MRI findings of cerebral cryptococcosis in immunocompetent patients

Worldwide, cerebral cryptococcal infections caused by cryptococcus neoformans are mostly found in immunocompromised patients, but less found in immunocompetent patients with fewer related imaging reports in literatures. This pictorial essay describes some important MR imaging features in arriving at diagnosis for cerebral cryptococcosis in immunocompetent patients by way of five illustrative cases with intact MRI data.     

传染性软疣样皮损表现的播散性隐球菌病2例

报告2例播散性隐球菌病。除系统累及表现外，皮损为传染性软疣样丘疹，组织液、血液及脑脊液检查找到隐球菌，皮损和淋巴结组织病理学检查见孢子。提示当发热性疾病伴传染性软疣样皮损时，应警惕隐球菌感染。避免误诊和延误诊断的关键是提高对本病的认识和对可疑病例做真菌检查。     

Infection due to Cryptococcus neoformans of unusual morphology in a patient with AIDS

Cryptococcus neoformans with a rare morphology of hand-mirror appearance was demonstrated by direct microscopic preparation of both cerebrospinal fluid (CSF) and sputum of a patient with AIDS. In addition, one to six blastoconidia were seen at the tip of a germ-tube like structure. Cr. neoformans was isolated in pure culture and the identification was confirmed by biochemical and serological tests as well as by animal pathogenicity.     

Leonard Bell Cox (1894–1976) – pioneer of Australian clinical neurology

The name of Leonard Bell Cox (1894–1976) will long be associated with a number of very significant areas in the intellectual and cultural life of the Australian State of Victoria. A quarter of a century after his death, his cultural achievements, and the enduring products of these achievements, continue to be celebrated in his native city, Melbourne. However his enormous contributions in these cultural fields were matched by his perhaps less widely known achievements in medicine, in particular in the neurosciences. In his time he not only pioneered the foundation and progressive development of the speciality of clinical neurology in Australia, but at the same time became a recognised world expert on the pathology of brain tumours.     

Cryptococcosis--a review of 13 autopsy cases from a 54-year period in a large hospital

From 1952 to 2005, 13 cases of cryptococcosis confirmed by postmortem examination were diagnosed in autopsy material from the University Hospital in Hradec Králové, the Czech Republic. Histologically, Cryptococcus was found in multiple organs (brain and spinal cord, lungs, lymph nodes, spleen, bone marrow, liver, kidneys and adrenal glands). The lungs and CNS were the organs most often involved. Only in two cases was the diagnosis of cryptococcal infection established during the patient's lifetime, in both presenting clinically as meningitis, with positive result of CSF cultivation. Data and issues of diagnostics and treatment of cryptococcosis are discussed.     

肺隐球菌病3例报告并文献复习

目的 提高对肺隐球菌病的诊断和治疗水平.方法 对3例肺隐球菌病患者的临床资料进行分析,并进行文献复习.结果 3例患者均行经皮肺穿刺活检,组织病理学确诊.1、2例为轻症,第3例为重症.痰培养和支气管镜检查均阴性,血清隐球菌荚膜乳胶凝集实验均阳性,第3例脑脊液压力升高,乳胶凝集实验阳性.1、2例应用氟康唑治疗,第3例应用两性霉素B治疗,均临床治愈.结论 肺隐球菌病临床误诊率高.采用血清隐球菌荚膜乳胶凝集实验和经皮肺穿刺活检相结合的方法,可明显提高诊断率.对于免疫功能正常和轻症患者,首选氟康唑,对于免疫受损和重症患者,首选两性霉素B.     

A rare case of Cryptococcus gattii pneumonia in a renal transplant patient

Cryptococcus neoformans and Cryptococcus gattii are environmental fungi that can cause fever, cough, pneumonia, meningoencephalitis, dissemination, and death. C. gattii causes cryptococcomas more frequently than does C. neoformans and may require prolonged antifungal treatment. We present a rare case of C. gattii pneumonia in a renal transplant patient. A 44‐year‐old man, living in a rural area endemic for C. gattii and who had received a kidney transplant, was admitted to the hospital with fever, vomiting, weight loss, and diarrhea. A chest computed tomography revealed 2 alveolar, nodular, subpleural infiltrates in the periphery of the lungs. Differential diagnoses included infectious infiltrates, granulomatosis, embolization, and hemorrhage. C. gattii, molecular type VGI, was confirmed on day 28. Treatment consisted of amphotericin B at 1 mg/kg/day or fluconazole at 800 mg/day for first 6 weeks, followed by fluconazole at 400 mg/day for the subsequent 12 months. Response to the therapy has been slow. Because of the occurrence of outbreaks and its high morbidity and mortality rates, physicians must be aware of this complication in transplant recipients to avoid delays in diagnosis and to provide prompt management.     

Application of the DiversiLab system for tracing the source of the mixed infections caused by Cryptococcus neoformans var. grubii from a patient with systemic lupus erythematosus

Two strains of Cryptococcus neoformans (PU 66 and PU112) were simultaneously isolated from a patient with systemic lupus erythematosus. We aimed to trace the source of the mixed infections. Multi‐locus sequence typing (MLST) and the DiversiLab system analyses were performed on the 2 clinical and 23 environmental C. neoformans from pigeon droppings, 11 from the home (H1) the patient visited, 12 from another home (H2) as control. All the strains were uniformly genotyped as C. neoformans var. grubii VNI. Clinical strain PU66 and all the H1 isolates had the same sequence type (ST) – ST5, while for PU112 a new ST was observed – ST265. However, there was only one single base of 7 MLST loci difference between PU66 and PU112. Sequence types of the H2 strains were ST31 and ST297. DiversiLab analysis showed that strain similarity between the two clinical strains was 96.7%. In relation to environmental samples, the highest strain similarity (99.3%) was observed for PU66 and PU70 (H1). However, none of the environmental isolates had similarity over 98.6% comparing to PU112. One source of the mixed infections has been detected, but another needs further investigation.     

Donor‐Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation,Infectious Diseases Community of Practice†

Donor‐derived fungal infections can be associated with serious complications in transplant recipients. Most cases of donor‐derived candidiasis have occurred in kidney transplant recipients in whom contaminated preservation fluid is a commonly proposed source. Donors with cryptococcal disease, including those with unrecognized cryptococcal meningoencephalitis may transmit the infection with the allograft. Active histoplasmosis or undiagnosed and presumably asymptomatic infection in the donor that had not resolved by the time of death can result in donor‐derived histoplasmosis in the recipient. Potential donors from an endemic area with either active or occult infection can also transmit coccidioidomycosis. Rare instances of aspergillosis and other mycoses, including agents of mucormycosis may also be transmitted from infected donors. Appropriate diagnostic evaluation and prompt initiation of appropriate antifungal therapy are warranted if donor‐derived fungal infections are a consideration. This document discusses the characteristics, evaluation and approach to the management of donor‐derived fungal infections in organ transplant recipients.