Urinary tract and bloodstream infections caused by novel Cryptococcus neoformans:One case report and literature review
Objective This study analyzed and summarized the ways and clinical characteristics of urinary tract infection with blood stream infection caused by Cryptococcus neoformans and provided reference for clinical diagnosis and treatment of Cryptococciasis neoformans.Methods A case of Cryptococcus neoformans urinary tract infection combined with a bloodstream infection was retrospectively analyzed.Using"Cryptococcus neoformans"and"Cryptococcus neoformans infection"as keywords,respectively,the foreign PubMed database,Chinese Wanfang Data Knowledge Service Platform and China National Knowledge Infrastructure were searched from 1965 to 2023.By consulting the relevant literature above,the clues and methods of diagnosis and treatment of Cryptococcus neoformans infection diseases were summarized.Results There were no reported cases of Cryptococcus neoformans urinary tract infection in Chinese databases.A review of foreign literature investigated the situation of 16 patients with positive midstream urine cultures for Cryptococcus neoformans from 1992 to 2003.Among them,15 patients had underlying diseases such as HIV infection,diabetes,hypertension,or systemic lupus erythematosus;9 patients received antifungal treatment;and the remaining 7 patients were misdiagnosed or died before treatment,with a case fatality rate of 64%.13 cases had symptoms of disseminated infection with Cryptococcus neoformans,and the remaining 3 cases presented with a single urinary tract infection.Cryptococcus neoformans was detected in the urine culturesof 16 patients,and 2 of them(13%)had positive urine tests for yeast.12 cases were positive for proteinuria(75%),and 5 cases were positive for pyuria(31%).Among the cases reported,the patient showed that yeast was positive in the urine routine test on the day of admission,and Cryptococcus neoformans was detected in midstream urine culture and blood culture.The patient was given anti-infection treatment with fluconazole,et al,and finally died of septic shock and multiple organ failure.Conclusion Urinary tract infections caused by Cryptococcus neoformans are extremely rare,and urinary tract trauma might be the main risk factor.The detection of Cryptococcus neoformans in urine was considered to be one of the early indicators of disseminated cryptococcosis.Clinically,we should improve our understanding of urinary tract infections caused by this strain,monitor them as early as possible,and carry out targeted treatment in time to improve the prognosis and survival rate.