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[Neurocryptococcosis caused by nonencapsulated Cryptococcus neoformans]

C S Lacaz1, E M Heins-Vaccari, N T Melo

  • 1Faculdade de Medicina da Universidade de São Paulo, Brasil.

Arquivos De Neuro-Psiquiatria
|September 1, 1993
PubMed
Summary

A rare case of meningoencephalitis caused by an unusual nonencapsulated Cryptococcus neoformans strain in an immunocompetent patient is presented. This finding highlights the importance of considering atypical fungal infections in diagnosing chronic central nervous system inflammation.

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Neuroscience

Background:

  • Meningoencephalitis is a serious central nervous system infection.
  • Cryptococcus neoformans typically causes disease in immunocompromised individuals.
  • Nonencapsulated strains of C. neoformans are rarely reported.

Observation:

  • A patient with chronic meningoencephalitis, initially misdiagnosed as tuberculosis, presented with no identifiable risk factors for opportunistic infections.
  • Cerebrospinal fluid (CSF) analysis revealed yeasts within macrophages, and culture identified a nonencapsulated strain of Cryptococcus neoformans.
  • In vivo studies in mice demonstrated transient capsule formation in the yeast, which was lost in subsequent cultures.

Findings:

  • Biochemical identification confirmed a nonencapsulated Cryptococcus neoformans strain.

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  • Electronic microscopy provided insights into the yeast's morphology.
  • The patient showed a favorable response to treatment with amphotericin B and 5-fluorocytosine.

    • Implications:

    • This case underscores the potential for nonencapsulated Cryptococcus neoformans to cause severe meningoencephalitis in immunocompetent hosts.
    • The dynamic nature of capsule expression in this strain warrants further investigation.
    • Diagnostic and therapeutic strategies for fungal meningoencephalitis may need to consider atypical presentations and strains.