Central Nervous System Cryptococcosis in Non-Immunosuppressed Patient
Bibliographic record
Abstract
Cryptococcus is a fungus related to bird droppings (especially pigeons). It is described as an opportunistic pathogen. The leading defense against this fungus is the T-cell immunity, reason why it is related to immunocompromised patients (human immunodeficiency virus (HIV), organ transplant patients among others). The annual incidence is 0.4 - 1.3 per 100,000. The central nervous system (CNS) involvement is the most common manifestation in an immunocompromised patient; conversely it is a very uncommon manifestation in non-immunocompromised patients. A 32-year-old Hispanic male patient with no medical history, heterosexual and no toxics habits visited our institution, after visiting three emergency rooms for 1 week, complaining of general malaise, constant non-throbbing holocephalic headache 4/10 and low-grade fever of 12 days of evolution. Labs were unremarkable and vital signs showed fever of 38.6 °C. Physical exam was remarkable for neck stiffness. Patient was admitted with suspected meningitis. HIV test was negative and lumbar puncture showed increased opening pressure and India ink stain was positive. Patient was managed successfully with fluconazole. CNS cryptococcosis in non-immunosuppressed patients is extremely unusual. Diagnosis could be delayed because of low suspicious index in healthy population. Most experts recommend amphotericin B combined with flucytosine. Our patient was managed successfully with fluconazole IV followed with oral fluconazole. Patients from countries where flucytosine is unavailable and cannot tolerate amphotericin B can benefit from fluconazole. J Med Cases. 2017;8(9):274-276 doi: https://doi.org/10.14740/jmc2886w
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".