Disseminated Cryptococcal Disease in Non-HIV, Nontransplant Patient

AlMutawa, Fatimah; Leto, Daniela; Chagla, Zain

doi:10.1155/2016/1725287

Cited by 5 publications

(6 citation statements)

References 21 publications

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“…In contrast, cryptococcus gattii serotypes B and C, endemic in Australia and Papua New Guinea, are more frequently reported in immunocompetent individuals. 3 …”

Section: Introductionmentioning

confidence: 99%

A Rare Presentation of Cryptococcal Meningoencephalitis in an Immunocompetent Individual

Malhotra

Rao

Kelly

et al. 2017

Clinics and Practice

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Cryptococcal meningoencephalitis is a leading of morbidity and mortality in immunocompromised individuals worldwide. However, there are few documented cases in immunocompetent patients. We present a rare case of disseminated Cryptococcus with progression to meningoencephalitis in an immunocompetent patient, with a possible atypical presentation. Magnetic resonance imaging of the brain and electroencephalogram to rule out brain metastasis were negative. Lumbar puncture resulted positive for Cryptococcus neoformans antigen at titers of 1:2048 and a detailed history later revealed occupational exposure to bird dander by cleaning floors and cages. Diagnosis is challenging, with delays often resulting in increased morbidity and mortality. Cerebrospinal fluid and serum Cryptococcus antigen play a key role in both diagnosis and determining treatment efficacy. Furthermore, current treatment guidelines are used for immunocompromised individuals. Due to the significant side effects of these medications, further research is needed to determine the optimal treatment duration for immunocompetent patients to minimize the need for unnecessary therapy.

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“…In contrast, cryptococcus gattii serotypes B and C, endemic in Australia and Papua New Guinea, are more frequently reported in immunocompetent individuals. 3 …”

Section: Introductionmentioning

confidence: 99%

A Rare Presentation of Cryptococcal Meningoencephalitis in an Immunocompetent Individual

Malhotra

Rao

Kelly

et al. 2017

Clinics and Practice

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“…Serotype A is responsible for 95% of infection and is frequently isolated, but serotype D is more common in Europe. Distribution of cryptococcus gattii is mainly in Papua new guinea, Australia, and less commonly in Canada, sub-Saharan Africa, and the United States northwest [ 12 ]. Cryptococcus neoformans causes infection via inhalation of spore or yeasts form of the fungus from bird excreta, especially pigeons and chickens, through the respiratory tract.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Cryptococcal Disease in a Patient With Monoclonal Gammopathy of Undetermined Significance and Polycythemia Vera: A Case Report and Review of the Literature

Guhjjar¹,

Ghazanfar²,

Ashraf³

et al. 2021

Cureus

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Cryptococcosis is a life-threatening opportunistic infection caused by Cryptococcus gattii and Cryptococcus neoformans. It affects both immunocompetent and immunosuppressed hosts. Disseminated cryptococcal infection is rare in immunocompetent patients, but the cryptococcal disease's neurological sequelae may be more prominent in this group. We present a case of a 58-year-old male patient with medical comorbidities of monoclonal gammopathy of undetermined significance (MGUS) and polycythemia vera. The patient presented with gradual worsening of mental status over one week. He was found to have Cryptococcus neoformans meningoencephalitis and fungemia. The patient received two weeks of liposomal amphotericin B (LAmB) and flucytosine with excellent clinical response. He was discharged on high dose fluconazole, and he returned to the hospital in one week with new-onset hemiplegia and cryptococcomas on imaging. Prolonged intravenous (IV) treatment of six weeks duration resulted in significant clinical improvement and disease-free state at two years follow-up. This article aims to stress the importance of individualized prolonged IV treatment with liposomal amphotericin B and flucytosine despite good initial response in patients with polycythemia vera and MGUS. This is the first reported case of cryptococcal disease, to the best of our knowledge, in a patient with MGUS and the third case of cryptococcal infection in patients with polycythemia vera in a non-HIV non-transplant state. Prolonged individualized IV treatment should be considered in immunocompetent patients with the above conditions, as this condition, if not adequately treated and relapses, lead to high morbidity and mortality.

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“… 7 CSF CrAg is the preferred method of diagnosis with a high sensitivity and specificity of 96% to 100% and 93% to 99% respectively. 5 - 8 …”

Section: Introductionmentioning

confidence: 99%

Disseminated Cryptococcal Infection in HIV-Infected Patients: A Retrospective Clinicopathological Review of 4 Autopsy Cases

Khaba

Kgole

Nevondo

et al. 2022

Clin Med�Insights�Pathol

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Cryptococcosis is an opportunistic infection with high mortality if not diagnosed and treated in time. The objective of this study was to review the clinicopathological information of decendents with final autopsy diagnosis of disseminated cryptococcal infection. This study collected data from 4 decendents who presented to an academic hospital/laboratory between 1 January 2015 to 31 December 2018. Their clinical, radiological and pathological findings including treatment were reviewed. Two decendents presented with respiratory symptoms whilst the other 2 presented with meningeal symptoms. Three were confirmed HIV positive. One decendent was on ART, one had defaulted treatment and one was ART naïve. Two decendents were diagnosed with cryptococcal meningitis, one with bacterial pneumonia and one with pulmonary tuberculosis. Three decendents died in emergency unit and one in the ward whilst on antifungal therapy. The autopsy findings confirmed disseminated cryptococcal infection in all cases. A high index of suspicion should be maintained in the right clinical context. Multi-organ involvement should be suspected in all patients and be actively sought out.

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Disseminated Cryptococcal Disease in Non-HIV, Nontransplant Patient

Cited by 5 publications

References 21 publications

A Rare Presentation of Cryptococcal Meningoencephalitis in an Immunocompetent Individual

A Rare Presentation of Cryptococcal Meningoencephalitis in an Immunocompetent Individual

Disseminated Cryptococcal Disease in a Patient With Monoclonal Gammopathy of Undetermined Significance and Polycythemia Vera: A Case Report and Review of the Literature

Disseminated Cryptococcal Infection in HIV-Infected Patients: A Retrospective Clinicopathological Review of 4 Autopsy Cases

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