Neuroimmunology of meningoencephalitis by Cryptococcus neoformans. A case report
Abstract
Introduction: Meningitis/meningoencephalitis is a non-frequent central nervous system infection produced by Cryptococcus neoformans.
Objective: To show the neuroimmunological response using reibergram in a patient with chronic meningoencephalitis due to Cryptococcus neoformans.
Case presentation: Serum and cerebrospinal fluid IgA, IgM, IgG and albumin levels were quantified in a patient suffering from the disease by means of five lumbar punctures during her evolution; the results were plotted in their corresponding reibergram. Syntheses of at least two intrathecal major immunoglobulin were confirmed. A percent bigger of IgG intrathecal synthesis was observed. There is no blood-brain barrier dysfunction.
Conclusion: Intrathecal immunoglobulin synthesis and blood-brain barrier situation constitute key element in the neuro-inflammation diagnosis.
Keywords: Cryptococcus neoformans, Neuroimmunology, reibergram, chronic meningoencephalitis.
Downloads
References
1. Meiring ST, Quan VC, Cohen C, Dawood H, Karstaedt AS, McCarthy KM, Whitelaw AC, Govender NP. A comparison of cases of paediatric-onset and adult-onset cryptococcosis detected through population-based surveillance, 2005-2007. AIDS 2012; 26: 2307-14.
2. Sarkis RA, Mays M, Isada C, Ahmed. MMRI findings in cryptococcal meningitis of the non-HIV population. Neurologist 2015; 19 (2):40-5.
3. Peter G, Pappas MD, FACP. Cryptococcal Infections in Non-Hiv-Infected Patients Trans Am Clin Climatol Assoc 2013 ; 124: 61–79.
4. Galindo Portuondo ES, León Blasco AM, Pérez RP, Ramírez Cancio O, Morell Artola AE. Meningoencefalitis causada por Cryptococcus neoformans: presentación de un caso. Rev Cubana Neurol Neurocir 2014; 4(2):148–52.
5. Chirag Patel, Ramila Rabindra, Nima Hashemi, Michael Ward, Jayamalathy Mannar Mannan. Chronic meningitis: a diagnostic challenge highlighted in a case of cryptococcal meningoencephalitis in an apparently immunocompetent older woman. BMJ Case Rep 2011; 20 (11):1-3.
6. Padilla-Docal B, Wainshtok-Tomás D, Martínez-Larrarte J, Rivero-Arias E, Herrera-Wainshtok A, Callol-Barroso J, Dorta-Contreras AJ. Respuesta neuroinmunológica en la encefalitis asociada al virus del dengue. VacciMonitor 2013; 22(3):9-13.
7. Reiber H, Peter JB. Cerebrospinal fluid analysis: disease-related data patterns and evaluation programs. J Neurol Sci 2001; 184:101-22.
8. Storch-Hagenlocher B, Reiber H, Wildemann B, Otto M. Cerebrospinal Fluid Analysis. In: Wildemann B, Oschmann P, Reiber H, editors. Laboratory Diagnosis in Neurology. George Thieme Verlag, Sttugart; 2010. p. 30-69.
9. Dorta-Contreras AJ. Pattern of intrathecal immunoglobulin synthesis in pediatric patients with infectious meningoencephalitis. Biotecnol Apl 2006; 4:382-6.
10. Dorta Contreras AJ, Reiber H. Teoría de la difusión molecular/flujo del líquido cefalorraquídeo. Rev Neurol 2004; 39: 564-9.
11. Joshi NS, Fisher BT, Prasad PA, Zaoutis TE. Epidemiology of cryptococcal infection in hospitalized children. Pediatr Infect Dis J 2010; 29: 91-5.
12. Sivasangeetha K, Harish BN, Sujatha S, Parija SC, Dutta TK. Cryptococcal meningoencephalitis diagnosed by blood culture. Indian J Med Microbiol 2007; 25(3):282–4.
13. Lin TY, Yeh KM, Lin JC, Wang NC, Peng MY, Chang FY. Cryptococcal disease in patients with or without human immunodeficiency virus: clinical presentation and monitoring of serum cryptococcal antigen titers. J Microbiol Immunol Infect 2009; 42(3):220–6.
14. Dorta-Contreras AJ. Respuesta poliespecífica en el sistema nervioso central: uso del índice de anticuerpo. Rev Neurol 2000; 31:1070-3.
15. Padilla-Docal B, Iglesias-González I, Bu-Coifiu-Fanego R, Socarrás-Hernández CA, Dorta-Contreras AJ. Review: Intrathecal activation as a typical immune response within the central nervous system in angiostrongyliasis. Am J Trop Med Hyg 88(2):2013; 230-5.
Figura 1 Reibergrama de las clases mayor
Download PDF
