Cryptococcal meningitis in HIV negative pregnant women: case report and review of literature.
BACKGROUND
Cryptococcosis has become an important entity due to the epidemic of AIDS and therefore it is a significant opportunistic infection. However, there are case reports of cryptococcal meningitis in immune competent pregnant women. Since pregnancy is considered a period of relative immunosuppression, which likely prevents fetal rejection, this could explain the occurrence of opportunistic infections.


OBJECTIVE
To report a case of cryptococcosis, and review all cases involving pregnancy and neurocryptococcal infection in immune competent pregnant patients.


METHODS
Case report and systematic review of the literature using the MEDLINE and SciELO databases.


CONCLUSIONS
A total of 27 patients were analyzed from 19 studies. The mean age at diagnosis was 26.4 years. There were six patients in their first trimester of pregnancy, 10 in the second, eight in the third and three post-partum. The most prevalent symptoms were headache (85.2%), altered vision (44.4%), altered mental status (44.4%), nausea (40.7%) and fever (33.3%). There were nine deaths (33.3%). Most of the patients received intravenous amphotericin B as treatment (77.8%). The majority (66.6%) of the patients accomplished a term delivery with healthy infants.


CONCLUSIONS
Cryptococcal meningitis should be considered during pregnancy in cases of unexplained headache, altered vision, altered mental status, nausea and fever. Patients with a confirmed diagnosis should be admitted and treated with amphotericin B.
Costa
Maria Laura Botelho
ML
Department of Gynecology and Obstetrics, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. mlaura@unicamp.br
Souza
João Paulo Dias de
JP
Oliveira Neto
Antônio Francisco de
AF
Pinto E Silva
João Luiz
JL
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D007121:Immunocompetence; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000188:drug therapy; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy
D000935:Antifungal Agents; D000666:Amphotericin B