium, resulting directly from the toxic effect of the Cryptococcus and from vasculitis due to antigen-antibody complex deposition, are most likely to cause vascular complications in CM. Exudative meningitis in the posterior fossa results in strangulation, vasospasm, constriction, periarteritis and even necrotizing panarteritis of the blood vessels, leading eventually to thrombosis and occlusion [14][15][16]. Secondly, the extensive inflammatory fibrosis of the subarachnoid space caused by Cryptococcus may mechanically compress the small veins, and thus increases blood flow resistance [17].…”

Section: Discussionmentioning

confidence: 99%

Cerebral infarction in HIV-negative patients with cryptococcal meningitis: its predictors and impact on outcomes

Zhang

Liu

et al. 2022

BMC Infect Dis

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Background Descriptions of the patterns of acute/subacute cerebral infarction (ASCI) in HIV-negative patients with cryptococcal meningitis (CM) are scarce, and the predictors of ischemic stroke and outcomes following ASCI remain unclear. Aim To study the clinical characteristics and evaluate the predictors of ASCI in HIV-negative patients with CM and assess the impact of ischemic stroke on the outcomes of the patients. Methods We retrospectively analyzed the data of 61 HIV-negative patients with CM treated between January, 2016 and February, 2022, and among them, 53 patients with complete neuroimaging and cerebrospinal fluid (CSF) data were enrolled in this study. The cohort was stratified by the occurrence of ASCI diagnosed based on MRI evidences for comparison of the clinical characteristics (consciousness disturbance, GCS score, duration of symptoms, and treatment), CSF parameters, imaging findings (meningeal inflammation, hydrocephalus, posterior fossa exudates) and outcomes of the patients. A favorable outcome was defined as a modified Rankin scale (mRS) score ≤ 2 and a poor outcome as a mRS score > 2. Logistic regression analysis was used to identify the risk factors of ASCI in the HIV-negative patients with CM. Results Of the 53 HIV-negative patients with CM, 14 (26.4%) had ASCI. The incidences of fever, headache, neck stiffness, duration of symptoms, CSF parameters, meningeal enhancement in brain MRI and the treatment regimens were similar between the patients with and those without ASCI. Most of the infarcts (92.9%) were of the lacunar type, involving both the anterior and posterior territories. Basal ganglia-corona radiata and the brainstem-cerebellum were the most frequently involved sites. Univariate logistic regression analysis suggested that consciousness disturbance (P = 0.002), MRI evidence of hydrocephalus (P = 0.042) and posterior fossa exudates (P = 0.028) were predictors of ASCI in these HIV-negative patients with CM. Multivariate analysis identified consciousness disturbance as a significant predictor of ASCI (P = 0.020). Compared with the patients without ASCI, the HIV-negative patients with CM and ASCI had poorer outcomes (P = 0.001). Conclusion ASCI can occur in HIV-negative patients with CM, presented commonly as multiple lacunar infarctions involving all the cerebrovascular territories. The presence of consciousness disturbance, hydrocephalus and posterior fossa exudates may increase the risk of ASCI in patients with CM. ASCI is associated with a poor outcome of the HIV-negative patients with CM.

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“…Exudative meningitis in the posterior fossa results in strangulation, vasospasm, constriction, periarteritis and even necrotizing panarteritis of the blood vessels, leading eventually to thrombosis and occlusion. 15,16,17 These changes jeopardize arterial blood ow and potentially cause cerebral ischemia and infarct. 15 Consistently, we found the presence of posterior fossa exudates in 71.4% of the patients with ASCI, as compared to 35.9% in the patients without ASCI.…”

Section: Discussionmentioning

confidence: 99%

Cerebral infarction in HIV-negative patients with cryptococcal meningitis: its predictors and impact on outcomes

Zhang

Liu

et al. 2022

Preprint

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Background Descriptions of the patterns of acute/subacute cerebral infarction (ASCI) in HIV-negative patients with cryptococcal meningitis (CM) are scarce, and the predictors of ischemic stroke and outcomes following ASCI with CM remain unclear. Aim To study the clinical characteristics and evaluate the predictors of ASCI in HIV-negative patients with CM and assess the impact of ischemic stroke on the outcomes of the patients. Methods We retrospectively analyzed the data of 61 HIV-negative patients with CM treated between January, 2016 and February, 2022, and among them, 53 patients with complete neuroimaging and cerebrospinal fluid (CSF) data were enrolled in this study. The cohort was stratified by the occurrence of ASCI diagnosed based on MRI evidences for comparison of the clinical characteristics, laboratory data, imaging findings and outcomes of the patients. Logistic regression analysis was used to identify the risk factors of ASCI in the HIV-negative patients with CM. Results ASCI occurred in 26.4% (14/53) of the HIV-negative patients with CM. The incidences of fever, headache, neck stiffness, duration of symptoms, CSF parameter, meningeal enhancement in brain MRI and the treatment regimens were similar between the patients with and those without ASCI. Most of the infarcts (92.9%) were of the lacunar type, involving both the anterior and posterior territories. Basal ganglia-corona radiata and the brainstem-cerebellum were the most frequently involved sites. Logistic regression analysis suggested that consciousness disorder (P = 0.002), MRI evidence of hydrocephalus (P = 0.042) and posterior fossa exudates (P = 0.028) were all independent predictors of ASCI in these HIV-negative patients with CM. Compared with patients without ASCI, the HIV-negative patients with CM and ASCI had unfavorable outcomes (P = 0.001). Conclusion ASCI is relatively rare in HIV-negative patients with CM, presented commonly as multiple lacunar infarctions involving all the cerebrovascular territories. The presence of consciousness disorder, hydrocephalus and posterior fossa exudates may increase the risk of ASCI in patients with CM. ASCI is associated with a poor outcome of the HIV-negative patients with CM.

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Deceptively asymptomatic cryptococcaemia in a renal transplant recipient: the lull before a storm

Cited by 5 publications

References 13 publications

Cryptococcemia in pancreas-kidney transplant patient

Cryptococcemia in pancreas-kidney transplant patient

Cerebral infarction in HIV-negative patients with cryptococcal meningitis: its predictors and impact on outcomes

Cerebral infarction in HIV-negative patients with cryptococcal meningitis: its predictors and impact on outcomes

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