Rare case of amphotericin-B resistant cryptococcal meningitis in HIV non reactive patient

Abstract

past two days. A physical examination revealed only the presence of mild hepatomegaly. As part of a routine work up for pyrexia of unknown origin (PUO), a chest x-ray performed revealed multiple bilateral nodular lesions. A subsequent contrast enhanced CT scan of the chest showed bilateral heterogeneously enhancing mass lesions, with features suggestive of a neoplastic aetiology.The patient rapidly deteriorated, developing neurological symptoms, (GCS: 3). Brain imaging studies reiterated the high probability of metastatic lesions. However, in view of the patient's symptomatology and his immunocompromised state, fungal assays were sent and serology revealed a positive Aspergillus antigen.Results: We report an unusual presentation of Invasive Aspergillosis in a patient with well controlled Aplastic Anaemia. The initial diagnosis misleadingly pointed towards neoplastic lesions in the lung with metastasis to the brain. IMAGE 1: Periodic acid Schiff (PAS) stain showing the hyphae of the fungal species (H&E; 400x) IMAGE 2: Contrast enhanced CT shows multiple lung nodules. CT guided biopsy was suggestive of aspergilloma IMAGE 3: Contrast enhanced CT brain shows multiple nonenhancing hypodense lesions in bilateral cerebral hemispheres Conclusion: This case exemplifies that a high index of clinical suspicion and an increased awareness of the possibility of invasive aspergillosis is paramount in improving patient outcomes. It also serves to show the difficulties faced with the parallel use of different treatment regimens and how unconventional treatment protocols may sometimes prove effective.

Pleiotropy and epistasis within and between signaling pathways defines the genetic architecture of fungal virulence

“…Our findings in the present study may also have implications for clinical treatment of cryptococcal disease. Outright resistance to antifungals such as amphotericin B is rare in Cryptococcus species (Kelly et al, 1994;Singhal et al, 2016), but variance in the minimum inhibitory concentrations of antifungals, including amphotericin B, have been observed within species. Such variation could lead to recurring instances of disease within patients (Govender et al, 2011;Hagen et al, 2012;Espinel-Ingroff et al, 2012;Singer et al, 2014).…”

Antifungal Combination of Ethyl Acetate Extract of Poincianella pluviosa (DC.) L. P. Queiros Stem Bark With Amphotericin B in Cryptococcus neoformans

“…Amphotericin B, a fungicidal agent, is considered the gold standard for the treatment of disseminated fungal infections ( WHO, 2018 ). Although antifungal resistance to this drug is rare among cryptococcal isolates, cases of therapeutic failure have been documented ( Singhal et al, 2016 ; Bandaranayake et al, 2018 ). Furthermore, prolonged treatment with AmB can lead to renal failure, hypokalemia, hypomagnesemia, and anemia ( Bermas and Geddes-McAlister, 2020 ).…”

Cryptococcus neoformans var. grubii: The In Vitro Antifungal Susceptibility Pattern in Addition to the Quantification of Phospholipase and Proteinase Enzymatic Activities

“…Fluconazole and amphotericin B are widely employed in developing countries. However, C. neoformans strains, resistant/non-responding to amphotericin B, fluconazole, and 5-flucytosine have been reported around the globe, resulting in treatment failure/relapse (5)(6)(7). Keeping these facts in mind, a prospective study was performed to determine the variety of Cryptococcus causing human infections and their antifungal susceptibility for fluconazole, amphotericin B, and voriconazole.…”