Cryptococcus neoformans Meningoencephalitis in an Immunocompetent Patient after COVID-19 Infection

Ghanem, Hebah; Sivasubramanian, Geetha

doi:10.1155/2021/5597473

Cited by 40 publications

(51 citation statements)

References 10 publications

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“…reported a case of a patient with disseminated cryptococcosis diagnosed on day 75 of COVID-19 infection in the setting of a prolonged course of both IV and oral steroids [ 10 ]. A case of cryptococcal meningoencephalitis with absent neurological symptoms is presented by Ghanem and Sivasubramanian [ 11 ]. These two cases highlight the importance of expanding the differential diagnosis to also include superimposed fungal infections in cases of COVID-19 with prolonged hospital courses.…”

Section: Discussionmentioning

confidence: 99%

The Emergence of Cryptococcemia in COVID-19 Infection: A Case Report

Gil¹,

Gil²,

Markou³

2021

Cureus

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Cryptococcus neoformans is a fungus that can cause pulmonary, central nervous system, and dermatological infections, especially in an immunocompromised patient. This is a case report of a patient, who was presumptively immunocompetent that developed isolated cryptococcemia while being treated for coronavirus disease 19 (COVID-19) infection. We report a case of a 59-year-old Hispanic man with a past medical history of hypertension, well-controlled diabetes mellitus, and class I obesity who was admitted for severe acute respiratory distress syndrome coronavirus 2 (SARS-COV-2) and subsequently was diagnosed with cryptococcal fungemia. The patient received 21 days of dexamethasone and during this period, blood and fungal cultures grew C. neoformans. The patient was alert and oriented, did not have focal neurological deficits or meningeal irritation signs; nonetheless, a lumbar puncture was attempted, but not successful. He was treated with intravenous amphotericin B for two weeks, followed by oral fluconazole for six weeks. Repeat blood cultures demonstrated clearance and he improved clinically. In conclusion, this case report describes the possibility of an association between the use of dexamethasone in COVID-19 patients and the development of cryptococcal fungemia. In the review of literature, rare case reports worldwide have discussed this topic. This is clinically challenging as the emergence of opportunistic infections in these debilitated hosts can be detrimental. Maintaining a high clinical suspicion for this opportunistic infection while treating COVID-19 patients is necessary to prevent further mortality associated with this pandemic.

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Section: Discussionmentioning

confidence: 99%

The Emergence of Cryptococcemia in COVID-19 Infection: A Case Report

Gil¹,

Gil²,

Markou³

2021

Cureus

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“…Antifungal agents, including amphotericin B, fluconazole, and 5-flucytosine, are the current approved treatment of cryptococcosis [ 68 ]. Till now, some cases of Cryptococcus infection were reported in COVID-19 patients [ 65 , 69 , 70 ], which one of them was a 60-year-old man who received tocilizumab plus corticosteroids and diagnosed with candidemia and cryptococcemia [ 65 ]. Despite antifungal therapy, the patient died within 10 days of cryptococcemia [ 65 ].…”

Section: Covid-19-associated Opportunistic Infectionsmentioning

confidence: 99%

“…Despite antifungal therapy, the patient died within 10 days of cryptococcemia [ 65 ]. Meningoencephalitis due to C. neoformans was reported in a 73-year-old woman who received azithromycin and dexamethasone after COVID-19 infection [ 70 ]. Other cases were reported from COVID-19 patients with several underlying diseases who received immunosuppressive therapy (e.g., corticosteroids and tocilizumab) [ 24 , 71 – 73 ].…”

Section: Covid-19-associated Opportunistic Infectionsmentioning

confidence: 99%

COVID-19-associated opportunistic infections: a snapshot on the current reports

2021

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Treatment of the novel Coronavirus Disease 2019 (COVID-19) remains a complicated challenge, especially among patients with severe disease. In recent studies, immunosuppressive therapy has shown promising results for control of the cytokine storm syndrome (CSS) in severe cases of COVID-19. However, it is well documented that immunosuppressive agents ( e.g., corticosteroids and cytokine blockers) increase the risk of opportunistic infections. On the other hand, several opportunistic infections were reported in COVID-19 patients, including Aspergillus spp . , Candida spp . , Cryptococcus neoformans , Pneumocystis jiroveci ( carinii ), mucormycosis, Cytomegalovirus (CMV), Herpes simplex virus (HSV), Strongyloides stercoralis, Mycobacterium tuberculosis, and Toxoplasma gondii . This review is a snapshot about the main opportunistic infections that reported among COVID-19 patients. As such, we summarized information about the main immunosuppressive agents that were used in recent clinical trials for COVID-19 patients and the risk of opportunistic infections following these treatments. We also discussed about the main challenges regarding diagnosis and treatment of COVID-19-associated opportunistic infections (CAOIs). Supplementary Information The online version contains supplementary material available at 10.1007/s10238-021-00751-7.

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“…Previous research has shown an association between high levels of IL-6 and resistance to cryptococcal infection [ 104 ]. The most recent case report presented a patient with COVID-19 who was treated with dexamethasone and developed severe cryptococcal meningitis [ 105 ]. The authors suggest that the impact of steroids on T-cell function should be further investigated, as T-cell depletion has been shown to be a driving factor for cryptococcal meningitis.…”

Section: Fungal Coinfectionsmentioning

confidence: 99%

Root Causes of Fungal Coinfections in COVID-19 Infected Patients

Amin

Vartanian

Poladian

et al. 2021

Infectious Disease Reports

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COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has infected over 200 million people, causing over 4 million deaths. COVID-19 infection has been shown to lead to hypoxia, immunosuppression, host iron depletion, hyperglycemia secondary to diabetes mellitus, as well as prolonged hospitalizations. These clinical manifestations provide favorable conditions for opportunistic fungal pathogens to infect hosts with COVID-19. Interventions such as treatment with corticosteroids and mechanical ventilation may further predispose COVID-19 patients to acquiring fungal coinfections. Our literature review found that fungal coinfections in COVID-19 infected patients were most commonly caused by Aspergillus, Candida species, Cryptococcus neoformans, and fungi of the Mucorales order. The distribution of these infections, particularly Mucormycosis, was found to be markedly skewed towards low- and middle-income countries. The purpose of this review is to identify possible explanations for the increase in fungal coinfections seen in COVID-19 infected patients so that physicians and healthcare providers can be conscious of factors that may predispose these patients to fungal coinfections in order to provide more favorable patient outcomes. After identifying risk factors for coinfections, measures should be taken to minimize the dosage and duration of drugs such as corticosteroids, immunosuppressants, and antibiotics.

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Cryptococcus neoformans Meningoencephalitis in an Immunocompetent Patient after COVID-19 Infection

Cited by 40 publications

References 10 publications

The Emergence of Cryptococcemia in COVID-19 Infection: A Case Report

The Emergence of Cryptococcemia in COVID-19 Infection: A Case Report

COVID-19-associated opportunistic infections: a snapshot on the current reports

Root Causes of Fungal Coinfections in COVID-19 Infected Patients

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