title: Cryptococcal meningitis caused by Cryptococcus neoformans in an immunocompetent soldier.
abstract: BACKGROUND
  Cryptococcus neoformans is an encapsulated yeast that commonly causes disease in individuals in the setting of immunocompromised states. It is rarely reported in immunocompetent patients in the literature.
  An active duty service member with no significant medical history presented with persistent headache, nausea, vomiting, weight loss, and nocturnal fevers for 2 months. The patient was admitted to the hospital where a lumbar puncture was performed showing an elevated white blood cell count, low glucose, and elevated protein. Subsequent cerebral spinal fluid analysis yielded cryptococcal antigen latex screen and culture which speciated C. neoformans. The patient received fluconazole and flucytosine, and completed a 10-week course to result in a full recovery.
  
  
  CONCLUSIONS
  C. neoformans is found throughout the world in soil contaminated with bird droppings and usually causes infection and disease in individuals who are immunosuppressed. Rare case reports exist where C. neoformans causes central nervous infection in immunocompetent hosts. This fungal etiology should be considered in all patients presenting with meningitis symptoms and a cerebral spinal fluid panel with low glucose and high protein, or without a clear bacterial etiology. This case illustrates the importance of broadening the differential when previously healthy service members present with common or nonspecific symptoms.
authors.affiliation: Department of Family Medicine, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310.
authors.forename: Jelaun
authors.initials: J
authors.lastname: Newsome
authors.affiliation: Department of Family Medicine, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310.
authors.forename: Dana
authors.initials: D
authors.lastname: Nguyen
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008889:Military Personnel; D013129:Spinal Puncture; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole; D005437:Flucytosine