1612. Characterizing Cryptococcosis in the Immunocompetent- a Rochester General Hospital Experience
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
Background: Cryptococcosis is a systemic opportunistic fungal infection, primarily occurring in immunocompromised hosts such as HIV infected and following organ transplants. Less frequently is the organism pathogenic in the immunocompetent. We present a case series of immunocompetent patients with cryptococcosis at Rochester General Hospital over a 2year period.

Methods: Four immunocompetent patients presented with symptoms of new and progressively worsening headaches, lethargy and confusion or altered mental status. CT head was grossly normal in all and brain MRI showed basilar meningeal involvement in one patient. Cerebrospinal fluid (CSF) analysis in all patients was significant for elevated nucleated cells, predominantly lymphocytic (Table 1). CSF and serum cryptococcal antigens were both present in two cases; one case was CSF-positive/serum-negative and one case was CSF-negative/serum-positive. One patient who presented with altered mental status initially felt secondary to a urinary tract infection was found to have urine cultures positive for cryptococcus neoformans that led to the diagnosis of disseminated disease. All patients were started on 14day induction therapy with intravenous amphotericin B and oral flucytosine. One patient was immediately transitioned to fluconazole due to intolerance to amphotericin. All four were discharged on a 6 month consolidation fluconazole therapy, but the eldest patient at aged 91 died soon after discharge from other contributing co-morbidities. The remaining three patients are seen recovering well but have persistent headaches on follow-up

Table. 1
Patient's age (years) 91 48 79 65
CSF protein (15-45mg/dl) - 60 99 96
CSF glucose (40-70mg/dl) 42 55 41 65
CSF nucleated cells (0-5/mcl) 358 114 103 268
CSF lymphocytes (40-80%) 79 91 88 89
CSF Cryptococcal Antigen (titre) 1:8 1:512 Not detected 1:64
Serum cryptococcal antigen (titre) 1:2 1:2 1:64 Not detected
Urine culture C.neoformans (10000 cfu/ml) - - -
HIV results Non reactive Non reactive Non reactive Non reactive

Conclusion: Although rare, disseminated cryptococcal infection may occur in immunocompetent individuals. Increased awareness with early diagnosis may thwart poor outcomes and facilitate cure.

Kadambari Vijaykumar, MD, Internal Medicine, Rochester General Hospital, Rochester, NY and Maryrose Laguio-Vila, MD, Infectious Diseases, University of Rochester Medical Center, Rochester, NY


K. Vijaykumar, None

M. Laguio-Vila, None

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