Cryptococcus neoformans meningitis in a HIV negative miliary tuberculosis-suspected patient

Cryptococcosis caused by Cryptococcus neoformans has a wide range of clinical presentations, varying from asymptomatic colonization of the respiratory airways to the dissemination of infection into different parts of body. It is more common among immunosupressed patients such as human immunodeficiency virus (HIV) positive ones. In this report we present a case with C. neoformans meningitis and miliary pulmonary infiltrates suggesting pulmonary tuberculosis without HIV infection. A-70-years-old male was admitted to the hospital with mental confusion, 3-weeks history of headache, weight loss, dry cough and fatigue. Physical examination was normal except neck stiffness. Cerebrospinal fluid (CSF) white cell count was 120/mm(3) (80% polimorphonuclear cells). Gram staining of CSF revealed poorly stained gram-positive yeast cells. Empirical therapy with lipozomal amphotericin B, ceftriaxone and ampicillin combination was started. When C. neoformans growth was detected on CSF culture, ceftriaxone and ampicillin were discontinued. Patient became conscious at 24(th) hour of the treatment. Peripheric blood flow-cytometric analysis revealed a significant decrease in absolute CD4(+) T lymphocytes, and in CD8(+)28(+) T lymphocytes in addition a significant increase in natural killer cell ratio. Blood immunoglobulin and complement levels were found normal. Cranial magnetic resonance imaging and computerized tomography (CT) of the abdomen were normal, however, chest CT revealed multiple parenchymal millimetric nodular infiltrations on both sides and minimal fibrotic alterations. Acid-fast staining of CSF, tuberculosis culture, tuberculosis PCR results and repeated HIV serology were found negative. Despite the lack of microbiological confirmation, empirical antituberculosis treatment was also started with the suspicion of miliary tuberculosis as the patient had a symptom of long-term dry cough, miliary infiltrations on chest CT, anergic tuberculin skin test and a history of pulmonary tuberculosis in childhood. After two weeks, amphotericin B was changed to oral fluconazole which was continued for an additional eight weeks. Antituberculosis therapy was given for nine months. Control chest CT taken after four months of antituberculosis therapy revealed improvement of the lesions. This presentation emphasizes the fact that cryptococcal infections may develop in HIV negative patients, even together with tuberculosis in certain cases and radiological findings of the two infections may be confusing when both of them invade the lungs.

Yazar Aydemir, Hande
Pikin, Nihal
Oeztoprak, Nefise
Celebi, Gueven
Tekin, Ishak Oezel
Akduman, Deniz
Yayın Türü Article
Tek Biçim Adres https://hdl.handle.net/20.500.12628/2330
Konu Başlıkları Cryptococcus neoformans
meningitis
miliary tuberculosis
Koleksiyonlar Araştırma Çıktıları | WoS | Scopus | TR-Dizin | PubMed | SOBİAD
PubMed İndeksli Yayınlar Koleksiyonu
WoS İndeksli Yayınlar Koleksiyonu
Dergi Adı MIKROBIYOLOJI BULTENI
Dergi Cilt Bilgisi 42
Dergi Sayısı 3
Sayfalar 519 - 524
Yayın Yılı 2008
Eser Adı
[dc.title]
Cryptococcus neoformans meningitis in a HIV negative miliary tuberculosis-suspected patient
Yazar
[dc.contributor.author]
Aydemir, Hande
Yazar
[dc.contributor.author]
Pikin, Nihal
Yazar
[dc.contributor.author]
Oeztoprak, Nefise
Yazar
[dc.contributor.author]
Celebi, Gueven
Yazar
[dc.contributor.author]
Tekin, Ishak Oezel
Yazar
[dc.contributor.author]
Akduman, Deniz
Yayın Yılı
[dc.date.issued]
2008
Yayıncı
[dc.publisher]
ANKARA MICROBIOLOGY SOC
Yayın Türü
[dc.type]
article
Özet
[dc.description.abstract]
Cryptococcosis caused by Cryptococcus neoformans has a wide range of clinical presentations, varying from asymptomatic colonization of the respiratory airways to the dissemination of infection into different parts of body. It is more common among immunosupressed patients such as human immunodeficiency virus (HIV) positive ones. In this report we present a case with C. neoformans meningitis and miliary pulmonary infiltrates suggesting pulmonary tuberculosis without HIV infection. A-70-years-old male was admitted to the hospital with mental confusion, 3-weeks history of headache, weight loss, dry cough and fatigue. Physical examination was normal except neck stiffness. Cerebrospinal fluid (CSF) white cell count was 120/mm(3) (80% polimorphonuclear cells). Gram staining of CSF revealed poorly stained gram-positive yeast cells. Empirical therapy with lipozomal amphotericin B, ceftriaxone and ampicillin combination was started. When C. neoformans growth was detected on CSF culture, ceftriaxone and ampicillin were discontinued. Patient became conscious at 24(th) hour of the treatment. Peripheric blood flow-cytometric analysis revealed a significant decrease in absolute CD4(+) T lymphocytes, and in CD8(+)28(+) T lymphocytes in addition a significant increase in natural killer cell ratio. Blood immunoglobulin and complement levels were found normal. Cranial magnetic resonance imaging and computerized tomography (CT) of the abdomen were normal, however, chest CT revealed multiple parenchymal millimetric nodular infiltrations on both sides and minimal fibrotic alterations. Acid-fast staining of CSF, tuberculosis culture, tuberculosis PCR results and repeated HIV serology were found negative. Despite the lack of microbiological confirmation, empirical antituberculosis treatment was also started with the suspicion of miliary tuberculosis as the patient had a symptom of long-term dry cough, miliary infiltrations on chest CT, anergic tuberculin skin test and a history of pulmonary tuberculosis in childhood. After two weeks, amphotericin B was changed to oral fluconazole which was continued for an additional eight weeks. Antituberculosis therapy was given for nine months. Control chest CT taken after four months of antituberculosis therapy revealed improvement of the lesions. This presentation emphasizes the fact that cryptococcal infections may develop in HIV negative patients, even together with tuberculosis in certain cases and radiological findings of the two infections may be confusing when both of them invade the lungs.
Açıklama
[dc.description]
WOS: 000258416900020
Açıklama
[dc.description]
PubMed: 18822899
Kayıt Giriş Tarihi
[dc.date.accessioned]
2019-12-23
Açık Erişim Tarihi
[dc.date.available]
2019-12-23
Yayın Dili
[dc.language.iso]
tur
Konu Başlıkları
[dc.subject]
Cryptococcus neoformans
Konu Başlıkları
[dc.subject]
meningitis
Konu Başlıkları
[dc.subject]
miliary tuberculosis
Haklar
[dc.rights]
info:eu-repo/semantics/closedAccess
ISSN
[dc.identifier.issn]
0374-9096
İlk Sayfa Sayısı
[dc.identifier.startpage]
519
Son Sayfa Sayısı
[dc.identifier.endpage]
524
Dergi Adı
[dc.relation.journal]
MIKROBIYOLOJI BULTENI
Dergi Sayısı
[dc.identifier.issue]
3
Dergi Cilt Bilgisi
[dc.identifier.volume]
42
Tek Biçim Adres
[dc.identifier.uri]
https://hdl.handle.net/20.500.12628/2330
Görüntülenme Sayısı ( Şehir )
Görüntülenme Sayısı ( Ülke )
Görüntülenme Sayısı ( Zaman Dağılımı )
Görüntülenme
35
09.12.2022 tarihinden bu yana
İndirme
1
09.12.2022 tarihinden bu yana
Son Erişim Tarihi
09 Şubat 2024 10:27
Google Kontrol
Tıklayınız
tuberculosis revealed therapy miliary pulmonary normal neoformans ampicillin ceftriaxone antituberculosis amphotericin staining infiltrations history started negative treatment infection infections significant culture lymphocytes patients months serology repeated results levels immunoglobulin Acid-fast alterations complement multiple fibrotic minimal
6698 sayılı Kişisel Verilerin Korunması Kanunu kapsamında yükümlülüklerimiz ve çerez politikamız hakkında bilgi sahibi olmak için alttaki bağlantıyı kullanabilirsiniz.

creativecommons
Bu site altında yer alan tüm kaynaklar Creative Commons Alıntı-GayriTicari-Türetilemez 4.0 Uluslararası Lisansı ile lisanslanmıştır.
Platforms