Abstract
A 53-year old immunocompetent Swiss female is described who developed severe meningoencephalitis due to infection with Cryptococcus gattii 13 months following exposure on Vancouver Island, Canada. Diagnosis was based on cerebrospinal fluid (CSF) examination, i.e., positive India-ink staining, positive latex particle agglutination, and positive culture. Species identification was performed by growth on L-canavanine–glycine–bromthymol blue medium and by sequencing of the intergenic and internal transcribed spacer regions of the rRNA genes. After initial therapy with fluconazole by which the patient did not improve, therapy was changed to amphotericin B and flucytosine and later to high-dose fluconazole and amphotericin B. Despite long-term treatment and external drainage of the CSF, the patient’s condition improved only slowly. The patient was discharged after 132 days of hospitalization.
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Kwon-Chung KJ, Varma A: Do major species concepts support one, two or more species within Cryptococcus neoformans? FEMS Yeast Res 2006; 6: 574–587.
Baro T, Torres-Rodriguez JM, De Mendoza MH, Morera Y, Alia C: First identification of autochthonous Cryptococcus neoformans var. gattii isolated from goats with predominantly severe pulmonary disease in Spain. J Clin Microbiol 1998; 36: 458–461.
Hoang LM, Maguire JA, Doyle P, Fyfe M, Roscoe DL: Cryptococcus neoformans infections at Vancouver Hospital and Health Sciences Centre (1997-2002): epidemiology, microbiology and histopathology. J Med Microbiol 2004; 53: 935–940.
Mitchell DH, Sorrell TC, Allworth AM, Heath CH, McGregor AR, Papanaoum K, Richards MJ, Gottlieb T: Cryptococcal disease of the CNS in immunocompetent hosts: influence of cryptococcal variety on clinical manifestations and outcome. Clin Infect Dis 1995; 20: 611–616.
Sugita T, Ikeda R, Shinoda T: Diversity among strains of Cryptococcus neoformans var. gattii as revealed by a sequence analysis of multiple genes and a chemotype analysis of capsular polysaccharide. Microbiol Immunol 2001; 45: 757–768.
Diaz MR, Boekhout T, Kiesling T, Fell JW: Comparative analysis of the intergenic spacer regions and population structure of the species complex of the pathogenic yeast Cryptococcus neoformans. FEMS Yeast Res 2005; 5: 1129–1140.
Lemmer K, Naumann D, Raddatz B, Tintelnot K: Molecular typing of Cryptococcus neoformans by PCR fingerprinting, in comparison with serotyping and Fourier transform infrared-spectroscopy-based phenotyping. Med Mycol 2004; 42: 135–147.
Katsu M, Kidd S, Ando A, Moretti-Branchini ML, Mikami Y, Nishimura K, Meyer W: The internal transcribed spacers and 5.8S rRNA gene show extensive diversity among isolates of the Cryptococcus neoformans species complex. FEMS Yeast Res 2004; 4: 377–388.
Bovers M, Hagen F, Kuramae EE, Boekhout T: Six monophyletic lineages identified within Cryptococcus neoformans and Cryptococcus gattii by multi-locus sequence typing. Fungal Genet Biol 2008; 45: 400–421.
Dromer F, Mathoulin S, Dupont B, Laporte A: Epidemiology of cryptococcosis in France: a 9-year survey (1985–1993). French Cryptococcosis Study Group. Clin Infect Dis 1996; 23: 82–90.
Kohl KH, Hof H, Schrettenbrunner A, Seeliger HP, Kwon-Chung KJ: Cryptococcus neoformans var. gattii in Europe. Lancet 1985; 1: 1515.
Tintelnot K, Lemmer K, Losert H, Schar G, Polak A: Follow-up of epidemiological data of cryptococcosis in Austria, Germany and Switzerland with special focus on the characterization of clinical isolates. Mycoses 2004; 47: 455–464.
Kidd SE, Hagen F, Tscharke RL, Huynh M, Bartlett KH, Fyfe M, Macdougall L, Boekhout T, Kwon-Chung KJ, Meyer W: A rare genotype of Cryptococcus gattii caused the cryptococcosis outbreak on Vancouver Island (British Columbia, Canada). Proc Natl Acad Sci USA 2004; 101: 17258–17263.
MacDougall L, Fyfe M: Emergence of Cryptococcus gattii in a novel environment provides clues to its incubation period. J Clin Microbiol 2006; 44: 1851–1852.
Lui G, Lee N, Ip M, Choi KW, Tso YK, Lam E, Chau S, Lai R, Cockram CS: Cryptococcosis in apparently immunocompetent patients. Q J Med 2006; 99: 143–151.
Brouwer AE, Rajanuwong A, Chierakul W, Griffin GE, Larsen RA, White NJ, Harrison TS: Combination antifungal therapies for HIV-associated cryptococcal meningitis: a randomised trial. Lancet 2004; 363: 1764–1767.
Saag MS, Graybill RJ, Larsen RA, Pappas PG, Perfect JR, Powderly WG, Sobel JD, Dismukes WE: Practice guidelines for the management of cryptococcal disease. Infectious Diseases Society of America. Clin Infect Dis 2000; 30: 710–718.
Bicanic T, Harrison TS: Cryptococcal meningitis. Br Med Bull 2004; 72: 99–118.
Fessler RD, Sobel J, Guyot L, Crane L, Vazquez J, Szuba MJ, Diaz FG: Management of elevated intracranial pressure in patients with Cryptococcal meningitis. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 17: 137–142.
Macsween KF, Bicanic T, Brouwer AE, Marsh H, Macallan DC, Harrison TS: Lumbar drainage for control of raised cerebrospinal fluid pressure in cryptococcal meningitis: case report and review. J Infect 2005; 51: 221–224.
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Georgi, A., Schneemann, M., Tintelnot, K. et al. Cryptococcus gattii Meningoencephalitis in an Immunocompetent Person 13 Months after Exposure. Infection 37, 370–373 (2009). https://doi.org/10.1007/s15010-008-8211-z
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DOI: https://doi.org/10.1007/s15010-008-8211-z