Cryptococcal meningitis with multiple cranial nerves palsies: A review of literature

Krishnamoorthy, Adhiti; Joel, Anjana; Abhilash, Kundavaram Paul Prabhakar

doi:10.4103/0974-777x.161739

Cited by 7 publications

(2 citation statements)

References 9 publications

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“…Data on long term (one year and beyond) quality of life are needed. Cranial nerve impairments resulting in vision loss and hearing loss possibly contribute to long term disability and low quality of life in individuals that have survived after a CM diagnosis [202][203][204] . Vision loss in cryptococcal meningitis can occur as a presenting symptom or a complication.…”

Section: [H1] Quality Of Lifementioning

confidence: 99%

Cryptococcal meningitis

Tugume,

Ssebambulidde,

Kasibante

et al. 2023

Nat Rev Dis Primers

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Cryptococcus neoformans and Cryptococcus gattii species complexes cause meningoencephalitis with high fatality rates and considerable morbidity, particularly in persons with deficient T cell mediated immunity, most commonly affecting people living with HIV. Whereas the global incidence of HIV-associated cryptococcal meningitis (HIV-CM) has decreased over the past decade, cryptococcosis still accounts for one in five AIDSrelated deaths globally due to the persistent burden of advanced HIV disease. Moreover, mortality remains high (~50%) in low resource settings. The armamentarium to decrease cryptococcosis-associated mortality is expanding: cryptococcal antigen (CrAg) screening in the serum and pre-emptive azole therapy for cryptococcal antigenemia are well established, whereas enhanced pre-emptive combination treatment regimens to improve survival of persons with cryptococcal antigenemia are under trials. Short course ( 7 days) amphotericin-based regimens combined with flucytosine are currently the preferred options for induction therapy of cryptococcal meningitis. Whether short course induction regimens improve long term morbidity such as depression, reduced neurocognitive performance and physical disability among survivors is subject to further study. Here, we discuss underlying immunology, changing epidemiology, and updates on management of cryptococcal meningitis with emphasis on HIV-associated disease.

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Section: [H1] Quality Of Lifementioning

confidence: 99%

Cryptococcal meningitis

Tugume,

Ssebambulidde,

Kasibante

et al. 2023

Nat Rev Dis Primers

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“…Other ophthalmic signs described in case reports include: retinal haemorrhages 8 , multi-focal choroiditis 9 , optic atrophy 10 , vascular tortuosity 11 , exudative retinal detachment 12 and intraocular cryptococcoma 13 . Ophthalmic signs in patients with cryptococcal meningitis may be indicative of neurological dysfunction including cranial nerve palsies 14 , 15 or may reflect concurrent systemic disease in patients with advanced HIV.…”

Section: Introductionmentioning

confidence: 99%

Ophthalmic signs in Ugandan adults with HIV-associated cryptococcal meningitis: A nested analysis of the ASTRO-CM cohort

et al. 2018

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Cryptococcal meningitis is a leading cause of morbidity and mortality among HIV-infected persons, accounting for 15% of AIDS-related deaths. Visual disturbance is commonly reported, and a wide range of ophthalmic signs may be present on examination. There is limited published literature to date describing the range and incidence of ophthalmic signs in HIV-associated cryptococcal meningitis. Nested within the Adjunctive Sertraline for the Treatment of HIV-Associated Cryptococcal Meningitis (ASTRO-CM) trial (ClinicalTrials.gov number: NCT01802385), we conducted an observational study of 696 Ugandan adults with HIV-associated cryptococcal meningitis. Patients were screened for visual disturbance and external ophthalmic signs at initial presentation and at follow-up appointments over 18 weeks. Assessment comprised simple clinical history and basic examination and required no specialist equipment. More than a quarter of our cohort demonstrated ocular signs or symptoms, which were observed throughout the study period. A broad range of ocular signs were demonstrated: these included neurological signs (10.9%), localized ocular pathology (4.5%), and evidence of concurrent systemic disease (12.9%). The range of signs observed demonstrates the complexities of case management in patients with advanced HIV and cryptococcosis and also the importance of basic ocular examination in low resource settings. There remains an urgent need for studies conducting comprehensive ocular examination in patients with HIV-associated cryptococcal meningitis; these studies should include formal assessment of visual acuity, slit lamp examination and dilated indirect ophthalmoscopy. Prospective studies should investigate whether there is a correlation between reported visual disturbance and objective signs, in order to further clarify the underlying mechanisms and to guide effective diagnosis, follow-up and management.

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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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Cryptococcal meningitis with multiple cranial nerves palsies: A review of literature

Cited by 7 publications

References 9 publications

Cryptococcal meningitis

Cryptococcal meningitis

Ophthalmic signs in Ugandan adults with HIV-associated cryptococcal meningitis: A nested analysis of the ASTRO-CM cohort

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

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