A fatal case of AIDS-defining meningoencephalitis by C. Neoformans, sensitive to antifungal therapy

Mohammad-Khani, S; Otremba, B; Klein, Russell A.; Capelle, HH; Logemann, Frank; Fc, Bange; Schmidt, R. E.; Stoll, M

doi:10.1186/2047-783x-15-11-504

Eur J Med Res

2010

DOI: 10.1186/2047-783x-15-11-504

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A fatal case of AIDS-defining meningoencephalitis by C. Neoformans, sensitive to antifungal therapy

S Mohammad-Khani

B Otremba²,

Russell A. Klein

et al.

Abstract: Cryptococcus neoformans is the most common cause of life threatening meningoencephalitis in HIV-infected patients. Diagnosis is based on tests for cryptoccocal antigen in serum and cerebrospinal fluid, and on culture of the organism. We present a case of AIDS-related cryptococcal meningoencephalitis unresponsive to antifungal combination therapy, despite of evidence of fungal susceptibility in vitro. Significant decreases in cryptococcal antigen titers in serum and cerebrospinal fluid did not correl… Show more

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Cited by 2 publications

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Multiple drugs Lack of efficacy: case report A 33-year-old man exhibited lack of efficacy during treatment with amphotericin-B-liposomal, dexamethasone, fluconazole and flucytosine for Cryptococcal meningitis. The man, who had HIV infection, presented for fever and unproductive cough. CT scan and chest X-ray showed diffuse homogeneous ground glass opacity in both lungs. Bronchoalveolar lavage showed pneumocystis jiroveci infection. Therefore, he successfully received cotrimoxazole (trimethoprim-sulfamethoxazole) and prednisolone. He also received emtricitabine/tenofovir and lopinavir/ritonavir for replicative HIV infection. After two months, he was admitted for increasing headache, focal seizures, emesis and lethargy. He was diagnosed with Cryptococcosis (Cryptococcus neoformans var grubii were found upon lumber puncture) with brain involvement. Hence Cryptococcal meningitis was considered, and he was admitted. He received IV treatment with fluconazole 400 mg/day, amphotericin-B-liposomal (liposomal amphotericin B) 4 mg/kg/day and flucytosine 150 mg/kg/day. Due to a rapid virological response under highly active antiretroviral therapy, initially an immune reconstitution inflammatory syndrome (IRIS)-associated cryptococcal meningitis could not be excluded. Therefore, dexamethasone was also started [route and dosage not stated]. Initially, an improvement in mental status was noted. Serum Cryptococcal antigen titer also dropped. However, following two weeks of the therapy with amphotericin-B-liposomal, fluconazole, flucytosine and dexamethasone, his clinical condition unexpectedly worsened continually (lack of efficacy). A lumbar puncture showed a three titer steps decrease of cerebrospinal fluid Cryptococcal antigen-titer. Biopsy confirmed accumulation of C. neoformans within brain parenchyma with little cellular immune reaction and without any evidence of granulomatous encephalitis. Brain CT-scan showed brain oedema. An elevated intracerebral pressure was also noted. Due to the risk of herniation, reduction of intra-cranial pressure at that time point would have require trepanation, which was denied by health care directives from him and his relatives.

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Importance of Follow-Up Cerebrospinal Fluid Analysis in Cryptococcal Meningoencephalitis

et al. 2014

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Cryptococcal meningoencephalitis represents a serious infection of the central nervous system, where reliable prognostic factors during the disease course are needed. Twenty-one patients diagnosed with cryptococcal meningoencephalitis in a German university hospital from 1999 to 2013 were analysed retrospectively. CSF parameters were analysed prior to therapy and during antifungal treatment and were compared between patients who survived or deceased. Fifteen patients clinically improved after antifungal therapy, while six patients died. No differences were observed between the outcome groups for the CSF parameters cell count, lactate, total protein, and CSF-serum albumin quotients (QAlb). Follow-up examinations of serum cryptococcal antigen titer and CSF cell count have shown that these parameters cannot be used to monitor the efficacy of antifungal therapy as well. In contrast, the course of QAlb during therapy was indicative for the outcome as a possible prognostic marker. In patients with clinical improvement QAlb values were falling under therapy, while rising QAlb values were found in patients with fatal outcome indicating a continuing dysfunction of the blood-CSF barrier. In conclusion, our results indicate that, among the various CSF parameters, the course of QAlb presents a promising marker that might be used to monitor the efficacy of antifungal therapy.

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A fatal case of AIDS-defining meningoencephalitis by C. Neoformans, sensitive to antifungal therapy

Cited by 2 publications

References 22 publications

Multiple drugs

Multiple drugs

Importance of Follow-Up Cerebrospinal Fluid Analysis in Cryptococcal Meningoencephalitis

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