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

dc.contributor.authorStack, Matthew
dc.contributor.authorHiles, Jon
dc.contributor.authorValinetz, Ethan
dc.contributor.authorGupta, Samir K.
dc.contributor.authorButt, Saira
dc.contributor.authorSchneider, Jack G.
dc.contributor.departmentMedicine, School of Medicine
dc.date.accessioned2024-02-22T16:20:21Z
dc.date.available2024-02-22T16:20:21Z
dc.date.issued2023-08-11
dc.description.abstractBackground: 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. Methods: 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. Results: 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. Conclusions: 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.
dc.eprint.versionFinal published version
dc.identifier.citationStack M, Hiles J, Valinetz E, Gupta SK, Butt S, Schneider JG. Cryptococcal Meningitis in Young, Immunocompetent Patients: A Single-Center Retrospective Case Series and Review of the Literature. Open Forum Infect Dis. 2023;10(8):ofad420. Published 2023 Aug 11. doi:10.1093/ofid/ofad420
dc.identifier.urihttps://hdl.handle.net/1805/38627
dc.language.isoen_US
dc.publisherOxford University Press
dc.relation.isversionof10.1093/ofid/ofad420
dc.relation.journalOpen Forum Infect Diseases
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.sourcePMC
dc.subjectPIIRS
dc.subjectCryptococcal
dc.subjectCryptococcus
dc.subjectFungal
dc.subjectMeningitis
dc.titleCryptococcal Meningitis in Young, Immunocompetent Patients: A Single-Center Retrospective Case Series and Review of the Literature
dc.typeArticle
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