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Copyright (c) 2021 Jennifer Katherine Guio Rodríguez, Ledmar Jovanny Vargas Rodríguez, Dania Fabiola Pérez Gómez, Edwar Jassir Rozo Ortíz, Javier Orlando Barón Barón
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ischemic Stroke as a Complication of Cryptococcal Meningitis: A case report
Corresponding Author(s) : Ledmar Jovanny Vargas Rodríguez
Ciencia e Innovación en Salud,
2021
Abstract
Background: Cryptococcosis is a systemic mycosis caused by the Cryptococcus neoformans and Cryptococcus gattii complex, capable of generating cerebrovascular accidents (CVA). Case Report: A 53-year-old man attended due to a clinical picture of 1 week of evolution consistent with unquantified febrile peaks associated with diarrheal stools with mucus and blood, emetic episodes of lyenteric content, asthenia, and vertiginous sensation. Blood cultures plus lumbar puncture with isolation of Cryptococcus neoformans were ordered. Later, he presented episode of neurological targeting, for which brain images were taken that suggested an ischemic event towards the juxtaventricular white matter adjacent to the knee of the corpus callosum on the right side. Discussion: Ischemic stroke is an unknown finding in patients with meningeal Cryptococcosis. It is a complication of the acute phase and its mechanism may be related to infectious vasculitis. Infectious diseases of the CNS are differential diagnosis of stroke that present with fever.
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- Vela-Duarte, D., Nyberg, E., Sillau, S., Pate, A., Castellanos, P., Chastain, D., Franco-Paredes, C., Henao-Martinez, A. Lacunar Stroke in Cryptococcal Meningitis: Clinical and Radiographic Features. J Stroke Cerebrovasc Dis. [Internet]. 2019 [Cited 2020 Apr 29]. Volume 28(6):1767-1772.https://pubmed.ncbi.nlm.nih.gov/30655043/?from_term=cryptococcus+and+stroke&from_pos=2
- Murray P, Rosenthal K, Pfaller M. Microbiologia medica. 7th ed. Barcelona: Elsvier; 2017.
- Trovero, A., Mazza, M., Rogé, A., Rivas, M., Bordagorría, X., Bruno, S., Davel, G. Production of a latex agglutination reagent for therapid diagnosis of cryptococcal meningitis. Rev Argent Microbiol [Internet]. 2019 [cited 2020 Apr 29]; Jun 5. Volume 51, Issue 2 pp. 101–188.
- Lizarazo J, Castañeda E. Consideraciones sobre la criptococosis en los pacientes con sida. Infectio. [Internet]. 2012 [Cited 2020 Apr 29]; 16:94-99. https://www.researchgate.net/publication/256941024_Consideraciones_sobre_la_criptococosis_en_los_pacientes_con_sida
- Góralska, K., Blaszkowska, J., Dzikowiec M. Neuroinfections caused by fungi. PMC [Internet]. 2018 [Cited 2020 Apr 29]; 46(4): 443–459. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096918/
- Ellis, J. P, Kalata, N, Joekes, E. C., Kampondeni, S., Benjamin, L. A., Harrison, T. Ischemic stroke as a complication of cryptococcal meningitis and immune reconstitution inflammatory syndrome: a case report. BMC Infect Dis [Internet]. 2018 [Cited 2020 Apr 29); 18(1), 520. https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-018-3386-0#citeas
- Leite AG, Vidal JE, Bonasser Filho F, et al. Cerebral infarction related to cryptococcal meningitis in an HIV infected patient: case report and literature review. Braz J Infect Dis [Internet]. 2004 [Cited 2020 Apr 29]; 8:175-179. https://pubmed.ncbi.nlm.nih.gov/15361996/
- Tornero Estebanez C, Paricio Blasco A, Pons España E. A cerebral infarct associated with cryptococcal meningitis in an AIDS patient. An Med Interna [Internet]. 1992 [Cited 2020 Apr 29]; 1992 Apr;9(4):206-7. https://pubmed.ncbi.nlm.nih.gov/1581461/
- Aharon-Peretz J, Kliot D, Finkelstein R, et al. Cryptococcal meningitis mimicking vascular dementia. Neurology [Internet]. 2004 [Cited 2020 Apr 29]; 2004 Jun 8;62(11):2135. https://pubmed.ncbi.nlm.nih.gov/15184639/
- Saul RF, Gallagher JG, Mateer JE. Sudden hemiparesis as the presenting sign in cryptococcal meningoencephalitis. Stroke [Internet]. 1986 [Cited 2020 Apr 29]; 1986;17:753-754. https://www.ahajournals.org/doi/10.1161/01.STR.17.4.753
- Lizarazo, D., Escandon, P., Montilla, E. Guia para la viglancia por laboratorio de Cryptococcus neofromans y Cryptococcus gattii. Direccion redes en salud pública. Instituto Nacional de Salud [Internet]. 2019. [cited 2020 Apr 29]. https://www.ins.gov.co/BibliotecaDigital/guia-para-la-vigilancia-por-laboratorio-de-cryptococcus-neoformans-y-cryptococcus-gattii.pdf#search=Criptococosis%2E%2E%2E
- Díaz J. A, García J, Mantilla, Pradilla G. Criptococoma en el sistema nervioso central de un paciente no inmunoafectado. Revista de Neurología [Internet]. 2008 [Cited 2020 Apr 29]; 2008;46:97-101. https://doi.org/10.33588/rn.4602.2007512
- Wilson, M. R., O'Donovan, B. D., Gelfand, J. M., Sample, H. A., Chow, F. C., Betjemann, J. P. et al. Chronic Meningitis Investigated via Metagenomic Next-Generation Sequencing. JAMA neurology [Internet]. 2018 [Cited 2020 Apr 29]; 1;75(8):1028. https://pubmed.ncbi.nlm.nih.gov/29710329/?from_term=cryptococcus+and+stroke&from_pos=4
- Mishra AK, Arvind VH, Muliyil D, et al. Cerebrovascular injury in cryptococcal meningitis. Int J Stroke [Internet]. 2018 [Cited 2020 Apr 30]; 13:57-65. https://pubmed.ncbi.nlm.nih.gov/28421878/
- Chen SF, Lu CH, Lui CC, et al. Acute/subacute cerebral infarction (ASCI) in HIV-negative adults with cryptococcal meningoencephalitis (CM): a MRI-based follow-up study and a clinical comparison to HIV-negative CM adults without ASCI. BMC Neurol [Internet]. 2011 [Cited 2020 Apr 30]; 2011;11:12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037868/
- Tsai, W., Lien, C., Lee, J., Hsiao, W., Huang, C., Tsai, N., Chang, C., Lu, CH., Chang, W. The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study. BMC Geriatr [Internet].2019 [Cited 2020 Apr 30]; 25;19(1):91. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1108-0#citeas 69
- Coenjaerts FE, van der Flier M, Mwinzi PN, et al. Intrathecal production and secretion of vascular endotelial growth factor during Cryptococcal Meningitis. J Infect [Internet]. 2004 [Cited 2020 Apr 30]; 2004;190:1310-1317. https://academic.oup.com/jid/article/190/7/1310/822276
- Shimoda Y, Ohtomo S, Arai H, et al. Subarachnoid small vein occlusion due to inflammatory fibrosis-a possible mechanism for cerebellar infarction in cryptococcal meningoencephalitis: a case report. BMC Neurol [Internet]. 2017 [Cited 2020 Apr 30]; 17:157. https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-017-0934-y#citeas
- Yanagawa B, Pettersson GB, Habib G, Ruel M, Saposnik G, Latter DA et al. Surgical management of infective endocarditis complicated by embolic stroke: practical recommendations for clinicians. Circulation [Internet]. 2016 [Cited 2020 Apr 30]. 134(17):1280-1292. https://pubmed.ncbi.nlm.nih.gov/27777297/
- Ramirez S, Roa L,Triana J, Martin J, et al. Criptococosis cerebral: descripción de una serie de casos con presentaciones típicas y atípicas en el Hospital Universitario San José Infantil de Bogotá. Acta Neurol Colomb [Internet]. 2015 [Cited 2021 Feb 20]; 31(2):158-166. http://www.scielo.org.co/pdf/anco/v31n2/v31n2a06.pdf
References
Vela-Duarte, D., Nyberg, E., Sillau, S., Pate, A., Castellanos, P., Chastain, D., Franco-Paredes, C., Henao-Martinez, A. Lacunar Stroke in Cryptococcal Meningitis: Clinical and Radiographic Features. J Stroke Cerebrovasc Dis. [Internet]. 2019 [Cited 2020 Apr 29]. Volume 28(6):1767-1772.https://pubmed.ncbi.nlm.nih.gov/30655043/?from_term=cryptococcus+and+stroke&from_pos=2
Murray P, Rosenthal K, Pfaller M. Microbiologia medica. 7th ed. Barcelona: Elsvier; 2017.
Trovero, A., Mazza, M., Rogé, A., Rivas, M., Bordagorría, X., Bruno, S., Davel, G. Production of a latex agglutination reagent for therapid diagnosis of cryptococcal meningitis. Rev Argent Microbiol [Internet]. 2019 [cited 2020 Apr 29]; Jun 5. Volume 51, Issue 2 pp. 101–188.
Lizarazo J, Castañeda E. Consideraciones sobre la criptococosis en los pacientes con sida. Infectio. [Internet]. 2012 [Cited 2020 Apr 29]; 16:94-99. https://www.researchgate.net/publication/256941024_Consideraciones_sobre_la_criptococosis_en_los_pacientes_con_sida
Góralska, K., Blaszkowska, J., Dzikowiec M. Neuroinfections caused by fungi. PMC [Internet]. 2018 [Cited 2020 Apr 29]; 46(4): 443–459. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096918/
Ellis, J. P, Kalata, N, Joekes, E. C., Kampondeni, S., Benjamin, L. A., Harrison, T. Ischemic stroke as a complication of cryptococcal meningitis and immune reconstitution inflammatory syndrome: a case report. BMC Infect Dis [Internet]. 2018 [Cited 2020 Apr 29); 18(1), 520. https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-018-3386-0#citeas
Leite AG, Vidal JE, Bonasser Filho F, et al. Cerebral infarction related to cryptococcal meningitis in an HIV infected patient: case report and literature review. Braz J Infect Dis [Internet]. 2004 [Cited 2020 Apr 29]; 8:175-179. https://pubmed.ncbi.nlm.nih.gov/15361996/
Tornero Estebanez C, Paricio Blasco A, Pons España E. A cerebral infarct associated with cryptococcal meningitis in an AIDS patient. An Med Interna [Internet]. 1992 [Cited 2020 Apr 29]; 1992 Apr;9(4):206-7. https://pubmed.ncbi.nlm.nih.gov/1581461/
Aharon-Peretz J, Kliot D, Finkelstein R, et al. Cryptococcal meningitis mimicking vascular dementia. Neurology [Internet]. 2004 [Cited 2020 Apr 29]; 2004 Jun 8;62(11):2135. https://pubmed.ncbi.nlm.nih.gov/15184639/
Saul RF, Gallagher JG, Mateer JE. Sudden hemiparesis as the presenting sign in cryptococcal meningoencephalitis. Stroke [Internet]. 1986 [Cited 2020 Apr 29]; 1986;17:753-754. https://www.ahajournals.org/doi/10.1161/01.STR.17.4.753
Lizarazo, D., Escandon, P., Montilla, E. Guia para la viglancia por laboratorio de Cryptococcus neofromans y Cryptococcus gattii. Direccion redes en salud pública. Instituto Nacional de Salud [Internet]. 2019. [cited 2020 Apr 29]. https://www.ins.gov.co/BibliotecaDigital/guia-para-la-vigilancia-por-laboratorio-de-cryptococcus-neoformans-y-cryptococcus-gattii.pdf#search=Criptococosis%2E%2E%2E
Díaz J. A, García J, Mantilla, Pradilla G. Criptococoma en el sistema nervioso central de un paciente no inmunoafectado. Revista de Neurología [Internet]. 2008 [Cited 2020 Apr 29]; 2008;46:97-101. https://doi.org/10.33588/rn.4602.2007512
Wilson, M. R., O'Donovan, B. D., Gelfand, J. M., Sample, H. A., Chow, F. C., Betjemann, J. P. et al. Chronic Meningitis Investigated via Metagenomic Next-Generation Sequencing. JAMA neurology [Internet]. 2018 [Cited 2020 Apr 29]; 1;75(8):1028. https://pubmed.ncbi.nlm.nih.gov/29710329/?from_term=cryptococcus+and+stroke&from_pos=4
Mishra AK, Arvind VH, Muliyil D, et al. Cerebrovascular injury in cryptococcal meningitis. Int J Stroke [Internet]. 2018 [Cited 2020 Apr 30]; 13:57-65. https://pubmed.ncbi.nlm.nih.gov/28421878/
Chen SF, Lu CH, Lui CC, et al. Acute/subacute cerebral infarction (ASCI) in HIV-negative adults with cryptococcal meningoencephalitis (CM): a MRI-based follow-up study and a clinical comparison to HIV-negative CM adults without ASCI. BMC Neurol [Internet]. 2011 [Cited 2020 Apr 30]; 2011;11:12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037868/
Tsai, W., Lien, C., Lee, J., Hsiao, W., Huang, C., Tsai, N., Chang, C., Lu, CH., Chang, W. The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study. BMC Geriatr [Internet].2019 [Cited 2020 Apr 30]; 25;19(1):91. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1108-0#citeas 69
Coenjaerts FE, van der Flier M, Mwinzi PN, et al. Intrathecal production and secretion of vascular endotelial growth factor during Cryptococcal Meningitis. J Infect [Internet]. 2004 [Cited 2020 Apr 30]; 2004;190:1310-1317. https://academic.oup.com/jid/article/190/7/1310/822276
Shimoda Y, Ohtomo S, Arai H, et al. Subarachnoid small vein occlusion due to inflammatory fibrosis-a possible mechanism for cerebellar infarction in cryptococcal meningoencephalitis: a case report. BMC Neurol [Internet]. 2017 [Cited 2020 Apr 30]; 17:157. https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-017-0934-y#citeas
Yanagawa B, Pettersson GB, Habib G, Ruel M, Saposnik G, Latter DA et al. Surgical management of infective endocarditis complicated by embolic stroke: practical recommendations for clinicians. Circulation [Internet]. 2016 [Cited 2020 Apr 30]. 134(17):1280-1292. https://pubmed.ncbi.nlm.nih.gov/27777297/
Ramirez S, Roa L,Triana J, Martin J, et al. Criptococosis cerebral: descripción de una serie de casos con presentaciones típicas y atípicas en el Hospital Universitario San José Infantil de Bogotá. Acta Neurol Colomb [Internet]. 2015 [Cited 2021 Feb 20]; 31(2):158-166. http://www.scielo.org.co/pdf/anco/v31n2/v31n2a06.pdf