Diabetes mellitus as a risk factor for cryptococcal meningitis in immunocompetent

Abstract

Cryptococcal meningoencephalitis (CM) is one of the major causes of mortality and morbidity in immunocompromised patients estimating 650,000 deaths each year. Across the globe, CM has been occasionally seen in apparently immunocompetent patients who otherwise don’t have established risk factors. The clinical presentation of CM in immunocompetent hosts is subtle and often results in complications including persistent neurological deficits and death. We present a case of Cryptococcal neoformans meningitis in a diabetic female with no other identified risk factors. Although her clinical presentation was atypical, her clinical course was uncomplicated. The pathophysiology in immunocompetent hosts appears somewhat different, so is the clinical presentation. Since there are no separate evidence-based treatment recommendations, it is challenging to treat this group of patients. There seems to be a need for further studies for management in CM for HIV negative, non-transplant immunocompetent patients.

Concomitant of Cryptococcal Meningitis and COVID-19 in a Female Patient with Primary Nephrotic Syndrome and Type 2 Diabetes

“…Current evidence suggests that diabetes may significantly increase the risk of meningitis, particularly in older adults. 20 One specific fungal pathogen, Cryptococcus neoformans, is known to cause infection in immunocompromised individuals, including those with HIV, organ transplant recipients, hematological malignancies, and diabetes. Type 2 diabetes can compromise the immune system, especially when poorly controlled, potentially leading to the development of rare inflammatory diseases such as CM.…”

Unusual infections and diabetes: dangerous fungi

“…CSF showed a positive India ink stain and Cryptococcus was subsequently confirmed. Steroids and amphotericin B, then prolonged oral fluconazole, were eventually successful 16 …”

“…Steroids and amphotericin B, then prolonged oral fluconazole, were eventually successful. 16 Cryptococcus neoformans is found world-wide in soil and decaying wood. It can cause meningitis and fungemia, previously mainly in AIDS.…”

Impact of host factors on susceptibility to antifungal agents

“…The MLC for C. neoformans in RPMI alone was less affected, exhibiting a fivefold decrease in MLC compared to an MLC measured in plasma alone, or plasma supplemented with glucose. This differential effect of the presence of plasma, as compared to medium alone, may explain the treatment failure reported despite laboratory-confirmed sensitivity [22][23][24][25][26][27].…”