![]() Nowadays, HIV represents the major risk factor (more than 50% of cases in the Western world while in Sub-Saharan Africa cryptococcosis is almost exclusively observed in HIV-infected patients). Patients with T-cell mediated immunodeficiency are at greatest risk for cryptococcal infections. Thanks to the introduction of highly active antiretroviral therapy (HAART), the rate of cryptococcosis has declined significantly in developed countries in the past few years with an increase of cryptococcosis in HIV-negative patients ( 131). However, this infection has emerged as a major cause of mortality among persons who do not have access to HAART in developing countries. One million cases are reported each year in Sub-Saharan Africa, with more than 600 000 deaths/year in HIV-infected patients ( 123). In 1990’s, 80% of cryptococcosis occurred in patients with AIDS ( 39). With the emergence of AIDS, the yeast gained increasing medical importance. However, cryptococcosis was rare before 1980’s ( 36, 132). neoformans exposition is frequent as 80% of adults have antibodies directed against C. VGII genotype can be further divided into three subtypes: VGIIa, VGIIb, VGIIc. gattii can be divised into four genotypes: VGI, VGII, VGIII, VGIV. These species are characterized by distinct geographic distribution, host preference clinical presentation and therapeutic recommendations. C. neoformans variety grubii corresponds to serogroup A and C. neoformans variety neoformans is serogoup D ( Table 1) ( 24, 36). Two Cryptococcus species are pathogenic in humans: C. Polysaccharide capsule and melanin are virulence factors. Although the patient was given polyvalent human immunoglobulins (IgG, IgA, and IgM levels were normal: 7.3 g/L, 2.34 g/L, and 0.17 g/L, respectively), the long-term immunosuppressive therapy caused severe TCD4 + lymphopenia (0.064 × 10 9/L) and was instrumental in allowing the infection and dissemination of the yeast.Cryptococcus spp.is a basidiomycetous yeast. Cryptococcus neoformans infection is rare among immunocompetent patients. Treatment with associating high doses of amphotericin B and flucytosine was quickly started, but the patient died 10 days later. BM examination suggested the diagnosis that was confirmed by additional tests. Disseminated cryptococcosis caused by Cryptococcus neoformans was confirmed by India ink stain and a cryptococcal antigenemia test was run on the cerebrospinal fluid. BM examination revealed no signs of dysmegakaryopoiesis or plasma cell invasion, but there were several histiocytes with intracellular encapsulated bodies identified as fungal cells. Complete blood count readings showed mild anemia (hemoglobin 105 g/L), normal white blood cell count (7.8 × 10 9/L) with severe lymphopenia (0.15 × 10 9/L), and severe thrombocytopenia (41 × 10 9/L), which prompted a bone marrow (BM) aspiration. After 3 relapses, she was treated with a combination of corticosteroids, cyclophosphamide, and pomalidomide and was believed to be in complete remission. Her International Staging System stage III MM had been diagnosed incidentally 8 years prior. Category: Infectious Disease > Fungi > CryptococcusĪ 77-year-old white woman who was followed for an IgA-λ multiple myeloma (MM) was admitted for the development of neurological symptoms.
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