Cryptococcal sternal osteomyelitis in a healthy woman: a review ofCryptococcus neoformans

Abstract

Cryptococcus, an opportunistic yeast, known to afflict immune-compromised patients is often overlooked in immune-competent patients. This has led to increasing morbidity and mortality worldwide. We present a case ofCryptococcuscausing sternal osteomyelitis in an immune-competent individual. Till date no case ofCryptococcuscausing sternal osteomyelitis in an immune-competent patient has been reported in the English literature since 1946–2011. With the rising incidence ofCryptococcusinfection it should be included among the list of infections causing osteomyelitis. Early detection and prompt treatment can decrease both morbidity and mortality.

Skeletal cryptococcosis from 1977 to 2013

“…The outcomes of patients with disseminated cryptococcosis were unfavorable, and those of patients with or without immune abnormalities were similar; these findings differ from previous studies (Corral et al, 2011 ; Jou et al, 2011 ; Qadir et al, 2011 ; Jain et al, 2013 ). This disparity might be explained by the recent CNVG outbreak.…”

“…In addition, the incidence of chronic diseases such as diabetes mellitus and hypertension has increased (Jain et al, 1999 ; Witte et al, 2000 ; Bruno et al, 2002 ). The number of patients with cryptococcal disease and who are classified as immunocompetent has risen greatly since 2004 and is estimated to increase by 0.2 per million every year (Zhang et al, 2012 ; Jain et al, 2013 ; Zhou et al, 2013 ). This increase was most likely due to the CNVG outbreak that originated in 1999 and resurged in 2004 (Chaturvedi and Chaturvedi, 2011 ).…”

“…After staining with India ink, the organism resembles cells with a halo due to a lack of capsule staining, and it is easily detected using specific PAS, mucicarmine, and GMS stains (although it is poorly stained by H & E). Urease-positive mucoid colonies are produced in cultures on SDA agar usually within 3–5 days (Mitchell and Perfect, 1995 ; Qadir et al, 2011 ; Jain et al, 2013 ). Currently available commercial methods for yeast identification, such as API 20 AUX (bioMerieux, Paris, France) and Vitek (bioMerieux), are used to identify the yeast-like organisms (Qadir et al, 2011 ; Zhou et al, 2013 ).…”

“…Except for the lungs ans CNS, no standardized treatment protocol exists for cryptococcal infection for specific body sites (Jain et al, 2013 ; Ramkillawan et al, 2013 ). For these sites, surgery in conjunction with antifungals, antifungals alone, or (rarely) surgery alone have been demonstrated to be effective.…”

“…Cryptococcosis, formerly known as torulosis, European blastomycosis, or Busse-Buschke disease, is caused by Cryptococcus neoformans ( C neoformans ). This species was first isolated from peach juice by Sanfelice in 1894 (Mitchell and Perfect, 1995 ; Jain et al, 2013 ). Cryptococcus is a spherical-to-oval, encapsulated, yeast-like fungus that is widespread in spoiled milk, soil, and bird droppings, especially pigeon excreta.…”