Diffuse Infiltration of the Lungs Associated With Cryptococcus Luteolus

Non-neoformans cryptococci have been generally regarded as saprophytes and rarely reported as human pathogens. However, the incidence of infection due to these organisms has increased over the past 40 years, with Cryptococcus laurentii and Cryptococcus albidus, together, responsible for 80% of reported cases. Conditions associated with impaired cell-mediated immunity are important risks for non-neoformans cryptococcal infections and prior azole prophylaxis has been associated with antifungal resistance. The presence of invasive devices was a significant risk factor for Cryptococcus laurentii infection (adjusted OR = 8.7; 95% CI = 1.48-82.9; p = 0.003), while predictors for mortality included age > or =45 years (aOR = 8.4; 95% CI = 1.18-78.82; p = 0.004) and meningeal presentation (aOR = 7.0; 95% CI = 1.85-60.5; p= 0.04). Because clinical manifestations of non-neoformans cryptococcal infections are most often indistinguishable from Cryptococcus neoformans, a high index of suspicion remains important to facilitate early diagnosis and prompt treatment for such infections.

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“…After the first report of Cryptococcus luteolus in a child with measles [7], more sporadic non-neoformans cases were reported.…”

Section: Epidemiologymentioning

confidence: 99%

Non-neoformans Cryptococcal Infections: a Systematic Review

2007

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“…The case involved a child with diffuse nodular pulmonary infiltrates secondary to C luteolus. 26 Since that time, there have been a total of 26 cases of non-neoformans cryptococcal infections reported in the English literature. Sixteen cases have occurred since 1993.…”

Section: E P I D E M I O L O G Ymentioning

confidence: 99%

“…The most common isolates identified are C laurentii 14,[16][17][18][19][20][21][22][23][24][25] and C albidus 6-14 that account for 54% and 35% of reported infections, respectively. Other nonneoformans cryptococci reported to cause human disease are C curvatus, 15 C luteolus, 26 and most recently C uniguttulatus. 27 Fungemia.…”

Section: I N I C a L M A N I F E S T A T I O N S O F I N F E C Tmentioning

confidence: 99%

“…The first case of nonneoformans cryptococcal infection described in 1956 involved the repeated isolation of C luteolus from bronchial washings obtained from a 4 year-old girl with pneumonia after a measles infection. 26 Since then, three other cases of isolated non-neoformans cryptococcal pulmonary infections have been described. 6,10,17 All affected individuals manifested a chronic, indolent illness.…”

Section: I N I C a L M A N I F E S T A T I O N S O F I N F E C Tmentioning

confidence: 99%

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Infections due to non-neoformans cryptococcal species

McCurdy

Morrow

2003

Compr Ther

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“…In the remaining seven cases, only the isolation of Cryptococcus colonies in pure culture suggested the identification of the etiologic agent. Although the fungus was isolated in multiple cultures in 8 of 12 cases (3, 4, 8, 11, 12, 25, 29 [2 cases]), in three of these (3, 11,12) it was recovered from normally contaminated sources such as sputum (3,11,12), bronchial wash (11), and gastric lavage (11). The diagnosis of one fungemia case with nonspecific symptoms was based solely on a single positive blood culture and the positive response of the patient to amphotericin B therapy (5).…”

Section: Resultsmentioning

confidence: 99%

Normally saprobic cryptococci isolated from Cryptococcus neoformans infections

et al. 1991

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We report two cases in which Cryptococcus laurentii was isolated from surgically resected pulmonary lesions but the cryptococcal cells in tissue reacted positively with a specific fluorescent antibody (FA) conjugate for Cryptococcus neoformans. Both patients had no apparent host defense defects. In both cases, multiple cryptococcal isolates were obtained from tissue, and yeastlike cells consistent with C. neoformans were seen in direct histology. The isolates were identified by assimilation patterns and standard procedures including phenoloxidase reactions. Since C. laurentii was consistently isolated by using stringent procedures, it was considered unlikely that the fungus represented surgical or laboratory contamination. Its presence may be the result of dual infection not detected by FA, but other possible explanations exist. The results show the value of the FA test in diagnostic mycology and call into question previous reports of cryptococci other than C. neoformans as agents of infection. There have been numerous reports over the years of Cryptococcus species other than C. neoformans causing human infection (Table 1). Isolates in these cases have most often been obtained from body sites which characteristically have been associated with C. neoformans infection. For example, in 6 of 12 published cases, isolates were obtained from cerebrospinal fluid (Table 1) while in 3 other cases, non-C. neoformans isolates were recovered from pulmonary sources. In 11 of the 12 cases, the species isolated was either C. albidus or C. Iaurentii, both of which are commonly isolated from normal skin (14, 17) and indoor and outdoor air (20, 31). Recently, we investigated two cases strongly suggestive of pulmonary infection by C. laurentii. In both instances, while multiple isolates of C. laurentii were obtained from surgically resected lung tissue, C. neoformans was not isolated. Fluorescent antibody staining (FA) techniques, however, indicated that the fungus present in the tissues was C. neoformans. These unusual findings suggest that a reassessment of the literature with respect to infections supposedly caused by Cryptococcus species other than C. neoformans is in order and that the clinical ecology of such infections requires clarification. CASE REPORTS Case 1. Over a 2-year period prior to admission, a 54-yearold woman resident of Ontario, Canada, experienced four

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Diffuse Infiltration of the Lungs Associated With Cryptococcus Luteolus

Cited by 16 publications

References 5 publications

Non-neoformans Cryptococcal Infections: a Systematic Review

Non-neoformans Cryptococcal Infections: a Systematic Review

Infections due to non-neoformans cryptococcal species

Normally saprobic cryptococci isolated from Cryptococcus neoformans infections

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