Atypical Cryptococcus neoformans cells isolated from cerebrospinal fluid samples

Abstract

Most pathogenic fungi show dual morphology features in their saprophytic and parasitic stage. Occasionally, yeast cells produce short and aberrant hyphae, or large cells which can be seen on granulomas histological analysis, and otherwise as giant forms in fresh pus from abscesses, or also as highly encapsulated - serotype B in tissue specimens. The present study reports a HIV positive 39 years old single male patient, who presented oral candidiasis, pulmonary tuberculosis, cardiac insufficiency, Corynebacterium sp meningitis, and neurocryptococcosis due to C. neoformans var. neoformans. The patient was treated with amphotericin B for 45 days, who received approximately a total of 1,960 mg of drug. Atypical C. neoformans cells in diverse sizes and blastoconidia forms were isolated from cerebrospinal fluid (CSF). CSF stained with a China ink preparation revealed the presence of ovoid, branched, and pseudohyphae forms surrounded by a thick capsule. The isolate variety was identified as C. neoformans var. neoformans. Antifungal susceptibility testing performed by means of EUCAST5 technique indicated that the strain was sensitive to amphotericin B (MIC = 0.12μg/mL), fluconazole (2μg/mL), and itraconazole (0.06 μg/mL). The previous reports on atypical yeast cells form described the occurrence of multiple and irregular blastoconidia in human clinical samples.