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First report of Cryptococcus laurentii meningitis and a fatal case of Cryptococcus albidus cryptococcaemia in AIDS
T Kordossis1, A Avlami, A Velegraki
1Department of Pathophysiology (AIDS Unit), Medical School, Athens, Greece.
Abstract:
We report the first case of Cryptococcus laurentii meningitis and a rare case of Cryptococcus albidus cryptococcaemia in AIDS patients. Both infections were treated with amphotericin B and flucytosine. The C. laurentii meningitis was controlled after 2 weeks of treatment with no evidence of infection 20 months later. The patient with C. albidus cryptococcaemia, despite the amphotericin B/flucytosine combination therapy, died on the 14th day of treatment. The minimum inhibitory concentrations (MICs) for C. laurentii, as determined by Etest on RPMI 1640 agar, were 0.25 microg ml(-1) of amphotericin B, 1.25 microg ml(-1) flucytosine, 4 microg ml(-1) fluconazole, 0.50 microg ml(-1) itraconazole and 1.0 microg ml(-1) of ketoconazole. The MIC of amphotericin B for C. albidus was 0.5 microg ml(-1), flucytosine 1.25 microg ml(-1), fluzonazole 4 microg ml(-1), itraconazole 0.5 microg ml(-1) and ketonazole 0.25 microg ml(-1). The agreement of the amphotericin B MIC values obtained in antibiotic medium 3 by the broth microdilution method, with those obtained on casitone medium by Etest, was within a two-dilution range for both isolates. C. laurentii may cause meningitis and may also involve the lungs in AIDS patients.
Insights
This study details rare fungal infections in AIDS patients, including Cryptococcus laurentii meningitis and Cryptococcus albidus fungemia. While C. laurentii meningitis responded to treatment, C. albidus fungemia was fatal, highlighting varied responses to antifungal therapy.
Area of Science:
- Mycology
- Infectious Diseases
- Immunocompromised Hosts
Background:
- Cryptococcosis is a significant opportunistic infection in individuals with Acquired Immunodeficiency Syndrome (AIDS).
- Non-albicans Cryptococcus species are increasingly recognized as pathogens in immunocompromised populations.
- Limited data exists on the clinical presentation and antifungal susceptibility of Cryptococcus laurentii and Cryptococcus albidus in AIDS patients.
Observation:
- The first reported case of Cryptococcus laurentii meningitis in an AIDS patient is presented.
- A rare case of Cryptococcus albidus fungemia (cryptococcaemia) in an AIDS patient is described.
- Both fungal isolates were tested for in vitro susceptibility to key antifungal agents.
Findings:
- Cryptococcus laurentii meningitis was successfully treated with amphotericin B and flucytosine, with no recurrence observed for 20 months.
- Cryptococcus albidus fungemia, despite combination therapy with amphotericin B and flucytosine, resulted in patient mortality.
- Minimum inhibitory concentrations (MICs) revealed varying susceptibility patterns for both C. laurentii and C. albidus against amphotericin B, flucytosine, fluconazole, itraconazole, and ketoconazole.
Implications:
- Cryptococcus laurentii should be considered a potential cause of meningitis and pulmonary infections in AIDS patients.
- The study underscores the importance of accurate species identification and antifungal susceptibility testing in managing cryptococcosis in immunocompromised individuals.
- Treatment outcomes for cryptococcosis can vary significantly depending on the Cryptococcus species and the patient's immune status.