ABSTRACT
To describe clinical characteristics, treatment and outcome of cryptococcal meningitis in immunocompetent children. Immunocompetent children with cryptococcal meningitis who attended Changzheng Hospital between 1998 and 2007 were retrospectively reviewed. During the 10 years reviewed, 11 children with cryptococcal meningitis were admitted to Changzheng hospital and identified as immunocompetent. The 11 children had a median age of 7.25 years. Headache (100%), fever (81.8%), nausea or vomiting (63.6%) and visual or hearing damage or loss (36.4%) were the most common symptoms before treatment. There is no evidence for other site infection of cryptococcus although all the cryptococcal antigen titre is high in blood. All the patients received amphotericin B or AmB liposome with 5-flucytosine for at least 6 weeks followed by fluconazole or itraconazole as consolidation treatment for at least 12 weeks. Nine patients were cured mycologically; however, sequela of visual damage was showed in one patient. Cryptococcal meningitis seems to be uncharacteristic of symptoms, and central nervous system may be the only common site for infection. Amphotericin B with 5-flucytosine should be the choice of induction treatment in this group of patients.
Subject(s)
Antifungal Agents/administration & dosage , Cryptococcus neoformans , Meningitis, Cryptococcal/drug therapy , Adolescent , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Antigens, Fungal/blood , Child , Child, Preschool , Drug Administration Schedule , Female , Fluconazole/administration & dosage , Fluconazole/therapeutic use , Flucytosine/administration & dosage , Flucytosine/therapeutic use , Humans , Immunocompetence , Itraconazole/administration & dosage , Itraconazole/therapeutic use , Male , Meningitis, Cryptococcal/immunology , Meningitis, Cryptococcal/microbiology , Retrospective Studies , Treatment OutcomeABSTRACT
We present a case of primary cutaneous aspergillosis caused by Aspergillus terreus in a patient with cutaneous T-cell lymphoma. A 41-year-old woman bruised her left shin and presented with a 1 x 2 cm ecchymosis on the upper third of the left shin for over 6 months. Before mycological examination and sequential biopsies, the patient was erroneously treated with antibiotics and local debridement. After final diagnosis of cutaneous aspergillosis caused by A. terreus cutaneous T-cell lymphoma on the basis of mycological, histopathological and immunohistochemical findings, the patient responded well to oral itraconazole and chemotherapy for over 1 month.
Subject(s)
Aspergillosis/diagnosis , Aspergillus/isolation & purification , Dermatomycoses/diagnosis , Lymphoma, T-Cell, Cutaneous/complications , Adult , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillosis/pathology , Dermatomycoses/drug therapy , Dermatomycoses/pathology , Female , Humans , Itraconazole/therapeutic useABSTRACT
An immunocompetent 8-year-old girl was presented with cryptococcal meningitis. She was cured clinically and mycologically after 6 weeks of amphotericin B plus flucytocin and 2 months of fluconazole, and no relapse and sequelae were observed. Mycological and clinical profile of the patient during treatment was recorded.
Subject(s)
Cryptococcus neoformans/isolation & purification , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/microbiology , Antifungal Agents/therapeutic use , Child , Cryptococcus neoformans/physiology , Female , Humans , Immunocompromised Host , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/immunologyABSTRACT
Objective To examine mycological profile of eryptococcal meningitis in patients with non-acquired immune deficiency syndrome (AIDS) during treatment and follow-up so that to support clinical therapy. Methods Data of 28 cuhure-confirmed cryptoeoccal meningitis patients with non-AIDS were retrospectively analyzed. Fungat smear, count, culture and latex agglutination test of cerebrospinal fluid (CSF) were done during treatment and follow-up. Initial treatment included intravenous amphotericin B plus oral flucytosine or f;uconazole for at least 6 weeks, and consolidation treatment included oral fluconazole and (or) itraeonazole for at least 2 months. All 28 patients were cured. The data were analyzed by rank-sum test. Results The positive rate of CSF fungal smear was 92.9% before treatment and gradually decreased, and the fungal count was significantly reduced over time after treatment. While fungal smears of some patients were still positive after initial treatment. Fungal growth time in culture was gradually extended, and fungal culture turned to be negative in all patients after 2 weeks of treatment. The positive rate of latex agglutination test of CSF was 100%. Cryptococcal antigen titer decreased steadily after treatment, which was not correlated with the decrease of fungal count. Conclusion Mycological tests of patients with eryptococcal meningitis should be interpreted comprehensively during treatment, and result of each test should be specifically analyzed.
ABSTRACT
A case of recurrent cryptococcosis with idiopathic CD4 lymphocytopenia is reported in this article. After an initial cryptococcal infection in the lung, the patient experienced one episode of cryptococcal meningitis and two more episodes of cryptococcal pneumonia within a period of 12 years. Genetic studies revealed that all isolated microbes were identical, indicating that all subsequent episodes were recurrence instead of re-infection.
