Cryptococcal meningitis in HIV negative pregnant women: case report and review of literature

Revista do Instituto de Medicina Tropical de São Paulo

Maria Laura Botelho Costa¹  João Paulo Dias De Souza¹  Antônio Francisco De Oliveira Neto¹  João Luiz Pinto E Silva¹ 

[1] ,Universidade Estadual de Campinas Department of Gynecology and Obstetrics Campinas São Paulo ,Brazil

关键词: Cryptococcal meningitis;    Cryptococcosis;    Pregnancy;    Antifungal therapy;   

DOI  :  10.1590/S0036-46652009000500010

来源: SciELO

【 摘 要 】

INTRODUCTION: Cryptococcosis has become an important entity due to the epidemic of AIDS and therefore it is a significant opportunistic infection. However, there are case reports of cryptococcal meningitis in immune competent pregnant women. Since pregnancy is considered a period of relative immunosuppression, which likely prevents fetal rejection, this could explain the occurrence of opportunistic infections. OBJECTIVE: To report a case of cryptococcosis, and review all cases involving pregnancy and neurocryptococcal infection in immune competent pregnant patients. METHODS: Case report and systematic review of the literature using the MEDLINE and SciELO databases. DISCUSSION: A total of 27 patients were analyzed from 19 studies. The mean age at diagnosis was 26.4 years. There were six patients in their first trimester of pregnancy, 10 in the second, eight in the third and three post-partum. The most prevalent symptoms were headache (85.2%), altered vision (44.4%), altered mental status (44.4%), nausea (40.7%) and fever (33.3%). There were nine deaths (33.3%). Most of the patients received intravenous amphotericin B as treatment (77.8%). The majority (66.6%) of the patients accomplished a term delivery with healthy infants. CONCLUSION: Cryptococcal meningitis should be considered during pregnancy in cases of unexplained headache, altered vision, altered mental status, nausea and fever. Patients with a confirmed diagnosis should be admitted and treated with amphotericin B.

【 授权许可】

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