Management of Cryptococcus gattii meningoencephalitis

Carlos Franco-Paredes, Tanea Womack, Teri Bohlmeyer, Brenda Sellers, Allison Hays, Kalpesh Patel, Jairo Lizarazo, Shawn R. Lockhart, Wajid Siddiqui, Kieren A. Marr

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
Pages (from-to)348-355
Number of pages8
JournalThe Lancet Infectious Diseases
Volume15
Issue number3
DOIs
StatePublished - Mar 1 2015

ASJC Scopus subject areas

  • Infectious Diseases

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    Franco-Paredes, C., Womack, T., Bohlmeyer, T., Sellers, B., Hays, A., Patel, K., Lizarazo, J., Lockhart, S. R., Siddiqui, W., & Marr, K. A. (2015). Management of Cryptococcus gattii meningoencephalitis. The Lancet Infectious Diseases, 15(3), 348-355. https://doi.org/10.1016/S1473-3099(14)70945-4