Serviço de Medicina Interna, Centro Hospitalar do Barlavento Algarvio, Portimão, Portugal.
Clin Drug Investig. 2013 Feb;33 Suppl 1:S47-50. doi: 10.1007/s40261-012-0021-5.
Cryptococcal meningitis is a rare entity among immunocompetent hosts but, when it occurs, it is associated with significant morbidity and mortality. Clinical presentation as well as the course of the disease is usually subtle and indolent with headache and altered mental status. The authors present the case of a 59-year-old man, who sought medical help with a 2-week history of headaches accompanied by nausea and visual and hearing disturbances. On admission the patient was afebrile, presented visual and hearing deficits and had a normal magnetic resonance image of the brain. A lumbar puncture was performed and microscopic examination of the cerebrospinal fluid revealed yeasts that were identified as Cryptococcus spp. and later, by means of molecular biology techniques, as Cryptococcus neoformans, var. grubii. The patient was treated with liposomal amphotericin B plus fluconazole for 28 weeks. At follow-up after 1 year the patient was asymptomatic and received fluconazole 400 mg/day as prophylactic therapy. The outcome of Cryptococcus infections in immunocompetent hosts is reported to be poor as a result of a delayed diagnosis and suboptimal initial antifungal therapy. The influence of the normal immune response is unclear.
隐球菌性脑膜炎在免疫功能正常的宿主中较为罕见，但当发生时，其与较高的发病率和死亡率相关。其临床表现和疾病进程通常较为隐匿和缓慢，以头痛和精神状态改变为特征。作者报告了一例 59 岁男性患者，其因 2 周头痛伴恶心以及视觉和听觉障碍而求医。入院时，患者无发热，存在视觉和听觉缺损，脑磁共振成像正常。行腰椎穿刺，脑脊液镜检发现酵母样细胞，鉴定为隐球菌属，随后通过分子生物学技术鉴定为新型隐球菌，格吕变种。患者接受 28 周脂质体两性霉素 B 联合氟康唑治疗。1 年后随访时，患者无症状，接受氟康唑 400mg/天预防治疗。由于诊断延迟和初始抗真菌治疗不当，免疫功能正常宿主的隐球菌感染预后较差。正常免疫反应的影响尚不清楚。
