Diagnostic approach in an older adult patient with neuroinfection of mycotic etiology, presentation of a case

Abstract

Background: Infectious meningitis of fungal etiology reports a high morbidity and mortality rate and presents clinical similarity to acute cerebrovascular event or epilepsy. This difficulty of diagnosis increases in the elderly, where classic clinical features such as meningismus whose manifestation is fever, neck stiffness, photophobia and headache are difficult to find or classify. Objective: To show the diagnostic approach of an older adult with neuroinfection. Methods: The patient’s medical history suggested taking a lumbar puncture, cultures, India ink, antigen test and specific labs. The literature suggests a three-phase treatment; the patient in the case died before completing the suggested treatment. Results: Cryptococcosis is the main one among the fungal etiologies, this was found in the patient of the case, with a mortality despite in-hospital management between 40 and 60% in areas of development. Conclusion: Lumbar puncture, culture of Indian ink and its analysis are the gold standard for diagnosing neuroinfection of fungal etiology, in the presence of meningitis and/or encephalitis, in this case generated by cryptococcosis in a older adult. A systematized initial treatment allows early management, improving the prognosis of patients.

Fecha de recepción: 22/12/2022

Aceptación de originales: 01/07/2023