Case report: chronic relapsing cryptococcal meningitis in a patient with low mannose-binding lectin and a low naïve CD4 cell count.
Background: Cryptococcal meningitis is most commonly found in HIV-infected patients. In HIV-negative patients, its low incidence can lead to prolonged time to diagnosis. Detailed case reports of chronic cryptococcal meningitis are scarce, but could provide clues for earlier diagnosis in this patient...
| Publicado en: | BMC Infectious Diseases Vol. 19; no. 1 |
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| Autores principales: | , , , , , , |
| Formato: | case study Journal Article |
| Publicado: |
BioMed Central
10/15/2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=139137624&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 139137624 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14712334 1CHU jtl: BMC Infectious Diseases issn: 14712334 maglogo: N pubinfo: dt: 10/15/2019 vid: 19 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 139137624 139137624 NLM31615425 139137624 10.1186/s12879-019-4515-0 NLM31615425 139137624 ppct: 1 formats: tig: atl: Case report: chronic relapsing cryptococcal meningitis in a patient with low mannose-binding lectin and a low naïve CD4 cell count. aug: au: Wagemakers, Alex Ang, Cornelis Willem Hagen, Ferry Bot, Joost Cornelis Johannes Bomers, Marije Kristianne Visser, Marieke Christine van Dijk, Karin affil: Department of clinical microbiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands sug: subj: Proteins Metabolism Meningitis, Cryptococcal Diagnosis T Lymphocytes Antigens, Fungal Cerebrospinal Fluid T Lymphocytes Metabolism Male Middle Age Cryptococcus Antifungal Agents Therapeutic Use Meningitis, Cryptococcal Immunology Meningitis, Cryptococcal Metabolism CD4 Lymphocyte Count Magnetic Resonance Imaging Recurrence Scales Middle Aged: 45-64 years Male ab: Background: Cryptococcal meningitis is most commonly found in HIV-infected patients. In HIV-negative patients, its low incidence can lead to prolonged time to diagnosis. Detailed case reports of chronic cryptococcal meningitis are scarce, but could provide clues for earlier diagnosis in this patient category.Case Presentation: A 60-year old man presented June 2015 with intermittent headaches for several months without any fever. Initial work-up showed a leukocytosis, raised CSF opening pressure and raised leukocytes and protein in the CSF. An MRI revealed leptomeningeal contrast enhancement and cerebellar oedema. While malignancy and various infectious causes were excluded, the patient had a spontaneous clinical and radiological recovery. One year later, the patient returned with complaints of headaches. Also, cerebellar oedema and leptomeningeal contrast enhancement had recurred. Eventually in March 2017, the novel cryptococcal antigen lateral flow assay (CrAg LFA) was positive on CSF, and one colony of Cryptococcus neoformans was cultured from CSF. The patient was treated with the standard antifungal regimen which resulted in resolution of his headaches. In retrospect, the cryptococcal antigen test was already positive on a serum sample from June 2015. Interestingly, post-treatment immunological analysis revealed both a low mannose-binding lectin (MBL) concentration and low naïve CD4 counts.Conclusions: We present a patient with cryptococcal meningitis in an HIV-negative patient with low MBL and low naïve CD4 count suffering a chronic relapsing meningo-encephalitis with relatively mild symptoms for around 2 years. In patients with an unexplained meningo-encephalitis such as this case, early performance of CrAg LFA on serum and/or CSF is an inexpensive and rapid method to reduce time-to diagnosis. pubtype: Academic Journal doctype: case study Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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