Cryptococcal Meningoencephalitis in Post COVID Period: Case Series and Review of Literature

Abstract

Following COVID -19 infection people are prone for developing bacterial, viral and fungal infections. The main reasons highlighted for increased susceptibility to infection are severe COVID -19 infection and use of immune suppressants. We had 3 cases of cryptococcal meningitis where two patients had mild COVID -19 and one had asymptomatic COVID -19. Evaluation for immune suppression revealed persisting pan lymphocyte depletion in one patient, isolated CD4 depletion in second patient and underlying HIV infection in the third patient with a very low CD4 count of 11 which was totally asymptomatic till then. Cryptococci is a ubiquitous pathogen and both innate and adaptive immunity is important in eradicating infection. COVID -19 per se as well as the various treatment modalities given in COVID -19 infection disrupts the immune system making people vulnerable for opportunistic infections. Even mild COVID -19 infection can predispose such diseases. A brief description of innate and acquired immune mechanisms preventing cryptococcal infection and how this is altered in COVID -19 infection is highlighted in this article. Post COVID patients when come with infections, unusual pathogens also should be considered. Unusual infection when occur in immune competent people, asymptomatic COVID -19 infection should also be ruled out. Keywords: CD4 cytopenia, Pan lymphocyte depletion, Cryptococcal meningitis, Cryptococcus, Covid 19 infection