Cryptococcus gattii meningoencephalitis in an HIV-negative patient from the Peruvian Andes

Abstract

We report a case of an immunocompetent Peruvian patient from the Andes with a one-month history of meningoencephalitis. Cryptococcus gattii was identified from a cerebrospinal fluid culture through assimilation of D-proline and D-tryptophan as the single nitrogen source. Initially, the patient received intravenous antifungal therapy with amphotericin B. The patient was discharged 29 days after hospitalization and continued with oral fluconazole treatment for ten weeks. During this period, the patient showed clinical improvement with slight right-side residual weakness. Through this case report, we confirm the existence of this microorganism as an infectious agent in Peru.

Fatal Cryptococcus gattii genotype AFLP6/VGII infection in a HIV‐negative patient: case report and a literature review

“…In this study, the MIC value for fluconazole was 8.0 μg ml −1 . The Infectious Diseases Society of America standardised treatment of C. gattii with 0.7 mg kg −1 day −1 of amphotericin B intravenously, 100 mg kg −1 day −1 of 5‐flucytosine orally for 2 weeks, followed by 400–800 mg day −1 orally of fluconazole for at least 8 weeks . In the case reported herein, amphotericin B was used alone at an initial dose of 0.8 mg kg −1 .…”

“…Previous studies have shown that headache is the predominant clinical sign; roughly 60%–85% of patients affected by C. gattii present CNS involvement . In patients with meningoencephalitis, the most common symptoms are as follows: headache, fever, cranial neuropathy, high intracranial pressure, lethargy, signs of meningeal irritation and coma . In this case, at the time of admission to the clinic (HGU), the patient presented with severe headache, fever, syncopal episodes and progressive loss of vision and hearing.…”

“…In this case, at the time of admission to the clinic (HGU), the patient presented with severe headache, fever, syncopal episodes and progressive loss of vision and hearing. During a physical examination, the patient appeared confused and presented isochoric and photoreactive pupils, but showed no meningeal signs; these signs and symptoms are similar to those described in the literature …”

“…13,14 In patients with meningoencephalitis, the most common symptoms are as follows: headache, fever, cranial neuropathy, high intracranial pressure, lethargy, signs of meningeal irritation and coma. 18,19 In this case, at the time of admission to the clinic (HGU), the patient presented with severe headache, fever, syncopal episodes and progressive loss of vision and hearing. During a physical examination, the patient appeared confused and presented isochoric and photoreactive pupils, but showed no meningeal signs; these signs and symptoms are similar to those described in the literature.…”

Nutritional and medicinal aspects of d-amino acids

“…1-Methyl-D-Trp is a useful immunotherapeutic agent for combination use with chemotherapy (Jia et al 2008). D-Trp can serve as a nitrogen source for Cryptococcus gatti meningoencephalitis (Gutierrez et al 2010). …”