Case Report | | Peer-Reviewed

Identifying Cryptococcus Neoformans Neuroinfection Through Neuropsychological Examination

Received: 26 December 2023     Accepted: 6 January 2024     Published: 18 January 2024
Views:       Downloads:
Abstract

Cryptococcus neoformans is a highly letal and hard-to-be-identified fungal disorder, being its neurocognitive impairment practically non-documented in literature. In this experience-based report, integrated analysis of symptomatology, history of life and neurocognitive assessment regarding a clinical case, provided a quick and easy-access identification of cryptococcus neoformans in a 77-year male (right-handed, 12 years of education). A semi-structured interview explored a variety of risk, favorable and influential factors. Neuropsychological battery included MMSE-2, Digit-Span, STROOP, RAVLT, COWAT, and Clock-Drawing Test. Quantitative and qualitative (verbalizations, test execution procedures and attitude) results have been integrated for his neuropsychological characterization. Main impairment occurred in semantics (mental confusion), processing speed and self-regulatory executive functions. Together, these cognitive functions rely on integrity of cortico-subcortical circuits. His verbal episodic memory was null, but this absent condition might be at least partially attributed to history of alcohol abuse. Motor disturbance slightly affected visuospatial praxia. Recommendations to identify rare neuroinfection through a neuropsychological approach include, beyond quantitative test results of a discriminant neurocognitive battery, proper identification of: an episode-related pattern of symptom evolution; a neurocognitive profile which resembles symptom evolution; and qualitative measures of transitory impairment. Thus, the proposed neuropsychological assessment approach is expected to fasten neuroinfection diagnosis and burn letal possibilities, in simplified, yet fidedign and specialized, clinical contexts.

Published in Clinical Neurology and Neuroscience (Volume 8, Issue 1)
DOI 10.11648/j.cnn.20240801.13
Page(s) 12-18
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Cryptococcus, Neuroinfection, Neuropsychological Assessment, Differential Diagnosis

References
[1] Aharon-Peretz, J., et al. Cryptococcal meningitis mimicking vascular dementia. Neurology 62.11, 2135-2135 (2004).
[2] Ala, T. A., Robert C. D., and Christopher J. Sullivan. Reversible dementia: a case of cryptococcal meningitis masquerading as Alzheimer's disease. Journal of Alzheimer's Disease 6.5, 503-508 (2004).
[3] Chen, Chang-Hung, et al. Neuro-psychological sequelae in HIV-negative cryptococcal meningitis after complete anti-fungal treatment. Acta Neurol Taiwan 21.1, 8-17 (2012).
[4] Chen, Meng-Hsiang, et al. Long-term neuropsychological sequelae in HIV-seronegative cryptococcal meningoencephalitis patients with and without ventriculoperitoneal shunts: a cine MRI study. Behavioural Neurology 2015 (2015).
[5] de Azevedo-Pereira, Annelise Velasco, et al. Rapidly progressive dementia by cryptococcal meningitis: A case report. Infectio (2022).
[6] de Paula, J. J. & Malloy-Diniz, L. F. RAVLT – Teste de Aprendizagem Auditivo-Verbal de Rey (RAVLT) [Rey Auditory Verbal Learning Test (RAVLT)]. (Vetor, 2018).
[7] Campanholo, K. R., et al. Performance of an adult Brazilian sample on the Trail Making Test and Stroop Test. Dementia & neuropsychologia 8, 26-31 (2014).
[8] Deb, S., et al. Cryptococcal dementia in a patient with sarcoidosis. The Medical Journal of Australia 184.2, 86-87 (2006).
[9] Esteves, C. S. et al. Phonemic and semantic verbal fluency tasks: normative data for elderly Brazilians. Psicologia: Reflexão e Crítica 28, 350-355 (2015).
[10] Folstein, M. F. et al. MMSE-2 – Mini exame do estado mental [MMSE-2 – Mini mental state examination]. (São Paulo, 2018).
[11] Hoffmann, Michael, et al. Cryptococcal meningitis misdiagnosed as Alzheimer's disease: complete neurological and cognitive recovery with treatment. Journal of Alzheimer's Disease 16.3, 517-520 (2009).
[12] Kalita, J., U. K. Misra, and P. Ranjan. Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis. European Journal of Neurology 14.1, 33-37 (2007).
[13] Kumar, Anil, et al. Infectious psychosis: cryptococcal meningitis presenting as a neuropsychiatry disorder. Neurology India 59.6, 909-911 (2011).
[14] Lezak, M. Neuropsychological assessment. (Oxford University Press, 2004).
[15] Lorber, John. The results of treatment of 549 cases of tuberculous meningitis. American Review of Tuberculosis 69.1, 13-25 (1954).
[16] Lu, C-H., et al. "Assessing the chronic neuropsychologic sequelae of human immunodeficiency virus–negative cryptococcal meningitis by using diffusion tensor imaging." American journal of neuroradiology 32.7 (2011): 1333-1339.
[17] Marr, Kieren A., et al. A multicenter, longitudinal cohort study of cryptococcosis in human immunodeficiency virus–negative people in the United States. Clinical Infectious Diseases 70.2, 252-261 (2020).
[18] Mota, N. Values beyond information: redefining neuroscience through an integrative psychological theory (Amazon, 2017).
[19] National Council of Psychology. Código de Ética Profissional do Psicólogo [Psychologist ethics code]. (Conselho Federal de Psicologia, 2005).
[20] Okamoto, I. H. Aspectos cognitivos da doença de Alzheimer no teste do relógio: avaliaçäo de amostra da populaçäo brasileira [Alzheimer cognitive aspects in the clock test: brazilian sample assessment]. Thesis dissertation, (University of São Paulo, 2001).
[21] Sachdeva, A., et al. Alcohol-related dementia and neurocognitive impairment: a review study. International journal of high risk behaviors & addiction 5.3 (2016).
[22] Soares, E. A., et al. Mortality by cryptococcosis in Brazil from 2000 to 2012: A descriptive epidemiological study. PLoS Neglected Tropical Diseases 13.7 (2019).
[23] Wechsler, David. WAIS-III: escala de inteligência Wechsler para adultos [Wechsler adult intelligence scale]. (Casa do Psicólogo, 2004).
Cite This Article
  • APA Style

    Mota, N. (2024). Identifying Cryptococcus Neoformans Neuroinfection Through Neuropsychological Examination. Clinical Neurology and Neuroscience, 8(1), 12-18. https://doi.org/10.11648/j.cnn.20240801.13

    Copy | Download

    ACS Style

    Mota, N. Identifying Cryptococcus Neoformans Neuroinfection Through Neuropsychological Examination. Clin. Neurol. Neurosci. 2024, 8(1), 12-18. doi: 10.11648/j.cnn.20240801.13

    Copy | Download

    AMA Style

    Mota N. Identifying Cryptococcus Neoformans Neuroinfection Through Neuropsychological Examination. Clin Neurol Neurosci. 2024;8(1):12-18. doi: 10.11648/j.cnn.20240801.13

    Copy | Download

  • @article{10.11648/j.cnn.20240801.13,
      author = {Nayara Mota},
      title = {Identifying Cryptococcus Neoformans Neuroinfection Through Neuropsychological Examination},
      journal = {Clinical Neurology and Neuroscience},
      volume = {8},
      number = {1},
      pages = {12-18},
      doi = {10.11648/j.cnn.20240801.13},
      url = {https://doi.org/10.11648/j.cnn.20240801.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20240801.13},
      abstract = {Cryptococcus neoformans is a highly letal and hard-to-be-identified fungal disorder, being its neurocognitive impairment practically non-documented in literature. In this experience-based report, integrated analysis of symptomatology, history of life and neurocognitive assessment regarding a clinical case, provided a quick and easy-access identification of cryptococcus neoformans in a 77-year male (right-handed, 12 years of education). A semi-structured interview explored a variety of risk, favorable and influential factors. Neuropsychological battery included MMSE-2, Digit-Span, STROOP, RAVLT, COWAT, and Clock-Drawing Test. Quantitative and qualitative (verbalizations, test execution procedures and attitude) results have been integrated for his neuropsychological characterization. Main impairment occurred in semantics (mental confusion), processing speed and self-regulatory executive functions. Together, these cognitive functions rely on integrity of cortico-subcortical circuits. His verbal episodic memory was null, but this absent condition might be at least partially attributed to history of alcohol abuse. Motor disturbance slightly affected visuospatial praxia. Recommendations to identify rare neuroinfection through a neuropsychological approach include, beyond quantitative test results of a discriminant neurocognitive battery, proper identification of: an episode-related pattern of symptom evolution; a neurocognitive profile which resembles symptom evolution; and qualitative measures of transitory impairment. Thus, the proposed neuropsychological assessment approach is expected to fasten neuroinfection diagnosis and burn letal possibilities, in simplified, yet fidedign and specialized, clinical contexts.
    },
     year = {2024}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Identifying Cryptococcus Neoformans Neuroinfection Through Neuropsychological Examination
    AU  - Nayara Mota
    Y1  - 2024/01/18
    PY  - 2024
    N1  - https://doi.org/10.11648/j.cnn.20240801.13
    DO  - 10.11648/j.cnn.20240801.13
    T2  - Clinical Neurology and Neuroscience
    JF  - Clinical Neurology and Neuroscience
    JO  - Clinical Neurology and Neuroscience
    SP  - 12
    EP  - 18
    PB  - Science Publishing Group
    SN  - 2578-8930
    UR  - https://doi.org/10.11648/j.cnn.20240801.13
    AB  - Cryptococcus neoformans is a highly letal and hard-to-be-identified fungal disorder, being its neurocognitive impairment practically non-documented in literature. In this experience-based report, integrated analysis of symptomatology, history of life and neurocognitive assessment regarding a clinical case, provided a quick and easy-access identification of cryptococcus neoformans in a 77-year male (right-handed, 12 years of education). A semi-structured interview explored a variety of risk, favorable and influential factors. Neuropsychological battery included MMSE-2, Digit-Span, STROOP, RAVLT, COWAT, and Clock-Drawing Test. Quantitative and qualitative (verbalizations, test execution procedures and attitude) results have been integrated for his neuropsychological characterization. Main impairment occurred in semantics (mental confusion), processing speed and self-regulatory executive functions. Together, these cognitive functions rely on integrity of cortico-subcortical circuits. His verbal episodic memory was null, but this absent condition might be at least partially attributed to history of alcohol abuse. Motor disturbance slightly affected visuospatial praxia. Recommendations to identify rare neuroinfection through a neuropsychological approach include, beyond quantitative test results of a discriminant neurocognitive battery, proper identification of: an episode-related pattern of symptom evolution; a neurocognitive profile which resembles symptom evolution; and qualitative measures of transitory impairment. Thus, the proposed neuropsychological assessment approach is expected to fasten neuroinfection diagnosis and burn letal possibilities, in simplified, yet fidedign and specialized, clinical contexts.
    
    VL  - 8
    IS  - 1
    ER  - 

    Copy | Download

Author Information
  • Independent Researcher, Salvador, Brazil

  • Sections