Cases Of Cryptococcal Meningitis Research Articles

Antifungal susceptibility and multilocus sequence typing (MLST) of Cryptococcus neoformans complex from HIV-associated cryptococcal meningitis patients in Manaus, Amazonas, Brazil.

Cryptococcus neoformans is primarily responsible for cases of cryptococcal meningitis in individuals with HIV/AIDS. This study evaluated the susceptibility of C. neoformans obtained from individuals with cryptococcal meningitis associated with HIV/AIDS in Manaus, Amazonas, Brazil, against the action of the antifungals amphotericin B, flucytosine, fluconazole, itraconazole and posaconazole and analyzed it using Multilocus Sequence Typing (MLST) in order to identify the Sequence Types (STs). We analyzed 30 isolates of C. neoformans, from 24 HIV/AIDS patients diagnosed with cryptococcosis from 2017 to 2019 in a reference hospital, in addition to 3 environmental isolates: 1 isolate obtained in the home of a patient and 2 isolates obtained from neighboring homes of patients. 86.6% (n = 26/30) of the clinical isolates were identified as C. neoformans VNI ST93, 6.6% (n = 2/30) as C. neoformans VNI ST5, 3.3% (n = 1/30) as C. neoformans VNI ST32 and 3.3% (n = 1/30) as C. neoformans VNB ST232. The environmental isolates were identified as C. neoformans VNI ST93 (n = 3/3). 96.6% (n = 29/30) isolates were sensitive to amphotericin B, though there was variation in the MIC. 60% (n = 18/30) presented a MIC above the proposed epidemiological cutoff values for one or more antifungals. All environmental isolates were sensitive to the tested antifungals. The MLST showed that there is an important relationship between C. neoformans VNI ST93 and individuals with HIV/AIDS, including in the environmental isolates analyzed. C. neoformans VNB ST232 was observed for the first time in Amazonas. Amphotericin B was proven to be the best drug, but fluconazole and posaconazole also showed relevant action.

Development and validation of quantitative PCR assays for HIV-associated cryptococcal meningitis in sub-Saharan Africa: a diagnostic accuracy study

HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related deaths, with a 10-week mortality rate of 25-30%. Fungal load assessed by colony-forming unit (CFU) counts is used as a prognostic marker andto monitor response to treatment in research studies. PCR-based assessment of fungal load could be quicker andless labour-intensive. We sought to design, optimise, and validate quantitative PCR (qPCR) assays for the detection, identification, and quantification of Cryptococcus infections in patients with cryptococcal meningitis in sub-Saharan Africa. We developed and validated species-specific qPCR assays based on DNA amplification of QSP1 (QSP1A specific to Cryptococcus neoformans, QSP1B/C specific to Cryptococcus deneoformans, and QSP1D specific to Cryptococcus gattii species) and a pan-Cryptococcus assay based on a multicopy 28S rRNA gene. This was a longitudinal study that validated the designed assays on cerebrospinal fluid (CSF) of 209 patients with cryptococcal meningitis at baseline (day 0) and during anti-fungal therapy (day 7 and day 14), from the AMBITION-cm trial in Botswana and Malawi (2018-21). Eligible patients were aged 18 years or older and presenting with a first case of cryptococcal meningitis. When compared with quantitative cryptococcal culture as the reference, the sensitivity of the 28S rRNA was 98·2% (95% CI 95·1-99·5) and of the QSP1 assay was 90·4% (85·2-94·0) in CSF at day 0. Quantification of the fungal load with QSP1 and 28S rRNA qPCR correlated with quantitative cryptococcal culture (R2=0·73 and R2=0·78, respectively). Both Botswana and Malawi had a predominant C neoformans prevalence of 67% (95% CI 55-75) and 68% (57-73), respectively, and lower C gattii rates of 21% (14-31) and 8% (4-14), respectively. We identified ten patients that, after 14 days of treatment, harboured viable but non-culturable yeasts based on QSP1 RNA detection (without any positive CFU in CSF culture). QSP1 and 28S rRNA assays are useful in identifying Cryptococcus species. qPCR results correlate well with baseline quantitative cryptococcal culture and show a similar decline in fungal load during induction therapy. These assays could be a faster alternative to quantitative cryptococcal culture to determine fungal load clearance. The clinical implications of the possible detection of viable but non-culturable cells in CSF during induction therapy remain unclear. European and Developing Countries Clinical Trials Partnership; Swedish International Development Cooperation Agency; Wellcome Trust/UK Medical Research Council/UKAID Joint Global Health Trials; and UKNational Institute for Health Research.

Cryptococcal meningitis in non-human immunodeficiency virus patients: A case series

Cryptococcosis is a fungal infection caused by encapsulated yeast in the genus Cryptococcus. It is mostly observed in immunocompromised, organ transplant, and human immunodeficiency virus (HIV) positive patients, but it is also seen in non-HIV and immunocompetent patients. The majority of the cases have been reported in patients suffering from cryptococcal meningitis in HIV/acquired immunodeficiency syndrome. In this study, we reported a case series of three cases of cryptococcal meningitis in non-HIV patients. These cases were suspected and diagnosed according to their underlying immune status and clinical presentations.

Epidemiological approach to Cryptococcus meningitis and related species in northeast Brazil: a scoping review

Introduction: Cryptococcosis is a fungal infection associated with yeast of the Cryptococcus genus. It is an opportunistic infection, more prevalent in individuals with AIDS, primarily manifesting as meningitis. Although there are numerous cases of cryptococcosis in northeastern Brazil, little is reported in the literature regarding meningitis cases. Objective: This study aimed to conduct a scoping review of meningitis cases associated with the Cryptococcus genus reported in the northeastern region of Brazil. Methodology: Four databases were utilized. Twenty-one studies were selected, totaling 492 cases. All states had publications on cryptococcal meningitis cases. RESULTS: The results revealed few studies on Cryptococcus meningitis in the region, with 492 identified cases. The majority were caused by Cryptococcus neoformans (356 cases), followed by C. gattii (98 cases), and other related species. AIDS was the primary underlying condition, associated with high mortality. Genetic research was underutilized. Conclusion: There is a need to enhance diagnostic methods in conjunction with increased case reporting to obtain a more detailed and comprehensive understanding of the epidemiology of neurocryptococcosis in northeastern Brazil.

Cryptococcus neoformans and cryptococcosis: a contribution made by Prof. Dr. Mahendra Pal

Mycotic infections are reported to occur in both sexes, all age groups, in all seasons, and in urban and rural areas of the world. The people with weakened immune systems are more likely to get an infection due to fungi, which are widely prevalent in our environment. Cryptococcosis primarily caused by Cryptococcus neoformans is a life-threatening enigmatic mycosis of global importance. It is estimated that 1000000 cases of cryptococcal meningitis complicating HIV/AIDS are reported every year worldwide. Disease has been encountered in humans as well as in a variety of animals including cats and dogs. The source of infection is exogenous, as the fungus occurs as a saprophyte in nature. Currently, the pigeon excreta serve as the chief saprobic reservoir of C. neoformans. Human as well as animals may acquire the infection from the environment where the fungus grows luxuriantly. The respiratory tract is recognized as the principal mode of entry of the organism. The pathogen can also enter through the fungal contaminated objects via traumatized skin. Clinical spectrum of disease is varied, as manifested with several forms, such as pulmonary, meningeal, visceral, osseous, and cutaneous. The laboratory help is imperative to confirm an unequivocal diagnosis of cryptococcosis. The pathogen can be easily isolated from the clinical specimens of the patients on Pal sunflower seed medium. Modified Pal sunflower seed can be employed to undertake the sexual compatibility studies of Cr. neoformans. Several drugs including amphotericin B, fluconazole, and itraconazole have been recommended for the treatment of disease. The immediate attention to the skin injury and use of face mask when dealing with avian droppings can help in the prevention of infection.

Clinical and Metagenomic Characterization of Neurological Infections of People With Human Immunodeficiency Virus in the Peruvian Amazon.

Neurological opportunistic infections cause significant morbidity and mortality in people with human immunodeficiency virus (HIV) but are difficult to diagnose. One hundred forty people with HIV with acute neurological symptoms from Iquitos, Peru, were evaluated for cerebral toxoplasmosis with quantitative polymerase chain reaction (qPCR) of cerebrospinal fluid (CSF) and for cryptococcal meningitis with cryptococcal antigen test (CrAg) in serum or CSF. Differences between groups were assessed with standard statistical methods. A subset of samples was evaluated by metagenomic next-generation sequencing (mNGS) of CSF to compare standard diagnostics and identify additional diagnoses. Twenty-seven participants were diagnosed with cerebral toxoplasmosis by qPCR and 13 with cryptococcal meningitis by CrAg. Compared to participants without cerebral toxoplasmosis, abnormal Glasgow Coma Scale score (P = .05), unilateral focal motor signs (P = .01), positive Babinski reflex (P = .01), and multiple lesions on head computed tomography (CT) (P = .002) were associated with cerebral toxoplasmosis. Photophobia (P = .03) and absence of lesions on head CT (P = .02) were associated with cryptococcal meningitis. mNGS of 42 samples identified 8 cases of cerebral toxoplasmosis, 7 cases of cryptococcal meningitis, 5 possible cases of tuberculous meningitis, and incidental detections of hepatitis B virus (n = 1) and pegivirus (n = 1). mNGS had a positive percentage agreement of 71% and a negative percentage agreement of 91% with qPCR for T gondii. mNGS had a sensitivity of 78% and specificity of 100% for Cryptococcus diagnosis. An infection was diagnosed by any method in only 34% of participants, demonstrating the challenges of diagnosing neurological opportunistic infections in this population and highlighting the need for broader, more sensitive diagnostic tests for central nervous system infections.

S3586 Advanced Alcoholic Liver Cirrhosis as an Immunocompromised State: A Case of Cryptococcal Meningitis

S3586 Advanced Alcoholic Liver Cirrhosis as an Immunocompromised State: A Case of Cryptococcal Meningitis

Fungal infections in Sudan: An underestimated health problem.

Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571 Pneumocystis pneumonia, and 462 cryptococcal meningitis cases. Aspergillus infections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs.

Cryptococcal Meningitis in Young, Immunocompetent Patients: A Single-Center Retrospective Case Series and Review of the Literature.

Cryptococcal meningitis is an uncommon but serious infection with high mortality and morbidity. Classically described in immunocompromised patients, including those with solid organ transplants or HIV/AIDS, cryptococcosis has also been reported in young and otherwise healthy patients, albeit rarely. We retrospectively searched for all cases of cryptococcal meningitis in young (≤50 years) and previously healthy patients with no known immunocompromising conditions from January 2015 to January 2022 at Indiana University Health (IU Health). Additionally, a PubMed literature review was performed with the keywords "cryptococcal meningitis" and "immunocompetent" from January 1988 to January 2022. Clinical courses, including outcomes and treatment regimens, were evaluated. We identified 4 local cases of cryptococcal meningitis in otherwise healthy patients age ≤50 years. Three cases were due to Cryptococcus neoformans, with 1 experiencing a postinfectious inflammatory response syndrome (PIIRS). The PubMed search identified 51 additional cases, with 32 (63%) being caused by Cryptococcus neoformans and 8 (17%) by Cryptococcus gattii. Of the 51 cases, only 2 resulted in death directly due to cryptococcosis. Fifteen (29%) had PIIRS, with steroid treatment documented in 11 of 15. Antifungal induction regimens and duration were varied but predominately consisted of amphotericin and flucytosine, with a mean induction duration of 5.0 weeks. Cryptococcal meningitis in young, previously healthy patients is likely under-recognized. PIIRS (akin to immune reconstitution inflammatory syndrome observed in HIV/AIDS) with prolonged recovery should be of concern. Determining risk factors for cryptococcosis in these patients remains elusive.

Reversal of uniocular blindness with corticosteroids in a solid organ transplant recipient with cryptococcal meningitis and immune reconstitution syndrome (IRIS): A case report

Cryptococcal meningitis is a life-threatening infection commonly seen in patients with advanced HIV infection and solid organ transplant recipients. We report a case of cryptococcal meningitis with immune reconstitution syndrome (IRIS) who presented to us with a headache and complete loss of vision in the left eye. He was managed with antifungals and a short course of steroids, and he regained vision completely. In the hospital, he developed complications including tacrolimus toxicity, fluconazole-induced QT prolongation, and flucytosine-induced thrombocytopenia. Our case demonstrates the importance of a multidisciplinary approach in the management of complex cases like cryptococcal meningitis in solid organ transplant recipients.

Cryptococcal Meningitis in an Immunocompetent Male: Case Report

Cryptococcal meningitis is a life-threatening condition caused by an invasive, opportunistic, encapsulated saprophytic fungus, either Cryptococcus neoformans or Cryptococcus gattii most often in immunocompromised patients, especially those with human immunodeficiency virus (HIV). Overwhelming invasive infection of immunocompetent patients is rather uncommon, and diagnosis is often challenging due to a more indolent course. We present a case of cryptococcal meningitis (CM) in a 72-year-old immunocompetent male following a recent motor vehicle accident.

A Case of Brainstem Cryptococcoma Causing Pontine Stroke in an Immunocompetent Male (P1-10.003)

<h3>Objective:</h3> N/A <h3>Background:</h3> Cryptococcus is an invasive fungal disease seen in immune compromised individuals and usually present as meningitis when involved in the Central Nervous System. Cerebral cryptococcoma is a rare form of cryptococcal infection which is often misdiagnosed. Literature reviews showed most of them are located in frontal lobe, parietal lobe or basal ganglia. The involvement of pons only has been extremely rare. There are cases of cryptococcal meningitis causing ischemic stroke due to vasculitis but this case was complicated by perforator infarct adjacent to the lesion. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> <h3>Case presentation:</h3> We are going to discuss a 58 years old immunocompetent male who initially presented with dizziness and double vision. MRI of brain showed small acute infarct in right paramedian pons with adjacent edema out of proportion to the infarct. The contrast showed ring enhancing lesion. The patient returned after 4 months with severe headache and double vision. Repeat MRI of brain showed slightly enlarged ring enhancing lesion in right ventral pons. CSF study was positive for Cryptococcus neoformans both times. <h3>Conclusions:</h3> Diagnosis of cryptococcoma is often challenging especially in immunocompetent individuals where the clinical suspicion is low. There have been case reports where it has been misdiagnosed as neoplasm, tumefactive demyelinating disease and stroke. Therefore, causing delays in treatment leading to increased mortality and morbidity. This discussion indicates that physicians should have low threshold to suspect cryptococcoma in immunocompetent individual with ring enhancing lesion as timely intervention can save lives from this invasive fungal disease. <b>Disclosure:</b> Dr. Jabeen has nothing to disclose. Dr. Maghsoudlou has nothing to disclose.

Herpes Simplex Virus (HSV), Varicella-Zoster Virus (VZV), and Cryptococcal Infections Associated With Sphingosine-1-Phosphate Receptor (S1PR) Modulators: A Review (P12-10.005)

<h3>Objective:</h3> To summarize the existing data on the incidence of herpes simplex virus (HSV), varicella-zoster virus (VZV), and Cryptococcus sp. infections with sphingosine-1-phosphate receptor (S1PR) modulators. <h3>Background:</h3> S1PR modulators are a novel class of disease-modifying therapies for multiple sclerosis (MS) that produce immunosuppression and potential lymphopenia. Herpesvirus and cryptococcal diseases were the most common opportunistic infections in clinical trials. Several post-hoc analyses have subsequently been published with revised incidence rates (IRs) for these conditions. <h3>Design/Methods:</h3> A literature review and descriptive analysis of phase-3 trials (n=6), post-marketing studies (n=8), and case reports (n=17) were conducted using PubMed and Google Scholar. Further data was accessed through Novartis AG, Bristol-Myers Squibb, and Janssen Pharmaceuticals. <h3>Results:</h3> <h3>FINGOLIMOD:</h3> Herpesvirus infection rates were similar between placebo (2.8%) and 0.5 mg (2.1%) but increased with 1.25 mg (5.5%) in the TRANSFORMS study. VZV rates were higher with fingolimod 0.5 mg (3.0%; 11 per 1000 patient-years [PY]) than with placebo (1.0%; 6 per 1000 PY), but comparable post-marketing. Cryptococcal infections (n=74) had an IR of 9 per 100,000 PY, and 13 cases were individually reported. <h3>SIPONIMOD:</h3> VZV reactivation occurred more frequently with siponimod (2%) than with placebo (1%); EXPAND extension analyses calculated an IR of 0.9 for HSV and 1.8 for VZV infections. One case of cryptococcal meningitis (from 7236 PY of exposure) was documented. <h3>OZANIMOD:</h3> An integrated safety analysis reported oral herpes at 1.5%, VZV at 1.4%, and HSV at 0.5% from all clinical trials versus 0.7%, 0.6%, and 0.1% from the phase-3 trials. The IR of herpes zoster was 5.3/1000 PY. <h3>PONESIMOD:</h3> The incidence of herpetic infections was equal between both groups (4.8%) in the OPTIMUM trial. Cryptococcal infections have not yet been reported with ozanimod or ponesimod. <h3>Conclusions:</h3> Overall, the incidence of these opportunistic infections associated with S1PR modulators in MS was low, with favorable outcomes and limited fatalities. <b>Disclosure:</b> Dr. Sharma has nothing to disclose. Mr. JHA has nothing to disclose. Dr. Khanal has nothing to disclose. Dr. Sriwastava has nothing to disclose.

Updated estimation of the burden of fungal disease in Vietnam.

Anecdotally, the burden of fungal diseases in Vietnam is rapidly rising, but there has been no updated estimate on this issue since a previous report in 2015. In this study, we aimed at estimating the incidence and prevalence of serious fungal infections for the year 2020. We made estimates with a previously described methodology, using reports on the incidence and prevalence of various established risk factors for fungal infections from local, regional or global sources. We estimated 2,389,661 cases of serious fungal infection occurred in Vietnam in 2020. The most common condition was recurrent vaginal candidiasis (4047/100,000 women annually). Among people living with HIV, we estimated 451 cases of cryptococcal meningitis, 1030 of pneumocystis pneumonia, 166 of histoplasmosis and 1612 of talaromycosis annually. Candidaemia incidence was estimated at 12/100,000 population each year. Owing to its high burden of tuberculosis and respiratory diseases, Vietnam had high rates of severe infections caused by Aspergillus species. Incidence of invasive aspergillosis is 24/100,000 population, allergic bronchopulmonary aspergillosis 78/100,000 and severe asthma with fungal sensitisation 102/100,000. Five-year period prevalence of chronic pulmonary aspergillosis is 120/100,000 population /5-year period. Mucormycosis, fungal keratitis and tinea capitis were estimated at 192, 14,431 and 201 episodes each year, respectively. The number of patients with mycoses in Vietnam is likely underestimated due to a lack of local data and limited diagnostic capacity, but at least 2.5% of the population might have some form of serious fungal disease.

Клиническое наблюдение криптококкового менингита у пациента с системной красной волчанкой

The risk of serious infectious diseases is significantly increased in individuals with systemic lupus erythematosus (SLE). The article describes a clinical case of meningoencephalitis caused by Cryptococcus neoformans, in a 33-year-old female patient with SLE. The diagnosis was based on the results of cerebrospinal fluid analysis, brain magnetic resonance imaging scans, and retrospective analysis of chest computed tomography features. The antifungal therapy comprising liposomal amphotericin B and fluconazole was used successfully. Distinctive features of this clinical case include a delayed diagnosis due to the slow development and the presence of non-specific neurological symptoms, as well as the onset of acute renal disorders amid the use of antifungal therapy. The authors discuss the issues of diagnosing infectious complications in patients with SLE, particularly fungal infections, and the up-to-date approaches to therapy of cryptococcal meningitis. The presented clinical report could help therapists and rheumatologists to improve timely recognition of cryptococcal infections in SLE patients. The authors emphasized that CSF examination plays the key role in diagnosing cryptococcal meningitis. KEYWORDS: cerebral cryptococcosis, opportunistic infection, meningoencephalitis in patients with systemic lupus erythematosus, clinical case, fungal infection, systemic lupus erythematosus. FOR CITATION: Kuzminykh D.A., Eliseev Yu.V., Matrosova M.S. et al. A clinical case of cryptococcal meningitis in patient with systemic lupus erythematosus. Russian Medical Inquiry. 2023;7(3):174–180 (in Russ.). DOI: 10.32364/2587-6821-2023-7-3-174-180.

1H NMR Using Metabolic Study in Body Fluids for Diagnosis of Cryptococcal Meningitis in Adults.

Cryptococcal meningitis is considered to affect HIV patients and those with impaired immune systems. Early identification and treatment are the keys to decreasing morbidity and mortality related to CM. Using 1H NMR spectroscopy, a prospective case-control study will assess the metabolic profile of adults' serum, urine, and CSF. The present multicentric study was conducted at Lucknow. The study included 150 participants, out of which there were 31 cryptococcal meningitis cases, 34 positive meningitis controls, and the rest, 85, were disease controls. The discriminant function analysis (DFA) of the three biofluids was used to find significant metabolites between the cases and the control group collectively. A group categorization between control group and the cases in serum, urine, and CSF samples was also made possible by the NMR spectral bin-based orthogonal signal correction and principal component analysis score plots of important metabolites produced from DFA. The cases group had a higher proportion of patients with higher CSF protein levels than the positive control group (BM and TM). Acetone was found among urine samples in both control samples, i.e., positive and negative. This is the first study to explore biomarkers in serum, urine, and CSF in addition to radiological features and clinical symptoms. Hence, a quick, non-invasive prognosis and diagnosis of cryptococcal meningitis in adults can be made using clinical and microbiological investigation, as well as metabolomic analysis of urine samples. This study shows that urine can be used as a biofluid to differentiate between Cryptococcus meningitis in adults. However, when compared to the negative control, our sample size was significantly smaller, necessitating further confirmation on a larger sample size.

An Alternative Diagnostic Method for C. neoformans: Preliminary Results of Deep-Learning Based Detection Model.

Cryptococcus neoformans is an opportunistic fungal pathogen with significant medical importance, especially in immunosuppressed patients. It is the causative agent of cryptococcosis. An estimated 220,000 annual cases of cryptococcal meningitis (CM) occur among people with HIV/AIDS globally, resulting in nearly 181,000 deaths. The gold standards for the diagnosis are either direct microscopic identification or fungal cultures. However, these diagnostic methods need special types of equipment and clinical expertise, and relatively low sensitivities have also been reported. This study aims to produce and implement a deep-learning approach to detect C. neoformans in patient samples. Therefore, we adopted the state-of-the-art VGG16 model, which determines the output information from a single image. Images that contain C. neoformans are designated positive, while others are designated negative throughout this section. Model training, validation, testing, and evaluation were conducted using frameworks and libraries. The state-of-the-art VGG16 model produced an accuracy and loss of 86.88% and 0.36203, respectively. Results prove that the deep learning framework VGG16 can be helpful as an alternative diagnostic method for the rapid and accurate identification of the C. neoformans, leading to early diagnosis and subsequent treatment. Further studies should include more and higher quality images to eliminate the limitations of the adopted deep learning model.

A Case of Cryptococcal Meningitis Complicated by Postinfectious Inflammatory Response Syndrome in an Apparently Immunocompetent Patient

Abstract Cryptococcal meningitis (CM) is a fungal infection most commonly seen in immunocompromised patients and rarely affecting immunocompetent patients. Cryptococcal meningitis can present with varying complications, such as disseminated disease and neurological complications that include intracranial hypertension, cerebral infarcts, and vision loss. Delayed diagnosis of CM contributes to the disease's mortality in the immunocompetent patient. We would like to present the case of a 27-year-old apparently immunocompetent woman admitted for CM with initial improvement and then neurological decline concerning for cryptococcal–postinfectious inflammatory response syndrome.

P243 Case series of Cryptococcal Meningitis—Experience in North Western India over 1 year (2021–22)

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectiveCryptococcosis is an opportunistic fungal infection causing high morbidity and mortality in patients, preferentially affecting immunocompromised. It can cause a wide array of clinical manifestation, which includes meningitis, pulmonary, as well as disseminated infection. Cryptococcus neoformans causes more than 90% cases of cryptococcal meningitis.MethodologyWe performed a retrospective review of patients with confirmed cryptococcal meningitis during 1 year period from 2021 to 2022 in tertiary care center, AIIMS Jodhpur. We assessed clinical, radiological, microbiological, and biochemical parameters along with treatment provided and outcomes of the patient.ResultsOf 189 patients screened for suspected cryptococcal meningitis, 6 were microbiologically confirmed positive. All the patients were immunocompromised, of which four were HIV positive and one was a solid organ transplant recipient on immunosuppression and one was old TB Meningitis. Most common symptom was headache and altered sensorium (100%). Radiological findings showed 30% had no significant abnormality. CSF examination revealed average CSF protein 97.6 (63-163), CSF chloride 103.3 (108-132), sugar 36.33 (1-68), with predominant lymphocytes. All the patients were microbiologically confirmed by CSF cryptococcal latex test. A total of 4/5 patients received amphotericin B (3 mg/kg) with fluconazole (1200 mg) for 2 weeks in the induction phase followed by fluconazole consolidation phase and maintenance phase. Of the five patients, four patients survive with a good response to the treatment with one fatality.ConclusionThrough our case series we emphasize the fact that Cryptococcal meningitidis may present with non-significant radiological features. Thus, the differential diagnosis of C. meningitidis must always be thought of when an immunocompromised patient presents with headaches and other signs and symptoms involving the central nervous system.

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

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