American Journal of Epidemiology and Infectious Disease
ISSN (Print): 2333-116X ISSN (Online): 2333-1275 Website: http://www.sciepub.com/journal/ajeid Editor-in-chief: Apply for this position
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American Journal of Epidemiology and Infectious Disease. 2015, 3(4), 80-83
DOI: 10.12691/ajeid-3-4-2
Open AccessCase Report

Management of AIDS Related Cryptococcus Neoformans Meningitis in a Rural Hospital Setting

Lai Nai Kiat Sean1, Cynthia Sandanamsamy1, Chan Weng Kit1, Naganathan1 and Ganesh Kasinathan2

1Department of Medicine, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia

2Department of Medicine, Segamat Hospital, KM 6 Jalan Genuang, Segamat, Johor, Malaysia

Pub. Date: November 09, 2015

Cite this paper:
Lai Nai Kiat Sean, Cynthia Sandanamsamy, Chan Weng Kit, Naganathan and Ganesh Kasinathan. Management of AIDS Related Cryptococcus Neoformans Meningitis in a Rural Hospital Setting. American Journal of Epidemiology and Infectious Disease. 2015; 3(4):80-83. doi: 10.12691/ajeid-3-4-2

Abstract

Background: Cryptococcal meningitis is an opportunistic infection caused by Cryptococcus neoformans or Cryptococcus gattii. Case Presentation: This case describes a 34 year-old Indonesian female who presented with fever associated with vomiting, headache, photophobia and neck stiffness. On physical examination she had high grade pyrexia with obvious signs of meningism. Lumbar puncture revealed intracranial hypertension of 90cmH2O. Cerebrospinal fluid (CSF) analysis detected the presence of cryptococcal antigen which was later confirmed as Cryptococcus neoformans on species identification testing using polymerase chain reaction (PCR) method. India Ink tested positive. The CECT and MRI of the brain were normal. Her HIV ELISA analysis was reactive with a low CD4 count of 38cells/mm3. The HIV viral load was 500,000 copies/ ml. She was treated with intravenous Amphotericin B and oral flucytosine for 4 weeks. She underwent repeated lumbar punctures until her CSF pressure normalized. Repeated CSF analysis post treatment showed complete clearance of Cryptococcus neoformans. Conclusion: Its effective management of Cryptococcus neoformans meningitis relies on quick identification of the organism, relief of intracranial pressure and commencement of antibiotic treatment.

Keywords:
meningitis fever cryptococcus antibiotic vomiting

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References:

[1]  Antinori, S. New Insights into HIV/AIDS-Associated Cryptococcosis. ISRN AIDS. 2013. pp 1-22.
 
[2]  Cox GM, Perfect JR. Epidemiology, clinical manifestations, and diagnosis of Cryptococcus neoformans meningoencephalitis in HIV-infected patients. Up-to-date; 2014.
 
[3]  Desalermos A, Kourkoumpetis TK, Mylonakis E. Update on the epidemiology and management of cryptococcal meningitis. Expert Opin Pharmacother.2012; 13: 783.
 
[4]  Mustafa M, Salih F, Parash M, Shimmi C, Rahman M. Cryptococcus Meningitis, in the patients with Human immunodeficiency Virus Infection. Int J Pharm Sci Invent. 2014 Sep; 3(9): 60- 65.
 
[5]  Dyavaiah M, Subasri, Prashanth GN. Bacterial and Mycotic Infections in Immunocompromised Hosts: Clinical and Microbiological Aspect-Yeast:Candida and Cryptococcus, OMICS Publishing Group. 2013; 11:1-15.
 
[6]  Day JN, Chau TTH, Wolbers M, Mai PP, Dung NT, et al. Combination Antifungal Therapy for Cryptococcal meningitis. N Engl J Med. 2013; 368: 1291-1302.
 
[7]  Sloan D, Dlamini S, Paul N, Dedicoat M, et al. Treatment of Acute Cryptococcal meningitis In HIV Infected Adults, With An Emphasis On Resource-Limited Settings (Review). Cochrane Libr. 2011; 10:1-43.
 
[8]  Yao ZW, Lu X, Shen C, Lin DF. Comparison of Flucytosine and Fluconazole Combined with Amphotericin B for the treatment of HIV- associated cryptococcal meningitis: a systemic review and meta-analysis. Clin Microbiol Infect. 2014, 33: 1339-1344.
 
[9]  Rolfes MA, Hullsiek KH, Rhein J, Nabeta HW, Taseera K, et al. The Effect of Therapeutic Lumbar Punctures on Acute Mortality from Cryptococcus meningitis. Clin Infect Dis. 59.11 (2014): 1607-1614.