The Brief Case – Cryptococcus gattii Meningitis with Ventriculitis

June 24, 2016 at 1:57 pm

Journal of Clinical Microbiology July 2016 V.54 N.7 P.1676-1678

Lars F. Westblade and Eileen M. Burd

aDepartment of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA

bDepartment of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA

cEmory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, Georgia, USA

A 39-year-old previously healthy man was transferred to Emory University Hospital Midtown, Atlanta, GA, USA, from Savannah, GA, USA, with a 1-month history of progressive headaches, drowsiness, blurred vision, and photosensitivity. Magnetic resonance imaging (MRI) revealed a noncommunicating obstructive hydrocephalus at the level of the third ventricle. Endoscopic ventriculostomy was attempted but could not be completed because of marked adhesions, scar tissue, and nodularity throughout the ependymal surfaces of the lateral ventricles. An external ventricular drainage catheter was placed, and a cerebrospinal fluid (CSF) sample was obtained. The CSF was bloody, with a normal glucose level of 40 mg/dl (normal range, 40 to 70 mg/dl), a corresponding serum glucose level of 100 mg/dl (normal range, 65 to 110 mg/dl), and an elevated CSF protein level of 148 mg/dl (normal range, 15 to 45 mg/dl). The CSF white blood cell count was elevated at 25 cells/μl (normal range, 0 to 5 cells/μl) with predominantly polymorphonuclear neutrophils (PMNs) (67%). A CSF Gram stain showed few PMNs but no organisms. A CSF cryptococcal latex agglutination antigen test (Meridian Bioscience Inc., Cincinnati, OH, USA) was negative, but a serum cryptococcal antigen titer performed a few days later was 32. Blood cultures taken at that time showed no growth, but bacterial and fungal cultures of the CSF grew a few cream-colored, mucoid colonies in 3 days (Fig. 1A). Direct microscopic examination of the colonies revealed round yeast cells that tested germ tube negative (Fig. 1B). The organism was able to hydrolyze urea, and a caffeic acid disk test was positive for melanin production, consistent with Cryptococcus neoformans, but upon growth, a blue coloration was produced on L-canavanine–glycine–bromothymol blue (CGB) agar (Centers for Disease Control and Prevention [CDC], Atlanta, GA, USA), distinguishing the isolate as Cryptococcus gattii (Fig. 1C). The identification was confirmed as C. gattii biotype VGI at the CDC by multilocus sequence typing, with 100% identity to the reference isolate across 4,141 nucleotides

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http://jcm.asm.org/content/54/7/1676.full.pdf+html

 

Journal of Clinical Microbiology July 2016 V.54 N.7 P.1934

Closing the Brief Case: Cryptococcus gattii Meningitis with Ventriculitis

Lars F. Westblade and Eileen M. Burd

aDepartment of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA

bDepartment of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA

cEmory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, Georgia, USA

ANSWERS TO SELF-ASSESSMENT QUESTIONS

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http://jcm.asm.org/content/54/7/1934.full.pdf+html

Entry filed under: Antimicoticos, Biología Molecular, Epidemiología, F.O.D, Health Care-Associated Infections, Infecciones del SNC, Infecciones micoticas, Metodos diagnosticos, Sepsis, Update. Tags: .

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