29 Cryptococcal Meningitis Leading to Fatal Outcomes in Immunocompetent Patients: A Case Study and Review of Literature

Abstract

Introduction

Cryptococcal Meningitis is a fungal infectious disease of worldwide distribution, primarily associated with underlying immunosuppression conditions such as HIV infection, glucocorticoid treatment, status post organ transplantation and oncological treatments. Prevalence is particularly high in third-world countries where it constitutes one of the primary causes of central nervous system infections and may carry fatal outcomes. We present two cases of Cryptococcal Meningitis that portray the vast spectrum of clinical presentations associated with Cryptococcal Meningitis as well as relevant diagnostic and therapeutic implications.

Methods

Case study - These adult otherwise healthy patients presented at a public urban university hospital in southern Colombia. Both had an unusual clinical course and suffered fatal outcomes despite being seemingly immunocompetent at baseline. A diagnosis of hepatic cirrhosis could have been considered a cause of immunosuppression in one of the patients and the diagnostic work-up for the other patient revealed no evidence of immunological deficiency.

Discussion

Cryptococcal Meningitis affecting immunocompetent individuals has been increasingly reported in recent years. Furthermore, outcomes in this population are particularly worse than those generally affected by the disease. A review of the literature related to the possible immunological mechanisms’ underlying the presented clinical course is included. We emphasize the importance of considering Cryptococcus spp. as a possible etiologic agent among differential diagnoses upon encountering suggestive meningeal conditions in immunocompetent patients.

Key words: Cryptococcus neoformans, Meningitis, Immunocompetent

Funding: None.