Clinical experience on cryptococcal meningoencephalitis in a public hospital from Venezuela

Introduction: The genus Cryptococcus includes around 37 species. Among these, Cryptococcus neoformans is the only species that is pathogenic, and comprises in turn three main varieties: var. gattii, var. neoformans and var. grubii. Currently most of the cases of neurocryptococcosis occur in HIV-infected patients; however, it can also exist in subjects without HIV infection (especially by Cryptococcus var. gattii and var. grubii). Objective: To describe the clinical experience on patients with the diagnosis of Cryptococcus neoformans meningoencephalitis Servicio Autonomo Hospital Universitario de Maracaibo, Venezuela, during the period 2004-2010. Methods: All patients who arrived to our hospital with combinations of the following symptoms were registered: headache, fever, vomiting and altered consciousness. The clinical diagnosis at arrival was acute meningoencephalitis and afterwards by cerebrospinal fluid cytochemistry, microbiological analyses (India ink stain and cultures), as well as antigenic determination, a confirmed diagnosis of Cryptococcus neoformans as the etiological agent was reached. Results: A total of 22 patients were analyzed, 69% males and 60% seronegatives to HIV infection. At hospital arrival 90% presented with headache, 65% fever, 40% vomiting, 35% altered mental status and 65% intracranial hypertension. A 75% of patients received amphotericin B as a first-line agent and the rest (25%) received fluconazol, observing a substantial clinical improvement in the majority of patients. Conclusion: Although more common in HIV-infected patients, neurocryptococcosis can occur in immunocompetent subjecs and should be considered on the differential diagnosis of meningoencephalitis even in non-HIV patients.