[Cryptococcosis not related to AIDS in Rio Grande do Sul: a report of 8 cases and a review of the literature]

Cryptococcal meningitis: description of 3 cases and estimation of T-cell subsets

OBJECTIVES

To describe three cases of cryptococcus neoformans meningitis and evaluate their cellular immunity.

METHODS

This study involved three cases of cryptococcus neoformans meningitis admitted to Children's Hospital of Shanxi Province between July 2010 and July 2011. Clinical presentations, laboratory findings, treatment and outcome in these cases has been discussed.

RESULTS

Staining cerebrospinal fluid (CSF) with India ink showed Cryptococcus neoformans. Flow cytometric analysis of T-cell subsets revealed that their cellular immunity were depressed, which mainly embodies decline in CD4+ levels.

CONCLUSIONS

The authors speculate that decreased CD4+ T lymphocyte counts are attributed to cryptococcal infection, emphasizing the significance and importance of evaluating cellular immunity in patients who present with unusual infections. Early diagnosis of cryptococcal meningitis and appropriate antifungal therapy are essential to achieve a better outcome.

Cryptococcal meningitis in HIV negative pregnant women: case report and review of literature

INTRODUCTION

Cryptococcosis has become an important entity due to the epidemic of AIDS and therefore it is a significant opportunistic infection. However, there are case reports of cryptococcal meningitis in immune competent pregnant women. Since pregnancy is considered a period of relative immunosuppression, which likely prevents fetal rejection, this could explain the occurrence of opportunistic infections.

OBJECTIVE

To report a case of cryptococcosis, and review all cases involving pregnancy and neurocryptococcal infection in immune competent pregnant patients.

METHODS

Case report and systematic review of the literature using the MEDLINE and SciELO databases.

DISCUSSION

A total of 27 patients were analyzed from 19 studies. The mean age at diagnosis was 26.4 years. There were six patients in their first trimester of pregnancy, 10 in the second, eight in the third and three post-partum. The most prevalent symptoms were headache (85.2%), altered vision (44.4%), altered mental status (44.4%), nausea (40.7%) and fever (33.3%). There were nine deaths (33.3%). Most of the patients received intravenous amphotericin B as treatment (77.8%). The majority (66.6%) of the patients accomplished a term delivery with healthy infants.

CONCLUSION

Cryptococcal meningitis should be considered during pregnancy in cases of unexplained headache, altered vision, altered mental status, nausea and fever. Patients with a confirmed diagnosis should be admitted and treated with amphotericin B.

Cryptococcosis in children

Cryptococcosis is a systemic-opportunistic mycosis caused by two species of the encapsulated yeast-like organism, Cryptococcus neoformans and C. gattii, which cause infection in immunocompromised individuals and in immunologically normal hosts, respectively. Most susceptible to infection are patients with T-cell deficiencies. The spectrum of disease ranges from asymptomatic pulmonary lesions to disseminated infection with meningoencephalitis. After the emergence of AIDS, cryptococcal infections have become much more common. The mycosis occurs less frequently in children than in adults. The purpose of this article is to discuss the aetiology, clinical presentation, predisposing conditions and outcomes in cases of cryptococcosis in children. Emphasis is placed upon paediatric cases occuring in Brazil and in particular to highlight the difference between cases diagnosed in Porto Alegre (South - subtropical climate) and in Belem (North - equatorial climate).