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Cryptococcus gattii meningoencephalitis in an immunocompetent person 13 months after exposure

A Georgi1, M Schneemann, K Tintelnot

  • 1Department of Medicine, University Hospital Zurich, Zurich, Switzerland.

Infection
|April 25, 2009
PubMed

Insights

A rare case of severe meningoencephalitis caused by Cryptococcus gattii infection in an immunocompetent individual is presented. This infection developed 13 months after exposure, highlighting the potential for delayed onset and severe neurological complications.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Neurology

Background:

  • Cryptococcus gattii is an emerging fungal pathogen causing meningoencephalitis, particularly in immunocompetent individuals.
  • Vancouver Island, Canada, is an endemic region for Cryptococcus gattii.
  • Delayed onset of cryptococcal meningoencephalitis can occur even in immunocompetent hosts.

Observation:

  • A 53-year-old immunocompetent female developed severe meningoencephalitis 13 months after exposure on Vancouver Island.
  • Diagnosis was confirmed by cerebrospinal fluid (CSF) India-ink staining, latex agglutination, and culture.
  • Species identification of Cryptococcus gattii was achieved through phenotypic and molecular methods.

Findings:

  • Initial fluconazole therapy was ineffective, necessitating a switch to amphotericin B and flucytosine.
  • Subsequent treatment involved high-dose fluconazole and amphotericin B.
  • Despite prolonged hospitalization (132 days) and CSF drainage, the patient showed only slow clinical improvement.

Implications:

  • This case underscores the importance of considering Cryptococcus gattii in unexplained meningoencephalitis, even with delayed presentation.
  • Aggressive and combination antifungal therapy, alongside supportive care, is crucial for managing severe cases.
  • Further research is needed to understand the pathogenesis and optimize treatment strategies for Cryptococcus gattii meningoencephalitis.

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