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Infectious Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Imran Rizvi, Ravindra Kumar Garg
The fungus, Cryptococcus neoformans, the causative agent of cryptococcal meningitis, can cause optic neuropathy as well.2 Cryptococcal meningitis commonly occurs in patients with immunocompromised states. Optic neuropathy may be part of cryptococcal meningitis. The optic neuropathy, in cryptococcal meningitis, results from direct fungal invasion. Other factors responsible for optic nerve damage are raised intracranial pressure and vasculitis of vasa nervorum.55 A rapid vision loss is mostly attributed to direct infection or inflammation. Slow deterioration of vision is generally attributed to raise intracranial pressure.56 Diagnosis of cryptococcal meningitis is made if India ink staining, antigen detection using latex agglutination method or culture of cerebrospinal fluid demonstrates the fungus. Treatment requires a combination of amphotericin B and flucytosine/fluconazole. Optic nerve sheath fenestration can be tried in selected patients.
Meningitis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Patients with asplenia or sickle cell disease are unable to activate the alternative complement pathway, rendering them susceptible to infection with encapsulated bacteria. Alcohol abuse is a risk factor for pneumococcal meningitis because it decreases cough reflex, reduces ciliary clearance and impairs bacterial killing. Impairment of neutrophil adherence, chemotaxis and bacterial killing is seen in poorly controlled diabetes. Patients living with HIV have a higher risk of invasive pneumococcal infection even if on HAART. Cryptococcal meningitis occurs if CD4 T-lymphocyte cell counts are lower than 100 cells/μL. Another group at risk for cryptococcal meningitis are solid organ transplant recipients. Cancer may cause dysfunction of the immune system, increasing risk of meningitis.
Fungal infections causing emergencies
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
R. Madhu, Pradeesh Arumugam, V. Hari Pankaj
Prognosis is poor in immunocompromised patients. Mortality from HIV-associated cryptococcal meningitis remains high (10%–30%), even in developed countries, because of the inadequacy of current antifungal drugs and combinations and the complication of raised intracranial pressure [10–12]. A study conducted by Ecevit et al. [13] shows that increased recognition and timely diagnosis of cryptococcal meningitis may improve outcomes. Mucormycosis has been reported to have an overall mortality rate of 44%.
Risk of invasive fungal infections among patients treated with disease modifying treatments for multiple sclerosis: a comprehensive review
Published in Expert Opinion on Drug Safety, 2021
R. Scotto, A. Reia, A.R. Buonomo, M. Moccia, G. Viceconte, E. Pisano, E. Zappulo, V. Brescia Morra, I. Gentile
For what concern fungal infections, in one observational study a case of genital candidiasis in a patient taking dimethyl fumarate was detected [41], while no IFI were reported in clinical trials [77–79]. However, a single case of cryptococcal meningitis was also reported [80]. This patient had been treated with dimethyl fumarate for almost 3 years. He presented with slowly progressive headache and recent onset of confusion, disorientation, nausea and vomiting. His serum lymphocyte count was about 1000/µl during dimethyl fumarate treatment. Both CT scan and MRI of the brain were unremarkable. CSF analysis revealed high cells (532 WBC/ul, 72% granulocytes), high opening pressure, high proteins and low glucose. Cryptococcal antigen was found on CSF and a fungal culture revealed the growth of Cryptococcus neoformans on CSF. Apart from the use of dimethyl fumarate, no other immunocompromising factors like HIV were identified. The patient was treated with amphotericin B and flucytosine for 1 month, and then, with oral fluconazole for one year. After the induction of antifungal therapy, confusion and disorientation quickly improved, but memory and attention deficits persisted; fungal culture and Cryptococcal antigen became negative; high intracranial pressure persisted, so that a ventriculoperitoneal shunt was required. The patient was discharged to a rehabilitation clinic for cognitive impairment after completion of induction therapy and then returned home.
Delays in lumbar puncture are independently associated with mortality in cryptococcal meningitis: a nationwide study
Published in Infectious Diseases, 2021
Armaghan-e-Rehman Mansoor, Jesse Thompson, Arif R. Sarwari
Cryptococcal meningitis is a potentially life-threatening invasive disease caused by the yeast Cryptococcus [1]. Often seen in the immunocompromised population, cryptococcal meningitis (CM) is the most common form of disseminated cryptococcal infection [2]. Human Immunodeficiency Virus (HIV) infection remains an important risk factor for CM; however, an increasing number of cases are reported in patients with solid organ transplantation, malignancies, chronic immunosuppressive therapy, and hepatic failure [3,4]. There is a worldwide distribution of disease, with the largest burden reported to be in sub-Saharan Africa, and South/Southeast Asia [5,6]. Inpatient mortality from CM continues to remain high with studies reporting mortality between 6–16%, and some reported single-centre estimates in resource-poor settings as high as 30–50% [7]. Patients who do survive CM can often be left with significant neurological deficits [8,9].
Disseminated cryptococcal infection in a patient with glioblastoma multiforme on treatment with lomustine and bevacizumab
Published in Baylor University Medical Center Proceedings, 2021
Adrienne M. Gonzales, Tauqeer Yousuf
There have been two similar case reports of patients with high-grade gliomas on chemotherapy who developed cryptococcal meningitis, one with glioblastoma on temozolomide and one with anaplastic astrocytoma on lomustine.5 Our patient had a history of resection and radiation and is on current combined therapy with lomustine, bevacizumab, and corticosteroids. His initial symptoms were concerning for isolated pulmonary disease, but we quickly found evidence of cryptococcal meningitis. This case highlights the fact that in the setting of immunosuppression with chemotherapy and chronic steroid use, physicians should maintain a high index of suspicion for opportunistic infections, including cryptococcosis. Cryptococcal meningitis is potentially treatable if recognized early, but is fatal if missed.