Case Report: Cryptococcal Meningitis

Popy Paramitha; Kiking Ritarwan

doi:10.3889/oamjms.2022.9238

Authors

Popy Paramitha Department of Neurology, Universitas Sumatera Utara, H. Adam Malik General Hospital Medan, Medan, Indonesia
Kiking Ritarwan Department of Neurology, Universitas Sumatera Utara, H. Adam Malik General Hospital Medan, Medan, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.9238

Keywords:

Cryptococcal meningitis, AIDS, Immunocompromised

Abstract

BACKGROUND: Cryptococcal meningitis is one of the most common opportunistic infections in immunocompromised patients. Mostly it manifests as subacute/chronic meningitis, although pathological findings suggest extensive tissue invasion of the brain parenchyma and meninges. This disease has a very high mortality rate, even with the administration of an antifungal combination.

CASE REPORT: Male, 53 years old, with clinical symptoms of headache, was experienced by the patient from 1 month before admission and worsening within 1 week. The headache describe throbbing throughout the head, with severe intensity, and does not go away with pain medications. The frequency of headaches is persistent and does not go away with pain medications. A history of weight loss was found, about 10 kg in 3 months. A history of free sex was found. History of HIV known since 1 day before admission to hospital and has not undergone antiretroviral treatment. The patient was diagnosed with cryptococcal meningitis on the basis of the finding of yeas t-like cells on the Indian ink test, and the patient was also a stage IV HIV patient with a decreased CD4 count. The patients treated with tapering off dexamethasone injection, 1× 960 mg Cotrimoxazole, 400 mg/24 h injection of fluconazole, and 3 × 1 folic acid, and received 1 × 1 fixed dose combination antiretrovirals therapy.

CONCLUSION: Cryptococcal meningitis is a disease caused by cryptococcal fungi and its incidence increases with the increase in diseases associated with immune system disorders such as HIV.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Efrida E, Ekawati D. Cryptococcal meningitis: Clinical aspects and laboratory diagnosis. J Kesehatan Andalas. 2012;1(1):39-44. DOI: https://doi.org/10.25077/jka.v1i1.7

Gunawan PY, Feliana F, Cucunawangsih C. Clinical Features and Analysis of Cerebrospinal Fluid in Cryptococcal Meningitis Patients with or without Human Immunodeficiency Virus Infection at SHLV Hospital. Medicinus. 2015;4(8):247-53.

Indrati AR. Diagnosis laboratorium Pada Infeksi Cryptococcus; 2012. Available from: http://pustaka.unpad.ac.id/wpcontent/uploads/2015/08/Diagnosis-Laboratorium-pada-Infeksi-Cryptococcus.pdf. [Last accessed on 2021 Aug 25].

Duarte SB, Oshima MM, Mesquita JV, Nascimento FB, Azevedo PC, Reis F. Magnetic resonance imaging finding in central nervous system cryptococcosis: Comparison between immunocompetent and immunocompromised patients. Radiol Bras. 2017;50(6):359-65. https://doi.org/10.1590/0100-3984.2016.0017 PMid:29307925 DOI: https://doi.org/10.1590/0100-3984.2016.0017

Utama MS, Sukmawati DD, Gayatri AA, Somia IK, dan Merati KT. Toksoplasmosis and Other Neurologic Infection; 2017. Available from: https://simdos.unud.ac.id/uploads/file_penelitian_dir/bf91cf0224e65c420ab4af3a622a5cc3.pdf. [Last accessed on 2021 Aug 25].

Abassi M, Boulware DR, Rhein J. Cryptococcal meningitis: Diagnosis and management update. Curr Trop Med Rep. 2015;2(2):90-9. https://doi.org/10.1007/s40475-015-0046-y PMid:26279970 DOI: https://doi.org/10.1007/s40475-015-0046-y

Perfect J, Dismukes W, Dromer F, Goldman D, Graybill J, Hamill R, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious disease society of America. Clin Infect Dis. 2010;50(3):291-332. DOI: https://doi.org/10.1086/649858

Sugianto P. Meningitis kriptokokus. In: Sugianto P, Mawuntu A, editors. Infeksi Pada Sistem Saraf. 2nd ed. Surabaya: Pusat Penerbitan dan Percetakan Universitas Airlangga; 2019. p. 125-46.

Susarla K, Mahadevan A. Cryptococcus. In: Turgut M, Challa S, Akhaddar A, editor. Fungal Infections of the Central Nervous System. Switzerland: Springer; 2019. p. 167-80. DOI: https://doi.org/10.1007/978-3-030-06088-6_12

Loyse A, Wainwright H, Jarvis JN, Bicanic T, Rebe K, Meintjes G, et al. Histopathology of the arachnoid granulations and brain in HlV-associated crypto-coccal meningitis: Correlation with cerebrospinal fluid pressure. AIDS. 2010;24(3):405-10. https://doi.org/10.1097/QAD.0b013e328333c005 PMid:19952714 DOI: https://doi.org/10.1097/QAD.0b013e328333c005

Tan ZR, Long XY, Li GL, Zhou JX, Long L. Spectrum of neuroimaging findings in cryptococcal meningitis in immunocompetent patients in China a series of 18 cases. J Neurol Sci. 2016;368:132-7. https://doi.org/10.1016/j.jns.2016.06.069 PMid:27538616 DOI: https://doi.org/10.1016/j.jns.2016.06.069

Imran D, Estiasari R, dan Maharani K. Infeksi Oportunistik Susunan Saraf Pusat pada AIDS. In: Aninditha T, Wiratman W, editors. Buku Ajar Neurologi. Buku 1. Deparetmen Neurologi Fakultas Kedokteran Universitas Indonesia; 2017. p. 239-48.

Day JN, Chau TT, Wolbers M, Mai PP, Dung NT, Mai NH, et al. Combination antifungal thera- py for cryptococcal meningitis. N Engl J Med. 2013;368(14):1291-302. https://doi.org/10.1056/NEJMoa1110404 PMid:23550668 DOI: https://doi.org/10.1056/NEJMoa1110404

French N, Gray K, Watera C, Nakiyingi J, Lugada E, Moore M, et al. Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults. AIDS. 2002;16(7):1031-8. https://doi.org/10.1097/00002030-200205030-00009 PMid:11953469 DOI: https://doi.org/10.1097/00002030-200205030-00009