Cryptococcal Meningitis in Young, Immunocompetent Patients: A Single-Center Retrospective Case Series and Review of the Literature
dc.contributor.author | Stack, Matthew | |
dc.contributor.author | Hiles, Jon | |
dc.contributor.author | Valinetz, Ethan | |
dc.contributor.author | Gupta, Samir K. | |
dc.contributor.author | Butt, Saira | |
dc.contributor.author | Schneider, Jack G. | |
dc.contributor.department | Medicine, School of Medicine | |
dc.date.accessioned | 2024-02-22T16:20:21Z | |
dc.date.available | 2024-02-22T16:20:21Z | |
dc.date.issued | 2023-08-11 | |
dc.description.abstract | Background: 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.version | Final published version | |
dc.identifier.citation | Stack 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.uri | https://hdl.handle.net/1805/38627 | |
dc.language.iso | en_US | |
dc.publisher | Oxford University Press | |
dc.relation.isversionof | 10.1093/ofid/ofad420 | |
dc.relation.journal | Open Forum Infect Diseases | |
dc.rights | Attribution 4.0 International | en |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0 | |
dc.source | PMC | |
dc.subject | PIIRS | |
dc.subject | Cryptococcal | |
dc.subject | Cryptococcus | |
dc.subject | Fungal | |
dc.subject | Meningitis | |
dc.title | Cryptococcal Meningitis in Young, Immunocompetent Patients: A Single-Center Retrospective Case Series and Review of the Literature | |
dc.type | Article |