title: Fulminant atypical Cryptococcus neoformans pneumonia confirmed by PLEX-ID.
abstract: Use of the PLEX-ID system can lead to a rapid molecular diagnosis in microbiology. To illustrate the clinical implications of this new diagnostic tool, we present the case of a 46-year-old patient admitted with severe respiratory failure and septic shock. Cryptococcal pneumonia was diagnosed by Fungi-Fluor™ staining of the bronchoalveolar lavage (BAL) and the patient tested positive for HIV. Unfortunately, he died 12h after admission despite intensive care support and treatment with broad-spectrum antibiotics, amphotericin B, and flucytosine. Retrospective use of the PLEX-ID on the BAL, bronchial aspirate, and blood yielded Cryptococcus neoformans in all fluids tested. Rapid molecular diagnosis with PLEX-ID, especially when performed on the blood of septic patients, may reduce the time to adequate treatment and limit the number of diagnostic procedures needed.
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Karim
authors.initials: K
authors.lastname: Gariani
authors.affiliation: Infectious Diseases Service, University of Geneva Hospitals and Faculty of Medicine, CH-1211 Geneva 14, Switzerland.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Rougemont
authors.affiliation: Bacteriology Laboratory, Service of Infectious Diseases, Department of Internal Medicine, Geneva University Hospitals, Geneva Switzerland.
authors.forename: Gesuele
authors.initials: G
authors.lastname: Renzi
authors.affiliation: Genomic Research Laboratory, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hibbs
authors.affiliation: Infectious Diseases Service, University of Geneva Hospitals and Faculty of Medicine, CH-1211 Geneva 14, Switzerland; Bacteriology Laboratory, Service of Infectious Diseases, Department of Internal Medicine, Geneva University Hospitals, Geneva Switzerland.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Emonet
authors.affiliation: Infectious Diseases Service, University of Geneva Hospitals and Faculty of Medicine, CH-1211 Geneva 14, Switzerland; Bacteriology Laboratory, Service of Infectious Diseases, Department of Internal Medicine, Geneva University Hospitals, Geneva Switzerland; Genomic Research Laboratory, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address: Jacques.schrenzel@hcuge.ch.
authors.forename: Jacques
authors.initials: J
authors.lastname: Schrenzel
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D060085:Coinfection; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D003455:Cryptococcus neoformans / Q000235:genetics* / Q000302:isolation & purification; D017809:Fatal Outcome; D005260:Female; D005437:Flucytosine / Q000627:therapeutic use; D015658:HIV Infections / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D021141:Nucleic Acid Amplification Techniques; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000666:Amphotericin B; D005437:Flucytosine
keywords: Cryptococcus neoformans; Molecular diagnostic; PLEX-ID