Cryptococcosis (Torulosis, European Blastomycosis) of the Knee Joint: A Case Report With Review of the Literature

A patient with monoarticular synovitis with an osteolytic lesion in the femoral condylar area due to Cryptococcus neoformans infection is presented. The role of exact diagnosis by synovial biopsy and fungal cultures in patients presenting with monoarticular synovitis is emphasized. The literature is reviewed. Drug therapy in conjunction with synovectomy is highly beneficial.     

A case of pulmonary cryptococcosis with non-small cell lung cancer in idiopathic CD4+ T-lymphocytopenia

Cryptococcus neoformans commonly causes opportunistic infections in immunocompromised patients, especially in patients with AIDS. CD4+ T-lymphocytopenia in AIDS indicates an increased risk of opportunistic infection and a decline in immunological function. Idiopathic CD4 T-lymphocytopenia (ICL) is characterized by depletions in the CD4+ T-cell subsets, without evidence of HIV infection. Immunodeficiency can exist in the absence of laboratory evidence of HIV infection, and T-cell subsets should be evaluated in patients who present with unusual opportunistic infections. We report a case of pulmonary cryptococcosis and lung cancer in a patient with persistently low CD4+ cell counts, without evidence of HIV infection.     

Isolation of Cryptococcus species including C. neoformans from cloaca of pigeons

Upper digestive tract of the pigeon (Columba livia) is well known as a reservoir for different species of Cryptococcus, but lower portions are not so frequently studied. In the present study, we tested on selective media a total of 331 pigeon cloacal swabs; Cryptococcus spp. were recovered from 26 (7.85%). Cryptococcus uniguttulatus was isolated from 11 samples (3.32%), C. laurentii from six (1.81%), C. neoformans var. neoformans from six (1.81%) and C. albidus from three of them (0.91%). The results show the importance of pigeon in the cryptococcosis epidemiology as reservoir and carrier for C. neoformans var. neoformans, but also for other Cryptococcus species of increasing clinical interest.     

Fine-needle aspiration diagnosis of primary cutaneous cryptococcosis in an immunocompetent patient: a case report

We report a case of a primary cutaneous cryptococcosis (PCC) in immunocompetent man diagnosed by fine-needle aspiration (FNA) and confirmed by special stains and culture study. The patient presented with a 2-wk history of two separate skin nodules over the forehead and the left lumbar region. FNA smears revealed a necrotizing suppurative granulomatous inflammation with numerous yeasts of Cryptococcus surrounded by clear halos, which were present within multinucleated giant cells and in the intercellular spaces. This was confirmed subsequently by special stains and a culture of the aspirated material. This case report reemphasizes the role of FNA as a useful modality in the early diagnosis of cutaneous cryptococcosis, especially in clinically unsuspected cases.     

Disseminated crytococcosis with extensive cutaneous involvement in AIDS

Cutaneous infections is observed in 15% of patients with disseminated cryptococcosis with AIDS. We present here a case of a 34 years old female with AIDS. She presented with multiple skin coloured umbilicated over face, neck, trunk and limbs, which mimicked molluscum contagiosum and kaposi sarcoma. The tissue from cutaneous lesions was collected by excision biopsy and processed by standard mycological methods. Cryptococcus neoformans was isolated and identified. Cerebrospinal fluid (CSF) also yielded the growth of C. neoformans . Cryptococcal antigen was detected with a titre of 1024 by Latex agglutination, is serum and CSF. Her serum was reactive for HIVI and 2 antibodies. The CD4 lymphocytes count was 80/cmm. The HIV viral load was 2,48,084 copies/mL. She was treated with amphotericin B injectable and oral fluconazole. She responded well and lesions regressed.     

特发性CD4+T淋巴细胞减少症伴播散性皮肤隐球菌病

患者女，23岁，左锁骨、腰部右侧及左膝部出现肿块并溃疡4个月，组织病理检查示组织中大量浆细胞及异物巨细胞；PAS染色显示大量散在或成团的孢子，经鉴定证实为新生隐球菌，连续T淋巴细胞亚群分析显示CD4^ T淋巴细胞明显减少，占总T淋巴细胞数20％以下．无人类免疫缺陷病毒(HIV)感染，诊断为特发件CD4^ T淋巴细胞减少症伴播散性皮肤隐球菌病．主要给予两性霉素B治疗，1个月后溃疡愈合．     

Pancytopenia and cutaneous cryptococcosis as an indicator disease of acquired immune deficiency syndrome

We present a case of pancytopenia and cutaneous cryptococcosis in a young girl with no complaints of fever, headache and vomiting. Fine-needle aspiration cytology and further investigation for pancytopenia revealed presence of Cryptococcus in skin and bone marrow aspirates. Fungal cultures of the skin aspirates, blood and bone marrow confirmed cryptococcal infection. Counselling and human immunodeficiency virus (HIV) test revealed the status of the patient to be retropositive. Although meningitis is the commonest manifestation of cryptococcosis among HIV-infected patients, rare cutaneous manifestation with pancytopenia but with no meningeal signs indicate the HIV status in an endemic area of penicilliosis, Manipur.     

儿童播散性隐球菌病8例临床特征和预后

目的 探讨儿童播散性隐球菌病的临床特征和预后。方法 回顾性分析2009年5月至2013年11月复旦大学附属儿科医院感染科收治的播散性隐球菌病患儿的临床资料,总结临床特征和预后。结果 8例播散性隐球菌病连续病例进入分析,男5例,女3例,平均年龄6.1岁。血清HIV抗体均阴性,流式细胞仪检测CD4细胞计数正常。2例起病前曾口服糖皮质激素,余6例否认免疫抑制剂服用史及基础疾病史。8例患儿家长均否认鸽子或其他禽类接触史。8例患儿起病均表现为持续发热,7例有明显的肝脾肿大,4例有黄疸,2例有咳嗽等呼吸道症状,2例服用糖皮质激素患儿有皮肤损害,8例均无头痛、呕吐或意识改变等神经系统症状。8例血清隐球菌抗原滴度均>1:640,6例血培养结果示新型隐球菌阳性,4例CSF隐球菌抗原升高,5例外周血嗜酸性粒细胞计数升高。8例血清IgE均升高,平均3 896.5 KuA·L-1。3例影像学检查提示累及胆道,肝内胆管扩张,胸部CT示7例累及肺部。8例起病至确诊2～7周,均接受全身性抗真菌治疗（两性霉素B联合5-氟胞嘧啶或氟康唑）,其中1例治疗后出现隐球菌相关性免疫重建炎症综合征,8例治疗反应良好。8例诱导治疗结束后外周血嗜酸性粒细胞计数和血清IgE水平均恢复正常,停药后随访3~6个月,均无复发。结论 播散性隐球菌病可发生于无HIV感染的儿童,可累及多系统脏器,以单核-巨噬细胞系统和肺部受累多见。外周血嗜酸性粒细胞计数升高和血清IgE水平升高是本病实验室检查的显著特点。     

Synthesis of a New Peptide–Coumarin Conjugate: A Potential Agent against Cryptococcosis

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Climatic Influences on Cryptoccoccus gattii Populations,Vancouver Island,Canada, 2002–2004

Vancouver Island, Canada, reports the world’s highest incidence of Cryptococcus gattii infection among humans and animals. To identify key biophysical factors modulating environmental concentrations, we evaluated monthly concentrations of C. gatti in air, soil, and trees over a 3-year period. The 2 study datasets were repeatedly measured plots and newly sampled plots. We used hierarchical generalized linear and mixed effect models to determine associations. Climate systematically influenced C. gattii concentrations in all environmental media tested; in soil and on trees, concentrations decreased when temperatures were warmer. Wind may be a key process that transferred C. gattii from soil into air and onto trees. C. gattii results for tree and air samples were more likely to be positive during periods of higher solar radiation. These results improve the understanding of the places and periods with the greatest C. gattii colonization. Refined risk projections may help susceptible persons avoid activities that disturb the topsoil during relatively cool summer days.