HIV-Negative “AIDS” in Kentucky: A Case of Idiopathic CD4+ Lymphopenia and Cryptococcal Meningitis

Ramirez, Julio A.; Srinath, Latha; Ahkee, Sunket; Huang, Anqi; Raff, Martin J.

doi:10.1097/00007611-199407000-00016

Cited by 5 publications

(3 citation statements)

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“…Only English language papers were reviewed. We found 258 cases diagnosed with ICL in 143 published papers[134567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980818283848586878889909192939495969798…”

Section: Methodsmentioning

confidence: 99%

Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases

2013

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Idiopathic CD4 lymphocytopenia (ICL) was first defined in 1992 by the US Centers for Disease Control and Prevention (CDC) as the repeated presence of a CD4+ T lymphocyte count of fewer than 300 cells per cubic millimeter or of less than 20% of total T cells with no evidence of human immunodeficiency virus (HIV) infection and no condition that might cause depressed CD4 counts. Most of our knowledge about ICL comes from scattered case reports. The aim of this study was to collect comprehensive data from the previously published cases to understand the characteristics of this rare condition. We searched the PubMed database and Science Direct for case reports since 1989 for Idiopathic CD4 lymphocytopenia cases. We found 258 cases diagnosed with ICL in 143 published papers. We collected data about age, sex, pathogens, site of infections, CD4 count, CD8 count, CD4:CD8 ratio, presence of HIV risk factors, malignancies, autoimmune diseases and whether the patients survived or died. The mean age at diagnosis of first opportunistic infection (or ICL if no opportunistic infection reported) was 40.7 ± 19.2 years (standard deviation), with a range of 1 to 85. One-sixty (62%) patients were males, 91 (35.2%) were females, and 7 (2.7%) patients were not identified whether males or females. Risk factors for HIV were documented in 36 (13.9%) patients. The mean initial CD4 count was 142.6 ± 103.9/mm3 (standard deviation). The mean initial CD8 count was 295 ± 273.6/mm3 (standard deviation). The mean initial CD4:CD8 ratio was 0.6 ± 0.7 (standard deviation). The mean lowest CD4 count was 115.4 ± 87.1/mm3 (standard deviation). The majority of patients 226 (87.6%) had at least one infection. Cryptococcal infections were the most prevalent infections in ICL patients (26.6%), followed by mycobacterial infections (17%), candidal infections (16.2%), and VZV infections (13.1%). Malignancies were reported in 47 (18.1%) patients. Autoimmune diseases were reported in 37 (14.2%) patients.

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Section: Methodsmentioning

confidence: 99%

Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases

2013

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“…A competent cell-mediated immunity is required for fungal clearance and to control CM, as demonstrated in murine models 18 and human studies 19,20 . In this context, although several factors may influence cell-mediated immunity, hyperglycemia causes disturbances such as neutrophilic chemotaxis impairment, altered opsonization, abnormal phagocytosis, and decreased lymphocyte blast transformation 21,22 …”

Section: Discussionmentioning

confidence: 99%

“…A competent cell-mediated immunity is required for fungal clearance and to control CM, as demonstrated in murine models 18 and human studies. 19,20 In this context, although several factors may influence cell-mediated immunity, hyperglycemia causes disturbances such as neutrophilic chemotaxis impairment, altered opsonization, abnormal phagocytosis, and decreased lymphocyte blast transformation. 21,22 Our HIV/AIDS patients presented significantly different clinical manifestations than non-HIV individuals; altered alertness was more frequently observed in the former than in the latter, while photophobia and ataxic gait were only observed in HIV/AIDS patients.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Meningitis in a Mexican Neurological Center

et al. 2023

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Background: Cryptococcal meningitis, one of the most severe infections affecting the central nervous system, often involves severe neurological sequels and high mortality. Methods: A retrospective review was performed, including 76 cases admitted in a 10-year period at a neurological referral center in Mexico City. From 68 isolates, 52 fungal specimens were identified as part of the Cryptococcus neoformans var. neoformans complex, 15 as C. neoformans var gattii complex, and one as Cryptococcus non-neoformans/gattii. Results: Higher cryptococcal meningitis incidence and severity were found in HIV-infected men; other risk factors frequently observed were diabetes mellitus and labor exposure to poultry. The main clinical manifestations were subacute headache, cognitive alterations, and photophobia (exclusively in HIV patients). MRI was highly sensitive for pathologic findings such as meningeal enhancements and cryptococcomas, most of them associated to C. neoformans complex. Eleven patients developed severe brain vasculitis, as observed by transcranial Doppler. Hydrocephalus with intracranial hypertension was the most frequent complication. Conclusions: One-half of the population died, and the rest had neurological sequels, mainly neuropsychiatric manifestations and secondary headaches. These patients developed severe functional limitations in performing daily activities in an independent manner.

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Chaitowitz

Shaw

Mokoena

2003

Digestive Diseases and Sciences

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Cryptococcus neoformans has been recognized as a human pathogen for over a century. Occurring primarily in immunocompromised patients, cryptococcosis has achieved new prominence in recent years with the emergence of the acquired immune deficiency syndrome pandemic (1). Although considered principally as a pathogen of the central nervous system, Cryptococcus is known to affect a wide variety of other organ systems (2). Involvement of the gastrointestinal tract was first described nearly 50 years ago (3) and probably occurs frequently in the setting of disseminated disease (4). Nevertheless, despite the recent dramatic increase in the incidence of this disease, the occurrence of overt gastrointestinal symptoms directly attributable to cryptococcal infection reported in the literature remains exceedingly rare. We report the case of a patient with gastrointestinal cryptococcosis presenting with intestinal perforation. CASE REPORTA 50-year-old South African Black male security guard presented to an outlying rural hospital following a short history of progressive abdominal pain culminating in him "collapsing" at his workplace. The patient had no significant medical or surgical history, did not smoke, and drank alcohol socially on weekends. He denied NSAID use. There was no history of significant exposure to birds or other animals. Features of an acute abdomen, together with the presence of free peritoneal gas seen on chest x-ray suggested the diagnosis of perforated peptic ulcer, and the patient was referred for an urgent exploratory laparotomy.

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HIV-Negative “AIDS” in Kentucky: A Case of Idiopathic CD4+ Lymphopenia and Cryptococcal Meningitis

Cited by 5 publications

References 0 publications

Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases

Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases

Cryptococcal Meningitis in a Mexican Neurological Center

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