Cryptococccal meningoencephalitis after H1N1 influenza.
Cryptococcus neoformans is associated with a spectrum of diseases including meningoencephalitis, pneumonia and soft tissue infections. Incidence is higher in immunocompromised hosts like HIV-infected individuals and solid organ transplant recipients. The influenza virus is known to cause immunologic defects. Additionally, the 2009-pandemic H1N1 virus is associated with increased incidence of acute respiratory distress syndrome (ARDS) requiring treatment with systemic steroids. The authors present the first case of cryptococcal meningitis in a patient with flu A-associated ARDS (FLAARDS). In this patient, risk factors for invasive fungal disease included a combination of severe and prolonged H1N1-influenza virus infection, corticosteroid therapy and broad-spectrum antibiotics. While prolonged corticosteroid use is a known risk factor for development of invasive fungal disease, the authors postulate that by causing immunologic defects and FLAARDS, the 2009-pandemic H1N1 virus may represent an additional independent risk for the development of C neoformans meningitis in a previously healthy individual.
Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.
Alireza
A
Hosseinnezhad
Alwyn
A
Rapose
D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D008875:Middle Aged; D058873:Pandemics; D012307:Risk Factors; D014481:United States / Q000453:epidemiology