Cryptococcal meningitis: Clinical, diagnostic and therapeutic overviews

Satishchandra, P; Mathew, Thomas; Gadre, Girish; Nagarathna, S; Chandramukhi, A; Mahadevan, Anita; Shankar, S K

doi:10.4103/0028-3886.35683

Cited by 85 publications

(60 citation statements)

References 28 publications

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“…In most studies, headache is considered the predominant clinical manifestation 4,30 . Similar to the results of Aslan and Chandrasekhara, in the present study, headache was the most common symptom observed, and altered sensorium was determined to be the poorest prognostic factor 30 .…”

Section: Discussionmentioning

confidence: 99%

“…Species identifi cation was determined using L-canavanine-glycine-bromothymol blue (CGB) medium to distinguish between C. neoformans and C. gattii isolates 10 . Molecular analysis was conducted using oligonucleotides of the minisatellite-specifi c sequence of phage M13 and of the microsatellite-specifi c sequence (GACA) 4 11,12 . Written informed consent was obtained from each patient.…”

Section: Microbiologymentioning

confidence: 99%

“…Acquired immunodeficiency syndrome (AIDS) and an expanding population with immunosuppressive therapies have contributed to an increase in cryptococcal disease, which is one of the most important opportunistic infections related to AIDS, particularly in the developing world 2,3 . Among AIDS patients, the rate of infection ranges from 23% to 48.6%, and approximately 70% to 90% of cryptococcal patients have signs and symptoms of subacute meningitis or meningoencephalitis with high mortality rates 4,5 . AIDS-associated cryptococcosis is primarily caused by C. neoformans var.…”

Section: Introductionmentioning

confidence: 99%

“…C. neoformans var. neoformans (serotype D) and AD hybrids have been recovered from approximately 98% of these patients 4,6 . A smaller proportion of disease is caused by C. gattii (serotypes B and C), which predominantly affects immunocompetent individuals, and C. gattii is considered to be endemic in the tropical and subtropical regions of the world 7 .…”

Section: Introductionmentioning

confidence: 99%

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Clinical and microbiological features of cryptococcal meningitis

Souza

Costa

Fernandes

et al. 2013

Rev. Soc. Bras. Med. Trop.

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Introduction: In this study, the clinical features, underlying diseases and clinical outcomes of patients with cryptococcosis were investigated. In addition, a molecular analysis of the Cryptococcus neoformans species complex isolated from these patients was performed. Methods: A prospective study of 62 cases of patients with cryptococcal infection was conducted at the Hospital de Doenças Tropicais de Goiás Dr. Anuar Auad from 2009-2010. Cryptococcal meningitis cases were diagnosed by direct examination and cerebrospinal fl uid (CSF) sample culture. The profi ling of these patients was assessed. The CSF samples were submitted to India ink preparation and cultured on Sabouraud dextrose agar, and C. neoformans was identifi ed by the production of urease, a positive phenoloxidase test and assimilation of carbohydrates. C. neoformans and C. gattii isolates were distinguished by growth on L-canavanine-glycine-bromothymol blue medium, and molecular analysis was conducted via PCR fi ngerprinting reactions using M13 and (GACA) 4 primers. Results: From the 62 patients with cryptococcosis, 71 isolates of CSF were obtained; 67 (94.4%) isolates were identifi ed as C. neoformans var. grubii/VNI, and 4 (5.6%) were identifi ed as C. gattii/VGII. Of these patients, 53 had an HIV diagnosis. The incidence of cryptococcosis was higher among patients 20-40 years of age, with 74.2% of the cases reported in males. Cryptococcus-related mortality was noted in 48.4% of the patients, and the symptoms were altered sensorium, headache, fever and stiff neck. Conclusions: The high morbidity and mortality observed among patients with cryptococcosis demonstrate the importance of obtaining information regarding the epidemiological profi le and clinical course of the disease in the State of Goiás, Brazil.

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Section: Discussionmentioning

confidence: 99%

Section: Microbiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical and microbiological features of cryptococcal meningitis

Souza

Costa

Fernandes

et al. 2013

Rev. Soc. Bras. Med. Trop.

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“…are important fungal pathogens worldwide. Cryptococcal meningitis is the fourth most common life-threatening opportunistic infection in individuals with AIDS [1], but is rare among immunocompetent hosts [2,5]. Cryptococcosis is a systemic mycosis associated with significant morbidity and mortality [3].…”

Section: Introductionmentioning

confidence: 99%

Fungal Meningitis in an Immunocompetent Patient

Louro

Ferreira

Pinheiro³

et al. 2013

Clin Drug Investig

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Cryptococcal meningitis is a rare entity among immunocompetent hosts but, when it occurs, it is associated with significant morbidity and mortality. Clinical presentation as well as the course of the disease is usually subtle and indolent with headache and altered mental status. The authors present the case of a 59-year-old man, who sought medical help with a 2-week history of headaches accompanied by nausea and visual and hearing disturbances. On admission the patient was afebrile, presented visual and hearing deficits and had a normal magnetic resonance image of the brain. A lumbar puncture was performed and microscopic examination of the cerebrospinal fluid revealed yeasts that were identified as Cryptococcus spp. and later, by means of molecular biology techniques, as Cryptococcus neoformans, var. grubii. The patient was treated with liposomal amphotericin B plus fluconazole for 28 weeks. At follow-up after 1 year the patient was asymptomatic and received fluconazole 400 mg/day as prophylactic therapy. The outcome of Cryptococcus infections in immunocompetent hosts is reported to be poor as a result of a delayed diagnosis and suboptimal initial antifungal therapy. The influence of the normal immune response is unclear.

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Cerebrospinal fluid pleocytosis in immunocompromised patients: Can it be Cryptococcus

Sood

Tyagi

Selhi

et al. 2019

Diagnostic Cytopathology

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Cryptococcal meningitis commonly affects immunocompromised cases and can have varied presentation. In some instances, the presence of a plethora of inflammatory cells on cerebrospinal fluid (CSF) in an immunosuppressed patient can lead to further investigations, which unravel the presence of cryptococcal meningitis. The aim of this retrospective study was to analyze the spectrum of CSF findings of immunosuppressed patients who were diagnosed to have cryptococcal meningitis. Retrospective analysis of CSF cytospin slides exhibiting pleocytosis and belonging to immunocompromised patients was performed, and these cases were found to have cryptococcal meningitis. Out of 932 cases of CSF (January 2016‐July 2017), 10 had pleocytosis and 5 of these 10 cases demonstrated spores of Cryptococcus. Male‐to‐female ratio was 1:1.5. All the patients were immunocompromised and had CSF leukocytosis. Lymphocytes and monocytes were present in all samples while only one case showed plasma cells. Spores of Cryptococcus were also noted in all the cases and highlighted on India Ink Preparation and Gomori Methenamine Silver stain. All the cases were positive for agglutination‐based cryptococcal antigen assay, except one where the test was not done. All immunosuppressed patients having pleocytosis in CSF were found to have cryptococcal infection. Therefore, pleocytosis in CSF in any immunosuppressed patient should raise the suspicion of cryptococcal meningitis. The pathologist and the clinician need to be vigilant in such scenarios to rule out any opportunistic infection and investigate the patient thoroughly for any underlying immunosuppression.

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Cryptococcal meningitis: Clinical, diagnostic and therapeutic overviews

Cited by 85 publications

References 28 publications

Clinical and microbiological features of cryptococcal meningitis

Clinical and microbiological features of cryptococcal meningitis

Fungal Meningitis in an Immunocompetent Patient

Cerebrospinal fluid pleocytosis in immunocompromised patients: Can it be Cryptococcus

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