Cryptococccal meningoencephalitis after H1N1 influenza

Cryptococcus neoformans is associated with a spectrum of diseases including meningoencephalitis, pneumonia and soft tissue infections. Incidence is higher in immunocompromised hosts like HIV-infected individuals and solid organ transplant recipients. The influenza virus is known to cause immunologic defects. Additionally, the 2009-pandemic H1N1 virus is associated with increased incidence of acute respiratory distress syndrome (ARDS) requiring treatment with systemic steroids. The authors present the first case of cryptococcal meningitis in a patient with flu A-associated ARDS (FLAARDS). In this patient, risk factors for invasive fungal disease included a combination of severe and prolonged H1N1-influenza virus infection, corticosteroid therapy and broad-spectrum antibiotics. While prolonged corticosteroid use is a known risk factor for development of invasive fungal disease, the authors postulate that by causing immunologic defects and FLAARDS, the 2009-pandemic H1N1 virus may represent an additional independent risk for the development of C neoformans meningitis in a previously healthy individual.