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Cholecystitis as the initial manifestation of disseminated cryptococcosis.

AIDS (Impact Factor: 6.56). 11/2007; 21(15):2111-2. DOI: 10.1097/QAD.0b013e32801424e3
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    ABSTRACT: We present an unusual case of disseminated cryptococcosis involving the lungs, placenta, and gall bladder in an apparently immunocompetent pregnant woman. The infection resulted in spontaneous abortion. The patient's condition only improved after cholecystectomy and several weeks of antifungal therapy. An in-depth evaluation revealed no central nervous system involvement or immunocompromising condition other than pregnancy.
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    ABSTRACT: Cryptococcus is a unique environmental fungus. Among the more than three dozen species of Cryptococcus, only C. neoformans and C. gattii commonly cause disease. Although many of these infections occur in immunocompromised patients, C. gattii has recently come to public attention because of an outbreak of devastating illness in immunocompetent individuals. The polysaccharide capsule of Cryptococcus is a major virulence factor, and in addition to surrounding the organism, it is also released into the environment. Cryptococcus is believed to enter the body through the lung causing pulmonary disease, but because of its neurotropic nature, the central nervous system is a major target organ. The major risk factors include HIV and organ transplantation. Depending on the site of infection and the patient's immune status, the clinical manifestations vary from asymptomatic to severe life-threatening disease. Treatment regimens depend on the immune status of the patient and the severity of the disease, and include both polyene and imidazole antifungal agents in addition to surgical adjuvant therapy. However, despite antifungal therapy, the mortality remains between 10 and 25% in patients with AIDS, and at least one-third of patients with cryptococcal meningitis experience mycological or clinical failure. Consequently, the mechanism of cryptococcal invasion, immune response, pathogenesis, and treatment continue to be areas of active study. With our advancing knowledge in these areas, we aim at better management for this devastating group of infections.
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    ABSTRACT: 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 neoformans(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.
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