ro13-9904 and Meningitis--Cryptococcal

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.

Topics: Adult; Amphotericin B; Antifungal Agents; Ceftriaxone; Cryptococcus neoformans; Fatal Outcome; Fluconazole; HIV Seronegativity; Humans; Male; Meningitis, Cryptococcal; Middle Aged; Treatment Outcome

Atypical presentations of cryptococcal infection have been described as clinical manifestations of immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients following commence of antiretroviral therapy (ART). The authors describe a patient presenting with cryptococcal meningoradiculitis two weeks after initiation of ART. In patients with advanced HIV disease, immune reconstitution induced by ART can precipitate onset of atypical clinical manifestations in those patients with latent cryptococcal infection of the central nervous system.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Anti-HIV Agents; Anti-Retroviral Agents; Ceftriaxone; Ciprofloxacin; Female; HIV Infections; Humans; Lamivudine; Meningitis, Cryptococcal; Nevirapine; Radiculopathy; Stavudine

We report a case of a large intracerebral CSF collection formed along the course of the catheter of an ommaya-type reservoir (Medtronic 12 mm), implanted in a patient suffered from cryptococcal meningitis in the frame of CLL. This collection was at first diagnosed as intracerebral abscess but emergency craniotomy proves clear CSF collection with no signs of infection. We describe the case and we discuss the issue of CSF pressure pathophysiology and changes in flow dynamics, to patients with cryptococcal meningitis.

Topics: Acyclovir; Aged; Amphotericin B; Anti-Infective Agents; Brain Abscess; Ceftriaxone; Cerebrospinal Fluid; Cerebrospinal Fluid Pressure; Diagnosis, Differential; Drainage; Fluconazole; Humans; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Metronidazole; Spinal Puncture; Teicoplanin

Topics: Adult; Antitubercular Agents; Brain; Ceftriaxone; Drug Therapy, Combination; Humans; Male; Meningitis, Cryptococcal; Penicillins; Tomography, X-Ray Computed; Vertebrobasilar Insufficiency