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Year : 2004  |  Volume : 22  |  Issue : 4  |  Page : 275
 

Chronic meningitis in an immunocompetent adult caused by Cryptococcus neoformans var gatti


Department of Microbiology, Jawaharlal Institute of Postgraduate, Medical Education and Research, Pondicherry - 605 006, India

Correspondence Address:
Department of Microbiology, Jawaharlal Institute of Postgraduate, Medical Education and Research, Pondicherry - 605 006, India



How to cite this article:
Khyriem A B, Sujatha S, Parija S C. Chronic meningitis in an immunocompetent adult caused by Cryptococcus neoformans var gatti. Indian J Med Microbiol 2004;22:275


How to cite this URL:
Khyriem A B, Sujatha S, Parija S C. Chronic meningitis in an immunocompetent adult caused by Cryptococcus neoformans var gatti. Indian J Med Microbiol [serial online] 2004 [cited 2019 Oct 15];22:275. Available from: http://www.ijmm.org/text.asp?2004/22/4/275/12827


Dear Editor,
Cryptococcus neoformans var gatti has emerged as a primary human pathogen typically affecting immunocompetent individuals. Here we report a case of chronic meningitis. A 26 year old male was admitted to our hospital in December 1999 with a history of bitemporal headache, low grade fever of 2 months duration with alteration of consciousness and seizures for one day. On examination, the patient was conscious, restless and uncooperative, with neck rigidity. Central nervous system examination revealed an ill sustained clonus of the right patella and ankle. Cranial nerve involvement was seen in the form of right lateral rectus palsy. Other systems were normal.
ELISA for HIV 1/2 antibodies was negative. Routine analysis of the cerebrospinal fluid sample showed a predominant lymphocyte count of 200/cmm, protein of 60 mg/dL and a glucose value of 50 mg/dL. A modified India ink stain of the specimen revealed capsulated budding yeast cells. On Sabouraud dextrose agar incubated at 25C and 37C, creamy mucoid colonies were seen after 48 hours of incubation. Brown colonies were produced on sunflower seed agar. Urease was positive and growth was observed on glycine bromothymol blue agar with a change of color to blue. The isolate was identified as C. neoformans var gatti. Resistance to amphotericin B and fluconazole by the macro broth dilution method showed MICs of 32 g/mL and 64 g/mL respectively. Cryptococcal polysaccharide antigen was detected in CSF, serum and urine of the patient by both latex agglutination (LAT) and Co-agglutination (CoA) tests with CSF titres of 512 (LAT) and 64 (CoA). Blood culture grew C. neoformans var gatti. The patient was treated with a combination of fluconazole (400mg/day) and amphotericin B (0.7mg/kg/day) prior to antifungal susceptibility testing, but left against medical advice after 10 days of admission.
The prevalence of C. neoformans var gatti is high in restricted locations in tropical and subtropical areas.[1] This organism has never been isolated from pigeons but an environmental niche has been identified. Exposure to trees that harbour this fungus like Eucalyptus calmodulensis and other species is necessary for infection to occur, which are common in late spring concomitant with the flowering of these trees. There are a few reports of C. neoformans var gatti in India from clinical as well as environmental sources.[2] C. neoformans var gatti infection presents in a more insidious form and has more neurological complications such as hydrocephalus and cranial nerve deficits. Our patient had sixth cranial nerve palsy though there was no hydrocephalus.
Resistance to fluconazole has been reported in literature[3] and though our isolate was found to be resistant to both amphotericin B and fluconazole in vitro, the in vivo response by the patient could not be ascertained as he left against medical advice and was lost to follow up. 

 ~ References Top

1.Sorrell TC. Cryptococus neoformans variety gatti. Med Mycol 2001;39:155-168.  Back to cited text no. 1    
2.Chakrabarti A, Jalana M, Kumar P, Chatha L, Kaushal A, Padhye AA. Isolation of Cryptococcus neoformans var gatti from Eucalyptus calmodulensis in India. J Clin Microbiol 1997; 35:3340-3342.  Back to cited text no. 2    
3.Aberg JA, Powderly WG. Cryptococcosis: Medline File//A:\Cryptococcosis L.htm 1998.  Back to cited text no. 3    
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2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

Online since April 2001, new site since 1st August '04