Version 1: Fatal disseminated Cryptococcosis with diverse risk factors: A Case series from a tertiary care hospital in eastern India

Background: Cryptococcos noeformans is a ubiquitous fungal infection that can cause life threatening meningitis and fungemia in both immunocompromised and immunocompetent host. Disseminated cryptococcosis is often a retrospective diagnosis when blood cultures are found positive for Cryptococcus species.

Case presentation: We report two cases of Disseminated cryptococcosis with different risk factors emphasizing on early clinical suspicion, diagnosis and treatment. First case was of non- alcoholic steatohepatitis patient who presented with complain of abdominal swelling and hemiparesis. Other case was of retro positive male presenting with complains of headache and fever. These patients underwent empirical antibacterial and anti-tubercular therapy which was ineffective. Finally, diagnosis was made on the basis of India ink stain, Gram stain and fungal culture which were confirmed by polymerase chain reaction and gene sequencing of both the isolates. But the patients could not be saved due to delay in diagnosis.

Conclusion: Disseminated cryptococcosis is an advanced potentially fatal disease. Cryptococcosis should be suspected not only in cases of HIV or transplant patients but also in cases of chronic liver diseases.  An early clinical suspicion would help recognize these cases sooner. The microbiologist should always have a keen eye and an equally high index of suspicion especially in the presence of capsulated round yeast cells in any sample of sick patients. Early diagnosis and treatment are imperative to prevent mortality.