Chronic meningitis by Cryptococcosis gatti in an immunocompetent patient: a case report
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Abstract
This paper aims to present an unusual case of neurocryptococcosis in an immunocompetent patient. As the previous literature proposes, the diagnosis is usually not evident and there is a delay in the cases resolution due to the symptoms being nonspecific, the tests being very sensitive, as well as the unusual neurological condition of fungal origin in a patient with no evidence of immunodeficiency. The history of alcoholism and the diagnosis of long-term type 2 diabetes raises the hypothesis that the patient had immunosuppression events. The diagnosis was made through hospital support in conjunction with a multidisciplinary team. Discussing the present case helps to elucidate the possible diagnoses involved in chronic meningitis, especially in fungal meningitis.
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References
Ginsberg L, Kidd D. Chronic and recurrent meningitis. Pract Neurol. 2008 Dec 1;8(6):348–61.
Zunt JR, Baldwin KJ. Chronic and Subacute Meningitis. CONTINUUM: Lifelong Learning in Neurology. 2012 Dec;18(6):1290–318.
Baldwin KJ, Avila JD. Diagnostic Approach to Chronic Meningitis. Neurol Clin. 2018 Nov;36(4):831–49.
Jha A, Adhikari S, Sigdel KR, Paudyal B, Basnyat B, Kayastha G, et al. Case Report: Cryptococcal meningitis in an apparently immunocompetent patient in Nepal - challenges in diagnosis and treatment. Wellcome Open Res. 2019 Jun 17;4:55.
Lizerazo J, Castañeda, E. Central Nervous System Cryptococcosis due to Cryptococcus gatti in the Tropics. Current Tropical Medicine Reports.2022;(9):1-7.
Centers for Disease Control and Prevention. C.gatti Infection Statistics. Available in:<https://www.cdc.gov/fungal/diseases/cryptococcosis-gattii/statistics.html>.Jul, 2023.
Ministério da Saúde do Brasil. Criptococose. Available in: < https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/c/criptococose>. Jul, 2023.
Goldman JD, Vollmer ME, Luks AM. Cryptococcosis in the immunocompetent patient. Respir Care. 2010 Nov;55(11):1499–503.
Belda W, Casolato ATS, Luppi JB, Passero LFD, Criado PR. Primary Cutaneous Cryptococcosis Caused by Cryptococcus gatti in an Elderly Patient. Trop Med Infect Dis.2022 Aug 23;7(9):206.
Coyle PK. Overview of acute and chronic meningitis. Neurol Clin. 1999 Nov;17(4):691–710.
Pagliano P, Arslan F, Ascione T. Epidemiology and treatment of the commonest form of listeriosis: meningitis and bacte-raemia. Infez Med. 2017 Sep 1;25(3):210–6.
Glass JP, Melamed M, Chernik NL, Posner JB. Malignant cells in cerebrospinal fluid (CSF): The meaning of a positive CSF cytology. Neurology. 1979 Oct 1;29(10):1369–75.
Ginsberg L, Kidd D. Chronic and recurrent meningitis. Pract Neurol. 2008 Dec 1;8(6):348–61.
Chamberlain MC. Neoplastic Meningitis. Oncologist. 2008 Sep 1;13(9):967–77.
Sze G, Soletsky S, Bronen R, Krol G. MR imaging of the cranial meninges with emphasis on contrast enhancement and me-ningeal carcinomatosis. American Journal of Roentgenology. 1989 Nov 1;153(5):1039–49.
Chamberlain MC, Sandy AD, Press GA. Leptomeningeal metastasis. Neurology. 1990 Mar;40(3 Part 1):435–435.
Schumacher M, Orszagh M. Imaging techniques in neoplastic meningiosis. J Neurooncol. 1998;38(2/3):111–20.
Schuknecht B, Huber P, Büller B, Nadjmi M. Spinal Leptomeningeal Neoplastic Disease. Eur Neurol. 1992;32(1):11–6.
Bradshaw MJ, Pawate S, Koth LL, Cho TA, Gelfand JM. Neurosarcoidosis. Neurology - Neuroimmunology Neuroinflam-mation. 2021 Nov 4;8(6):e1084.
Nakajima T, Yasufuku K, Fujiwara T, Yoshino I. Recent advances in endobronchial ultrasound-guided transbronchial needle aspiration. Respir Investig. 2016 Jul;54(4):230-6. doi: 10.1016/j.resinv.2016.02.002. Epub 2016 Mar 5. PMID: 27424821.
Baud MO, Vitt JR, Robbins NM, Wabl R, Wilson MR, Chow FC, et al. Pleocytosis is not fully responsible for low CSF glucose in meningitis. Neurology - Neuroimmunology Neuroinflammation. 2018 Jan 26;5(1):e425.
Romiopoulos I, Pana ZD, Pyrpasopoulou A, Linardou I, Avdelidi E, Sidiropoulou M, et al. Fulminant cryptococcal menin-goencephalitis after successful treatment of primary cutaneous cryptococcosis. Germs. 2020 Dec;10(4):388–91.
DeBess E, Cieslak PR, Marsden-Haug N, Goldoft M, Wohrle R, Free C, et al. Emergence of Cryptococcus gattii - Pacific Northwest, 2004-2010. Morbidity and Mortality Weekly Report. 2010;59(28):865–8.
Centers for Disease Control and Prevention NC for E and ZID (NCEZID), D of FW and ED (DFWED). C.gatti infections. https://www.cdc.gov/fungal/diseases/cryptococcosis-gattii/definition.html. 2020.
Campuzano A, Wormley F. Innate Immunity against Cryptococcus, from Recognition to Elimination. Journal of Fungi. 2018 Mar 7;4(1):33.
Poley M, Koubek R, Walsh L, McGillen B. Cryptococcal Meningitis in an Apparent Immunocompetent Patient. J Investig Med High Impact Case Rep. 2019 Jan 4;7:232470961983457.
Akash MSH, Rehman K, Fiayyaz F, Sabir S, Khurshid M. Diabetes-associated infections: development of antimicrobial re-sistance and possible treatment strategies. Arch Microbiol. 2020 Jul 3;202(5):953–65.
Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA, Lancaster DJ, et al. Cryptococcosis in Human Immunodeficiency Virus–Negative Patients in the Era of Effective Azole Therapy. Clinical Infectious Diseases. 2001 Sep;33(5):690–9.
Day JN, Chau TTH, Wolbers M, Mai PP, Dung NT, Mai NH, et al. Combination Antifungal Therapy for Cryptococcal Men-ingitis. New England Journal of Medicine. 2013 Apr 4;368(14):1291–302.
Baldwin KJ, Zunt JR. Evaluation and Treatment of Chronic Meningitis. Neurohospitalist. 2014 Oct 10;4(4):185–95.
Williamson PR, Jarvis JN, Panackal AA, Fisher MC, Molloy SF, Loyse A, et al. Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy. Nat Rev Neurol. 2017 Jan 25;13(1):13–24.