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[Pleural cryptococcosis in patients with human immunodeficiency virus infection]
M Mauri1, A Fernández Solà, J A Capdevila
1Unitat de Malalties Infeccioses, Hospital General Vall d'Hebron, Barcelona.
Abstract:
Four cases of pleural cryptococcosis as the form of onset of cryptococcosis in patients with human immunodeficiency virus (HIV) infection are reported. In two out of the four cases cryptococci were simultaneously isolated in other localizations (blood and meninges). In the two remaining patients the pleura was the only site of the disease, with serum determination of the cryptococci antigen being negative in one. The four patients evolved favourably, with three being exclusively treated with fluconazol. Pleuritis is an infrequent manifestation in cryptococcosis although it may be the form of onset and the only localization of the disease. Only 10 cases have been reported in patients with HIV infection. The present four cases represent 11% of the authors' series of cryptococcosis in AIDS patients. The diagnostic possibility of cryptococcosis should be considered in patients with human immunodeficiency virus infection presenting pleural effusion.
Insights
Pleural cryptococcosis can be the initial sign of disease in individuals with human immunodeficiency virus (HIV). This rare presentation, even as the sole manifestation, warrants consideration in HIV patients with pleural effusion.
Area of Science:
- Infectious Diseases
- Pulmonology
- Immunology
Background:
- Cryptococcosis is a serious fungal infection, particularly in immunocompromised individuals.
- Pleural involvement in cryptococcosis is uncommon, especially as an initial presentation.
- Human immunodeficiency virus (HIV) infection significantly increases the risk of opportunistic infections like cryptococcosis.
Observation:
- This report details four cases of pleural cryptococcosis as the primary manifestation in HIV-infected patients.
- In two cases, cryptococci were found in blood and meninges concurrently.
- In the other two cases, the pleura was the only affected site, with one having a negative serum cryptococcal antigen test.
Findings:
- Pleural cryptococcosis, though infrequent, can be the sole site of infection and the initial presentation of the disease.
- The study highlights that cryptococcosis should be suspected in HIV patients presenting with pleural effusion.
- Three of the four patients were successfully treated with fluconazole.
Implications:
- Early recognition of pleural cryptococcosis is crucial for timely diagnosis and treatment in HIV patients.
- This finding expands the understanding of cryptococcosis's diverse clinical presentations in immunocompromised populations.
- Considering cryptococcosis in HIV patients with unexplained pleural effusions can improve patient outcomes.