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Cryptococcal meningitis in apparently immunocompetent patients: association with idiopathic CD4+ lymphopenia

Samuel Shribman1, Alastair Noyce2, Sharmilee Gnanapavan3

  • 1Department of Neurology, St George's Hospital, London, UK.

Practical Neurology
|December 11, 2017
PubMed

Insights

Cryptococcal meningitis can occur in HIV-negative individuals with idiopathic CD4+ lymphopenia. Early blood and cerebrospinal fluid cryptococcal antigen testing is recommended for lymphocytic meningitis to improve diagnosis and outcomes.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Neurology

Background:

  • Cryptococcal meningitis is a serious opportunistic infection, particularly in immunocompromised individuals.
  • Idiopathic CD4+ lymphopenia (ICL) is a rare condition characterized by low CD4+ T-cell counts without identifiable causes of immunodeficiency.
  • Diagnosis of cryptococcal meningitis in HIV-negative patients presents significant challenges, with high mortality rates.

Observation:

  • Two cases of cryptococcal meningitis were identified in patients later diagnosed with idiopathic CD4+ lymphopenia.
  • Patients initially presented with non-specific symptoms like new-onset headaches, leading to repeated emergency department visits and initial misdiagnosis.
  • The absence of typical HIV risk factors complicated the initial diagnostic pathway.

Findings:

  • Both patients were diagnosed with cryptococcal meningitis and subsequently found to have idiopathic CD4+ lymphopenia.
  • The study highlights the potential for cryptococcal meningitis to manifest in individuals with ICL.
  • Delayed diagnosis contributed to the severity and management difficulties in these cases.

Implications:

  • Performing blood and cerebrospinal fluid cryptococcal antigen tests should be considered in all patients presenting with lymphocytic meningitis, irrespective of HIV status.
  • This approach may aid in the early detection of cryptococcal meningitis in at-risk populations, including those with ICL.
  • Improved diagnostic strategies are crucial to reduce the significant morbidity and mortality associated with cryptococcal meningitis in HIV-negative individuals.

Keywords:
infectious diseaseslymphopaeniameningitis

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