Cryptococcus gattii meningoencephalitis in an immunocompetent person 13 months after exposure

Infection. 2009 Aug;37(4):370-3. doi: 10.1007/s15010-008-8211-z. Epub 2009 Apr 23.

Abstract

A 53-year old immunocompetent Swiss female is described who developed severe meningoencephalitis due to infection with Cryptococcus gattii 13 months following exposure on Vancouver Island, Canada. Diagnosis was based on cerebrospinal fluid (CSF) examination, i.e., positive India-ink staining, positive latex particle agglutination, and positive culture. Species identification was performed by growth on L-canavanine-glycine-bromthymol blue medium and by sequencing of the intergenic and internal transcribed spacer regions of the rRNA genes. After initial therapy with fluconazole by which the patient did not improve, therapy was changed to amphotericin B and flucytosine and later to high-dose fluconazole and amphotericin B. Despite long-term treatment and external drainage of the CSF, the patient's condition improved only slowly. The patient was discharged after 132 days of hospitalization.

Publication types

  • Case Reports

MeSH terms

  • Amphotericin B / therapeutic use
  • Antifungal Agents / therapeutic use
  • Cerebrospinal Fluid / microbiology
  • Cryptococcosis / diagnosis*
  • Cryptococcosis / drug therapy
  • Cryptococcosis / microbiology
  • Cryptococcosis / surgery
  • Cryptococcus / genetics
  • Cryptococcus / isolation & purification*
  • Culture Media / chemistry
  • DNA, Fungal / chemistry
  • DNA, Fungal / genetics
  • DNA, Ribosomal Spacer / chemistry
  • DNA, Ribosomal Spacer / genetics
  • Drainage
  • Female
  • Fluconazole / therapeutic use
  • Flucytosine / therapeutic use
  • Humans
  • Meningoencephalitis / drug therapy
  • Meningoencephalitis / microbiology*
  • Meningoencephalitis / surgery
  • Middle Aged
  • Molecular Sequence Data
  • Phylogeny
  • Sequence Analysis, DNA
  • Switzerland
  • Travel

Substances

  • Antifungal Agents
  • Culture Media
  • DNA, Fungal
  • DNA, Ribosomal Spacer
  • Amphotericin B
  • Fluconazole
  • Flucytosine

Associated data

  • GENBANK/GQ398006
  • GENBANK/GQ398007