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Cryptococcosis in a renal unit.

N C Kong1, W Shaariah, Z Morad

  • 1Department of Medicine, National University of Malaysia, Kuala Lumpur.

Australian and New Zealand Journal of Medicine
|October 1, 1990
PubMed
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Cryptococcosis is an opportunistic infection common in immunocompromised patients, particularly those on immunosuppressants like steroids. Early diagnosis and treatment are crucial to prevent severe outcomes and mortality in these vulnerable individuals.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Neurology

Background:

  • Cryptococcosis is a significant opportunistic infection in immunocompromised individuals.
  • Patients with systemic lupus erythematosus (SLE) and those post-renal transplant are at increased risk.
  • Immunosuppressive therapies, including steroids, azathioprine, and cyclosporin, are common in affected patients.

Purpose of the Study:

  • To review the clinical experience of cryptococcosis cases presenting between 1975 and 1988.
  • To identify common clinical presentations, diagnostic methods, and treatment outcomes.
  • To emphasize the importance of recognizing cryptococcosis in immunocompromised hosts.

Main Methods:

  • Retrospective case series analysis of patients presenting with cryptococcosis.

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  • Diagnosis confirmed by positive cerebrospinal fluid (CSF) cryptococcal antigen (latex agglutination) and cultures.
  • Clinical data, imaging (CT brain scans, chest X-ray), and treatment outcomes were reviewed.

    • Main Results:

    • Headaches, fever, mental confusion, epilepsy, and papilledema were common symptoms; meningism was infrequent.
    • CT scans revealed focal lesions or cerebral atrophy in some patients.
    • Amphotericin B and 5-fluorocytosine were primary treatments; ketoconazole used in select cases. Four early deaths occurred due to delayed diagnosis and concurrent infections.

    Conclusions:

    • Cryptococcosis requires high clinical suspicion in immunocompromised patients presenting with neurological symptoms like headache, confusion, or fever.
    • Prompt diagnosis and appropriate antifungal therapy are critical for improving outcomes.
    • Awareness of this opportunistic infection is essential for managing immunosuppressed patient populations.