Clinical profile of disseminated cryptococcal infection-a case series

来源 :Asian Pacific Journal of Tropical Medicine | 被引量 : 0次 | 上传用户:sweetlijun
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Objective:To study disseminated cryptococcal infection in a tertiary care hospital in Southern India.Methods:The clinical profile of 12 disseminated cryptococcosis patients with the age group of 28-52 years was retrospectively analyzed.Results:7(58.3%) presented with fever < 30 days and 3(25%) > 30 days whereas 2(16.7%) did not have fever.All the 12(100%) had headache. 2(16.7%) had altered sensorium,one(8%) seizure.5(41.7%) had diarrhea and vomiting.6(50%) had oral candidiasis,and anemia.9(75%) had elevated erythrocyte sedimentation rate(ESR).6(50%) had neck stiffness.Cerebrospinal fluid(CSF) pressure was elevated in all 12(100%) patients. Blood culture positive for Cryptococcus neqformans(C.neoformans) in 11(91.7%) and CSF culture positive in all 12(100%),one(8%) had urine culture positive.India ink preparation was positive in 10(83.3%).CD4 count was less than 50/microl in 4(33.3%),between 50-100 in 6(50%) and 2(16.7%) in the range of 100-200.6(50%) were treated with parenteral amphotericin B(0.7 mg/kg/d) during intensive phase followed by oral fluconazole 400 mg/d for 8 weeks then maintenance oral fluconazole 200 mg/d.5(41.6%) were treated with fluconazole alone.8(66.7%) improved and 4(33.3%) patients died.Among those who succumbed to the illness,2(16.7%) received amphotericin and fluconazole,2(16.7%) patients received fluconazole alone.Conclusions:Disseminated cryptococcosis can cause considerable mortality in HIV patients and immunocompromised non- HIV individuals.At times,its presentation closely mimics that of Tuberculosis.Early diagnosis and appropriate treatment should be started as early as possible. Objective: To study disseminated cryptococcal infection in a tertiary care hospital in Southern India. Methods: The clinical profile of 12 disseminated cryptococcosis patients with the age group of 28-52 years was retrospectively analyzed. Results: 7 (58.3%) presented with fever < 30 days and 3 (25%)> 30 days even 2 (16.7%) did not have fever. All the 12 (100%) had headache. 2 (16.7%) had altered sensorium, one (8%) seizure.5 41.7% had had diarrhea and vomiting.6 had oral candidiasis, and anemia.9 had had elevated erythrocyte sedimentation rate (ESR) .6 (50%) had neck stiffness. Cerebrospinal fluid (CSF) pressure was Blood culture positive for Cryptococcus neqformans (C. neoformans) in 11 (91.7%) and CSF culture positive in all 12 (100%), one (8%) had urine culture positive. CD4 count was less than 50 / microl in 4 (33.3%), between 50-100 in 6 (50%) and 2 (16.7%) in the range of 100-200.6 (83.3% 50%) were treated with parenteral amphot ericin B (0.7 mg / kg / d) during intensive phase followed by oral fluconazole 400 mg / d for 8 weeks then maintenance oral fluconazole 200 mg / d.5 (41.6%) were treated with fluconazole alone.8 (66.7%) improved 2 (16.7%) patients received fluconazole alone. Conclusions: Disseminated cryptococcosis can cause considerable mortality in HIV patients and immunocompromised Non-HIV individuals.At times, its presentation closely mimics that of Tuberculosis. Early diagnosis and appropriate treatment should be started as early as possible.
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