Zoonotic transmission of Cryptococcus neoformans from a magpie to an immunocompetent patient

We report a case of cryptococcal meningitis in an immunocompetent female patient with exposure to a pet magpie (Pica pica). Genetically indistinguishable isolates were cultured from the cerebrospinal fluid of the patient and excreta of the bird. Our data strongly suggest zoonotic transmission of Cryptococcus neoformans var. grubii from a magpie to this patient.     

Cryptococcus neoformans isolation from swallow (Hirundo rustica) excreta in Iran

Cryptococcus neoformans is an encapsulated yeast that can cause cryptococcosis, a life-threatening infection that mainly occurs in immunocompromised patients. The major environmental sources of C. neoformans have been shown to be soil contaminated with avian droppings. In the present study, we evaluated the isolation of C. neoformans from swallow (Hirundo rustica) excreta in two northern cities of Iran. Ninety-seven swallow droppings were evaluated and 498 yeast-like colonies were isolated and identified as Rhodotorula spp. (62.8%), Candida spp. (28.5%)and C. neoformans (8.7%). Cryptococcus neoformans was isolated from 5/97 (5.2%) of collected samples. Min-Max colony forming units (CFU) per one gram for the positive samples were 3-10 C. neoformans colonies. The total mean CFU per one gram for the positive samples was 4.8. The results of this study demonstrate that excreta of swallow may harbor different species of potentially pathogenic yeasts, mainly C. neoformans, and may be capable of disseminating these fungi in the environment.     

Evidence of zoonotic transmission of Cryptococcus neoformans from a pet cockatoo to an immunocompromised patient

BACKGROUND: Although cryptococcosis has been associated with birds for almost 50 years, point sources for infection have not been identified. OBJECTIVE: To document zoonotic transmission of Cryptococcus neoformans. DESIGN: Case report. SETTING: A home in Boston, Massachusetts. PATIENT: A 72-year-old woman who received a diagnosis of cryptococcal meningitis in November 1998. The patient, who had been taking immunosuppressant drugs since undergoing renal transplantation in 1989, owned a pet cockatoo. MEASUREMENTS: Cryptococcus neoformans was isolated from the feces of the cockatoo. Isolates from excreta and from the patient were compared by using biochemical profiles, monoclonal antibody binding patterns, restriction fragment length polymorphism analysis, and karyotyping. RESULTS: The isolates from the patient and the cockatoo had identical biochemical profiles, the same monoclonal antibody immunofluorescence patterns, and indistinguishable patterns on restriction fragment length polymorphism analysis and karyotyping. CONCLUSIONS: The indistinguishable patient and cockatoo isolates strongly suggest that the patient's infection resulted from exposure to aerosolized cockatoo excreta. Although the incidence of cryptococcal infection due to such exposure is unknown, it may be prudent to advise immunocompromised patients to avoid pet birds and avian excreta.     

The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis.

The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis are reviewed. Two varieties of C. neoformans have been recognized. C. neoformans variety neoformans has been found in nature worldwide, primarily in association with bird droppings, although nonavian sources have also been found. Most cases of human cryptococcosis are caused by this variety. C. neoformans var. gattii has recently been isolated in nature in association with Eucalyptus trees. Infections caused by this variety occur mainly in tropical and subtropical regions. Because exposure to C. neoformans is probably common and clinically apparent cases of cryptococcosis in healthy hosts are rare, it is presumed that most people can mount adequate host defenses upon exposure to the organism. At least 5%-10% of patients with AIDS become infected with Cryptococcus; the epidemiology of this infection is different in many respects from that seen in patients without AIDS.     

北京昌平区鸽粪中新生隐球菌的分离鉴定及其血清型、配型分析

目的了解鸽粪中新生隐球菌的携带率及其血清型、配型。方法在北京昌平区收集家养鸽粪便标本,利用沙包培养基、尿素培养基、多巴培养基和CGB培养基对鸽粪中的新生隐球菌进行分离鉴定。PCR扩增ITS基因进行分子生物学鉴定,并通过特异性引物PCR扩增,分析其血清型和配型。结果143份鸽粪标本中共分离得到6株新生隐球菌,分离阳性率为4.87%,其血清型均为A型,其中3株为α配型,3株为a配型。结论在北京昌平区家养鸽携带新生隐球菌的阳性率为4.87%,其血清型均为A型。     

SXI2a基因在新生和格特隐球菌交配型鉴定中的作用

目的设计针对a交配型位点内特有的SXI2a基因的特异扩增法,评价其在鉴定新生和格特隐球菌所有主要基因型a交配型中的作用。方法在SXI2a基因4号外显子的序列保守区设计引物SXI2aF-SXI2aR特异扩增新生和格特隐球菌a交配型,并比较其与现有的针对STE20a、MFa或STE3a基因的特异扩增法及交配试验在鉴定新生和格特隐球菌所有主要基因型a交配型中的作用。结果针对SXI2a基因的特异扩增法准确鉴定受试的各主要基因型a交配型菌株,而针对STE20a、MFa或STE3a基因的特异扩增法均至少无法扩增1种以上主要基因型的a交配型。部分受试菌株不能发生交配,交配试验无法鉴定其交配型。结论针对SXI2a基因的PCR扩增可鉴定新生和格特隐球菌各主要基因型的a交配型。SXI2aF-SXI2aR引物在快速鉴定a交配型中具有更好的通用性和特异性。     

新型隐球菌脑膜炎的治疗疗效观察

目的 探讨新型隐球菌脑膜炎的治疗疗程对疾病预后的影响.方法 回顾性分析30例新型隐球菌脑膜炎患者的临床资料,观察脑脊液新型隐球菌培养转阴时间,进一步分析两性霉素B(AmB)鞘内注射与非鞘内注射的疗效差异.数据采用t检验进行统计学分析.结果 新型隐球菌转阴时间在11例AmB鞘内注射的患者为(22.73士10.00)d,在13例非鞘内注射的患者为(18.92士7.26)d,两者差异无统计学意义(t=0.172,P>0.05).在评价疗程对疾病预后影响的分析中,抗真菌治疗2周的有效率为45.8%,治疗6周的有效率达100.0%,治愈率为0;治疗结柬(治疗3～4个月)的10例患者均有效.结论 规范、足疗程的抗真菌治疗是提高新型隐球菌脑膜炎治愈率的关键.     

Health hazards posed by feral pigeons

A comprehensive literature search of epidemiological studies and reports of transmissions of disease from feral pigeons to humans was performed. There were 176 documented transmissions of illness from feral pigeons to humans reported between 1941 and 2003. Feral pigeons harbored 60 different human pathogenic organisms, but only seven were transmitted to humans. Aerosol transmission accounted for 99.4% of incidents. There was a single report of transmission of Salmonella enterica serotype Kiambu to humans from feral pigeons, and no reports of transmission of Campylobacter spp. The most commonly transmitted pathogens continue to be Chlamydophila psittaci and Cryptococcus neoformans. Although feral pigeons pose sporadic health risks to humans, the risk is very low, even for humans involved in occupations that bring them into close contact with nesting sites. In sharp contrast, the immunocompromised patient may have a nearly 1000-fold greater risk of acquiring mycotic disease from feral pigeons and their excreta than does the general population.     

Pulmonary infection with Cryptococcus neoformans in the face of underlying sarcoidosis

We present a case of limited pulmonary cryptococcal infection following exposure to pigeon excreta in a patient with sarcoidosis. The pathogenicity of Cryptococcus neoformans depends on the interplay between the immune status of the host and the virulence of the infecting strain. It can range from asymptomatic lung colonization in the immunocompetent host to rapidly progressive meningitis in immunocompromised patients. Immunological models of respiratory disease emphasize a distinction between infections associated with immune suppression on the one hand and diseases such as sarcoidosis believed to involve an excessive Th1-mediated immune response on the other. This case exemplifies the complex nature of immunological responses in the lung and highlights the importance of considering the possibility of co-existent fungal infection in individuals with sarcoidosis. Novel immunotherapeutic options for cryptococcal infection are discussed.     

Occurrence and significance of Cryptococcus neoformans in vegetables and fruits

Cryptococcus neoformans was isolated from three of 437 (0.6%) samples of a wide variety of vegetables collected from a number of markets in Delhi. The vegetables yielding C. neoformans were tomato, Lycopersicon esculentum (1/70), 'vegetable sponge', Luffa cylindrica (1/56) and brinjal, Solanum melongena (1/55). Only solitary samples of these three vegetables were found to be positive. In vitro studies at 25 degrees C revealed that a reference C. neoformans isolate readily colonized, as did Candida albicans and Candida viswanathii (controls), sterilized slices of almost all the test vegetables and fruits (cut or uncut surface) which included tomato, 'vegetable sponge', brinjal, potato, carrot, radish, apple, guava, pineapple, pear, papaya, banana and mango. Sterilized juices of the same vegetables and fruits also supported adequate growth of the reference C. neoformans isolate as well as of C. albicans and C. viswanathii. However, the growth of C. neoformans on the afore-mentioned vegetables and fruits was rapidly masked by miscellaneous molds and bacteria if the test samples had not been sterilized prior to inoculation. Cryptococcus neoformans was not found in any of the 275 fruit samples investigated from the same markets. The results indicate that vegetables and fruits are unsuitable as natural habitats for C. neoformans although it may be sporadically isolated from these sources.     

Experimental cryptococcal myocarditis.

Rabbits and rats developed myocarditis on the 16th, 30th, and 60th day after intrarenal inoculation with Cryptococcus neoformans. The cardiac lesions consist of focal necrosis with infiltrations of small round cells in the myocardium. Cryptococcal antigens were demonstrated by a direct immunofluorescent antibody method in the damaged myocardial lesions. Cryptococcus neoformans itself was found by periodic acid-Schiff stain in the damaged myocardial lesions.     

新型隐球菌脑膜炎发病相关因素的回顾性巢式病例对照研究

目的 探讨急性脑炎、脑膜炎人群中发生新型隐球菌脑膜炎的危险因素。方法 采用1∶4匹配的回顾性巢式病例对照研究方法寻找脑炎、脑膜炎人群发生新型隐球菌脑膜炎的危险因素,使用条件Logistic回归进行分析。结果 在1 037例急性脑炎、脑膜炎病例中,真菌培养确诊新型隐球菌脑膜炎23例,累计发病率、发病密度分别为2.22%、10.50人年。78.26%(18例)的病例是15岁以下儿童。多因素条件Logistic回归分析发现发病至就诊的间隔时间在20 d以上(OR=28.78)、曾暴露于鸽子等鸟类及其粪便、植物和土壤(OR=20.49)、患者或其家长大专及以上学历(OR=0.10)、伴有其他基础疾病(OR=8.85)是该病的相关因素。结论 发病至就诊的间隔时间在20 d以上,曾暴露于鸽子等鸟类及其粪便、植物和土壤等腐生物质,伴有其他基础疾病是该病的危险因素;患者或其家长大专及以上学历是其保护因素。     

新生隐球菌TUP1△株群体效应分子的筛选鉴定

目的 明确新生隐球菌群体感应现象,分离鉴定其群体效应分子.方法 观察以不同密度接种的新生隐球菌TUP1△株生长情况,取高密度生长的培养滤过液加入低密度接种TUP1△株的培养基中,观察滤过液促其生长作用,提纯并分析滤过液中的活性物质.结果 新生隐球菌TUP1△株具有密度依赖生长特性,只有高于特定密度接种才能形成正常菌落,从高密度生长菌落培养滤过液中分离出一种11肽,可促低密度TUP1△株生长,命名为quorum sensing peptide 1(QSP1).人工合成该活性物质QSP1,同样可使低密度接种的TUP1△菌株形成正常菌落.结论 新生隐球菌存在群体感应现象,其群体效应分子为QSP1.     

Primary cutaneous cryptococcosis due to Cryptococcus neoformans var. gattii serotype B,in an immunocompetent patient

The authors report a male patient, a seller with no detected immunosuppression, with an extensive ulcerated skin lesion localized on the left forearm, caused by Cryptococcus neoformans var. gattii serotype B. Oral treatment with fluconazole was successful. A review of the literature showed the rarity of this localization in HIV-negative patients. In contrast, skin lesions frequently occurs in HIV-positive patients, with Cryptococcus neoformans var. neoformans serotype A predominating as the etiological agent. In this paper, the pathogenicity of C. neoformans to skin lesions in patients immunocompromised or not, is discussed, showing the efficacy of fluconazole for the treatment of these processes.     

Cryptococcus neoformans var. gattii meningitis in an HIV-positive patient: first observation in the United Kingdom

We present a case of meningitis due to Cryptococcus neoformans var. gattii in an HIV-infected man recently returned from South Africa. We believe this is the first imported case of meningitis secondary to Cryptococcus neoformans var. gattii in an HIV-infected patient to be reported in the UK.     

Environmental strains of Cryptococcus neoformans variety grubii in the city of Santos, SP, Brazil

This study involved a total of 116 samples, 79 taken from pigeon droppings and 37 of atmospheric air taken close to accumulations of excrement. Cryptococcus neoformans var. grubii was isolated from 11 (13.9%) of these samples. Other species of Cryptococcus were also isolated from these samples, such as C. albidus (12.6%) and C. laurentii (8.9%). C. neoformans was not isolated from the air samples, though C. albidus (5.4%) was. All the strains of C. neoformans were found to belong to the A serotype (C. neoformans var. grubii). In regard to the studies with the antifungal agents 5-fluorocytosine, fluconazole, itraconazole, amphotericin B and voriconazole, by means of the microdilution method (EUCAST), we point out that one sample demonstrated resistance to fluconazole, this being especially significant because this is an environmental strain.     

Characterization of Cryptococcus neoformans isolated from urban environmental sources in Goiânia, Goiás State, Brazil

Cryptococcus neoformans is an opportunistic fungal pathogen that causes meningoencephalitis as the most frequent clinical presentation in immunocompromised patients, mainly in people infected by HIV. This fungus is an environmental encapsulated yeast, commonly found in soil enriched with avian droppings and plant material. A total of 290 samples of pigeon and the other avian droppings, soil, ornamental trees and vegetable material associated with Eucalyptus trees were collected to study environmental sources of Cryptococcus species in Goiania, Goiás State. The determination of varieties, serotypes and the susceptibility in vitro to fluconazole, itraconazole and amphotericin B of C. neoformans isolates were performed. C. neoformans var. grubii (serotype A) was found in 20.3% (36/177) of pigeon dropping samples and in 14.3% (5/35) of samples of Eucalyptus. None of the environmental isolates of C. neoformans showed in vitro resistance to three antifungal agents. The knowledge of major route for human cryptococcal infection (inhalation of infectious particles from saprophytic sources) and a total of 60 C. neoformans isolates obtained from AIDS patients with cryptococcal meningitis between October 2001 and April 2002 justify the study of the habitats of these yeasts as probable sources of cryptococcosis in this city.     

隐球菌临床及环境分离株对卡泊芬净与特比萘芬的体外联合药敏试验

目的　了解隐球菌临床及环境分离株对卡泊芬净与特比萘芬的体外联合抗菌活性。方法　采用美国国家实验室标准委员会 (NCCLS)M 2 7 A方案推荐的酵母菌微量稀释法及其微量稀释棋盘法 ,检测 78株新生隐球菌临床和环境分离株对卡泊芬净与特比萘芬的体外抗菌活性及其联合抗菌活性。结果　卡泊芬净和特比萘芬对新生隐球菌最小抑菌浓度 (MIC)值范围分别是 0 .2 5～ 32 μg/ml、2～16 μg/ml;几何均数分别是 32 μg/ml、8μg/ml。联合药敏试验结果显示 ,两者联合后对其中 5 %菌株有协同作用 ,4 2 %菌株有累加作用及 5 3%菌株有无关作用 ,任何菌株均无拮抗作用。同时卡泊芬净的MIC几何均数由 2 6 .8μg/ml降至 2 0 .6 μg/ml(P <0 .0 0 0 1) ,特比萘芬的MIC几何均数由7.9μg/ml降至 1.3μg/ml(P <0 .0 0 0 1)。此外 ,有 4株菌株对卡泊芬净药物敏感 ,其MIC分别是 2 μg/ml、2 μg/ml、0 .5 μg/ml、0 .2 5 μg/ml。 结论　卡泊芬净与特比萘芬的体外联合药敏试验表明 ,两者联合应用对新生隐球菌具有较好的体外抗菌活性     

新型隐球菌及念珠菌临床分离株对5种抗真菌药物的体外敏感性

目的 了解临床分离的新型隐球和念珠菌对氟康唑、两性霉素B、伊曲康唑、氟胞嘧啶和酮康唑的体外敏感性及临床治疗效果的相关性。方法 采用标准微量稀释法测定了上述5种抗真菌药物对临床分离株的35株新型隐球菌和56株念株菌量的最低抑菌浓度（MIC）。结果 56株念珠菌对5种药物的敏感性（MIC）分别为氟康唑0.125～64ug/ml,94.6%的菌株对氟康唑敏感,1.8%为剂量依赖性敏感,3.6%耐药;伊曲康唑0.03～1ug/ml,57.1%敏感,37.5%剂量依赖性敏感,5.4%耐药;氟咆嘧啶 0.125～32ug/ml,92.8%敏感,3.6%中度敏感,3.6%耐药;两性霉素B0.06～2ug/ml;酮康唑0.03～0.5ug/ml。35株新型隐球菌对5种药物的MIC范围分别为氟康唑2～64ug/ml,伊曲康唑0.25～1ug/ml,两性霉素B0.3～1ug/ml,氟胞嘧啶0.25～64ug/ml,酮康唑0.125～1ug/ml。结论 标准微量稀释法测定酵母菌对抗真菌药物的敏感性其结果具有可重复性和一致性的特点。     

In vitro susceptibility to antifungal agents of clinical and environmental Cryptococcus neoformans isolated in Southern of Brazil.

The purpose of the present study was to compare the susceptibility to four antifungal agents of 69 Cryptococcus neoformans strains isolated from AIDS patients with that of 13 C. neoformans strains isolated from the environment. Based on the NCCLS M27-A methodology the Minimal Inhibitory Concentrations (MICs) obtained for amphotericin B, itraconazole and ketoconazole were very similar for clinical and environmental isolates. Clinical isolates were less susceptible to fluconazole than environmental isolates. The significance of these findings and aspects concerning the importance, role and difficulties of C. neoformans susceptibility testing are also discussed.