Disseminated Cryptococcosis in HIV Seropositive Patient

-P.Akshay Khumar

Abstract…• Cryptococcus neoformans causes Opportunistic Infection• May cause Dissemination and Death• Indicator for Dissemination- skin lesion• Immediate anti fungal therapy prevent further

complications• Here we would discuss a HIV Positive individual with

skin lesions from whom C.neoformans were isolated by culture from skin and blood

• The patient died before Antifungal therapy could be initiated

Introduction…• C.neoformans is an encapsulated

heterobasidiomycetous fungi• World wide opportunistic pathogen• Cryptococcus has about 70 species but human

infection is caused only by C.neoformans and C.gatti

• May cause Asymptomatic colonisation of Repiratory tract to disseminated infection

Contd…• Cryptococcal meningoencepalitis occurs in

HIV patients with CD4 less than 100 cells/µl• Skin lesions provides first evidence of

Dissemination• Has poor prognosis• Early diagnosis and treatment can improve

survival

Case Report:• A 52 yrs Male Pt, Bus Driver by profession,

From Theni district • Presented with multiple elevated skin lesions

over face, nape of the neck, trunk and rt lower limb of 3 weeks duration

• Headche of 10 days• No H/O seizures• No H/O Diabetes, Hypertension and Jaundice

• H/O Pulmonary tuberculosis and was treatment since 1 month

• A known HIV positive individual on Antiretroviral therapy

• Differntial diagnoses : AIDS with Disseminated cryptococcosis,Penicilliosis and Molluscum contagiosum

Investigations…

• Blood Ivestigations: Anaemia Low TLC• Renal function tests and Liver function tests

were within normal limits.• CD4 count 67 cells/cumm• Chest X-Ray – Normal• CT Brain – No abnormality

Contd…• Skin excision biopsy showed plenty of budding

yeast cells with well defined capsules by India Ink and Gram stain

• Specimens were inoculated in SDA with antibiotics at 37°C and 25°C

• Yeast like highly mucoid creamy coloured growth was observed after 3 days

• Were confirmed as C.neoformans by Grams stain,Positive urease test, and non-utilisation of D-Proline and D-Tryptophan on assimilation agar at 25°C

Yeast like highly mucoid creamy coloured growth

Discussion…• Disseminated Cryptococcosis confirmed is defined

by(i) A positive culture from atleast two different sites (ii) A positive blood culture• Skin lesions are of poor prognosis• Lesions occur at head and neck and may present as

papules,plaques,nodules,ulcers,lesions simulating Molluscum contagiosum and Kaposi’s sarcoma

Contd…

• CSF was not tapped due to raised ICT• However studies indicate lumbar puncture should

be done on patients suspected for Cryptococcal meningitis

• Mortality rate is 70-80%• In our case the clinical deterioration manifested as

loss of consciousness, Seizures due C.neoformans meningoencephalitis with dissemination to skin before the administration of antifungal therapy.

Conclusion…

• In HIV positive patients with cutaneous lesions there are high chances of Cryptococcosis

• Laboratory diagnosis and antifungal therapy are essential to improve survival

Acknowledgements…

• Institute of Microbiology, MMC, Chennai• National Journal on Basic Medical Sciences• www.njbms.com