Cases reported "Meningitis, Cryptococcal"

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1/6. A cryptic cause of cryptococcal meningitis.

    cryptococcus neoformans commonly causes opportunistic infection in immunocompromised patients, especially in patients with AIDS. The CD4 T-lymphocyte count is measured in patients with hiv infection, because it signals an increased risk of opportunistic infection and a decline in immunological function. We report a case of cryptococcal meningitis in a patient with persistently low CD4 cell counts without evidence of hiv infection. The patient's underlying immunocompromised state was attributed to idiopathic CD4 T-lymphocytopenia (ICL), a recently described syndrome characterized by depletions in the CD4 T-cell subsets without evidence of hiv infection. Immunodeficiency can exist in the absence of laboratory evidence of hiv infection, highlighting the importance of evaluating T-cell subsets in patients who present with unusual infections.
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ranking = 1
keywords = idiopathic
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2/6. Two patients with cryptococcal meningitis and idiopathic CD4 lymphopenia: defective cytokine production and reversal by recombinant interferon- gamma therapy.

    BACKGROUND: Although cryptococcus neoformans is a fungal pathogen that causes human disease predominantly in the immunocompromised host, severe cryptococcal infections are occasionally encountered in apparently immunocompetent individuals. Activation of cellular immunity by proinflammatory cytokines plays a central role in anticryptococcal defense. methods: We describe 2 patients with severe cryptococcal meningitis who appeared to have idiopathic CD4 lymphopenia. For these patients and for 4 healthy volunteers, ex vivo stimulation of whole blood with microbial stimuli was used to investigate putative defects in cytokine production capacity. RESULTS: Assessment of the cytokine released from the 2 patients with CD4 lymphopenia revealed a defective production of the proinflammatory cytokines interferon (IFN)- gamma and tumor necrosis factor (TNF) but not of the anti-inflammatory cytokine interleukin-10 (IL-10). One patient with disease progression despite receipt of antifungal treatment was administered immunotherapy with recombinant IFN- gamma . Administration of recombinant IFN- gamma resulted in both restoration of immunological parameters and a sustained clinical recovery. CONCLUSIONS: Refractory meningitis may be due to defective TNF and IFN- gamma production, and IFN- gamma treatment may be useful in patients with an impaired cellular immune response and refractory cryptococcal meningitis.
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ranking = 5
keywords = idiopathic
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3/6. Idiopathic Cd4 T-lymphocytopenia--two unusual patients with cryptococcal meningitis.

    Idiopathic CD4 T-lymphocytopenia (ICL) is a syndrome characterised by the depletion in the CD4 T-cells but without evidence of hiv infection. Aside from low CD4 lymphocyte counts, the immunologic findings in these patients are distinct from the abnormalities found in hiv infection. There are numerous reports of ICL associated with different diseases and clinical conditions. opportunistic infections, mostly seen in hiv patients are the most common among them. We describe two patients without risk factors for human immunodeficiency virus (hiv) infection, each of whom presented with cryptococcal meningitis and was found to have idiopathic CD4 T-lymphocytopenia. One of them also acquired EBV and CMV coinfection of the central nervous system.
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ranking = 1
keywords = idiopathic
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4/6. Profound and possibly primary "idiopathic CD4 T lymphocytopenia" in a patient with fungal infections.

    A profound and long-lasting reduction in circulating CD4 T lymphocytes (< 80/microliters) was found in a 37-year-old man (without known risk factors for hiv infection) presenting with recurrent oral candidiasis who subsequently developed cryptococcal meningitis. Infection with hiv was ruled out by serological and virological studies. in vitro and in vivo cell-mediated immunity was severely impaired. Abnormal phenotypic patterns of both CD4 and CD8 cells were consistently observed. A systematic family survey revealed in some of his asymptomatic relatives several immunological abnormalities which may point to a genetically based primary immunodeficiency disorder.
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ranking = 4
keywords = idiopathic
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5/6. hiv-negative "AIDS" in kentucky: a case of idiopathic CD4 lymphopenia and cryptococcal meningitis.

    Here we describe a case of unexplained CD4 T-lymphocyte depletion and cryptococcal meningitis in a patient without evidence of human immunodeficiency virus (hiv) infection. This newly recognized syndrome has been named idiopathic CD4 lymphopenia (ICL). When hiv infection is suspected in a patient with an opportunistic infection, a CD4 lymphocyte count should be obtained, even if the patient's hiv test is negative. patients with persistently low CD4 counts (< 300 cells/microL, or < 20%) who show no evidence of hiv infection, who have no defined immunodeficiency, and who are not receiving therapy associated with CD4 depletion have disease that meets the definition of ICL, and the case should be reported to the Centers for Disease Control.
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ranking = 5
keywords = idiopathic
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6/6. Idiopathic CD4 T-lymphocytopenia--four patients with opportunistic infections and no evidence of hiv infection.

    BACKGROUND AND methods. We describe four patients without major risk factors for human immunodeficiency virus (hiv) infection, each of whom presented with severe opportunistic infections and was found to have idiopathic CD4 T-lymphocytopenia. We performed assays to detect the presence of retroviruses and undertook immunophenotyping of subgroups of peripheral-blood lymphocytes. RESULTS. The opportunistic infections at presentation included pneumocystis carinii pneumonia, cryptococcal meningitis (two patients, one with concurrent pulmonary tuberculosis), and histoplasma-induced brain abscess. During 10 to 68 months of observation, none of the four patients had evidence of infection with hiv type 1 or 2 or human T-cell lymphotropic virus type I or II on the basis of epidemiologic, serologic, or polymerase-chain-reaction studies or culture, nor was there any detectable reverse transcriptase activity. Although all the patients had severe, persistent CD4 T-lymphocytopenia (range, 12 to 293 cells per cubic millimeter), the CD4 cell count progressively declined in only one and was accompanied by multiple opportunistic infections. All four patients had significantly reduced numbers of circulating CD8 T cells, natural killer cells, or B cells (or all three). CONCLUSIONS. These four patients had idiopathic CD4 T-lymphocytopenia with opportunistic infections but no evidence of hiv infection. Instead of the progressive, selective depletion of CD4 T cells characteristic of hiv infection, some patients with idiopathic immunodeficiency have stable CD4 cell counts accompanied by reductions in the levels of several other lymphocyte subgroups.
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ranking = 3
keywords = idiopathic
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