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Cryptococcal meningoencephalitis with Actinomyces odontolyticus sepsis: a case report and literature review
Qingyu Huang1, Zhuquan Hong1, Quanlong Hong2
1Department of Neurology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China.
Background:
The combined infection of actinomyces odontolyticus sepsis and cryptococcal encephalitis is rare in routine clinical practice. Thus, we presented this case report and literature review to provide clues to improve such patients' diagnoses and treatment processes.
Case Presentation:
The main clinical manifestations of the patient were high fever and intracranial hypertension. Then, we completed the routine cerebrospinal fluid examination, biochemical detection, cytological examination, bacterial culture, and India ink staining. Firstly, the blood culture suggested actinomyces odontolyticus infection, considering the possibility of actinomyces odontolyticus sepsis and intracranial actinomyces odontolyticus infection. Accordingly, the patient was administered penicillin for treatment. Although the fever was slightly relieved, the symptoms of intracranial hypertension did not relieve. After 7 days, the characteristics of brain magnetic resonance imaging and the results of pathogenic metagenomics sequencing and cryptococcal capsular polysaccharide antigen suggested that cryptococcal infection. Based on the above results, the patient was diagnosed with a combined infection of cryptococcal meningoencephalitis and actinomyces odontolyticus sepsis. Anti-infection therapy with 'penicillin, amphotericin, and fluconazole' was provided, improving the clinical manifestations and objective indexes.
Conclusion:
The combined infection of Actinomyces odontolyticus sepsis and cryptococcal encephalitis is first reported in this case report, and combined antibiotics with 'penicillin, amphotericin, and fluconazole' are effective.
Insights
This case report details a rare dual infection of Actinomyces odontolyticus sepsis and cryptococcal encephalitis. A combination therapy of penicillin, amphotericin, and fluconazole proved effective in treating this complex condition.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Combined Actinomyces odontolyticus sepsis and cryptococcal encephalitis is an exceptionally rare clinical occurrence.
- This case report addresses the diagnostic and therapeutic challenges posed by this dual infection.
Approach:
- A patient presented with high fever and intracranial hypertension.
- Diagnostic methods included cerebrospinal fluid analysis, bacterial culture, India ink staining, and metagenomic sequencing.
- Initial treatment with penicillin was insufficient, necessitating a broader anti-infective approach.
Key Points:
- Blood culture identified Actinomyces odontolyticus, while brain MRI and cryptococcal antigen testing confirmed cryptococcal infection.
- The patient was diagnosed with concurrent Actinomyces odontolyticus sepsis and cryptococcal meningoencephalitis.
- Combined therapy with penicillin, amphotericin, and fluconazole led to significant clinical improvement.
Conclusions:
- This is the first reported case of combined Actinomyces odontolyticus sepsis and cryptococcal encephalitis.
- The presented antibiotic regimen (penicillin, amphotericin, fluconazole) demonstrated efficacy in managing this rare dual infection.
