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[Cryptococcosis of the central nervous system. A report of five cases]
O Fernández-Concepción1, M C Ariosa-Acuña, J L Giroud-Benítez
1Instituto Nacional de Neurología y Neurocirugía, La Habana, Cuba.
Introduction:
Since the 1980s, in relation to the spread of AIDS, there has been an enormous increase in cryptococcosis, a mycotic disorder which usually affects the central nervous system (CNS). This disease is caused by Cryptococcus neoformans, a microorganism acquired by inhalation of bird excrement. This germ produces a capsule which protects it from phagocytosis, can synthesize melanin which acts as an antioxidant of the cytotoxic lymphocytes and can reproduce at body temperature. Clinically it may show as chronic or subacute meningitis and/or encephalitis, as endocranial hypertension or as an intracranial space occupying lesion (crytococcoma). To establish the diagnosis, Chinese ink, culture and the latex agglutination test are useful. Treatment is with amphotericin B associated or not with fluocytokine and fluconazole, the protocol used depending on the clinical form.
Objective:
To review the most up-to-date literature on cryptococcosis of the CNS to study the condition in relation to five cases.
Clinical Cases:
We report five patients with cryptococcosis of the CNS diagnosed and treated in the Instituto Nacional de Neurología y Neurocirugia de la Habana, Cuba, showing an increase in the frequency of the occurrence of cases not related to HIV infection, great variety of clinico-humoral presentation and the characteristics of the treatment given.
Conclusion:
Cryptococcosis can be cured completely when the condition is diagnosed early; without treatment it is invariably fatal.
Insights
Early diagnosis of cryptococcosis, a fungal infection affecting the central nervous system (CNS), is crucial for a complete cure. Without timely treatment, this CNS fungal infection is invariably fatal.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Cryptococcosis, a fungal infection caused by Cryptococcus neoformans, has seen increased incidence since the 1980s, often affecting the central nervous system (CNS).
- Acquired through inhalation of contaminated bird excrement, Cryptococcus neoformans possesses protective mechanisms including a capsule and melanin synthesis.
- Clinical manifestations of CNS cryptococcosis range from chronic meningitis and encephalitis to intracranial hypertension and space-occupying lesions (cryptococcomas).
Observation:
- A review of five CNS cryptococcosis cases in Cuba revealed a notable increase in non-HIV-related infections.
- The study observed a wide spectrum of clinical and humoral presentations among the patients.
- Treatment protocols involved amphotericin B, fluocytosine, and fluconazole, tailored to individual clinical forms.
Findings:
- Diagnostic tools such as Chinese ink, culture, and latex agglutination tests are vital for identifying CNS cryptococcosis.
- The study highlights the importance of early diagnosis for successful treatment outcomes.
- Cryptococcosis, if left untreated, has a uniformly fatal prognosis.
Implications:
- Prompt diagnosis and appropriate treatment of CNS cryptococcosis can lead to complete patient recovery.
- Understanding the diverse clinical presentations is essential for timely recognition and management of this opportunistic infection.
- Further research into non-HIV-associated cryptococcosis may reveal new insights into its epidemiology and pathogenesis.