Cryptococcal Meningitis in an Immunocompetent Swiftlet Rancher – First Reported Case

@#Cryptococcal meningitis is a central nervous system infection cause by Cryptococcus neoformans. Although Cryptococcus is found in bird droppings, it has never been reported for those ranchers involved in the niche swiftlet ranching industry despite having close proximity with the bird droppings. We present here a case of a 41-year-old healthy swiftlet rancher who presents with a history of prolonged fever, headache and altered behaviour of a month duration. Cerebral spinal fluid analysis revealed the presence of Cryptococcus. He was treated with intravenous amphotericin B and flucytosine and discharged well with fluconazole consolidation therapy for 8 weeks, followed by maintenance therapy for 1 year. We believe this is the first reported case of Cryptococcal meningitis (CM) occurring in an immunocompetent swiftlet rancher. This case should highlight the needs to wear a proper personal protective equipment inside a swiftlet ranch due to the constant exposure to the potential cryptococcal-rich environment. A high index of suspicion, careful history taking and physical examination focusing on neurologic assessment is key to early diagnosis and timely management of CM.

Lack of IL-6 increases blood–brain barrier permeability in fungal meningitis.

The pathogenesis of increased blood–brain barrier permeability during Cryptococcus meningitis is still largely unknown. Interleukin (IL-6) is a multifunctional cytokine, and numerous studies have shown that IL‐6 influences the integrity of the blood–brain barrier. In this study we investigated the role of IL-6 in Cryptococcus meningitis. First, wild-type or IL-6−/− mice were injected with Cryptococcus neoformans (C. neoformans) and the survival time in both groups was recorded. Second, the number of fungi was measured in the brains of IL-6−/− wild-type mice. Finally, the blood–brain barrier permeability index was detected in infected IL-6−/− mice treated with recombinant human IL-6. The blood–brain barrier permeability index was measured in infected wild-type mice treated with anti-IL-6 antibodies as well. The survival of IL-6−/− mice injected with C. neoformans was significantly lower than that of identically challenged wild-type mice. The infected IL-6−/− mice had significantly larger brain fungal burdens than wild-type mice. Furthermore, increased blood–brain barrier index was found in infected IL-6−/− mice when compared with that in infected control mice. Similar results were obtained when mice challenged with C. neoformans were treated systemically with neutralizing anti-IL-6 antibodies, resulting in an elevation of vascular permeability. Our data revealed that IL-6 reduced the blood–brain barrier permeability during Cryptococcus meningitis, and it might provide an explanation for the significantly lower survival of infected IL-6−/− mice.

Clinical analysis of 19 AIDS patients coinfected with cryptococcus meningitis / 临床神经病学杂志

Objective To observe the clinical features of AIDS coinfected with cryptococcus meningitis. Methods The clinical data of 19 AIDS patients coinfected with cryptococcus meningitis were retrospectively analyzed.Results Among 19 patients, the main clinical manifestation including headache (100.0%), nausea/vomiting (94.7%), fever (78.9%) and neck stiffness (84.2%).Seven cases revealed increased CSF protein, 10 cases showed depressed CSF glucose levels and 11 patients revealed elevated CSF pressures.The mean CD4+cell count was (58.9 ±27.8)/mm3.Imaging examination showed the neurological complications were hydrocephalus, cerebral infarction, cerebral atrophy and cerebral hernia.The usage rate of amphotericin B, amphotericin B liposome, fluconazole and fluorine cytosine was 31.6%, 21.1%, 47.4% and 47.4%, respectively.Only 2 cases received antiretroviral therapy.The misdiagnosis rate was 31.6%, and mortality rate was 21.1%.Conclusions AIDS coinfected with cryptococcus meningitis onsets hidden, with the clinical manifestation is atypical, and the misdiagnosis rate is higher.Early diagnosis and early usage of appropriate antifungal therapy/antiretroviral therapy can help to prevent the development of it.

A Case of Cryptococcal Meningitis in a Brest Cancer Patient with Liver Metastasis, Suffering from Herpes Zoster / 대한암학회지

Cryptococcosis is a relatively common mycosis of human caused by a worldwide Cryptococcus neoformans. Cryptococcosis occurs more frequently in immuno-compromised hosts such as patients with lymphoma, AIDS, leukemia and other debilitating diseases which manifest a condition of altered cell mediated immunity. Also cancer patients with anticancer chemotherapy are at high risk. Cryptococcosis is primarily a pulmonary disease that remains asymptomatic and unrecognised in most cases. Meningitic and meningoencephalitc forms are more frequently diagnosed because of their striking clinical symptoms.Meningoencephalitis is an uncommon form of cryptoccocosis that often leads to coma and death within a short time, if it is not quickly diagnosed and treated properly. The treatment of choice for the cryptococcosis consists of intravenous amphotericin B and 5-fluorocytocine. We report a case of cryptococcal meningitis in 47-year-old female breast cancer patient with liver metastasis after systemic chemotherapy. She complained headach, fever and diagnosed as cryptococcal meningitis after the India ink smear and culture of CSF. After treated with amphotericin B, her conditions were improved.