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Cryptococcal Meningoencephalitis in Phenotypically Normal Patients
Pia M Cumagun1, Mary Katherine Moore2, Todd P McCarty1
1Department of Medicine, Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Abstract:
Cryptococcosis is an invasive fungal infection found worldwide that causes significant morbidity and mortality among a broad range of hosts. There are approximately 223,000 new cases of cryptococcosis annually throughout the world, and at least 180,000 deaths are attributed to this infection each year. Most of these are due to complications of cryptococcal meningoencephalitis among HIV-infected patients in resource-limited environments. The majority of individuals diagnosed with cryptococcosis have underlying conditions associated with immune dysfunction such as HIV, solid organ transplant, hematologic malignancy, organ failure syndromes, and/or the use of immunosuppressive agents such as glucocorticosteroids and biologic agents. In most clinical series, there is a small proportion of patients with cryptococcosis who are phenotypically normal; that is, they have no clinically obvious predisposition to disease. Cryptococcal meningoencephalitis (CME) presentation and management differ substantially between these normal individuals and their immunocompromised counterparts. In this review, we will focus on CME in the phenotypically normal host and underscore differences in the clinical presentation, management, outcome, and potential risk factors for these patients compared to immunocompromised persons who develop this potential devastating invasive fungal infection.
Insights
Cryptococcosis, a global fungal infection, causes over 180,000 deaths annually, primarily from cryptococcal meningoencephalitis in HIV patients. This review focuses on cryptococcal meningoencephalitis in healthy individuals, distinct from immunocompromised cases.
Area of Science:
- Infectious Diseases
- Mycology
- Immunology
Background:
- Cryptococcosis is a serious worldwide fungal infection with high mortality.
- Cryptococcal meningoencephalitis (CME) is a major cause of death, especially in HIV-infected individuals.
- Most patients have underlying immune dysfunction, but a subset are phenotypically normal.
Purpose of the Study:
- To review and highlight the distinct clinical presentation, management, and outcomes of CME in phenotypically normal hosts.
- To compare CME in normal hosts versus immunocompromised individuals.
- To identify potential risk factors for CME in the absence of apparent immune compromise.
Main Methods:
- Literature review focusing on cryptococcal meningoencephalitis.
- Analysis of clinical presentations, management strategies, and outcomes.
- Comparison of patient cohorts: phenotypically normal versus immunocompromised.
Main Results:
- CME presentation and management vary significantly between immunocompromised and phenotypically normal individuals.
- Phenotypically normal hosts may have different risk factors and prognoses.
- Further research is needed to fully understand CME in healthy individuals.
Conclusions:
- Cryptococcal meningoencephalitis in phenotypically normal hosts represents a distinct clinical entity.
- Understanding these differences is crucial for appropriate diagnosis and treatment.
- This review underscores the need for tailored approaches to CME management across different host populations.
