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© Benea et al; licensee BioMed Central Ltd. 2013
Published: 16 December 2013
In the era of HAART C neoformans meningitis remains one of the most important opportunistic infections associated with HIV infection, with a high mortality (35-65%).
We present 3 cases of C neoformans meningitis occurred in immunocompromised patients with advanced HIV infection (CD4<50 cells/cmm) caused by strains with susceptibility to fluconazole dose-dependent and different clinical course.
The first case: a 28 years old patient, confirmed with HIV infection in 2009. He is diagnosed with systemic infection with C neoformans with pneumonia, meningitis and cutaneous cryptococcosis and a CD4<50 cells/cmm. Blood and CSF cultures were positive for C neoformans. CSF changes were minimal, but with high pressure. Was treated with fluconazole - 1200 mg/day and lumbar punctures were performed repeatedly. CSF cultures were negative with difficulty, after about 8 weeks of treatment. The evolution was unfavorable with neurocognitive deterioration, seizures and death.
The second case: a 24 years old patient, diagnosed with HIV infection in childhood, with a history of multiple antiretroviral regimens but with discontinued treatment two years ago is diagnosed with C neoformans meningitis and a CD4<50 cells/cmm. CSF changes were minimal and CSF pressure was increased. Under treatment with liposomal amphotericin and lumbar punctures at 2-3 days intervals the evolution was slowly favorable. After 8 weeks of antifungal therapy the antiretroviral treatment has been resumed.
The third case: a 54 years old patient with confirmed HIV infection in 2011 is diagnosed with C neoformans meningitis and a CD4<50 cells/cmm. CSF had significant changes with incresed cellularity and low glycorrachia. Treated with fluconazole – 1200 mg/day plus flucytosine – the evolution was favorable.
We discussed the different factors that determine the clinical course of C neoformans infection in HIV-infected patients with advanced immunosuppression.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.