Cryptococcosis at the university hospital of Marseille: A case series
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Abstract:
Cryptococcosis is a fungal infection burdened by a high case-fatality rate in immunocompromised patients. Once limited to human immunodeficiency virus (HIV)-infected patients, the epidemiology of cryptococcosis has evolved in recent years and new risk factors have emerged. It is therefore essential to identify these risk factors in order to improve prevention and therapeutic efficacy. We conducted a retrospective observational study including all cases of cryptococcosis between January 2016 and December 2022, diagnosed at the University Hospital of Marseille. During the study period 15 cases of cryptococcosis were diagnosed. Six patients were HIV-infected. Nine patients had one or more comorbidities including liver cirrhosis, type 2 diabetes mellitus, primary immunodeficiency disorder, chronic lymphocytic leukemia and solid organ transplantation. Ten patients had central nervous system cryptococcosis, four had pulmonary cryptococcosis and one patient had extra-pulmonary disseminated cryptococcosis. Of the three patients with liver cirrhosis, two patients died with a post-mortem diagnosis. Our data suggest that emerging risk factors are probably underestimated by clinicians. It emphasizes the need for cryptococcal antigenemia as part of syndromic investigation of any unexplained fever or neurological symptoms in an at-risk patient. Early diagnosis and treatment are essential for patient's survival.Keywords:
Case fatality rate
Cryptococcosis is a fungal infection caused by Cryptococcus neoformans encapsulated agent, being the variant gattii responsible for infection in immunocompetents and the variant grubii for infection in immunodeficients. C. neoformans infections have been increasingly recognized as a significant threat to the health of immune compromised populations throughout the world, especially in individuals with AIDS. The agent is acquired by inhalation, especially in immunocompromised the disease spreads through the hematogenic way affecting the central nervous system (CNS), skin, among other systems. Cutaneous manifestations occur in 10-15% of all cases of systemic cryptococcosis and is often associated with systemic infection. In this report we describe a case of a patient of 28 years, HIV positive, in which markedly cutaneous involvement provided the clinical suspicious of disseminated cryptococcosis, confirmed with analysis cerebrospinal fluid (CSF) and lesion histopathology analysis. Despite the recognition and correct treatment of the mycosis, the patient died after three days of hospital stay, reinforcing the severity of this condition and the need of clinical suspicious in the presence of typical cutaneous lesions.
Histopathology
Cryptococcus gattii
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Cryptococcosis is a systemic mycosis with a universal distribution caused by a levadure-form fungi, Cryptococcus neoformans. We present the case of a male, human immunodeficiency virus positive patient and cutaneous cryptococcosis.
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Opportunistic infection
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Cryptococcosis is an opportunistic infection caused by Cryptococcus neoformans that typically presents in immunocompromised patients, most commonly in those with human immunodeficiency virus (HIV) infection. It rarely has been described in patients with diabetes mellitus (DM). Defects in the host defense mechanisms due to hyperglycemia predispose diabetic patients to opportunistic infections such as cryptococcosis. We present a rare case of disseminated cryptococcosis in a 48-year-old HIV-negative man with DM.
Opportunistic infection
AIDS-Related Opportunistic Infections
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Neuroradiology
Presentation (obstetrics)
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Cryptococcosis is a systemic mycosis caused by Cryptococcus neoformans. The disease occurs in patients with cellular immunodeficiency. The incidence of cryptococcosis arises with aids, and mycosis is one of the opportunistic infections that defines AIDS. After the HAART era the occurrence of cryptococcosis decreased all over the world, but it still continues to be a prevalent disease in Brazil. Thus, we consider this paper to be very important as a result of our reviewing of Brazilian literature regarding some relevant aspects of that disease.
Fungal disease
Opportunistic infection
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ABSTRACT: Isolated cutaneous cryptococcosis developed in a 62‐year‐old white man with an idiopathic deficiency of J‐lymphocytes. The patient was healthy, except for the cutaneous infection, and displayed no other evidence of an immunodeficiency disorder. An immunologic workup should be conducted in all patients with cryptococcal infection, regardless of their apparent health status.
Immunosuppression
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