Disseminated Cryptococcosis with Adrenal Insufficiency and Meningitis in an Immunocompetent Individual

Ito, Masae; Hinata, Takashi; Tamura, Kouichi; Koga, Ayano; Ito, Tsuyoshi; Fujii, Hiroko; Hirata, F.; Sakuta, Hidenari

doi:10.2169/internalmedicine.56.7356

Cited by 14 publications

(8 citation statements)

References 12 publications

(21 reference statements)

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“…[ 1 , 2 , 16 , 17 ] In recent years, CM has also been reported in a small number of patients without immunodeficiency disease. [ 18 – 23 ] Therefore, it is essential to further study the clinical characteristics and effective treatment, especially for intracranial hypertension, to reduce the morbidity and mortality rates of CM patients. In the present study, non-HIV CM patients were divided different surgery group, HYC, and non-HYC group.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment and operation time in human immunodeficiency virus-negative cryptococcal meningitis

Zhao¹,

Zhao²,

Yang³

et al. 2020

Medicine

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There are still no unified guidelines of surgical treatment and timing for human immunodeficiency virus (HIV)-negative patients with cryptococcal meningitis (CM). The clinical data and follow-up data were collected from HIV-negative CM patients in Xiangya Hospital of Central South University from January 2009 to November 2018, and 42 patients who were treated with surgical intervention were enrolled in the present study. These 42 patients were divided into ventriculoatrial (VA) group, ventriculoperitoneal group, external ventricle drainage (EVD) group, hydrocephalus (HYC) group, non-HYC group, EVD group, and non-EVD group (VA/ ventriculoperitoneal) according to different surgical procedures. Statistical analyses were conducted using SPSS (version 19.0, Chicago, IL). Signs of headache, fever, and loss of consciousness in the VA group were significantly improved compared with the EVD group at 1 week after operation ( P < .05). The mortality rate of the VA group was significantly lower than that of the EVD group ( P < .05). Moreover, male patients were more prone to have HYC ( P < .05). Younger patients tended to develop HYC ( P < .05). Cerebrospinal fluid sugar in the non-HYC group was significantly lower compared with the HYC group ( P < .05). Time of CM-to-operation in the non-HYC group was markedly shorter compared with the HYC group ( P < .01). VA procedure could be one of the first choices for the treatment of uncontrollable intracranial hypertension caused by CM. Severe uncontrollable headache, loss of consciousness, and cerebral hernia were indications of emergency surgery. Repeated headache, hearing impairment, and especially progressive loss of vision were indications of early surgery to avoid permanent damage to nerve functions of HIV-negative CM patients.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment and operation time in human immunodeficiency virus-negative cryptococcal meningitis

Zhao¹,

Zhao²,

Yang³

et al. 2020

Medicine

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“…High-dose FLCZ is reportedly associated with AI ( 16 ). Adrenal cryptococcosis can also cause AI, as reported in several cases, where an adrenal biopsy largely contributed to the diagnosis and treatment ( 17 , 18 ). In our case, though, a biopsy was not indicated because of his low platelet count.…”

Section: Discussionmentioning

confidence: 94%

Progressive Cytopenia Developing during Treatment of Cryptococcosis in a Patient with HIV Infection and Bone Marrow Cryptococcal Infection

et al. 2022

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Cytopenia is a common complication in patients with human immunodeficiency virus (HIV) infection. Identifying the cause is demanding because of the wide range of possible diagnoses. We herein report an HIV-infected patient with disseminated cryptococcosis involving multiple organs including the blood, brain, lungs, and bone marrow, who developed progressive pancytopenia after initiation of anti-fungal treatment with liposomal amphotericin-B (L-AMB) and flucytosine (5FC). The pancytopenia persisted despite early 5 FC discontinuation. A bone marrow biopsy revealed cryptococcal infiltration and the blood examination findings recovered quickly after resuming L-AMB. Thus, this HIV-infected patient's pathological findings and clinical course suggested that the primary cause of the pancytopenia was bone marrow cryptococcosis.

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“…Disseminated disease can affect multiple organs simultaneously. Lesions have been described in the liver [ 28 ], lymph nodes [ 29 ], peritoneum [ 30 ], urogenital tract [ 31 ], adrenal glands [ 32 ] and eyes [ 33 ].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Treatment of Cryptococcal Meningitis: How Have We Got Here and Where are We Going?

Ngan

Flower

Day

2022

Drugs

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Cryptococcal meningitis is a devastating brain infection cause by encapsulated yeasts of the Cryptococcus genus. Exposure, through inhalation, is likely universal by adulthood, but symptomatic infection only occurs in a minority, in most cases, months or years after exposure. Disease has been described in almost all tissues, but it is the organism’s tropism for the central nervous system that results in the most devastating illness. While invasive disease can occur in the immunocompetent, the greatest burden by far is in immunocompromised individuals, particularly people living with human immunodeficiency virus (HIV), organ transplant recipients and those on glucocorticoid therapy or other immunosuppressive drugs. Clinical presentation is variable, but diagnosis is usually straightforward, with cerebrospinal fluid microscopy, culture, and antigen testing proving significantly more sensitive than diagnostic tests for other brain infections. Although disease incidence has reduced since the advent of effective HIV therapy, mortality when disease occurs remains extremely high, and has changed little in recent decades. This Therapy in Practice review is an update of a talk first given by JND at the European Congress on Clinical Microbiology and Infectious Diseases in 2019 in the Netherlands. The review contextualizes the most recently published World Health Organization (WHO) guidelines for the treatment of HIV-associated cryptococcal meningitis in terms of the data from large, randomized, controlled trials published between 1997 and 2022. We discuss the rationale for induction and maintenance therapy and the efficacy and undesirable effects of the current therapeutic armamentarium of amphotericin, flucytosine and fluconazole. We address recent research into repurposed drugs such as sertraline and tamoxifen, and potential future treatment options, including the novel antifungals fosmanogepix, efungumab and oteseconazole, and non-pharmaceutical solutions such as neurapheresis cerebrospinal fluid filtration.

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Disseminated Cryptococcosis with Adrenal Insufficiency and Meningitis in an Immunocompetent Individual

Cited by 14 publications

References 12 publications

Surgical treatment and operation time in human immunodeficiency virus-negative cryptococcal meningitis

Surgical treatment and operation time in human immunodeficiency virus-negative cryptococcal meningitis

Progressive Cytopenia Developing during Treatment of Cryptococcosis in a Patient with HIV Infection and Bone Marrow Cryptococcal Infection

Treatment of Cryptococcal Meningitis: How Have We Got Here and Where are We Going?

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