Co-infection of Central Nervous System by M. Tuberculosis, Cryptococcus and possibly Naegleria fowleri
K Ravinder1, B Uppal1, P Aggarwal1
1Department of Microbiology, Maulana Azad Medical College, New Delhi- 110002, India.
Abstract:
Co-infection due to Mycobacterium tuberculosis, Cryptococcus and Naegleria fowleri has not been reported till now in literature, to the best of our knowledge. Here we report a curious case of co-infection of the central nervous system due to these three pathogens in an apparently immune-competent, HIV negative boy. The 15 year old boy was a diagnosed case of tubercular meningitis and was on anti-tubercular and anti-epileptic treatment. However, two months later he presented again in the emergency department with sudden loss of consciousness. His CSF showed presence of capsulated budding yeast cells (suggestive of Cryptococcus) and flagellated parasites (resembling the flagellated stage of Naegleria fowleri). CSF was also positive for Cryptococcal antigens by Latex Agglutination test. The boy was HIV negative and apparently immuno-competent. He was subsequently put on amphotericin B therapy for six weeks. Repeat microscopy, done towards the end of amphotericin B course, showed clearing of CSF. However, the patient's condition improved only slightly, owing to neurological damage caused by the pathogens as suggested by brain CT and MRI scans. Thus infection caused by the members of three different kingdoms in an apparently immunocompetent boy highlights the importance of thinking beyond the ordinary causative pathogens, and actively searching for rarer etiologies to ensure timely intervention; especially in nonresponsive cases.
Insights
This case report details a rare central nervous system co-infection involving Mycobacterium tuberculosis, Cryptococcus, and Naegleria fowleri in an immunocompetent adolescent. The findings underscore the need to consider unusual pathogens in non-responsive meningitis cases.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Central nervous system (CNS) co-infections involving pathogens from different kingdoms are exceptionally rare.
- Mycobacterium tuberculosis, Cryptococcus, and Naegleria fowleri are distinct pathogens causing severe neurological conditions.
- Co-infection with these three specific agents has not been previously documented in medical literature.
Purpose of the Study:
- To report the first known case of CNS co-infection with Mycobacterium tuberculosis, Cryptococcus, and Naegleria fowleri.
- To highlight the diagnostic challenges and clinical implications of such a rare co-infection in an apparently immunocompetent individual.
- To emphasize the importance of considering rare etiologies in refractory CNS infections.
Main Methods:
- Case presentation of a 15-year-old male with diagnosed tubercular meningitis.
- Cerebrospinal fluid (CSF) analysis including microscopy for yeast and parasites, and Latex Agglutination test for Cryptococcal antigens.
- Brain CT and MRI scans to assess neurological damage.
- Treatment with anti-tubercular therapy, anti-epileptic drugs, and amphotericin B.
Main Results:
- The patient presented with altered consciousness, and CSF analysis revealed Mycobacterium tuberculosis (presumed from prior diagnosis), Cryptococcus (yeast cells, positive antigen test), and Naegleria fowleri (flagellated parasites).
- The patient was HIV-negative and appeared immunocompetent.
- Despite a six-week course of amphotericin B and CSF clearing, neurological improvement was limited due to pre-existing damage.
Conclusions:
- This case represents a unique CNS co-infection involving three pathogens from different kingdoms in an immunocompetent host.
- The findings stress the critical need for broad diagnostic consideration and investigation of rare pathogens, particularly in cases of CNS infections that do not respond to standard treatments.
- Early identification and intervention for unusual co-infections are crucial for improving patient outcomes, despite potential for irreversible neurological sequelae.
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