A Case of Disseminated Infection with Skin Manifestation due to Non-neoformans and Non-gattii Cryptococcus in a Patient with Refractory Acute Myeloid Leukemia

Cryptococcus spp. other than Cryptococcus neoformans or Cryptococcus gattii were previously considered saprophytes and thought to be non-pathogenic to humans. However, opportunistic infections associated with non-neoformans and non-gattii species, such as Cryptococcus laurentii and Cryptococcus albidus, have increased over the past four decades. We experienced a case of cryptococcosis caused by non-neoformans and non-gattii spp. in a 47-year-old female with refractory acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation. The patient underwent salvage chemotherapy with fluconazole prophylaxis and subsequently developed neutropenic fever with multiple erythematous umbilicated papules. A skin biopsy revealed fungal hyphae and repetitive blood cultures showed yeast microorganisms that were identified later as C. laurentii by Vitek-II®. Skin lesions and fever began to improve with conventional amphotericin B therapy. The treatment regimen was continued for 21 days until the disseminated cryptococcosis was completely controlled.

Cryptococcus laurentii fungaemia in a cervical cancer patient

ABSTRACT Infections caused by emerging Cryptococcus non-neoformans species are being reported with increasingly frequency. Here, we present a case of fungaemia byCryptococcus laurentii in a woman receiving aggressive immunosuppressive therapy for cervical neoplasia. Three venous blood samples were aseptically collected on consecutive days and C. laurentiiwas isolated and identified through phenotypic and molecular methods. After central venous catheter removal and appropriate antifungal therapy, the patient showed significant improvement and blood culture became negative. Thus, patients following immunosuppressive therapies and using invasive medical devices are at risk of C. laurentii blood infections.

Fatal meningitis by Cryptococcus laurentii in a post‑partum woman: A manifestation of immune reconstitution inflammatory syndrome.

Cryptococcal meningitis in immunocompetent post‑partum women has been rarely reported. Immune restoration during post‑partum period leads to unmasking of many opportunistic infections that may have been acquired during pregnancy but manifest itself in the post‑partum period due to immune reconstitution inflammatory syndrome. This case highlights the importance of considering opportunistic pathogens in immunocompetent patients who may be undergoing immune restoration. We report here a fatal case of post‑partum immunocompetent women who presented with clinical features of meningitis. Prognosis of the cryptococcal meningitis not only depends on the immune status of the patient but also on how early the disease is diagnosed in the course of illness.

Optimization of lipids production by Cryptococcus laurentii 11 using cheese whey with molasses

This study aimed the optimization of culture condition and composition for production of Cryptococcus laurentii 11 biomass and lipids in cheese whey medium supplemented with sugarcane molasses. The optimization of pH, fermentation time, and molasses concentration according to a full factorial statistical experimental design was followed by a Plackett-Burman experimental design, which was used to determine whether the supplementation of the culture medium by yeast extract and inorganic salts could provide a further enhancement of lipids production. The following conditions and composition of the culture medium were found to optimize biomass and lipids production: 360 h fermentation, 6.5 pH and supplementation of (g L-1): 50 molasses, 0.5 yeast extract, 4 KH2PO4, 1 Na2HPO4, 0.75 MgSO4•7H2O and 0.002 ZnSO4•H2O. Additional supplementation with inorganic salts and yeast extract was essential to optimize the production, in terms of product concentration and productivity, of neutral lipids by C. laurentii 11. Under this optimized condition, the production of total lipids increased by 133% in relation to control experiment (from 1.27 to 2.96 g L-1). The total lipids indicated a predominant (86%) presence of neutral lipids with high content of 16- and 18- carbon-chain saturated and monosaturated fatty acids. This class of lipids is considered especially suitable for the production of biodiesel.

Características in vitro de isolados do complexo Cryptococcus laurentii em diferentes meios de cultura / In vitro characteristics of isolates of Cryptococcus laurentii complex in different culture media

Cryptococcus laurentii é um fungo distribuído em diversos ambientes e, eventualmente, causa infecção no homem. Por ser uma espécie considerada emergente, requer, para sua identificação laboratorial, conhecimento técnico mais especializado, provas ou testes laboratoriais específicos que nem sempre estão disponíveis. O objetivo deste trabalho foi descrever características fenotípicas invitro de isolados do complexo C. laurentii em meios de cultura utilizados na rotina de laboratório de microbiologia. Foram estudados isolados do complexo C. laurentii em diferentes meios de culturae condições...

Cryptococcus laurentii is a fungus distributed in different environments, where individuals comeinto contact with it, become colonized and develop infections that vary according to their immunestatus. This species is considered emerging, and for its laboratory identification specialized technical knowledge is required, as well asspecific laboratory tests that are not always available. The objective was to describe the phenotypic characteristics of in vitro C. laurentii complexes in culture mediathat are routinely used in microbiology laboratories...

Comparison of primers for RAPD-PCR from environmental isolates of Cryptococcus neoformans, Cryptococcus albidus and Cryptococcus laurentii complex

Various organisms have been characterized by molecular methods, including fungi of the genus Cryptococcus. The purposes of this study were: to determine the discriminatory potential of the RAPD (Random Amplified Polymorphic DNA) primers, the pattern of similarity of the Cryptococcus species, and discuss their useful application in epidemiological studies. We analyzed 10 isolates of each specie/group: C. albidus, C. laurentii complex, C. neoformans var. grubii, all from environmental source, and two ATCC strains, C. neoformans var. grubii ATCC 90112, and C. neoformans var. neoformans ATCC 28957 by RAPD-PCR using the primers CAV1, CAV2, ZAP19, ZAP20, OPB11 and SEQ6. The primers showed a good discriminatory power, revealing important differences between them and between species; the SEQ6 primer discriminated a larger number of isolates of three species. Isolates of C. laurentii showed greater genetic diversity than other species revealed by all six primers. Isolates of C. neoformans were more homogeneous. Only the primer CAV2 showed no amplification of DNA bands for C. albidus. It was concluded that the use of limited number of carefully selected primers allowed the discrimination of different isolates, and some primers (e.g., CAV2 for C. albidus) may not to be applied to some species.

Infección asociada a catéter central por Cryptococcus laurentii en niño críticamente enfermo: a propósito de un caso y revisión del tema / Cryptococcus laurentii infection of central catheter in critically ill child: in regards to a case and literature review

La criptococosis es una infección fúngica que afecta de forma predominante a pacientes con compromiso de la inmunidad celular; Cryptococcus neoformans es el agente patógeno más frecuente de este género. La infección asociada a los catéteres endovasculares es una entidad muy poco frecuente descrita con Cryptococcus laurentii y, en casos excepcionales, con C. neoformans. Se presenta el caso de un paciente de tres meses de edad con bronquiolitis aguda por adenovirus que lo llevó a falla respiratoria, requirió manejo inotrópico y desarrolló múltiples complicaciones infecciosas. Se aisló C. laurentii en el cultivo de la punta del catéter central, el cual no se logró obtener en los hemocultivos. Recibió tratamiento con anfotericina B con una dosis acumulada de 10 mg/kg y los cultivos de control también fueron negativos. La evolución, desde el punto de vista respiratorio, fue mala con fracaso de la respiración mecánica asistida y muerte.

Cryptococcosis is a fungal infection that predominantly affects patients with compromised cellular immunity. Cryptococcus neoformans is the most common pathogen of this class. Endovascular catheter-related infection is a rare entity described for Cryptococcus laurentii and, in exceptional cases, for C. neoformans. A case of a 3-month-old child with adenovirus acute bronchiolitis which lead to respiratory failure requiring inotropy and developing multiple infectious complications is presented. Cryptococcus laurentii was isolated in the culture from the tip of the central catheter, which could not be obtained in blood cultures. He was treated with amphotericin B in a cumulative dose of 10 mg/kg with negative control cultures. From a respiratory point of view, evolution was not good, with a failure from mechanical ventilation and posterior death.

Isolados de Cryptococcus neoformans, C. gattii E C. laurentii produtores de protease e fosfolipase / Protease and phospholipase production of Cryptococcus neoformans, C. gattii and C. laurentii isolates

A criptococose é uma micose sistêmica com caráter oportunista, que pode acometer homens e diferentes espécies animais, principalmente em casos de imunodepressão. A levedura penetra pela via respiratória, pode disseminar-se por via hematógena e atingir o sistema nervoso central. Objetivando o isolamento da levedura Cryptococcus neoformans a partir de sistema nervoso central de cães na cidade do Rio de Janeiro, procederam-se coleta de amostras de cérebro no Laboratório de Diagnóstico de Raiva do Instituto Municipal de Medicina Veterinária Jorge Vaitsman, no bairro da Mangueira, Rio de Janeiro. As etapas de isolamento, identificação e avaliação da produção de protease e fosfolipase ocorreram no Laboratório de Leveduras Patogênicas e Ambientais da Universidade Federal Rural do Rio de Janeiro (LLPA-UFRRJ). Para a avaliação de protease, utilizou-se meio de cultura contendo albumina bovina e para avaliação de fosfolipase, o meio utilizado compunha-se de gema de ovo e CaCi2. Foram utilizadas 166 amostras de sistema nervoso central, com quatro isolamentos positivos para o gênero, sendo um de Cryptococcus laurentii, dois de Cryptococcus neoformans e um de Cryptococcus gattii, todos produtores de protease e fosfolipase.

Avaliação da produção de melanina por espécies de Cryptococcus em quatro diferentes meios de cultura / Evaluation of melanin production by Cryptococcus species in four different culture media

A capacidade de Cryptococcus spp produzir melanina em meios contendo compostos fenólicos é amplamente utilizada na identificação destas espécies no laboratório. O objetivo do presente trabalho foi comparar a produção desse pigmento em quatro meios de cultura por Cryptococcus sp. Foram testadas 16 cepas de Cryptococcus neoformans, 17 de Cryptococcus albidus, 13 de Cryptococcus laurentii, e 2 de Cryptococcus uniguttulatus nos meios: ágar batata e cenoura, ágar alpiste, ágar semente de girassol e ágar L-dopa. A produção de melanina foi avaliada com base na pigmentação das colônias, e demonstrada em 5 dias de incubação por 93,8 por cento das cepas de Cryptococcus neoformans nos meios ágar batata e cenoura, ágar semente de girassol e ágar L-dopa. Dos isolados de Cryptococcus albidus, 29,4 por cento produziram o pigmento em ágar batata e cenoura e L-dopa, 11,8 por cento em ágar alpiste, e 36 por cento em ágar girassol. De Cryptococcus laurentii, 53,8 por cento produziram em batata e cenoura e em semente de girassol, 61,5 por cento em L-dopa, 84,6 por cento em ágar alpiste. Somente uma cepa de Cryptococcus uniguttulatus produziu fracamente o pigmento em ágar batata e cenoura.

The capacity of Cryptococcus spp to produce melanin in media containing phenol compounds is widely used for identifying these species in the laboratory. The aim of the present study was to compare the production of this pigment by Cryptococcus spp. in four culture media. Sixteen strains of Cryptococcus neoformans, 17 of Cryptococcus albidus, 13 of Cryptococcus laurentii and two of Cryptococcus uniguttulatus were tested in the following media: potato-carrot agar, Niger seed agar, sunflower seed agar and L-dopa agar. The melanin production was evaluated on the basis of colony pigmentation. Its production after five days of incubation was demonstrated by 93.8 percent of the strains of Cryptococcus neoformans in the media of potato-carrot agar, sunflower seed agar and L-dopa agar. From the isolates of Cryptococcus albidus, 29.4 percent produced the pigment in potato-carrot agar and L-dopa agar, 11.8 percent in Niger seed agar and 36 percent in sunflower seed agar. From Cryptococcus laurentii, 53.8 percent produced the pigment in potato-carrot agar and sunflower seed agar, 61.5 percent in L-dopa agar and 84.6 percent in Niger seed agar. Only one strain of Cryptococcus uniguttulatus presented slight production of the pigment, in potato-carrot agar.

A Case of Mixed Fungemia with Cryptococcus laurentii and Candida zeylanoides / 대한임상병리학회지

Cryptococcus laurentii is one of several non-neoformans cryptococci that have rarely been associated with human infection. Candida zeylanoides, an unusual Candida species, is also infrequently reported as a human pathogen. We report a case of mixed fungemia with C. laurentii and C. zeylanoides in a 12-year-old girl. The patient with acute myelogenous leukemia was receiving intensive remission induction chemotherapy through a central venous catheter (CVC) and was severely neutropenic. She had been treated with oral fluconazole prophylaxis since admission. C. laurentii and C. zeylanoides were simultaneously isolated from the peripheral blood cultures collected on days 29 and 31 of her hospital stay. The culture of the removed catheter tip grew >15 CFU of both C. laurentii and C. zeylanoides. In vitro susceptibility testing of the strains showed that the MIC of fluconazole for C. laurentii and C. zeylanoides were 8 microgram/mL and 4 microgram/mL, respectively. The patient was successfully treated by CVC removal and by treatment with amphotericin B intravenously. To our knowledge, this represents the first report of C. laurentii and C. zeylanoides fungemia in Korea.