Clinical profile of disseminated cryptococcal infection-a case series

Vishwanath Sathyanarayanan, Ragini Bekur, Abdul Razak, Joydeep Chakraborty

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)818-820
Number of pages3
JournalAsian Pacific Journal of Tropical Medicine
Volume3
Issue number10
DOIs
Publication statusPublished - 01-10-2010

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Fluconazole
Cryptococcosis
Infection
Amphotericin B
Fever
HIV
Cerebrospinal Fluid Pressure
Oral Candidiasis
Cryptococcus neoformans
Blood Sedimentation
Immunocompromised Host
Tertiary Healthcare
CD4 Lymphocyte Count
Tertiary Care Centers
Vomiting
Headache
Cerebrospinal Fluid
Anemia
Early Diagnosis
India

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Sathyanarayanan, Vishwanath ; Bekur, Ragini ; Razak, Abdul ; Chakraborty, Joydeep. / Clinical profile of disseminated cryptococcal infection-a case series. In: Asian Pacific Journal of Tropical Medicine. 2010 ; Vol. 3, No. 10. pp. 818-820.
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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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Clinical profile of disseminated cryptococcal infection-a case series. / Sathyanarayanan, Vishwanath; Bekur, Ragini; Razak, Abdul; Chakraborty, Joydeep.

In: Asian Pacific Journal of Tropical Medicine, Vol. 3, No. 10, 01.10.2010, p. 818-820.

Research output: Contribution to journalArticle

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AB - 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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