Multifocal Choroiditis in Disseminated Cryptococcus neoformans Infection

Andreola, Carla; Ribeiro, Maria P.D.; Carli, Claudio De; Gouvêa, Ana Luisa Figueira; Curi, André Luiz Land

doi:10.1016/j.ajo.2006.03.024

Cited by 28 publications

(15 citation statements)

References 5 publications

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“…Although papilledema is the most common manifestation, blurred vision, visual field defects, extraocular muscle paresis, impaired pupillary/accommodative function, choroiditis, retinal hemorrhage, endophthalmitis, and optic atrophy have all been reported (27,130,208,211) (Table 4). Visual loss is particularly disabling; in C. neoformans infection, it is thought to be due to direct invasion of the optic nerve by cryptococci or to the effects of raised ICP or from local arachnoiditis leading to choroidal infiltration with fungus (291,292). The mechanism of eye involvement is likely to be similar in C. gattii infection.…”

Section: Clinical Complications Of Human Infection Neurological Complmentioning

confidence: 99%

Cryptococcus gattii Infections

2014

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SUMMARY Understanding of the taxonomy and phylogeny of Cryptococcus gattii has been advanced by modern molecular techniques. C. gattii probably diverged from Cryptococcus neoformans between 16 million and 160 million years ago, depending on the dating methods applied, and maintains diversity by recombining in nature. South America is the likely source of the virulent C. gattii VGII molecular types that have emerged in North America. C. gattii shares major virulence determinants with C. neoformans , although genomic and transcriptomic studies revealed that despite similar genomes, the VGIIa and VGIIb subtypes employ very different transcriptional circuits and manifest differences in virulence phenotypes. Preliminary evidence suggests that C. gattii VGII causes severe lung disease and death without dissemination, whereas C. neoformans disseminates readily to the central nervous system (CNS) and causes death from meningoencephalitis. Overall, currently available data indicate that the C. gattii VGI, VGII, and VGIII molecular types more commonly affect nonimmunocompromised hosts, in contrast to VGIV. New, rapid, cheap diagnostic tests and imaging modalities are assisting early diagnosis and enabling better outcomes of cerebral cryptococcosis. Complications of CNS infection include increased intracranial pressure, severe neurological sequelae, and development of immune reconstitution syndrome, although the mortality rate is low. C. gattii VGII isolates may exhibit higher fluconazole MICs than other genotypes. Optimal therapeutic regimens are yet to be determined; in most cases, initial therapy with amphotericin B and 5-flucytosine is recommended.

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Section: Clinical Complications Of Human Infection Neurological Complmentioning

confidence: 99%

Cryptococcus gattii Infections

2014

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“…Our other case with AIDS had bilateral multifocal choroiditis and papillitis along with central nervous system manifestations of cryptococcal infection in the form of disorientation, meningitis, and hearing difficulty at the time of ophthalmic evaluation. 3 Thus, the recognition of this condition by ophthalmologists on a routine fundus evaluation can help physicians diagnose a disseminated, fatal disease.…”

Section: Discussionmentioning

confidence: 99%

“…1 Other manifestations include papillitis, diplopia, nystagmus, ophthalmoplegia, ptosis, optic atrophy, and multifocal choroiditis. [1][2][3][4][5] Primary multifocal choroiditis due to cryptococcal infection without any other symptoms is a rare finding and suggests a severe disseminated cryptococcal infection. In our series of 930 HIV-positive patients, we have encountered only 2 cases of multifocal choroiditis due to cryptococcal infection.…”

Section: Discussionmentioning

confidence: 99%

Primary Bilateral Multifocal Choroiditis as an Initial Manifestation of Disseminated Cryptococcosis in a HIV-Positive Patient

Babu¹,

Murthy²,

Rajagopalan

2008

Ocular Immunology and Inflammation

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“…Invasion of the optic nerves and chiasm is felt to be the major cause of visual loss [3]. Other causes of visual loss have been reported, such as neuroretinitis, chorioretinitis, endophthalmitis as well as a rare form of multifocal choroiditis in association with disseminated Cryptococcus infection in HIV-positive patients [4].…”

Section: Discussionmentioning

confidence: 99%