Cryptococcus Infection in an Immunocompetent Patient

Abstract

Cryptococcal meningitis is a fungal infection of the CNS, generally thought of as an opportunistic infection in those with T-cell immunodeficiencies including AIDS (usually with a CD4 count of less than 100), chronic steroid use, hematological malignancies, and transplant recipients.It can have irreversible CNS morbidity, including vision loss, intracranial hypertension, and cognitive decline. Diagnosis depends on cerebrospinal fluid (CSF) analysis, in which cultures and cryptococcal antigen are most sensitive. CSF PCR can also be done. Most patients have disseminated disease, and blood cultures are also positive. Outcomes remain guarded, with a poor prognosis (morbidity and high mortality) among survivors. This article presents a case of cryptococcal meningitis in an immunocompetent individual, where absolutely no identifiable risk factor was present.

Cryptococcal Meningitis Presenting as Chronic Headache in an Apparently Immunocompetent Patient

“…Following the initial antifungal therapy, patients usually require prolonged fluconazole administration to clear the infection. Some individuals will necessitate lumbar punctures to alleviate increased pressure in the brain [ 16 ]. In our case, we also performed serial lumbar punctures; the opening pressure gradually decreased and was within the normal range in the last session, coinciding with symptomatic improvement.…”

“…The disease is uniformly fatal without treatment. Even with treatment, mortality is estimated to be 20%, mostly due to elevated intracranial pressure [ 16 ]. The differential diagnosis of cryptococcosis should be considered in patients presenting with headaches and neurological symptoms, prompting early imaging and CSF analysis for timely diagnosis and treatment.…”

A Suspected Case of COVID-19-Induced Immunosuppression

“…This article seeks to highlight that even in subclinical presentations (where COVID-19 testing is positive and there are mild or no symptoms), maladaptive immune responses may still be at play, predisposing infected patients to opportunistic infections, as in this patient, or potentially trigger underlying and previously indolent ailments [ 10 ]. While we still strongly recommend vaccination, social distancing, handwashing, and using facemasks, we would like to point out that even the seemingly unaffected may be at increased risk of other infectious diseases, whether or not they have previously documented underlying immune suppression or vaccination [ 19 ].…”

A Case Reflecting the Impact of a Deferred Transesophageal Echocardiogram on a COVID-19 Disease Patient

“…COVID-19 disease has seen an advancement in vaccine science and the development of mRNA vaccines, including the Moderna, Pfizer, and AstraZeneca vaccines [12]. The global impact has subsided, and although COVID-19 remains of high public health importance, much of the stigma surrounding the virus has been elucidated [13,14].…”