Diagnostic Dilemma of <i>Aspergillus</i> Meningitis in Patients With Hepatitis C Virus Co-Infection: A Case Series
Bibliographic record
Abstract
Aspergillus meningitis can occur in immunocompromised and immunocompetent patients. The diagnostic yield is only 39% in immunocompromised patients and 69% in immunocompetent patients. Diagnosis can be challenging, as repeated cerebrospinal fluid (CSF) cultures can be negative. Even with multiple cultures, the diagnostic yield is meager, sometimes requiring a tissue diagnosis. However, prompt recognition and treatment initiation are crucial to minimize morbidity. We present two cases of patients with a history of intravenous drug use disorder (IVDU) co-infected with hepatitis C virus (HCV) and Aspergillus . Two young Caucasian patients with untreated HCV infection and a history of IVDU, presented with fevers and headaches. Their imaging and multiple CSF samples showing pleocytosis with negative fungal cultures led to a diagnostic dilemma. Due to progressive decline and to ascertain a definitive diagnosis, a brain biopsy resulted in a tissue diagnosis of fungal meningitis secondary to Aspergillus , with hyphae and granulomas, in both individuals. In the workup of chronic meningitis, Aspergillus infection should be strongly considered in patients with IVDU and HCV co-infection. In patients with chronic meningitis lacking definitive diagnosis from spinal fluid, tissue sampling should be pursued as soon as possible to ensure rapid treatment and prevent disability. HCV is associated with a reduction in cellular immunity; our two cases support that HCV and a history of IVDU carry risks of immunosuppression, warranting early and expedited workup for chronic fungal meningitis. J Neurol Res. 2022;12(1):25-29 doi: https://doi.org/10.14740/jnr706
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| 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".