Difficulty in diagnosing chronic meningitis caused by capsule-deficient Cryptococcus neoformans

Sugiura, Y.; Homma, M.; Yamamoto, T.
October 2005
Journal of Neurology, Neurosurgery & Psychiatry;Oct2005, Vol. 76 Issue 10, p1460
Academic Journal
journal article
We report a case of chronic meningitis due to capsule-deficient Cryptococcus neoformans which could not be diagnosed by routine morphological and immunological cerebrospinal fluid (CSF) examination. Repeated CSF examination and culture did not disclose the fungal body, and the cryptococcal antigen tests were always negative. Culture of ventricular fluid showed non-encapsulated cultured cells which were stained positively by indirect immunofluorescence using diluted sera from another patient diagnosed with cryptococcal meningitis. Inoculation of dispersed colonies into mice resulted in encapsulated C neoformans. It is important to suspect capsule-deficient C neoformans when the conventional diagnostic approaches fail to identify the organism or antigens.


Related Articles

  • Cryptococcal Antigen Screening in Patients Initiating ART in South Africa: A Prospective Cohort Study. Longley, Nicky; Jarvis, Joseph Nicholas; Meintjes, Graeme; Boulle, Andrew; Cross, Anna; Kelly, Nicola; Govender, Nelesh P.; Bekker, Linda-Gail; Wood, Robin; Harrison, Thomas S. // Clinical Infectious Diseases;3/1/2016, Vol. 62 Issue 5, p581 

    Background. Retrospective data suggest that cryptococcal antigen (CrAg) screening in patients with late-stage human immunodeficiency virus (HIV) initiating antiretroviral therapy (ART) may reduce cryptococcal disease and deaths. Prospective data are limited. Methods. CrAg was measured using...

  • Cerebrospinal Fluid Culture Positivity and Clinical Outcomes After Amphotericin-Based Induction Therapy for Cryptococcal Meningitis. Rolfes, Melissa A.; Rhein, Joshua; Schutz, Charlotte; Taseera, Kabanda; Nabeta, Henry W.; Hullsiek, Kathy Huppler; Akampuira, Andrew; Rajasingham, Radha; Musubire, Abdu; Williams, Darlisha A.; Thienemann, Friedrich; Bohjanen, Paul R.; Muzoora, Conrad; Meintjes, Graeme; Meya, David B.; Boulware, David R. // Open Forum Infectious Diseases;Fall2015, Vol. 2 Issue 4, p1 

    Background. Amphotericin-based combination antifungal therapy reduces mortality from human immunodeficiency virus (HIV)-associated cryptococcal meningitis. However, 40%-50% of individuals have positive cerebrospinal fluid (CSF) fungal cultures at completion of 2 weeks of amphotericin induction...

  • Cryptococcal meningitis in an immunocompetent child. Shinjoh, Masayoshi; Miyairi, Isao; Sakurai, Michiko; Takahashi, Miki; Ariyasu, Daisuke; Nakayama, Tetsuo; Tokumura, Mitsuaki; Yamashita, Ryoko; Sunakawa, Keisuke; Takahashi, Takao // European Journal of Pediatrics;Sep2005, Vol. 164 Issue 9, p596 

    Provides information on a medical case presented involving an immunocompetent child infected with cryptococcal meningitis and was cured without any sequelae or relapse with six months of antifungal treatment. Symptoms experienced by the Japanese boy upon admission to a local hospital; Methods...

  • Analysis of cerebrospinal fluid protein concentrations of patients with cryptococcal meningitis treated with antifungal agents. Liang Huang; Hui Ye; Junyan Qu; Yanbin Liu; Cejun Zhong; Guangmin Tang; Ying Liu; Yao Huang; Xiaoju Lv // BMC Infectious Diseases;Aug2015, Vol. 15 Issue 1, p1 

    Background: Many neurological diseases are accompanied by an increase in the cerebrospinal fluid (CSF) protein concentration, which indicates dysfunction of the blood-CSF/blood-brain barrier. However, the significance CSF protein concentration of patients with cryptococcal meningitis (CM) is not...

  • Baseline Correlation and Comparative Kinetics of Cerebrospinal Fluid Colony-Forming Unit Counts and Antigen Titers in Cryptococcal Meningitis. Brouwer, Annemarie E.; Teparrukkul, Paprit; Pinpraphaporn, Supraphada; Larsen, Robert A.; Chierakul, Wirongrong; Peacock, Sharon; Day, Nicholas; White, Nicholas J.; Harrison, Thomas S. // Journal of Infectious Diseases;8/15/2005, Vol. 192 Issue 4, p681 

    Cerebrospinal fluid (CSF) cryptococcal colony-forming unit counts and CSF cryptococcal antigen titers serve as alternative measures of organism load in cryptococcal meningitis. For these measures, we correlated baseline values and rates of decline during the first 2 weeks of therapy in 68 human...

  • Fluconazole-Resistant Cryptococcus neoformans Isolated from an Immunocompetent Patient without Prior Exposure to Fluconazole . Orni-Wasserlauf, Ruth; Izkhakov, Elena; Siegman-Igra, Yardena; Bash, Edna; Polacheck, Itzhack; Giladi, Michael // Clinical Infectious Diseases;12/1/1999, Vol. 29 Issue 6, p1592 

    Describes a case of meningitis due to fluconazole-resistant Cryptococcus neoformans in an immunocompetent patient without prior exposure to fluconazole. Results of cerebrospinal fluid analysis; Treatment with amphotericin B combined with flucytosine.

  • Cryptococcal meningitis with secondary cutaneous involvement in an immunocompetent host. Tabassum, Saadia; Rahman, Atiya; Herekar, Fivzia; Masood, Sadia // Journal of Infection in Developing Countries; 

    Cryptococcosis is a potentially fatal fungal disease caused by variants of Cryptococcus neoformans species. The respiratory tract is the usual portal of entry, with a peculiar predilection to invade the central nervous system. The skin can be secondarily involved in disseminated infection or be...

  • Atypical forms of Cryptococcus neoformans in CSF of an AIDS patient. Bava, Javier; Solari, Ruben; Isla, Guillermina; Troncoso, Alcides // Journal of Infection in Developing Countries;2008, Vol. 2 Issue 5, p403 

    The microscopic recognition of typical rounded capsulated yeasts in centrifuged cerebrospinal fluid (CSF), stained with India ink, is a common, rapid and effective method for the diagnosis of cryptococcal meningitis among AIDS patients. The presence of atypical forms of Cryptococcus neoformans...

  • Combination Versus Monotherapy for the Treatment of HIV Associated Cryptococcal Meningitis. VAIDHYA, SHASHANK ANANT; GUPTA, BHARAT BHUSHAN; JHA, RAJESH KUMAR; KUMAR, RAVINDRA // Journal of Clinical & Diagnostic Research;Feb2015, Vol. 9 Issue 2, p14 

    Objective: To study the efficacy of anti Cryptococcal treatment by cerebrospinal fluid (CSF) fungal negativity after two weeks of treatment with amphotericin B alone or combined with fluconazole in treatment of HIV associated Cryptococcal meningitis (CM). Materials and Methods: A total of 84...


Read the Article


Sign out of this library

Other Topics