A Deadly Fungus: Case of an Unidentified Severe Cryptococcal Meningoencephalitis
Bibliographic record
Abstract
A 45-year-old man with no systemic illnesses was found by his neighbor lying unconscious and with recurrent involuntary movements, reason for which he was endotracheally intubated and brought to our institution. Upon evaluation, we found an acutely ill-looking man, with decreased level of consciousness (Glasgow coma scale 11) off sedation, on mechanical ventilator support with adequate oxygenation. Physical exam was remarkable for fever, scalp lacerations with old sutures, generalized rigidity and diaphoresis, with clear lungs and no abnormal heart sounds. Laboratory results showed no leukocytosis or leukopenia, but normocytic normochromic anemia; there were no electrolyte disturbances and negative toxicology screen. Head CT without intravenous contrast showed no findings suggesting bleeding, ischemia or space occupying lesions but reported parenchymal disease, and old skull and maxillofacial fractures. Patient’s neighbor referred that he was hospitalized 2 weeks ago at another institution with seizures that apparently caused him a 12-feet fall at work. Re-evaluation showed a positive Kernig and Brudzinski signs. Lumbar puncture was performed. The opening pressure was markedly elevated (> 30 cm H 2 O) and cerebrospinal fluid (CSF) analysis was consistent with fungal infection. He was promptly started in empiric antifungal therapy with amphotericin and flucytosine while waiting for CSF culture results. Meanwhile, serial lumbar punctures were performed to decrease intracranial pressure. HIV tests were sent and resulted positive. CSF culture showed Cryptococcus neoformans , and CSF cryptococcal antigen titer was positive in 1:32 dilutions. Diagnosis of severe cryptococcal meningoencephalitis was confirmed. Cryptococcus neoformans is one of the leading opportunistic infections seen in untreated patients with HIV and is uniformly fatal within approximately 2 weeks if untreated. Our patient’s prognosis was poor since admission; however, we just cannot stop thinking that maybe his prognosis could have been different if meningitis was even suspected and confirmed during patient’s previous hospitalization for seizures 2 weeks ago. J Med Cases. 2015;6(9):406-408 doi: http://dx.doi.org/10.14740/jmc2194w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".