Академический Документы
Профессиональный Документы
Культура Документы
*
* A 32-year-old man with known AIDS is brought
to the emergency room with headache and fever for the past 3 days.
him, he has been confused, forgetful, and irritable for a few weeks prior to the onset of these symptoms.
low CD4 count and has had bouts of pneumocystis pneumonia, candidal esophagitis, and Kaposi sarcoma.
* On physical examination:
* On examination, he is cachetic and frail
appearing.
* He is confused and only oriented to his name. * His temperature is 37.8C (100F), and his
other vital signs are normal.
* Examination of his cranial nerves is normal. * He has minimal nuchal rigidity. * Cardiovascular, pulmonary, and abdominal
examinations are normal.
* He is hyperreflexic.
*
* A head CT scan is normal. * A report of the microscopic examination of his
cerebrospinal fluid obtained by lumbar puncture comes back from the lab and states that there were numerous white blood cells, predominantly lymphocytes, and no organisms identified on Gram stain but a positive India ink test.
*
* Bacteria: Neisseria meningitidis Streptococcus pneumoniae Haemophilus influenzae type B Escherichia coli group B streptococci staphylococci pseudomonas and other Gram-negative bacilli.
* Viral: Enteroviruses herpes simplex virus type 2 varicella zoster virus mumps virus HIV LCMV
* Parasitic: Angiostrongylus cantonensis Gnathostoma spinigerum Schistosoma Cysticercosis toxocariasis baylisascariasis paragonimiasis
*
* Introduction:
Cryptococcus neoformans is an encapsulated monomorphic fungi that commonly causes chronic meningitis in immune-suppressed individuals and occasionally in immunecompetent persons.
The lungs are the primary site of infection, although the organism appears to have specific affinity for the brain and meninges on systemic spread. C. neoformans is the leading cause of fungal meningitis and is an important cause of mortality in AIDS patients.
Meningitis: Inflammation of the meninges. Nuchal rigidity: Stiffness of the neck associated with meningitis. Cachetic: Weight loss or wasting because of disease or illness.
humans is via aerosolization of the organism followed by inhalation into the lungs.
been shown.
monomorphic, not dimorphic, and grows as budding yeast cells at both 25C in culture and at 37C in tissues. white- or tan-colored mucoid colonies in 2-3 days on a variety of common fungal media.
large size and structure and has also been shown to interfere with antigen presentation and the development of T-cell-mediated immune responses at sites of infection.
allow for multiplication of the organism and promotion of its spread outside the respiratory tract.
*
* Inhalation of these aerosolized yeast cells leads
to a primary pulmonary infection.
disease is meningitis, which results from hematogenous spread of the organism from the lung to the meninges.
or those who are immunosuppressed for other reasons, but it can occasionally occur in persons without underlying conditions.
have a preference for the cerebrospinal fluid (CSF), but disseminated disease can also cause infections of the skin, eye, and bone.
onset, slowly causing mental status changes, irritability, or confusion that occurs over weeks to months, or it can occur acutely, with immediate changes in mentation and meningeal symptoms. headache, irritability, dizziness, and difficulty with complex cerebral functions and may even be mistaken as psychoses. may appear in late clinical course.
primarily by clinical presentation and examination of CSF for increased pressure, increased number of white cells, and low glucose levels.
India ink test, which is an easy and rapid test that is positive in approximately 50 percent of patients with cryptococcal disease.
and mixed with a loopful of CSF sediment or a small amount of isolated yeast cells.
*
* C. neoformans infections can be treated with
antifungal agents such as amphotericin B or fluconazole.
* Amphotericin B is a broad-spectrum
chemotherapeutic agent and is the most effective drug for severe systemic mycoses.
to which all patients have adverse reactions such as fever, chills, dyspnea, hypotension, and nausea.