Cryptococcal meningitis in a patient with undiagnosed HIV infection

Overview

Cryptococcus neoformans is an opportunistic pathogen, which affects individuals who are severely immunosuppressed for any number of reasons. Before the introduction of antiretroviral therapy and antimycotic Fluconazole this pathogen had occurred in 10 % of patients with advanced HIV infection. Nowadays, this disease primarily affects patients with so far undiagnosed, thus untreated, severe immunosuppression. The patient outlined here presented with so far undiagnosed HIV infection, nevertheless, patients can be affected following severe induced immunosuppression - particularly following transplantation. The disease is typified by a gradual onset of non-specific symptoms. Often, a headache or a temperature can be the only manifestation of the disease. For this reason, a delay can frequently occur in diagnosing patients with undiagnosed immunosuppression. The diagnosis is verified by confirmation of the pathogen by latex agglutination of cryptococcal capsular antigen and by cultivation. Amphotericin B is the first-choice therapy. Relatively frequent side-effects are the reason for the change of therapy to the less effective Fluconazole. Sensory dysfunction and impaired consciousness are two of the unfavourable prognostic factors that were noticed in the presented patient. The prognosis of the disease is always severe, and in spite of properly introduced therapy, the mortality rate is 10 %. Relapses and the latent survival of the pathogen in the prostate gland are possible.

Key words:
Cryptococcal meningitis, Cryptococcus neoformans, immunosuppression, HIV infection.