Cryptococcus neoformans wear a capsule to defend themselves from our immune system. But our mighty white blood cells are usually too powerful for the tiny fungi. But In HIV aids patients with weakened immune systems; it can cause some serious complications like pneumonia and meningoencephalitis. let's discuss the interesting case of Cryptococcus neoformans, today on tiny medicine.
Cryptococcus neoformans is a unicellular fungus, and therefore a type of yeast. It lives worldwide in soil, plants, and in the droppings of some birds like pigeons. It's not contagious and You get the infection by inhaling the fungal spores from the environment. An estimated 220,000 cases occur worldwide each year. Most of these cases are reported in patients with HIV AIDS.
The infection is usually asymptomatic if you have good immunity. But in some cases, the fungus can remain latent in the lungs, and reactivate if your immunity gets weakened someday, due to old age or a medical condition.
Now, let's talk about immune-compromised patients.
• When the CD4 white blood cell count is lower than 250 in HIV patients, it’s called AIDS or acquired immune deficiency syndrome. As AIDS gets advanced, the risk of Cryptococcus neoformans infection becomes greater.
• Other than HIV AIDS, People can have weakened immunity due to chronic diseases, organ transplants, and long term use of immune-suppressive medications.
• Since the fungus is transmitted by inhalation, they first develop lung infections like pneumonia. Cough, Shortness of breath, fever, and chest pain that exacerbates with respiration are the symptoms.
• It can spread through the bloodstream to the brain and cause meningoencephalitis. Symptoms are Fever, Headache, Neck Stiffness, Photophobia, seizures, altered levels of consciousness, Nausea and Vomiting.
• Treating HIV patients with Cryptococcal meningoencephalitis can be challenging. If the CD4 white cell counts increase rapidly they can flood the brain and cause a potentially fatal condition called Immune reconstitution inflammatory syndrome, or IRIS. It can cause permanent brain scarring.
Diagnosis can be confirmed by staining cerebrospinal fluid with India stain to visualize the fungus. Detecting fungal antigens from Serum and Cerebrospinal fluid has a high sensitivity. But the gold standard test is to culture the organism from human body samples.
• Asymptomatic and Mild to moderate pneumonia patients are treated with fluconazole for at least 6 months.
• Severe pneumonia and meningoencephalitis are initially treated with a combination of amphotericin B and flucytosine, followed by an extended course of fluconazole.
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9 окт 2019
