Reversible dementia: A case of cryptococcal meningitis masquerading as Alzheimer's disease
Center for Alzheimer Disease and Related Disorders, Southern Illinois University School of Medicine, Springfield, IL 62794-9643, USA.Journal of Alzheimer's disease: JAD (Impact Factor: 4.15). 11/2004; 6(5):503-8.
A 70-year-old man presented to us in 1994 with a three-year history of worsening dementia. With the exceptions of a Mini-Mental State exam score of 20 and an inability to tandem walk, his physical and neurological examinations were normal. His past medical history revealed that in 1992 he had been evaluated at another institution for memory impairment and bifrontal headaches. A spinal tap had been done in 1992 showing elevated protein, reduced glucose, and a pleocytosis; his CSF fungal culture and cryptococcal antigen test were negative. He subsequently was lost to follow-up, and although his headaches had resolved, his mental status had continued to worsen. In 1994 his CSF cryptococcal antigen was positive, and his CSF fungal culture grew C. neoformans. He gradually improved with treatment for cryptococcal meningitis (CM). With the exception of mild memory impairment, in 2003 he and his family thought that his mental status had returned to normal. This case emphasizes that: 1) CM should always be kept in the differential diagnosis of dementia; 2) CM may be extremely insidious and difficult to diagnose; and 3) if one is to rule out unequivocally all possible reversible causes of dementia, one should perform a spinal tap.
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ABSTRACT: RD is an extremely important problem for the practice of geriatricians. Rationale for this review had come from our question: could we increase and improve the cognitive function of our patients by treating some of "internal medicine" diseases at our hospital. Our clinical experience is telling us that it might be so. We administered the mini mental state examination (MMSE) test on 77 patients to check, if there is a relation between mental state and physical health. Patients were treated with appropriate cardiological, pulmonological and other needed therapies. Results indicate that recovering from the main disease increases the MMSE scores. This leads to the conclusion that successful treatment of patients can be followed and also confirmed by the results of the MMSE test. We have also observed that damaged physical health can inflict cognitive functions, no matter how old a person is.
Article: Cryptococcal infection[Show abstract] [Hide abstract]
ABSTRACT: Cryptococcus neoformans is a major cause of morbidity and mortality, specifically in a host with compromised cell-mediated immunity. Clinically relevant Cryptococcus neoformans is almost always in the form of an encapsulated yeast and reproduces by asexual budding. Cryptococcal cells are visualized on microscopy as spherical or ovoid and measure 4–6 mm in diameter without their capsule. Their main identifying feature is the presence of a polysaccharide capsule, the presence of which is implied by the characteristic halo effect of the India-ink stain. Disseminated cryptococcosis is the most common life-threatening fungal infection in patients with AIDS—affecting up to 8% of patients with advanced HIV infection. With the use of highly active antiretroviral therapy (HAART) for the treatment of HIV infection and the widespread use of azole antifungals, the incidence of invasive cryptococcosis in HIV-infected populations has declined in the Western world. Cryptococcal species have the potential for a sexual cycle, allowing the exchange of virulence factors and the development of more pathogenic strains. Cryptococcal infection is usually acquired via the respiratory route, when either the yeast form or the basidospores are inhaled. Initial colonization and infection of the respiratory tract occur, and there may or may not be subsequent dissemination. Skin involvement in cryptococcosis is usually a feature of dissemination.
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