title: First case of mixed infection withCryptococcus deuterogattiiandCryptococcus neoformansVNI in an Ivorian HIV-positive patient.
abstract: BACKGROUND
  Cryptococcal meningitis (CM) may be caused by several species ofCryptococcus.
  
  
  METHODS
  We describe a fatal case of CM in a HIV-positive patient from Ivory Coast infected byCryptococcus neoformansVNI andCryptococcusdeuterogattii. Isolates were recovered from cerebrospinal fluid (CSF) prior to systemic antifungal treatment. Six isolates were studied (the entire culture plus five isolated colonies from it). Serotyping was performed via LAC 1 and CAP 64 gene amplification. Genotyping was performed using restriction fragment length polymorphism (RFLP) analysis of the URA5 gene, (GACA)4, (GTG)5and M13 PCR fingerprinting. URA5-RFLP analysis identified the original culture with two different molecular type combinations. However, URA5-RFLP profiles of the five colonies isolated from the original sample revealed two different species. Four colonies were identified asC.deuterogattiiand the last isolate asC.neoformansVNI. Thein vitrosusceptibility profile was determined using the standard method according to the CLSI M27-A3 protocol. The isolates were susceptible to the tested antifungals (fluconazole, flucytosine and amphotericin B). Treatment with fluconazole (1200  mg day-1) was initiated; however, the patient died 17 days after the onset of antifungal therapy.
  
  
  CONCLUSIONS
  This is the first reported case of mixed infection withC. neoformansandC.deuterogattiiin a HIV-positive patient.
authors.affiliation: Université Félix Houphouët Boigny, UFR Pharmacie, Laboratoire de Parasitologie et Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les autres maladies infectieuses), CHU de Treichville, BP V3, Abidjan, Cote d'Ivoire; UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie, 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5, France.
authors.forename: Fulgence K
authors.initials: FK
authors.lastname: Kassi
authors.affiliation: UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Bellet
authors.affiliation: Service des Maladies Infectieuses et Tropicales, CHU de Treichville , 01 BP V3, Abidjan , Côte d'Ivoire.
authors.forename: Adama
authors.initials: A
authors.lastname: Doumbia
authors.affiliation: UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France.
authors.forename: Donika
authors.initials: D
authors.lastname: Krasteva
authors.affiliation: UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Drakulovski
authors.affiliation: Service des Maladies Infectieuses et Tropicales, CHU de Treichville , 01 BP V3, Abidjan , Côte d'Ivoire.
authors.forename: Gisèle A
authors.initials: GA
authors.lastname: Kouakou
authors.affiliation: UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France.
authors.forename: François
authors.initials: F
authors.lastname: Gatchitch
authors.affiliation: UMI 233 Service des Maladies Infectieuses et Tropicales, CHU Gui de Chauliac` , Montpellier , France.
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.affiliation: UMI 233 Service des Maladies Infectieuses et Tropicales, CHU Gui de Chauliac` , Montpellier , France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Reynes
authors.affiliation: UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Mallié
authors.affiliation: Université Félix Houphouët Boigny, UFR Pharmacie, Laboratoire de Parasitologie et Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les autres maladies infectieuses), CHU de Treichville, BP V3, Abidjan , Cote d'Ivoire.
authors.forename: Hervé I E
authors.initials: HI
authors.lastname: Menan
authors.affiliation: UMI 233 IRD-UM-INSERM U1175 Laboratoire de Parasitologie et Mycologie médicale UFR Pharmacie , 15 Av. C. Flahault, BP 14491, 34093 Montpellier Cedex 5 , France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bertout
keywords:  Cryptococcus neoformans; AIDS; Cryptococcus deuterogattii; antifungal susceptibility; genotyping; mixed infection