Cryptococcosis: Early diagnosis reduces neurological deficits
October 10 2016
Cryptococcosis is associated with significant mortality and morbidity including long-term neurological sequelae, especially in non-HIV infected people. A recent retrospective chart review report by Aye and colleagues from Australia (2016) found a significant association exists between delay in diagnosis and subsequent poor neurological outcomes.
Cryptococcus neoformans is predominantly responsible for infection in immunosuppressed patients including those with human immunodeficiency virus infection (HIV)/AIDS while Cryptococcus gattii mainly affects immunocompetent individuals, although both species can occur among different immune groups.The worse outcomes are more common in immunocompetent people compared with the immunocompromised possibly because of a longer delay in diagnosis.
This new report highlights the importance of early diagnosis and the need to limit raised intracranial pressure (ICP) to minimize long-term neurological deficits. The median time of symptom onset to diagnosis was 39 days and the median time of presentation to diagnosis was 9 days among the 29 patients. The overall mortality rate was 10.3%, but 45% of patients with CNS involvement developed long-term neurological deficits. Both longer time from onset of symptoms to diagnosis (median of 45.5 days versus 18.5 days, respectively) and time from presentation to diagnosis (median 14.5 days versus 7 days, respectively) were significantly associated with long-term neurological deficits. Another key finding was a significant association between female gender and poor neurological outcomes.
Sabouraud agar plate showing Cryptococcus neoformans colonies
A previous report by Bratton et al. (2012) had shown that time to diagnosis is longer in non-HIV, non-immunocompromised patients than in HIV-positive and immunocompromised groups. This delay may have contributed to a higher attributable mortality and poorer outcomes in the former group.