Clinical and imaging features of acquired immunodeficiency syndrome associated with cryptococcal meningitis

Abstract

Abstract: AIDS-associated with cryptococcal meningitis is a fatal infectious disease in the central nervous system, which is the main cause of HIV-related mortality worldwide. The clinical manifestations show the disease has a chronic process. The main clinical manifestations include fever (low fever and moderate fever), progressive headache, severe mental disorder, drowsiness, and etc. The location of cryptococcal meningitis lesions has certain characteristics, which can show abnormal signals in the both sides of basal ganglia. The imaging feature is the change of Virchow Robin space (VRS), which can be manifested as the dilated VRS gelatinous pseudocyst, and the damage of brain parenchyma. After cryptococcus infection breaks through the blood-brain barrier, it can form granuloma in brain parenchyma, that with ependyma or choroid plexus with the size of 5-20 mm. On contrast-enhanced MRI, mild or moderate enhancement of the lesions can be seen. Clinical diagnosis can be made by the location of the lesions and the characteristics of enhancement.

Key words: Acquired immunodeficiency syndrome, Cryptococcal meningitis, Imaging diagnosis

Yuan Hong, Hu Zhiliang, Xu Chuanjun. Clinical and imaging features of acquired immunodeficiency syndrome associated with cryptococcal meningitis[J]. Electronic Journal of Emerging Infectious Diseases, 2020, 5(1): 56-59.

References

[1] Lakshmi V, Sudha T, Teja VD, et al.Prevalence of central nervous system cryptococcosis in human immunodeficiency virus reactive hospitalized patients[J]. Indian J Med Microb, 2007, 25(2): 146.
[2] Sloan DJ, Parris V.Cryptococcal meningitis: epidemiology and therapeutic options[ J]. Clin Epidemiol, 2014, 6(1): 169-182.
[3] 刘正印, 王贵强, 朱利平, 等. 隐球菌性脑膜炎诊治专家共识[J]. 中华内科杂志,2018, 57(5):317-323.
[4] 王芳,黄琛,杜艳,等. 36例新型隐球菌性脑膜炎的临床分析[J]. 中国抗生素杂志,2019,44(2):273-276.
[5] Dias AI,Matsumoto FE,Melhem MS,et a1.Comparative analysis of Etest and broth miemdilution method AFST-EUCAST)for trends in antifungal drug susceptibility testing of Brazilian Cryptoeoccus neoformans isolates[J].J Med Microbiol,2006,55(12):1693-1699.
[6] Pappas PG,Perfect JR,Cloud GA,et al.Cryptocoecosis in htlmanimmunodefieiency virus.negative patients in the era of effective a20le therapy[J].Clin Infect Dis,2001,33(5):690-699.
[7] Husain S,Wagener MM,Singh N.Cryptococeus neoformans infection in organ transplant recipients:valtables influencing clinical characteristics and outcome[J].Emerg Infect Dis, 2001,7(3):375-381.
[8] Vilchez RA,Fung J,Kusne S.Cryptoeoeeosis in organ transplant recipients:an overview[I].Am J Transplant,2002,2(7):575-580.
[9] Singh N,Alexander BD,Lortholary O,et a1.Cryptococcus neoformans in organ transplant recipients:impact of ealeineurin—inhibitor agents on mortality[J].J Infect Dis,2007,195(5): 756-764.
[10] 刘正印,王爱霞,李太生,等. 隐球菌性脑膜炎26例临床分析[J]. 中华内科杂志, 2002,41(8):541-543.
[11] 常艳宇,胡学强.新型隐球菌性脑膜炎和(或)脑炎102例诊断与治疗经验[J].中国现代神经疾病杂志,2014,14(8):687-692.
[12] Lee YC,Wang JT, Sun HY,et al.Comparisons of clinical features and mortality of cryptococcal meningitis between patients with and without human immunodeficiency virus infection[J].J Microbiol Immunol Intect,2011,44(5):338—345.
[13] 中华医学会感染病学分会艾滋病丙型肝炎学组,中国疾病预防控制中心.中国艾滋病诊疗指南(2018版)[J].新发传染病电子杂志,2019,4(2):65-84.
[14] Offiah CE, Naseer A .Spectrum of imaging appearances of intracranial cryptococcal infection in HIV/AIDS patients in the anti-retroviral therapy era[J]. Clin Radiol, 2016, 71(1): 9-17.
[15] 许传军, 胡志亮, 魏洪霞, 等. 艾滋病患者中枢神经系统隐球菌感染的磁共振成像特征[J]. 中南大学学报(医学版), 2017, 42(10): 1184-1190.
[16] 汪兰,王晓玲,朱斌,等. 颅脑隐球菌感染的磁共振影像分析[J]. 中华医院感染学杂志, 2019, 29(16):2459-2462.
[17] 李超,杜超,许传军,等.艾滋病相关性颅内隐球菌感染的 MRI 表现分析[J].医学影像学杂志, 2017 ,27(10):1858-1862.
[18] 杨根东, 陆普选, 詹能勇,等.2例艾滋病并发新型隐球菌性脑膜炎头颅CT表现[J]. 传染病信息, 2007, 20(6): 375-377.
[19] 甘清鑫,刘晋新,张烈光,等.艾滋病合并新型隐球菌脑膜脑炎的MRI表现[J].磁共振成像,2015,6(7):491-495.
[20] Corti M, Villafañe MF, Negroni R, et al.Magnetic resonance imaging findings in AIDS patients with central nervous system cryptococcosis[J]. Rev Iberoam Micol, 2008, 25(4): 211-214.
[21] 李建灵, 高剑波, 张淼. 艾滋病合并脑内机遇性感染的MRI表现[J]. 磁共振成像, 2010, 1(5): 363-365.
[22] 何云. 临床医生应该如何理解《中国艾滋病诊疗指南(2018版)》[J]. 新发传染病电子杂志,2019,4(2):125-128.
[23] 陶然,师金川,郭永征,等. 两性霉素B去氧胆酸盐、两性霉素B脂质体和伏立康唑诱导治疗HIV相关性隐球菌脑膜炎的效果比较[J]. 新发传染病电子杂志,2019,4(1):97-102.