Cryptococcal pericarditis in a heart transplant recipient

Cryptococcus neoformans endocarditis in an immunocompetentpatient a case report

BACKGROUND

Cryptococcus neoformans is an invasive fungal infection commonly affecting immunocompromised patients as pneumonia or meningitis. More rarely, case reports describe Cryptococcus neoformans endocarditis, though nearly exclusively among patients with active immunosuppression, implanted cardiac devices or prosthetic valves.

CASE PRESENTATION

We report the case of a patient with underlying substance abuse disorder and systolic heart failure presenting with fever, altered mental status, and shower emboli subsequently found to have native tricuspid valve vegetations and blood cultures positive for cryptococcus neoformans in the absence of immunosuppression.

CONCLUSIONS

Historically, Cryptococcus neoformans fungemia manifests clinically as pneumonia or meningitis among the immunosuppressed. There have been rare reports of endocarditis in this population and even fewer reports of native valve endocarditis exist. The present case along with mortality reported in prior literature, suggest suspicion must be maintained in the absence of immunosuppression, even in patients with native valves.

Opportunist Coinfections by Nontuberculous Mycobacteria and Fungi in Immunocompromised Patients

Nontuberculous mycobacteria (NTM) and many fungal species (spp.) are commonly associated with opportunistic infections (OPIs) in immunocompromised individuals. Moreover, occurrence of concomitant infection by NTM (mainly spp. of Mycobacterium avium complex and Mycobacterium abscessus complex) and fungal spp. (mainly, Aspergillus fumigatus, Histoplasma capsulatum and Cryptococcus neoformans) is very challenging and is associated with poor patient prognosis. The most frequent clinical symptoms for coinfection and infection by single agents (fungi or NTM) are similar. For this reason, the accurate identification of the aetiological agent(s) is crucial to select the best treatment approach. Despite the significance of this topic it has not been sufficiently addressed in the literature. This review aims at summarizing case reports and studies on NTM and fungi coinfection during the last 20 years. In addition, it briefly characterizes OPIs and coinfection, describes key features of opportunistic pathogens (e.g., NTM and fungi) and human host predisposing conditions to OPIs onset and outcome. The review could interest a wide spectrum of audiences, including medical doctors and scientists, to improve awareness of these infections, leading to early identification in clinical settings and increasing research in the field. Improved diagnosis and availability of therapeutic options might contribute to improve the prognosis of patients’ survival.