Central nervous system cryptococcoma in a Ugandan patient with Human Immunodeficiency Virus

Velamakanni, Sruti; Bahr, Nathan C; Musubire, Abdu K; Boulware, David R.; Rhein, Joshua; Nabeta, Henry W.

doi:10.1016/j.mmcr.2014.08.003

Cited by 11 publications

(8 citation statements)

References 15 publications

(19 reference statements)

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“…Cryptococcoma may be indicated by the presence of a ring-shaped enhancement of mass lesions, with or without cystic changes, under MRI. The most common locations include the basal ganglia, cerebellum or parietal lobe, with the lesions being found more rarely in the intraspinal area and pons [ 27 , 28 ]. Most symptoms are similar to cryptococcal meningitis: headaches, nausea, vomiting, confusion and high body temperature, convulsions, depression, mental changes, drowsiness, confusion, polyuria, and cranial nerve tract deficiency [ 27 , 28 ].…”

Section: Etiological Factors Of Fis-cnsmentioning

confidence: 99%

Neuroinfections caused by fungi

2018

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BackgroundFungal infections of the central nervous system (FIs-CNS) have become significantly more common over the past 2 decades. Invasion of the CNS largely depends on the immune status of the host and the virulence of the fungal strain. Infections with fungi cause a significant morbidity in immunocompromised hosts, and the involvement of the CNS may lead to fatal consequences.MethodsOne hundred and thirty-five articles on fungal neuroinfection in PubMed, Google Scholar, and Cochrane databases were selected for review using the following search words: “fungi and CNS mycoses”, CNS fungal infections”, “fungal brain infections”, " fungal cerebritis”, fungal meningitis”, “diagnostics of fungal infections”, and “treatment of CNS fungal infections”. All were published in English with the majority in the period 2000–2018. This review focuses on the current knowledge of the epidemiology, clinical presentations, diagnosis, and treatment of selected FIs-CNS.ResultsThe FIs-CNS can have various clinical presentations, mainly meningitis, encephalitis, hydrocephalus, cerebral abscesses, and stroke syndromes. The etiologic factors of neuroinfections are yeasts (Cryptococcus neoformans, Candida spp., Trichosporon spp.), moniliaceous moulds (Aspergillus spp., Fusarium spp.), Mucoromycetes (Mucor spp., Rhizopus spp.), dimorphic fungi (Blastomyces dermatitidis, Coccidioides spp., Histoplasma capsulatum), and dematiaceous fungi (Cladophialophora bantiana, Exophiala dermatitidis). Their common route of transmission is inhalation or inoculation from trauma or surgery, with subsequent hematogenous or contiguous spread. As the manifestations of FIs-CNS are often non-specific, their diagnosis is very difficult. A fast identification of the etiological factor of neuroinfection and the application of appropriate therapy are crucial in preventing an often fatal outcome. The choice of effective drug depends on its extent of CNS penetration and spectrum of activity. Pharmaceutical formulations of amphotericin B (AmB) (among others, deoxycholate-AmBd and liposomal L-AmB) have relatively limited distribution in the cerebrospinal fluid (CSF); however, their detectable therapeutic concentrations in the CNS makes them recommended drugs for the treatment of cryptococcal meningoencephalitis (AmBd with flucytosine) and CNS candidiasis (L-AmB) and mucormycosis (L-AmB). Voriconazole, a moderately lipophilic molecule with good CNS penetration, is recommended in the first-line therapy of CNS aspergillosis. Other triazoles, such as posaconazole and itraconazole, with negligible concentrations in the CSF are not considered effective drugs for therapy of CNS fungal neuroinfections. In contrast, clinical data have shown that a novel triazole, isavuconazole, achieved considerable efficacy for the treatment of some fungal neuroinfections. Echinocandins with relatively low or undetectable concentrations in the CSF do not play meaningful role in the treatment of FIs-CNS.ConclusionAlthough the number of fungal species causing CNS mycosis is increasing, only som...

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Section: Etiological Factors Of Fis-cnsmentioning

confidence: 99%

Neuroinfections caused by fungi

2018

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“…Typically, the formation of cryptococcoma depends on an inflammatory response and are therefore more often seen in immunocompetent individuals or those who have initiated on ART. Case reports of cryptococcoma have described patients who presented with persistent neurological findings with sterile CSF or a low fungal burden [ 6 ]. This is because the walled off mass is thought to continuously shed Cryptococcus neoformans into the CSF [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Case reports of cryptococcoma have described patients who presented with persistent neurological findings with sterile CSF or a low fungal burden [ 6 ]. This is because the walled off mass is thought to continuously shed Cryptococcus neoformans into the CSF [ 6 ]. As with CM, the mainstay of treatment is combination amphotericin-based antifungal agents.…”

Section: Discussionmentioning

confidence: 99%

Neurological deterioration in a patient with HIV-associated cryptococcal meningitis initially improving on antifungal treatment: a case report of coincidental racemose neurocysticercosis

et al. 2021

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Background Managing HIV-associated cryptococcal meningitis (CM) can become challenging in the presence of concurrent unusual central nervous system infections. Case presentation A 58-year old HIV infected woman new ART starter, who was being treated effectively for cryptococcal meningitis, represented with worsening of neurological symptoms. Brain MRI revealed a multicystic lesion in the left temporal lobe. Anti-fungal treatment was escalated for a suspected cryptococcoma, but post-mortem CSF serological test confirmed racemose neurocysticercosis. Conclusion Patients with HIV-associated CM are highly immunocompromised and may have multiple pathologies simultaneously. In endemic countries, neurocysticercosis should be considered in the differential diagnosis where there is central nervous system deterioration despite effective therapy for CM.

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“…During our literature review we found only seven Englishlanguage case reports of cerebellar cryptococcoma caused by C. gattii (Li et al, 2010;Colom et al 2005;Velamakanni et al, 2014). Among them, three cases were treated with only antifungal drugs and four received surgical intervention along with antifungal treatment.…”

Section: Discussionmentioning

confidence: 99%

Cerebellar cryptococcoma due to Cryptococcus gattii VGI; a rare and first report from India

et al. 2015

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Introduction: Cryptococcus gattii is an emerging global pathogen. Recent reports suggest that C. gattii cryptococcosis is more common in immunocompetent as well as HIV-infected patients than earlier estimated. We report the first case of cerebellar cryptococcoma from India due to C. gattii in an immunocompetent individual.Case Presentation: A 73-year-old immunocompetent male, presented with a 3 month history of severe headache, neck stiffness, walking difficulty, bilateral papilloedema and slight cerebellar signs including gait imbalance and giddiness. Magnetic resonance imaging (MRI) revealed a well-defined enhancing lesion in the cerebellum, suggestive of abscess and mild hydrocephalus. Blood parameters and liver function tests were within normal limits. The patient underwent paramedian suboccipital craniotomy, and the aspirated purulent material grew Cryptococcus neoformans. Histologically, the lesion was a cryptococcoma. The isolate was further identified as C. gattii VGI, serotype C, mating type alpha, and produced extracellular phospholipase enzyme. It was sensitive to amphotericin B, 5-flucytosine and azoles. The patient was treated with intravenous amphotericin B (0.7 mg kg -1 day -1 ) for 15 days along with a maintenance dose of oral fluconazole (400 mg day -1 ) for 6 months. The patient's symptoms recovered while on treatment but he was lost to follow up. Conclusion:Cryptococcus gattii is an emerging pathogen in India that affects otherwise healthy, immunocompetent individuals and requires rapid identification and treatment in order to prevent severe neurological sequelae.

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Central nervous system cryptococcoma in a Ugandan patient with Human Immunodeficiency Virus

Cited by 11 publications

References 15 publications

Neuroinfections caused by fungi

Neuroinfections caused by fungi

Neurological deterioration in a patient with HIV-associated cryptococcal meningitis initially improving on antifungal treatment: a case report of coincidental racemose neurocysticercosis

Cerebellar cryptococcoma due to Cryptococcus gattii VGI; a rare and first report from India

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