Possibly, the eradication of Cryptococci relies on natural killer cells and antibody-dependent cell-mediated killing. The host response includes both cellular and humoral components. neoformans in this extracellular environment is glucosylceramide synthase. The essential factor in the survival of C. After being deposited into the pulmonary alveoli, the yeast spores must survive the normal to high pH and the physiological concentrations of carbon dioxide before they are phagocytized by alveolar macrophages, a more acidic environment, and disseminated after a latent period of containment in the lung lymph nodes. An elevated gamma gap, while classically associated with monoclonal gammopathy, canĪlso be associated with chronic infections such as HIV.The organism is acquired by inhalation.The incidence of which ranges from 7.6% to 30%, dependent on various factors including Of antifungal therapy to reduce the risk of immune reconstitution inflammatory syndrome, Antiretroviral therapy is typically started at least two weeks after initiation On a randomized study that demonstrated no mortality benefit and increased adverse eventsĪnd disability. The 2010 Infectious Diseases Society of America guidelines recommend against the use of corticosteroids for elevated intracranial pressure, based One study found a 69% relative risk reduction in mortality with therapeutic LP.
Cryptococcal meningitis csf findings serial#
Via serial lumbar punctures or lumbar/ventricular drains. Pressure to less than 20 cm are critical to decrease mortality and are accomplished Therapy with fluconazole, then fluconazole maintenance therapy for at least one year.Ĭlose neurologic monitoring and control of intracranial pressure to reduce opening CT head findings are often normal or nonspecific.ĭiagnosis is made with serum or CSF cryptococcal antigen or CSF culture.Ĭryptococcal meningitis is treated with induction therapy with liposomal amphotericinī and flucytosine for at least two weeks, followed by eight weeks of consolidation Symptoms occurring in only 25% of patients. With headache and fever developing over a median of two weeks, with classic meningeal Cryptococcal meningitis commonly presents Predictors of poor outcomes include immunosuppressive medications and a CSF whiteĬell count less than 20 per cubic millimeter. Mortality is altered mental status, defined as lethargy or obtundation. Per year) in patients with untreated AIDS. Meningitis is a common opportunistic infection (estimated 223,100 cases worldwide The diagnosis is cryptococcal meningitis in the setting of advanced HIV. His course wasĬomplicated by flucytosine-related pancytopenia and septic shock. Status remained poor with progression to absent brainstem reflexes. Placed, due to the risk of herniation with the degree of cerebral edema. He received hypertonic saline and serial lumbar punctures. The following day, he became obtunded, requiring intubation and transfer to the ICU.Ī CT of the head revealed diffuse cerebral edema (Figure). (white arrows) and compression of ventricles (yellow arrows). CT of the head revealing diffuse cerebral edema with loss of grey-white differentiation Liposomal amphotericin (3 mg/kg IVĭaily) and flucytosine (100 mg/kg four times daily) were initiated.įigure. Lumbar puncture revealed 33 cm H 2O opening pressure (normal ≤20 cm), 10 cm closing pressure, and cerebrospinalįluid (CSF) positive for cryptococcal antigen. HIV testing was ordered and returned positive with a CD4 count of 29 cells/mm 3 and a viral load of 80,600 copies/mL. Labs were significant for an elevated gamma gap of 4.6 g/dL (normal <4 g/dL). On theĬurrent presentation, he was oriented but agitated and had a normal head CT.
Urinalysis, and chest X-ray were normal and SARS-CoV-2 testing was negative. Time he was found to have low-grade fevers (maximum temperature 100.2 ☏), ultimatelyĪttributed to a possible upper respiratory infection. He had been admitted three weeks prior with hypertensive urgency, at which A 44-year-old man with hypertension presented with one week of fever, headache, andĬonfusion.
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