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[Cryptococcus meningitis: clinical course, development and histopathologic aspects depending on the predisposing
A M Fiorillo1, R H Lima, R Martinez
1Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto.
Abstract:
Seventeen consecutive cases of cryptococcal meningitis diagnosed at Hospital das Clínicas of Ribeirão Preto Medical School (São Paulo State Brazil) between 1969 and 1985 were reviewed. For analysis the patients were separated in 3 groups: I. three patients without immunodeficiency; II. six patients with associated disease: cancer (3), diabetes (2) and alcoholism (1); III. Eight renal transplant recipients that developed cryptococcosis after 18 to 67 months of immunosupression with steroids and azathioprine. The median interval between onset of symptoms and diagnosis of infection was greater in Group II (53 days) than in Groups I (25 days) or III (28 days). Neck stiffness, cranial nerve involvement and papilledema were more frequent in Group I than in Group II or III, but fever and focal neurological signs were observed only in patients of two last groups. Cerebrospinal fluid examination showed a mild lymphocytic pleocytosis in most patients, but transplant cases had polymorphonuclear cells more frequently. Late mortality was higher in patients with underlying disease and the prognosis was better for transplant patients that received effective antifungal therapy. Besides cryptococci, autopsy findings in 8 cases revealed granuloma formation in tissues, except in patients of Group II (2 cases). The differences between the groups suggest that clinical characteristics, evolution and postmortem findings of the cryptococcal meningitis are changed according to type of immunodeficiency presented by the patient.
Insights
Cryptococcal meningitis presentation and outcomes vary significantly based on the patient's immune status. Immunocompromised patients, particularly transplant recipients, show distinct clinical features and prognoses compared to those without immunodeficiency.
Area of Science:
- Infectious Diseases
- Immunology
- Neurology
Context:
- Cryptococcal meningitis is a serious fungal infection affecting the central nervous system.
- Diagnosis and management are complicated by varying degrees of host immunodeficiency.
- This study reviews cases from Brazil between 1969 and 1985.
Purpose:
- To analyze and compare the clinical characteristics, evolution, and postmortem findings of cryptococcal meningitis in patients with different types of immunodeficiency.
- To identify factors influencing the presentation and prognosis of cryptococcal meningitis.
Summary:
- Seventeen cases were categorized into three groups: no immunodeficiency, associated diseases (cancer, diabetes, alcoholism), and renal transplant recipients on immunosuppressive therapy.
- Clinical presentations differed: neck stiffness and cranial nerve involvement were more common in non-immunocompromised patients, while fever and focal neurological signs appeared in others.
- Cerebrospinal fluid analysis revealed distinct cellular patterns, and late mortality was higher in patients with underlying diseases, though transplant recipients receiving antifungal therapy had a better prognosis.
Impact:
- Highlights the crucial role of the host's immune status in shaping the clinical trajectory of cryptococcal meningitis.
- Suggests that tailored diagnostic and therapeutic approaches may be necessary depending on the underlying cause of immunodeficiency.
- Provides insights into the pathogen-host interaction in cryptococcal meningitis across different immunocompromised states.