Abstract
Introduction: Cerebral Cryptococcosis (CC) is the most common CNS fungal infection, it is especially in patients with some type of immunodeficiency, but can also be found in immunocompetent, being more severe and with variable neurological manifestations in that cases. While the typical manifestations are the most frequently seeing, atypical manifestations especially in immunocompetent patients, may present in 60% of cases as radiological studies, so it is important to recognize in order to ensure early diagnosis and timely intervention.
Objective: to describe the clinical characteristics of typical and atypical presentations of cerebral cryptococcosis in Hospital Universitario San José Infantil de Bogotá.
Materials and methods: we report a series of cases between March 2013 and March 2014 at the Hospital Universitario San Jose Infantil. A total of 8 cases of cerebral cryptococcosis described. The diagnosis in all cases was done according to the histopathological findings or cultures.
Results: in 8 patients described 6 were men (75%), most under 60 years ( = 13.25 = 42.25 years), 7 patients (87.5%) were immunosuppressed, of which 5 HIV-seropositive patients (62.5%). The main complaint was headache (87.5%). The clinical manifestations was more severe in HIV-seronegative patients. Several patients showed neuropsychiatric disorders. In 5 patients (62.5%) atypical manifestations were found: cryptococcoma brain in 25% (n = 2), ventriculitis in 12.5% (n = 1) and septic venous sinus thrombosis in 25% (n = 2).
Conclusion: in our population CC was similar to those reported in other studies, where more than half had atypical manifestations especially HIV-seronegative. Additionally several neuropsychiatric manifestations were found. Physicians should consider neuropsychiatric changes and atypical presentations essentially in HIV-seronegative patients in order to make a quick diagnosis and initiate early treatment for CC.
References
SINGER EJ, VALDÉS-SUEIRAS M, COMMINS D, LEVINE A. Neurologic presentations of AIDS. Neurol Clin. 2010;28(1):253-75.
JARVIS JN, HARRISON TS. HIV-associated cryptococcal meningitis. AIDS 2007;21(16):2119-29.
KUMARI R, RAVAL M, DHUN A. Cryptococcal choroid plexitis: rare imaging findings of central nervous system cryptococcal infection in an immunocompetent individual. Br J Radiol. 2010;83(985):e14-7.
SPEED B, DUNT D. Clinical and host differences between infections with the two varieties of Cryptococcus neoformans. Clin Infect Dis. 1995;21(1):28-34; discussion 5-6.
ROZENBAUM R, GONÇALVES AJ, WANKE B, CAIUBY MJ, CLEMENTE H, LAZERA MOS, ET AL. Cryptococcus neoformans varieties as agents of cryptococcosis in Brazil. Mycopathologia 1992;119(3):133-6.
MCTAGGART L, RICHARDSON SE, SEAH C, HOANG L, FOTHERGILL A, ZHANG SX. Rapid identification of Cryptococcus neoformans var. grubii, C. neoformans var. neoformans, and C. gattii by use of rapid biochemical tests, differential media, and DNA sequencing. J Clin Microbiol. 2011;49(7):2522-7.
LIAO CH, CHI CY, WANG YJ, TSENG SW, CHOU CH, HO CM, ET AL. Different presentations and outcomes between HIV-infected and HIV-uninfected patients with Cryptococcal meningitis. J Microbiol Immunol Infect. 2012;45(4):296-304.
NGUYEN MH, HUSAIN S, CLANCY CJ, PEACOCK JE, HUNG CC, KONTOYIANNIS DP, ET AL. Outcomes of central nervous system cryptococcosis vary with host immune function: results from a multi-center, prospective study. J Infect. 2010;61(5):419-26.
LIZARAZO J, LINARES M, DE BEDOUT C, RESTREPO A, AGUDELO CI, CASTAÑEDA E. Results of nine years of the clinical and epidemiological survey on cryptococcosis in Colombia, 1997-2005. Biomédica 2007;27(1):94-109.
ESCANDÓN P, DE BEDOUT C, LIZARAZO J, AGUDELO CI, TOBÓN A, BELLO S, ET AL. Cryptococcosis in Colombia: results of the national surveillance program for the years 2006-2010. Biomédica 2012;32(3):386-98.
KAPLAN JE, HANSON D, DWORKIN MS, FREDERICK T, BERTOLLI J, LINDEGREN ML, ET AL. Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy. Clin Infect Dis. 2000;30 Suppl 1:S5-14.
D'ARMINIO MONFORTE A, DUCA PG, VAGO L, GRASSI MP, MORONI M. Decreasing incidence of CNS AIDS-defining events associated with antiretroviral therapy. Neurology 2000;54(9):1856-9.
MASCHKE M, KASTRUP O, ESSER S, ROSS B, HENGGE U, HUFNAGEL A. Incidence and prevalence of neurological disorders associated with HIV since the introduction of highly active antiretroviral therapy (HAART). J Neurol Neurosurg Psychiatry. 2000;69(3):376-80.
DROMER F, MATHOULIN-PÉLISSIER S, FONTANET A, RONIN O, DUPONT B, LORTHOLARY O, ET AL. Epidemiology of HIV-associated cryptococcosis in France (1985-2001): comparison of the pre- and post-HAART eras. AIDS 2004;18(3):555-62.
HEYDERMAN RS, GANGAIDZO IT, HAKIM JG, MIELKE J, TAZIWA A, MUSVAIRE P, ET AL. Cryptococcal meningitis in human immunodeficiency virus-infected patients in Harare, Zimbabwe. Clin Infect Dis. 1998;26(2):284-9.
MOOSA MY, COOVADIA YM. Cryptococcal meningitis in Durban, South Africa: a comparison of clinical features, laboratory findings, and outcome for human immunodeficiency virus (HIV)-positive and HIV-negative patients. Clin Infect Dis. 1997;24(2):131-4.
HAKIM JG, GANGAIDZO IT, HEYDERMAN RS, MIELKE J, MUSHANGI E, TAZIWA A, ET AL. Impact of HIV infection on meningitis in Harare, Zimbabwe: a prospective study of 406 predominantly adult patients. AIDS 2000;14(10):1401-7.
CURRIE BP, CASADEVALL A. Estimation of the prevalence of cryptococcal infection among patients infected with the human immunodeficiency virus in New York City. Clin Infect Dis. 1994;19(6):1029-33.
DROMER F, MATHOULIN S, DUPONT B, LAPORTE A. Epidemiology of cryptococcosis in France: a 9-year survey (1985-1993). French Cryptococcosis Study Group. Clin Infect Dis. 1996;23(1):82-90.
PYRGOS V, SEITZ AE, STEINER CA, PREVOTS DR, WILLIAMSON PR. Epidemiology of cryptococcal meningitis in the US: 1997-2009. PLoS One 2013;8(2):e56269.
SHELBURNE SA, DARCOURT J, WHITE AC, GREENBERG SB, HAMILL RJ, ATMAR RL, ET AL. The role of immune reconstitution inflammatory syndrome in AIDS-related Cryptococcus neoformans disease in the era of highly active antiretroviral therapy. Clin Infect Dis. 2005;40(7):1049-52.
VERGARA SM, SARAVIA J, GONZÁLEZ G, LORENZANA P ACea. Criptococosis del sistema nervioso central. Estudio de 32 casos 1975-1991. Acta Médica Colombiana [Internet]. 1993;18(4):199-210. Recuperado de: http://www.actamedicacolombiana.com/anexo/articulos/04-1993-03-Criptococosis_del_sistema_nervioso_central_Estudi.pdf.
AWASTHI M, PATANKAR T, SHAH P, CASTILLO M. Cerebral cryptococcosis: atypical appearances on CT. Br J Radiol. 2001;74(877):83-5.
TIEN RD, CHU PK, HESSELINK JR, DUBERG A, WILEY C. Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 cases. AJNR Am J Neuroradiol. 1991;12(2):283-9.
LIZARAZO J, CASTAÑEDA E. Consideraciones sobre la criptococosis en los pacientes con sida. Infectio. 2012;16(Supl.3):94-9.
URIBE RA, DÍAZ G. Estudio prospectivo-clínico y microbiológico de las meningitis subagudas y crónicas. Antioquia Médica [Internet]. 1973;23:153-64.
GREER DL dPL. Criptococosis en Colombia: Resumen de la literatura y presentación de doce casos en el Valle del Cauca. Acta Méd. Valle [Internet]. 1977;8:160-6. Recuperado de: http://www.monografias.com/trabajos904/criptococosis-histoplasmosis-colombia/criptococosis-histoplasmosis-colombia.shtml.
LIZARAZO MM, PALACIOS D, VALLEJO A, BUSTAMANTE A OEea. Criptococosis ocasionada por Cryptococcus neoformans variedad gattii. Acta Médica Colombiana [Internet]. 2000;25:171-8. Recuperado de: http://www.actamedicacolombiana.com/anexo/articulos/04-2000-04.htm.
SOUTHWICK FS, RICHARDSON JR., SWARTZ MN. Septic thrombosis of the dural venous sinuses. Medicine (Baltimore) 1986;65(2):82-106.
FERRO JM, CANHAO P, STAM J, BOUSSER MG, BARINAGARREMENTERIA F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 35. United States 2004; p. 664-70.
LILIANG PC, LIANG CL, CHANG WN, CHEN HJ, SU TM, LU K, ET AL. Shunt surgery for hydrocephalus complicating cryptococcal meningitis in human immunodeficiency virus-negative patients. Clin Infect Dis. 37. United States 2003. p. 673-8.
CHEN CH, CHANG CC, CHANG WN, TSAI NW, LUI CC, LIN WC, ET AL. Neuro-psychological sequelae in HIV-negative cryptococcal meningitis after complete anti-fungal treatment. Acta Neurol Taiwan 21. China Republic: 1949-2012. p. 8-17.
SAIGAL G, POST MJ, LOLAYEKAR S, MURTAZA A. Unusual presentation of central nervous system cryptococcal infection in an immunocompetent patient. AJNR Am J Neuroradiol 26. United States: 2005. p. 2522-6.
PATIL SA, KATYAYANI S, ARVIND N. Significance of antibody detection in the diagnosis of cryptococcal meningitis. J Immunoassay Immunochem. 2012;33(2):140-8.
GRAYBILL JR, SOBEL J, SAAG M, VAN DER HORST C, POWDERLY W, CLOUD G, ET AL. Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis. The NIAID Mycoses Study Group and AIDS Cooperative Treatment Groups. Clin Infect Dis. 2000;30(1):47-54.
BENNETT JE, DOLIN R, BLASER MJ. MANDELL, D. Bennett's Principles and Practice of Infectious Diseases. Volume 1. Philadelphia, PA. Elsevier: Saunders; 2015.
CHENG YC, LING JF, CHANG FC, WANG SJ, FUH JL, CHEN SS, ET AL. Radiological manifestations of cryptococcal infection in central nervous system. J Chin Med Assoc. 2003;66(1):19-26.
PERFECT JR, CASADEVALL A. Cryptococcosis. Infect Dis Clin North Am. 2002;16(4):837-74, v-vi.
PERFECT JR, DISMUKES WE, DROMER F, GOLDMAN DL, GRAYBILL JR, HAMILL RJ, ET AL. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010;50(3):291-322.
SATISHCHANDRA P, MATHEW T, GADRE G, NAGARATHNA S, CHANDRAMUKHI A, MAHADEVAN A, ET AL. Cryptococcal meningitis: clinical, diagnostic and therapeutic overviews. Neurol India 2007;55(3):226-32.
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