A Case Report of Cryptococcal Meningitis

Document Type : Research Paper

Authors

1 Assistant Professor of Pediatrics, Mashhad University of Medical Sciences, Mashhad,

2 - Resident of Pediatrics, Mashhad University of Medical Sciences, Mashhad,

3 Professor of Pediatrics, Shiraz University of Medical Sciences, Shiraz,

Abstract

Introduction
 
Fungi are rare causes of meningitis. Cryptococcus neoformans is the most common cause of fungal meningitis. Although meningitis is the most common form of cryptococcal disease but cryptococcal infection almost always originates from lung.
Case report
We present a 13 –year- old boy with sarcoidosis that developed fever, headache and vomiting He was hospitalized and treated with clinical diagnosis of acute bacterial meningitis, However, the treatment was not effevtive and due to hydrocephalus in brain CT, anti-TB therapy was initiated. Finally both CSF the culture and smear tested positive for cryptococcus neoformans, and the patient was successfully treated by Amphotricin and then fluconazol in a period of one year.
Conclusion: In differential diagnosis of aseptic meningitis and hydrocephalus, Cryptococcus neoformans must be considered in adition to TB meningitis.

Keywords


1. Nasr Isfahani B, Shadzi Sh, Chadegani Pour M, Ilchi N. Isolation and detection of Cryptococcus Neoformans from
pigeon droppings: Isfahan and its suburbs province pigeon towers. J Res Med Sci 2001; 6:20-22.
2.Bineshian F, Zaini F. Study of cryptococcus neoformans var-gattii from eucalyptus camaldulensis in some northern
regions of Iran. komesh J Semnan Unive Med Sci 2001; 3:67-59.
3. Moghadami M, Kordbacheh P, Emami M. A case report of cryptococcal meningitis.Iran J Pub Health 1988; 17:68-61.
4. Zini F, Mahbod A, Emami M. Medical mycology.Tehran Univ Pub 1998;102-4.
5.Rahbari Manesh AA, Tabatabaei P, Zamani A, Ghoreishi AS, Daneshjoo Kh. Systemic fungal diseases in
children.Iran J Pediatr 2005;15:271-275.
6. Joshi NS, Fisher BT, Prasad PA, Zaoutis TE . Epidemiology of cryptococcal infection in hospitalized children.
Pediatr Infect Dis J 2010; 12:91-5.
7. Dismukes WE, Cloud G, Gallis HA, Kerkering TM, Medoff G, Craven PC, et al . Treatment of cryptococcal
meningitis with combination amphotericin B and flucytosine for four as compared with six weeks. N Engl J Med 1987;
317:334-341.
8. Diamond RD, Bennett JE . Prognostic factors in cryptococcal meningitis. A study in 111 cases. Ann Intern Med
1974; 80:176-181.
9. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, et al. Clinical practice guidelines for the
management of cryptococcal disease: 2010 update by the infectious diseases society of America. Clin Infect Dis 2010;
50:291-322.
10. Dismukes WE, Cloud G, Gallis HA, Kerkering TM, Medoff G, Craven PC, et al . Treatment of cryptococcal
meningitis with combination amphotericin B and flucytosine for four as compared with six weeks. N Engl J Med 1987;
317:334-341.
11. Graybill JR, Sobel J, Saag M, van Der Horst C, Powderly W, Cloud G, et al. Diagnosis and management of
increased intracranial pressure in patients with AIDS and cryptococcal meningitis. The NIAID Mycoses Study Group
and AIDS Cooperative Treatment Groups. Clin Infect Dis 2000; 30:47-54.
12. Park MK, Hospenthal DR, Bennett JE . Treatment of hydrocephalus secondary to cryptococcal meningitis by use of
shunting. Clin Infect Dis 1999; 28:629-633.
13. Macsween KF, Bicanic T, Brouwer AE, Marsh H, Macallan DC, Harrison TS.