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Cryptococcal Meningitis in a Mexican Neurological Center. Neurologist 2023:00127893-990000000-00053. [PMID: 36592340 DOI: 10.1097/nrl.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cryptococcal meningitis, one of the most severe infections affecting the central nervous system, often involves severe neurological sequels and high mortality. METHODS A retrospective review was performed, including 76 cases admitted in a 10-year period at a neurological referral center in Mexico City. From 68 isolates, 52 fungal specimens were identified as part of the Cryptococcus neoformans var. neoformans complex, 15 as C. neoformans var gattii complex, and one as Cryptococcus non-neoformans/gattii. RESULTS Higher cryptococcal meningitis incidence and severity were found in HIV-infected men; other risk factors frequently observed were diabetes mellitus and labor exposure to poultry. The main clinical manifestations were subacute headache, cognitive alterations, and photophobia (exclusively in HIV patients). MRI was highly sensitive for pathologic findings such as meningeal enhancements and cryptococcomas, most of them associated to C. neoformans complex. Eleven patients developed severe brain vasculitis, as observed by transcranial Doppler. Hydrocephalus with intracranial hypertension was the most frequent complication. CONCLUSIONS One-half of the population died, and the rest had neurological sequels, mainly neuropsychiatric manifestations and secondary headaches. These patients developed severe functional limitations in performing daily activities in an independent manner.
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Peláez N, Dunlop D, Negro E. Multiple cerebral infarctions as a complication of cryptococcal meningitis in a patient undergoing single lung transplantation. Neurologia 2022; 37:411-412. [PMID: 34521543 DOI: 10.1016/j.nrl.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/13/2021] [Accepted: 05/22/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- N Peláez
- Hospital Universitario Reina Sofía, Córdoba, España.
| | - D Dunlop
- Hospital Universitario Reina Sofía, Córdoba, España
| | - E Negro
- Hospital Universitario Reina Sofía, Córdoba, España
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Multiple cerebral infarctions as a complication of cryptococcal meningitis in a patient undergoing single lung transplantation. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:411-412. [DOI: 10.1016/j.nrleng.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/22/2021] [Indexed: 11/21/2022] Open
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Qu J, Jiang J, Lv X. The utility of cerebrospinal fluid white cell count during the prognostic assessment for cryptococcal meningitis patients: a retrospective study. BMC Infect Dis 2020; 20:571. [PMID: 32758162 PMCID: PMC7405376 DOI: 10.1186/s12879-020-05287-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/22/2020] [Indexed: 02/05/2023] Open
Abstract
Background The incidence of cryptococcal meningitis (CM) has gradually increased in recent years. Cerebrospinal fluid (CSF) cytology and cell count are very important for CM on etiology diagnosis and assessment of disease status and therapeutic response. However, the clinical significance of CSF white cell count (WCC) in CM patients is not fully understood. Using longitudinal data of CSF WCC and its relationship with clinical outcomes in CM patients, we aimed to elucidate the clinical significance of this test. Methods We retrospectively analyzed the medical records of 150 CM patients admitted to our hospital between January 2008 and December 2018. Results CM patients with lower baseline CSF WCC, CSF protein concentration or CD4/CD8 ratio, and those with altered mentation or HIV coinfection were more likely to have poor clinical outcome (P<0.05). CM patients with triple therapy during the induction period presented with a better clinical outcome (P<0.05). Baseline CSF WCC had a moderate positive correlation with peripheral CD4+ T lymphocyte count (r = 0.738, P < 0.001) and CD4+ T lymphocyte percentage (r = 0.616, P < 0.001). The best cut-off value to predict a poor clinical outcome was 40 cells/μL during baseline CSF WCC. The predictive model incorporating longitudinal data of CSF WCC had better sensitivity, specificity, and accuracy than a model incorporating only baseline CSF WCC data. Conclusions Our results indicated that baseline CSF WCC and changes in CSF WCC over time could be used to assess the prognosis of CM patients.
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Affiliation(s)
- Junyan Qu
- Center of Infectious Disease, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China
| | - Jingwen Jiang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Lv
- Center of Infectious Disease, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China.
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Ma Q, Yao J, Yuan S, Liu H, Wei N, Zhang J, Shan W. Development of a lateral flow recombinase polymerase amplification assay for rapid and visual detection of Cryptococcus neoformans/C. gattii in cerebral spinal fluid. BMC Infect Dis 2019; 19:108. [PMID: 30717679 PMCID: PMC6360735 DOI: 10.1186/s12879-019-3744-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background For definitive diagnosis of cryptococcal meningitis, Cryptococcus neoformans and/or C. gattii must be identified within cerebral spinal fluid from the patients. The traditional methods for detecting Cryptococcus spp. such as India ink staining and culture are not ideal. Although sensitive and specific enough, detection of cryptococcal antigen polysaccharide has a high dose hook effect. Therefore, the aim of this study was to introduce a new rapid and simple detection method of Cryptococcus neoformans and C. gattii in cerebral spinal fluid. Methods The lateral flow strips combined with recombinase polymerase amplification (LF-RPA) assay was constructed to detect the specific DNA sequences of C. neoformans and C. gattii. The detection limit was evaluated using serial dilutions of C. neoformans and C. gattii genomic DNA. The specificity was assessed by excessive amount of other pathogens genomic DNA. The optimal detection time and amplification temperature were also analyzed. The diagnostic parameters were first calculated using 114 clinical specimens and then compared with that of other diagnostic method. A brief analysis and comparison of different DNA extraction methods was discussed, too. Results The LF-RPA assay could detect 0.64 pg of genomic DNA of C. neoformans per reaction within 10 min and was highly specific for Cryptococcus spp.. The system could work well at a wide range of temperature from 25 to 45 °C. The overall sensitivity and specificity were 95.2 and 95.8% respectively. As amplification template for LF-RPA assay, both cell lysates and genomic DNA produce similar experimental results. Conclusions The LF-RPA system described here is shown to be a sensitive and specific method for the visible, rapid, and accurate detection of Cryptococcus spp. in cerebral spinal fluid and might be useful for clinical preliminary screening of cryptococcal meningitis.
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Affiliation(s)
- Qinglin Ma
- Institute of Maternity and Child Medical Research, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Shenzhen, 518028, Guangdong, China.,Clinical Laboratory, Shenzhen Third People's Hospital, No.29 Bulan Road, Shenzhen, 518112, Guangdong, China
| | - Jilong Yao
- Institute of Maternity and Child Medical Research, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Shenzhen, 518028, Guangdong, China
| | - Shixin Yuan
- Institute of Maternity and Child Medical Research, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Shenzhen, 518028, Guangdong, China
| | - Houming Liu
- Clinical Laboratory, Shenzhen Third People's Hospital, No.29 Bulan Road, Shenzhen, 518112, Guangdong, China
| | - Ning Wei
- Personnel Section, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Shenzhen, 518028, Guangdong, China.
| | - Jianming Zhang
- Institute of Maternity and Child Medical Research, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Shenzhen, 518028, Guangdong, China.
| | - Wanshui Shan
- Clinical Laboratory, Shenzhen Third People's Hospital, No.29 Bulan Road, Shenzhen, 518112, Guangdong, China.
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