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.

[1]  Y. Liu,et al.  [Idiopathic CD4+ T-lymphocytopenia in a child with disseminated cryptococcosis]. , 2005, Zhonghua er ke za zhi = Chinese journal of pediatrics.

[2]  R. Macgregor,et al.  The effect of acute severe illness on CD4+ lymphocyte counts in nonimmunocompromised patients. , 2000, Archives of internal medicine.

[3]  I. Shuaib,et al.  Idiopathic CD4+ T-lymphocytopenia in a child with disseminated cryptococcosis. , 1998, Annals of tropical paediatrics.

[4]  A. Yinnon,et al.  Invasive cryptococcosis in a family with epidermodysplasia verruciformis and idiopathic CD4 cell depletion. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  A. Jack,et al.  CD4 cell counts used as surrogate test for HIV infection , 1995, BMJ.

[6]  J. Roberts.  Effects of drinking green tea. , 1995, BMJ.

[7]  C Collins,et al.  Helping health services in the developing world , 1995, BMJ.

[8]  J. Morley,et al.  Idpathic CD4+ T Lymphopenia in Older Persons , 1994, Journal of the American Geriatrics Society.

[9]  M. Saag,et al.  Measurement of cryptococcal antigen in serum and cerebrospinal fluid: value in the management of AIDS-associated cryptococcal meningitis. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  J. Laurence.  T-Cell Subsets in Health, Infectious Disease, and Idiopathic CD4+T Lymphocytopenia , 1993, Annals of Internal Medicine.

[11]  C. Cunningham-Rundles,et al.  New Insights into Common Variable Immunodeficiency , 1993, Annals of Internal Medicine.

[12]  S. Holmberg,et al.  Unexplained opportunistic infections and CD4+ T-lymphocytopenia without HIV infection. An investigation of cases in the United States. The Centers for Disease Control Idiopathic CD4+ T-lymphocytopenia Task Force. , 1993, The New England journal of medicine.

[13]  A. Fauci.  CD4+ T-lymphocytopenia without HIV infection--no lights, no camera, just facts. , 1993, The New England journal of medicine.

[14]  S. Stevens,et al.  CD4+ T-lymphocytopenia without HIV infection. , 1993, The New England journal of medicine.

[15]  S. Levitz.  The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis. , 1991, Reviews of infectious diseases.

[16]  D. Marriott,et al.  Mycoses in AIDS Patients , 2011, Springer US.

[17]  Johannes Müller.  Immunological aspects of cryptococcosis in AIDS patients. , 1990 .

[18]  S. Chuck,et al.  Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. , 1989, The New England journal of medicine.

[19]  J. Murphy.  Clearance of Cryptococcus neoformans from immunologically suppressed mice , 1989, Infection and immunity.