Cryptococcal meningitis due to Cryptococcus neoformans genotype AFLP1/VNI in Iran: a review of the literature

Abstract

Cryptococcal meningitis is the most important opportunistic fungal infection with a high mortality in HIV-patients in less developed regions. Here, we report a case of cryptococcal meningitis in a 49-year-old HIV-positive female due to Cryptococcus neoformans (serotype A, mating-type alpha, genotype AFLP1/VNI) in Sari, Iran. In vitro antifungal susceptibility tests showed MICs of isavuconazole (0.016 μg ml(-1) ), voriconazole (0.031 μg ml(-1) ), posaconazole (0.031 μg ml(-1) ), itraconazole (0.063 μg ml(-1) ), amphotericin B (0.125 μg ml(-1) ) and fluconazole (8 μg ml(-1) ). Despite immediate antifungal therapy, the patient died 4 days later due to respiratory failure. Cryptococcal infections have been infrequently reported from Iran and therefore we analysed all published cases of cryptococcosis in Iran since the first reported case from 1969.

The Etiological Spectrum of Febrile Encephalopathy in Adult Patients: A Cross-Sectional Study from a Developing Country

“…In a systematic review (2016) of acute bacterial meningitis in Iran, S. pneumoniae was reported as the most prevalent causative pathogen of bacterial meningitis [ 30 ]. Despite common bacterial and viral agents responsible for CNS infections, other endemic and rare pathogens, including rabies virus [ 31 ], M. tuberculosis [ 32 , 33 ], Brucella species [ 34 , 35 ], Bacillus anthracis [ 36 ], Borrelia recurrentis [ 37 ], Plasmodium species [ 38 ], Echinococcus species [ 39 ], Naegleria fowleri [ 40 ], Cryptococcus neoformans [ 41 ], Prions [ 42 ], and many others have been reported in studies on CNS infections from Iran but mostly described as case reports or small case series. In our study, the diagnosis of only around one-third of the patients with CNS infections was documented microbiologically.…”

Molecular epidemiology and antifungal susceptibility profiles of clinical Cryptococcus neoformans/Cryptococcus gattii species complex

“…Limited data regarding the epidemiology of cryptococcosis are available in the Middle East [15]. Cryptococcosis is a relatively rare disease; accordingly, few cases of these infections were reported between 1969 and 2018 in Iran [16][17][18][19][20][21][22].…”

Concurrent Presence of Cryptococcal Meningitis and Neoplastic Meningitis in a Recipient of Hematopoietic Stem Cell Transplantation: A Case Report

“…Also tuberculosis is the leading cause of chronic meningitis in our country, thus we should be aware of its other causes, and even coinfections. Moreover, cryptococcal infections have been infrequently reported from Iran, but all the factors for its existence are available in this part of the world (8) and central nervous system co-infection with tuberculosis and Cryptococcus neoformans has also been reported (9).…”