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Abstract

Introduction:

Cryptococcal meningitis (CM) may be caused by several species of

Case presentation:

We describe a fatal case of CM in a HIV-positive patient from Ivory Coast infected by VNI and . Isolates were recovered from cerebrospinal fluid (CSF) prior to systemic antifungal treatment. Six isolates were studied (the entire culture plus five isolated colonies from it). Serotyping was performed via LAC 1 and CAP 64 gene amplification. Genotyping was performed using restriction fragment length polymorphism (RFLP) analysis of the URA5 gene, (GACA), (GTG)and M13 PCR fingerprinting. URA5-RFLP analysis identified the original culture with two different molecular type combinations. However, URA5-RFLP profiles of the five colonies isolated from the original sample revealed two different species. Four colonies were identified as and the last isolate as VNI. The susceptibility profile was determined using the standard method according to the CLSI M27-A3 protocol. The isolates were susceptible to the tested antifungals (fluconazole, flucytosine and amphotericin B). Treatment with fluconazole (1200  mg day) was initiated; however, the patient died 17 days after the onset of antifungal therapy.

Conclusion:

This is the first reported case of mixed infection with and in a HIV-positive patient.

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2016-07-11
2020-01-17
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References

  1. Aminnejad M., Diaz M., Arabatzis M., Castañeda E., Lazera M., Velegraki A., Marriott D., Sorrell T. C., Meyer W.. 2012; Identification of novel hybrids between Cryptococcus neoformans var. grubii VNI and Cryptococcus gattii VGII. Mycopathologia173:337–346 [CrossRef][PubMed]
    [Google Scholar]
  2. Aoussi E. F., Ehui E., Dembélé J. P., Kolia-Diafouka P., Elloh N. F., Ouattara S. I., Tanon K. A., Doumbia A., Adou-Bryn K. D.. 2012; Cryptoccocal meningitis and HIV in the era of HAART in Côte d'Ivoire. Med Mal Infect42:349–354 [CrossRef][PubMed]
    [Google Scholar]
  3. Barchiesi F., Hollis R. J., Messer S. A., Scalise G., Rinaldi M. G., Pfaller M. A.. 1995; Electrophoretic karyotype and in vitro antifungal susceptibility of Cryptococcus neoformans isolates from AIDS patients. Diagn Microbiol Infect Dis23:99–103 [CrossRef][PubMed]
    [Google Scholar]
  4. Bertout S., Drakulovski P., Kouanfack C., Krasteva D., Ngouana T., Dunyach-Rémy C., Dongtsa J., Aghokeng A., Delaporte E., other authors. 2013; Genotyping and antifungal susceptibility testing of Cryptococcus neoformans isolates from Cameroonian HIV-positive adult patients. Clin Microbiol Infect19:763–769 [CrossRef][PubMed]
    [Google Scholar]
  5. Bovers M., Hagen F., Kuramae E. E., Diaz M. R., Spanjaard L., Dromer F., Hoogveld H. L., Boekhout T.. 2006; Unique hybrids between the fungal pathogens Cryptococcus neoformans and Cryptococcus gattii . FEMS Yeast Res6:599–607 [CrossRef][PubMed]
    [Google Scholar]
  6. Bovers M., Hagen F., Kuramae E. E., Hoogveld H. L., Dromer F., St-Germain G., Boekhout T.. 2008; AIDS patient death caused bynovel Cryptococcus neoformans × C. gattii hybrid. Emerg Infect Dis14:1105–1108 [CrossRef][PubMed]
    [Google Scholar]
  7. Chau T. T., Mai N. H., Phu N. H., Nghia H. D., Chuong L. V., Sinh D. X., Duong V. A., Diep P. T., Campbell J. I.. 2010; A prospective descriptive study of cryptococcal meningitis in HIV uninfected patients in Vietnam high prevalence of Cryptococcus neoformans var grubii in the absence of underlying disease. BMC Infect Dis10:199 [CrossRef][PubMed]
    [Google Scholar]
  8. Chong H. S., Dagg R., Malik R., Chen S., Carter D.. 2010; In vitro susceptibility of the yeast pathogen Cryptococcus to fluconazole and other azoles varies with molecular genotype. J Clin Microbiol48:4115–4120 [CrossRef][PubMed]
    [Google Scholar]
  9. Chowdhary A., Randhawa H. S., Sundar G., Kathuria S., Prakash A., Khan Z., Sun S., Xu J.. 2011; In vitro antifungal susceptibility profiles and genotypes of 308 clinical and environmental isolates of Cryptococcus neoformans var. grubii and Cryptococcus gattii serotype B from north-western India. J Med Microbiol60: 961– 967 [CrossRef][PubMed]
    [Google Scholar]
  10. Clinical and Laboratory Standards Institute 2008; Reference Methods for Broth Dilution Antifungal Susceptibility Testing of Filamentous Fungi, Approved Standard, 2nd edn. Wayne, PA: Clinical Laboratory Standards Institute;
    [Google Scholar]
  11. Connolly J. H., Krockenberger M. B., Malik R., Canfield P. J., Wigney D. I., Muir D. B.. 1999; Asymptomatic carriage of Cryptococcus neoformans in the nasal cavity of the koala (Phascolarctos cinereus). Med Mycol37:331–338 [CrossRef][PubMed]
    [Google Scholar]
  12. Cookman L., Hugi M.. 2013; Meningitis secondary to Cryptococcus gattii, an emerging pathogen affecting immunocompetent hosts. World J Emerg Med4:151–153 [CrossRef][PubMed]
    [Google Scholar]
  13. Desnos-Ollivier M., Patel S., Spaulding A. R., Charlier C., Garcia-Hermoso D., Nielsen K., Dromer F.. 2010; Mixed infections and in vivo evolution in the human fungal pathogen Cryptococcus neoformans . MBio1:e00091-10 [CrossRef][PubMed]
    [Google Scholar]
  14. Espinel-Ingroff A., Aller A. I., Canton E., Castanon-Olivares L. R., Chowdhary A., Cordoba S., Cuenca-Estrella M., Fothergill A., Fuller J.. 2012a; Cryptococcus neoformans-Cryptococcus gattii species complex: an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for fluconazole, itraconazole, posaconazole, and voriconazole. Antimicrob Agents Chemother56:5898–5906 [CrossRef]
    [Google Scholar]
  15. Espinel-Ingroff A., Chowdhary A., Cuenca-Estrella M., Fothergill A., Fuller J., Hagen F., Govender N., Guarro J, Johnson E.. 2012b; Cryptococcus neoformans-cryptococcus gattii species complex: an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for amphotericin B and flucytosine. Antimicrob Agents Chemother56:3107–3113 [CrossRef]
    [Google Scholar]
  16. Favalessa O. C., Lazera M. S., Wanke B., Vieira A. C., Trilles L., Takahara D. T., Tadano T., Dias L. B., Vieira A. C., Novack G. V.. 2014; Fatal Cryptococcus gattii genotype AFLP6/VGII infection in a HIV-negative patient: case report and a literature review. Mycoses 57:639––643.[CrossRef]
    [Google Scholar]
  17. Hagen F., Khayhan K., Theelen B., Kolecka A., Polacheck I., Sionov E., Falk R., Parnmen S., Lumbsch H. T.. 2015; Recognition of seven species in the Cryptococcus gattii/Cryptococcus neoformans species complex. Fungal Genet Biol78:16–48 [CrossRef][PubMed]
    [Google Scholar]
  18. Haynes K. A., Sullivan D. J., Coleman D. C., Clarke J. C., Emilianus R., Atkinson C., Cann K. J.. 1995; Involvement of multiple Cryptococcus neoformans strains in a single episode of cryptococcosis and reinfection with novel strains in recurrent infection demonstrated by random amplification of polymorphic DNA and DNA fingerprinting. J Clin Microbiol33:99–102[PubMed]
    [Google Scholar]
  19. Igreja R. P., Mdos S. L., Wanke B., Galhardo M. C., Kidd S. E., Meyer W.. 2004; Molecular epidemiology of Cryptococcus neoformans isolates from AIDS patients of the brazilian city, Rio de Janeiro. Med Mycol42:229–238 [CrossRef][PubMed]
    [Google Scholar]
  20. Illnait-Zaragozí M. T., Martínez-Machín G. F., Fernández-Andreu C. M., Hagen F., Boekhout T., Klaassen C. H., Meis J. F.. 2010; Microsatellite typing and susceptibilities of serial Cryptococcus neoformans isolates from Cuban patients with recurrent cryptococcal meningitis. BMC Infect Dis10:289 [CrossRef][PubMed]
    [Google Scholar]
  21. Klein K. R., Hall L., Deml S. M., Rysavy J. M., Wohlfiel S. L., Wengenack N. L.. 2009; Identification of Cryptococcus gattii by use of L-canavanine glycine bromothymol blue medium and DNA sequencing. J Clin Microbiol47:3669–3672 [CrossRef][PubMed]
    [Google Scholar]
  22. Lazera M. S., Salmito Cavalcanti M. A., Londero A. T., Trilles L., Nishikawa M. M., Wanke B.. 2000; Possible primary ecological niche of Cryptococcus neoformans . Med Mycol38:379–383 [CrossRef][PubMed]
    [Google Scholar]
  23. Mlinaric-Missoni E., Hagen F., Chew W. H., Vazic-Babic V., Boekhout T., Begovac J.. 2011; In vitro antifungal susceptibilities and molecular typing of sequentially isolated clinical Cryptococcus neoformans strains from Croatia. J Med Microbiol60:1487–1495 [CrossRef][PubMed]
    [Google Scholar]
  24. Pfaller M. A., Messer S. A., Boyken L., Rice C., Tendolkar S., Hollis R. J., Doern G. V., Diekema D. J.. 2005; Global trends in the antifungal susceptibility of Cryptococcus neoformans (1990–2004). J Clin Microbiol43:2163–2167 [CrossRef][PubMed]
    [Google Scholar]
  25. Staib F., Seibold M., Antweiler E., Fröhlich B., Weber S., Blisse A.. 1987; The brown colour effect (BCE) of Cryptococcus neoformans in the diagnosis, control and epidemiology of C. neoformans infections in AIDS patients. Zentralbl Bakteriol Mikrobiol Hyg A266:167–177 [CrossRef][PubMed]
    [Google Scholar]
  26. Steele K. T., Thakur R., Nthobatsang R., Steenhoff A. P., Bisson G. P.. 2010; In-hospital mortality of HIV-infected cryptococcal meningitis patients with C. Gattii and C. neoformans infection in Gaborone, Botswana. Med Mycol48:1112–1115 [CrossRef][PubMed]
    [Google Scholar]
  27. Trilles L., Meyer W., Wanke B., Guarro J., Lazéra M.. 2012; Correlation of antifungal susceptibility and molecular type within the Cryptococcus neoformans/C. gattii species complex. Med Mycol50:328–332 [CrossRef][PubMed]
    [Google Scholar]
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