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Mixed infection by Cryptococcus neoformans and Cryptococcus gattii and coinfection with paracoccidioidomycosis in

Marcela de Faria Ferreira1, Fabio Brito-Santos2, Pedro Henrique Nascimento Theodoro1

  • 1National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-900, Brazil.

Medical Mycology Case Reports
|March 8, 2022
PubMed

Insights

This study details a rare mixed Cryptococcus neoformans and Cryptococcus gattii infection in an HIV patient, complicated by false-negative CSF tests and paracoccidioidomycosis. Effective treatment with amphotericin B and TMP-SMX led to recovery.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Immunology

Background:

  • Cryptococcus neoformans and Cryptococcus gattii are leading causes of fungal meningitis in immunocompromised individuals, particularly those with HIV.
  • Co-infections with other opportunistic pathogens can complicate diagnosis and management.

Observation:

  • A patient with HIV presented with respiratory and skin symptoms, initially confounding diagnosis.
  • Cerebrospinal fluid (CSF) tests, including latex agglutination assay (CrAg LFA) and Indian ink staining, were falsely negative for Cryptococcus.
  • Mixed infection with Cryptococcus gattii in sputum and Cryptococcus neoformans in CSF was diagnosed, alongside paracoccidioidomycosis (PCM).

Findings:

  • The study highlights a rare co-infection of Cryptococcus neoformans and Cryptococcus gattii in an HIV-positive individual.
  • False-negative CrAg LFA in CSF posed a diagnostic challenge.
  • Diagnosis was confirmed by fungal isolation from sputum and CSF, and serological testing for PCM.

Implications:

  • This case underscores the importance of considering mixed fungal infections in immunocompromised patients, even with initially negative diagnostic tests.
  • Prompt and appropriate treatment, including antifungal therapy and antiretroviral therapy, is crucial for patient recovery and immune reconstitution.
  • Highlights the need for awareness of diagnostic limitations and potential co-infections in endemic areas.
Keywords:
Cryptococcal antigen (CrAg)CryptococcosisHIVLateral Flow Assay (LFA)Paracoccidioidomycosis

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