title: Cryptococcus gattii meningoencephalitis in an immunocompetent person 13 months after exposure.
abstract: A 53-year old immunocompetent Swiss female is described who developed severe meningoencephalitis due to infection with Cryptococcus gattii 13 months following exposure on Vancouver Island, Canada. Diagnosis was based on cerebrospinal fluid (CSF) examination, i.e., positive India-ink staining, positive latex particle agglutination, and positive culture. Species identification was performed by growth on L-canavanine-glycine-bromthymol blue medium and by sequencing of the intergenic and internal transcribed spacer regions of the rRNA genes. After initial therapy with fluconazole by which the patient did not improve, therapy was changed to amphotericin B and flucytosine and later to high-dose fluconazole and amphotericin B. Despite long-term treatment and external drainage of the CSF, the patient's condition improved only slowly. The patient was discharged after 132 days of hospitalization.
authors.affiliation: Department of Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Georgi
authors.forename: M
authors.initials: M
authors.lastname: Schneemann
authors.forename: K
authors.initials: K
authors.lastname: Tintelnot
authors.forename: R C
authors.initials: RC
authors.lastname: Calligaris-Maibach
authors.forename: S
authors.initials: S
authors.lastname: Meyer
authors.forename: R
authors.initials: R
authors.lastname: Weber
authors.forename: P P
authors.initials: PP
authors.lastname: Bosshard
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D003454:Cryptococcus / Q000235:genetics / Q000302:isolation & purification*; D003470:Culture Media / Q000737:chemistry; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D004322:Drainage; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D008590:Meningoencephalitis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D008875:Middle Aged; D008969:Molecular Sequence Data; D010802:Phylogeny; D017422:Sequence Analysis, DNA; D013557:Switzerland; D014195:Travel
chemical_list: D000935:Antifungal Agents; D003470:Culture Media; D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine