Fatal cryptococcal meningitis in a non-HIV patient: A case report

Pushpa Yadav; Manodeep Sen; Janamejai Kumar Srivastava; Anupam Das; Tanushri Chatterji

doi:10.53730/ijhs.v6nS1.6010

Authors

Pushpa Yadav PhD. Scholar, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Malhour, Gomti Nagar Extension Lucknow-228028, India & Dept. of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow-226010, India
Manodeep Sen
sen_manodeep6@yahoo.com
MD Professor, Dept. of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow-226010, India
Janamejai Kumar Srivastava PhD. Director, Biotechnology, Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Malhour, Gomti Nagar Extension Lucknow-228028, India
Anupam Das MD Professor, Dept. of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow-226010, India
Tanushri Chatterji PhD (Reader), Dept. of Microbiology, Babu Banarasi Das College of Dental Sciences, Babu Banarasi Das University, Lucknow-226028, India

Keywords:

cryptococcal infection, cardiopulmonary Arrest, cryptococcus neoformans, cryptococcal meningitis

Abstract

Cryptococcal infections (Cryptococcosis) are fatal fungal infections typically caused by Cryptococcus neoformans, a saprophyte frequently found in soil contaminated with pigeon droppings and frequently seen in immunocompromised (specifically HIV Positive) individuals. Now a day’s awareness is emerging on cryptococcal disease among non-immunocompromised patients also. We present a case of Cryptococcus meningitis (CM) in a patient with cardiopulmonary arrest. A 55 year old male patient came with history of headache and fever with neck rigidity since last 3 months. The patient was admitted as a case of CM based on clinical findings and radiological features. Investigations were done to rule out other disorders of the immune system. He was treated with Amphotericine B (IV) and Fluconazole orally for 2 weeks. Culture of CSF was done which showed presence of Cryptococcus neoformans. It is concluded from the findings that Cryptococcus may also affect non-HIV patients regardless to their immune system.

Downloads

Download data is not yet available.

References

Harmian D. Sittambalam, Md, Heidi Hanna, Md, Justin Martello, Md & Dimitra Mitsani, Md (2012) Cryptococcus infection in a non-HIV patient: a case report, Journal of Community Hospital Internal Medicine Perspectives, 2:3, 19254, DOI: 10.3402/jchimp.v2i3.19254. DOI: https://doi.org/10.3402/jchimp.v2i3.19254

(http://www.usrds.org/default.aspx)

Fisher JF, Valencia-Rey PA, Davis WB. Pulmonary cryptococcosis in the immunocompetent patient-many questions, some answers. Open Forum Infect Dis 2016; 3: ofw167. DOI: https://doi.org/10.1093/ofid/ofw167

G. D. Brown, D. W. Denning, N. A. R. Gow, S. M. Levitz, M. G. Netea and T. C. White, “Hidden killers: human fungal infections,” Science Translational Medicine, vol. 4, no. 165, Article ID 165rv13, 2012. DOI: https://doi.org/10.1126/scitranslmed.3004404

Rajasingham R, Smith RM, Park BJ, Jarvis JN, Govender NP, Chiller TM, et al. Global burden of disease of HIV-associated cryptococcal meningitis: An updated analysis. Lancet Infect Dis 2017; 17: 873-881. DOI: https://doi.org/10.1016/S1473-3099(17)30243-8

Estelle Pasquier, John Kunda, Pierre De Beaudrap, Angela Loyse, Elvis Temfack, Síle F. Molloy, Thomas S. Harrison and Olivier Lortholary. Long-term Mortality and Disability in Cryptococcal Meningitis: A Systematic Literature Review Clinical Infectious Diseases® 2018; 66(7): 1122–32. DOI: https://doi.org/10.1093/cid/cix870

Lee KT, Yong KY, Chua HH. Cryptococcal meningitis with pulmonary cryptococcoma in an immunocompetent patient: A case report. Asian Pac J Trop Med 2020; 13(1): 46-48. DOI: https://doi.org/10.4103/1995-7645.273574

V. Pyrgos, A. E. Seitz, C. A. Steiner, D. R. Prevots, and P. R. Williamson, “Epidemiology of Cryptococcal Meningitis in the US: 1997–2009,” PLoS ONE, vol. 8, no. 2, Article ID e56269, 2013. DOI: https://doi.org/10.1371/journal.pone.0056269

M. Musabende, C. Mukabatsinda, E. D. Riviello, and O. Ogbuagu, “Concurrent cryptococcal meningitis and disseminated tuberculosis occurring in an immunocompetent male,” BMJ Case Reports, vol. 2016, 2016. DOI: https://doi.org/10.1136/bcr-2015-213380

K. S. S. Han, A. Bekker, S. Greeff, and D. R. Perkins, “Cryptococcus meningitis and skin lesions in an HIV negative child,” Journal of Clinical Pathology, vol. 61, no. 10, pp. 1138–1139, 2008. DOI: https://doi.org/10.1136/jcp.2008.056119

Y. Ramkillawan, H. Dawood, and N. Ferreira, “Isolated cryptococcal osteomyelitis in an immune- competent host: a case report,” International Journal of Infectious Diseases, vol. 17, no. 12, pp. e1229– e1231, 2013. DOI: https://doi.org/10.1016/j.ijid.2013.04.013

P. Singh, D. Joshi, and N. Gangane, “Cryptococcus peritonitis a rare manifestation in HIV positive host: a case report,” Diagnostic Cytopathology, vol. 39, no. 5, pp. 365–367, 2011. DOI: https://doi.org/10.1002/dc.21445

B. R. Yehia, M. Eberlein, S. D. Sisson, and D. N. Hager, “Disseminated cryptococcosis with meningitis, peritonitis, and cryptococcemia in a HIV-negative patient with cirrhosis: a case report,” Cases Journal, vol. 2, no. 10, article no. 170, 2009. DOI: https://doi.org/10.1186/1757-1626-2-170

V. L. S. Marques, R. C. Gomes, G. R. Viola et al., “Pulmonary cryptococcosis in childhood systemic lupus erythematosus and Sjogren syndrome overlap: a rare opportunistic infection,” ¨ Lupus, vol. 22, no. 13, pp. 1409–1412, 2013. DOI: https://doi.org/10.1177/0961203313502859

Sen M, Chatterji T, Singh V, Yadav P, Das A and Mittal V, Cryptococcal meningitis in HIV (AIDS) patients, Annals of Applied BioSciences. 2017. 1344 DOI: https://doi.org/10.21276/AABS.2017.1344

Nandennavar M, Karpurmath S, Santosh KV, Rojaramani P, Ramakrishna NVS. Cryptococcal meningitis in a human immunodeficiency virus negative patient with follicular lymphoma. Indian Journal of Medical and Paediatric Oncology : Official Journal of Indian Society of Medical & Paediatric Oncology. 2014;35(1):118–9. https://doi.org/10.4103/0971-5851.133739 DOI: https://doi.org/10.4103/0971-5851.133739

Guo L, Liu L, Liu Y, et al. Characteristics and outcomes of cryptococcal meningitis in HIV seronegative children in Beijing, China, 2002–2013. BMC Infect Dis. 2016;16:635. https://doi.org/10.1186/s12879-016-1964-6. DOI: https://doi.org/10.1186/s12879-016-1964-6

Sciaudone G, Pellino G, Guadagni I, Somma A, D’Armiento FP, Selvaggi F. Disseminated Cryptococcus neoformans infection and Crohn’s disease in an immunocompetent patient. J Crohns Colitis 2011; 5(1): 60-63 DOI: https://doi.org/10.1016/j.crohns.2010.08.003

Kushawaha A, Mobarakai N, Parikh N, Beylinson A. Cryptococcus neoformans meningitis in a diabetic patient - the perils of an overzealous immune response: a case report. Cases Journal. 2009;2:209. https://doi.org/10.1186/1757-1626-2-209 DOI: https://doi.org/10.1186/1757-1626-2-209

Pappas PG. Therapy of cryptococcal meningitis in non-HIV-infected patients. Curr Infect Dis Rep 2001; 3: 365-70. DOI: https://doi.org/10.1007/s11908-001-0077-5

Byrnes EJ 3rd, Bartlett KH, Perfect JR, Heitman J. Cryptococcus gattii: An emerging fungal pathogen infecting humans and animals. Microbes Infect 2011; 13: 895-907. DOI: https://doi.org/10.1016/j.micinf.2011.05.009

Gottfredsson M, Perfect J R, Fungal Meningitis 2000, Seminars in Neurology; 20: 3 DOI: https://doi.org/10.1055/s-2000-9394

Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA, Lortholary O, Nguyen MH, Pappas PG, Powderly WG, Singh N, Sobel JD and Sorrell TC, Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America Clinical Infectious Diseases 2010; 50: 291-322. DOI: https://doi.org/10.1086/649858

Hall V, Thomsen RW, Henriksen O, Lohse N. Diabetes in sub Saharan Africa 1999-2011: epidemiology and public health implications. A systematic review. BMC Public Health. 2011; 11: 564. https://doi.org/10.1186/1471-2458- 11-564. DOI: https://doi.org/10.1186/1471-2458-11-564

Owuor OH , P Chege. CryptococcaL meningitis in a HIV negative newly diagnosed diabetic patient: a Case report. BMC Infectious Diseases. 2019; 19:5 DOI: https://doi.org/10.1186/s12879-018-3625-4

Kiertiburanakul S, Wirojtananugoon S, Pracharktam R, Sungkanuparph Cryptococcosis in human immunodeficiency virus-negative patients. Int J Infect Dis 2006; 10: 72-8. DOI: https://doi.org/10.1016/j.ijid.2004.12.004

S. A. Howell, K.C. Hazen, and M.E. Brandt,”Candida, Cryptococcus, and other yeasts of medical importance,” in Mannual of Clinical Microiology, J.H. Jorgensen and M.A. Pfaller, Eds., pp. 1984-2014,ASM Press, Washington DC, USA, 2015. DOI: https://doi.org/10.1128/9781555817381.ch117

Majaliwa ES, et al. Survey on acute and chronic complications in children and adolescents with type 1 diabetes at Muhimbili National Hospital in Dar Es Salaam, Tanzania. Diabetes Care. 2007; 30(9): 2187–92. https://doi.org/10. 2337/dc07-0594. DOI: https://doi.org/10.2337/dc07-0594

MOH. Cameroon Burden of Diabetes Project (Cambod): Baseline Survey Report. Ministry of Health, Cameroon; 2004.

Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA, Lancaster DJ, Henderson H, et al. Cryptococcosis in human immunodeficiency virus- negative patients in the era of effective azole therapy. Clin Infect Dis.2001; 33(5): 690-699. DOI: https://doi.org/10.1086/322597

Chau, T.T., N.H. Mai, N.H. Phu, H.D. Nghia and L.V. Choung et al., 2010. A prospective descriptive study of cryptococcal meningitis in HIV uninfected patients in Vietnam- high prevalence of Cryptococcus neoformans var grubii in the absence of underlying disease. Bmc. Infect. Dis., 10:199-199. DOI: 10.1186/1471-2334-10-199. DOI: https://doi.org/10.1186/1471-2334-10-199