Poley Marian, Koubek Richard, Walsh Leonard, McGillen Brian
1 Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
J Investig Med High Impact Case Rep. 2019 Jan-Dec;7:2324709619834578. doi: 10.1177/2324709619834578.
Cryptococcal meningitis is an uncommon and severe infection that tends to affect immunocompromised hosts worldwide and in the United States. Annually it is estimated that there are 200 000 cases of cryptococcal meningitis, with the most recent estimate of 3400 cases per year in the United States alone. However, despite the low incidence, 1-year mortality is estimated at 20% to 30% even with long-term consolidation antifungal therapy. A 37-year-old man presented to the emergency department with headaches, dysarthria, hallucinations, and acute worsening of altered mental status, and he was found to have increased intracranial pressure, cerebrospinal fluid leukocytosis, and few encapsulated yeasts consistent with Cryptococcus neoformans meningitis in addition to radiologic evidence consistent with a cryptococcoma of the lungs. This report highlights the occurrence of Cryptococcus neoformans meningitis in a presumed immunocompetent host. The clinician should be aware of sources of minor immunosuppression, as they may contribute to development of Cryptococcus neoformans meningitis. Mortality in this condition remains high due to subacute presentations and delayed diagnosis in non-immunocompromised patients.
隐球菌性脑膜炎是一种罕见且严重的感染，在全球和美国往往影响免疫功能低下的宿主。据估计，每年有20万例隐球菌性脑膜炎病例，仅美国最近的估计就为每年3400例。然而，尽管发病率较低，但即使进行长期巩固抗真菌治疗，1年死亡率估计仍为20%至30%。一名37岁男性因头痛、构音障碍、幻觉和精神状态急性恶化就诊于急诊科，除了肺部隐球菌瘤的影像学证据外，还发现他颅内压升高、脑脊液白细胞增多以及少量与新型隐球菌脑膜炎相符的有荚膜酵母。本报告强调了新型隐球菌脑膜炎在假定免疫功能正常宿主中的发生情况。临床医生应意识到轻度免疫抑制的来源，因为它们可能促成新型隐球菌脑膜炎的发生。由于非免疫功能低下患者的亚急性表现和诊断延迟，这种情况下的死亡率仍然很高。
