Clinical Images: A Rare Case of Cryptococcal Meningoencephalitis in an Immunocompetent Patient

摘要

Central nervous system (CNS) cryptococcal infection occurs when the encapsulated yeast Cryptococcus neoformans , normally a harmless airway colonizer, infects the CNS space, resulting in meningitis, encephalitis, or meningoencephalitis. Cryptococcus is rarely the cause of serious infection in immunocompetent individuals. However, patients with immune suppression from human immunodeficiency virus (HIV), corticosteroids, organ transplantation, primary immune deficit, or reticuloendothelial malignancy are more susceptible to cryptococcal meningitis.In the patient population at our institution, HIV and organ transplantation are disproportionately represented, so CNS cryptococcal infection is expected to also be disproportionately represented. With the advent and widespread adoption of antiretroviral medications in the 1990s, the incidence of cryptococcal infections has decreased in patients with HIV and acquired immune deficiency syndrome (AIDS).1 This decline, along with an outbreak of Cryptococcus gattii in a largely immunocompetent population of British Columbia, Canada, and the northwest United States, has led to increased interest in cryptococcal infections in the immunocompetent population.2.