Post partum osteomyelitis due to Cryptococcus neoformans

Annapureddy, S.R.; Masterson, Sean W.; David, Henry P.; Greig, Jane

doi:10.1080/00365540600953479

Cited by 18 publications

(8 citation statements)

References 7 publications

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“…Patients typically complain of focal pain and tenderness. Symptoms are typically progressive and may range from trivial at onset to refusal to bear weight. When a bony prominence is involved, erythema, soft tissue swelling, and tenderness to palpation were noted.…”

Section: Discussionmentioning

confidence: 99%

Isolated Crytococcus Neoformans Osteomyelitis of the Proximal Femur: A Case Report and Review of Literature

Jacobson

Griesser

Paloski

et al. 2012

Orthopaedic Surgery

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Section: Discussionmentioning

confidence: 99%

Isolated Crytococcus Neoformans Osteomyelitis of the Proximal Femur: A Case Report and Review of Literature

Jacobson

Griesser

Paloski

et al. 2012

Orthopaedic Surgery

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“…gattii meningitis during the postpartum period, with markedly elevated intracranial pressure, in an Australian aboriginal woman in whom receipt of antifungal therapy was ultimately shown to revert Th2 to Th1 response [59]. Lesions of cryptococcal osteomyelitis worsened abruptly after delivery in a woman in whom antifungal therapy was deferred initially because of minimally symptomatic disease that had been present since the first trimester [60]. In another instructive case report, a patient became symptomatic several weeks after delivery, with signs of pneumonia [61].…”

Section: Fungimentioning

confidence: 96%

Immune Reconstitution Syndrome and Exacerbation of Infections after Pregnancy

Singh

Perfect

2007

Clinical Infectious Diseases

167

143

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Pregnancy is a state of subtle immunosuppression characterized by physiologic suppression of proinflammatory host responses that are meant to promote embryonic implantation. Rapid reversal of these changes and a rebound of inflammatory responses during the postpartum period can result in quiescent or latent infection manifesting as symptomatic disease. Infections due to several microbial pathogens and noninfectious diseases with an autoimmune basis have been shown to worsen or begin during the postpartum period. Awareness that symptoms resulting from immune reconstitution can occur in any host with a rapidly changing immunologic repertoire, including women in the postpartum phase, is a critical first step in fully understanding this phenomenon. Future studies to discern the precise pathophysiologic basis of immune reconstitution, to identify pregnant women at risk, and to determine markers that may be diagnostically helpful have significant implications for optimizing treatment of these patients.

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“…This is established by the expression of Th2 and Th3 responses such as transforming growth factor– β by maternal tissue and simultaneous inhibition of Th1 or proinflammatory cytokines [144]. Rapid reversal of this immunological environment in the postpartum period can lead to overt clinical symptoms of previously stable infections [123, 145, 146]. Indeed, nearly 45% of the cases of cryptococ-cosis in pregnancy reported in the literature presented with symptomatic disease in the third trimester or postpartum period [135].…”

Section: What Is the Appropriate Treatment For Cryptococcosis In mentioning

confidence: 99%

Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America

Perfect

Dismukes

Dromer

et al. 2010

Clinical Infectious Diseases

2,323

2,304

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Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)–infected individuals, (2) organ transplant recipients, and (3) non–HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary crypto-coccosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and crypto-coccomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.

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Post partum osteomyelitis due to Cryptococcus neoformans

Abstract: We report a case of Cryptococcus neoformans in a pregnant woman whose initially mild symptoms of infection deteriorated after delivery. This is the first reported case of C. neoformans osteomyelitis in pregnancy.

Cited by 18 publications

References 7 publications

Isolated Crytococcus Neoformans Osteomyelitis of the Proximal Femur: A Case Report and Review of Literature

Isolated Crytococcus Neoformans Osteomyelitis of the Proximal Femur: A Case Report and Review of Literature

Immune Reconstitution Syndrome and Exacerbation of Infections after Pregnancy

Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America

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