title: Management of Cryptococcus gattii meningoencephalitis.
abstract: Cryptococcosis is a fungal disease caused by Cryptococcus neoformans and Cryptococcus gattii. By inhalation and subsequent pulmonary infection, it may disseminate to the CNS and cause meningitis or meningoencephalitis. Most cases occur in immunosuppressed hosts, including patients with HIV/AIDS, patients receiving immunosuppressing drugs, and solid organ transplant recipients. However, cryptococcosis also occurs in individuals with apparently healthy immune systems. A growing number of cases are caused by C gattii, with infections occurring in both immunosuppressed and immunocompetent individuals. In the majority of documented cases, treatment of C gattii infection of the CNS requires aggressive management of raised intracranial pressure along with standard antifungal therapy. Early cerebrospinal fluid evacuation is often needed through placement of a percutaneous lumbar drain or ventriculostomy. Furthermore, pharmacological immunosuppression with a high dose of dexamethasone is sometimes needed to ameliorate a persistently increased inflammatory response and to reduce intracranial pressure. In this Grand Round, we present the case of an otherwise healthy adolescent female patient, who, despite aggressive management, succumbed to C gattii meningoencephalitis. We also present a review of the existing literature and discuss optimum clinical management of meningoencephalitis caused by C gattii.
authors.affiliation: Phoebe Putney Memorial Hospital, Albany, GA, USA; Hospital Infantil de Mexico, Federico Gomez, Mexico City, Mexico. Electronic address: carlos.franco.paredes@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Franco-Paredes
authors.affiliation: Phoebe Putney Memorial Hospital, Albany, GA, USA.
authors.forename: Tanea
authors.initials: T
authors.lastname: Womack
authors.affiliation: Phoebe Putney Memorial Hospital, Albany, GA, USA.
authors.forename: Teri
authors.initials: T
authors.lastname: Bohlmeyer
authors.affiliation: Phoebe Putney Memorial Hospital, Albany, GA, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Sellers
authors.affiliation: Phoebe Putney Memorial Hospital, Albany, GA, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Hays
authors.affiliation: Albany Neurology, Albany, GA, USA.
authors.forename: Kalpesh
authors.initials: K
authors.lastname: Patel
authors.affiliation: Hospital Universitario Erasmo Meoz, Cúcuta, Norte de Santander, Colombia.
authors.forename: Jairo
authors.initials: J
authors.lastname: Lizarazo
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Shawn R
authors.initials: SR
authors.lastname: Lockhart
authors.affiliation: Phoebe Putney Memorial Hospital, Albany, GA, USA.
authors.forename: Wajid
authors.initials: W
authors.lastname: Siddiqui
authors.affiliation: Johns Hopkins University Medical Center, Baltimore, MD, USA; the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003453:Cryptococcosis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D056285:Cryptococcus gattii / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D008828:Microbiological Techniques; D008853:Microscopy; D011859:Radiography
chemical_list: D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents