Pneumonia and Pleural Effusion due toCryptococcus Laurentiiin a Clinically Proven Case of AIDS

Abstract

Non-neoformans cryptococci were previously considered to be saprophytes and nonpathogenic to humans.Cryptococcus laurentiiis frequently used as a biological means to control fruit rot. Interestingly,C laurentiihas recently been reported to be a rare cause of infection in humans. The authors report a case of pulmonary cryptococcosis caused byC laurentiiin a diabetic AIDS patient who was on antituberculosis and antiretroviral treatments. The sputum smear revealed capsulated yeast cells that were identified asC laurentii. Repeated pleural fluid culture revealed growth ofC laurentii. Both respiratory samples were negative for acid-fast bacilli.Moraxella catarrhalisandKlebsiella pneumoniaewere also found in the sputum, but not in the pleural fluid. The patient had a good response to oral fluconazole therapy at 600 mg/day for five weeks and was then discharged. The present article is the first to report on the rare pulmonary involvement ofC laurentiiin the Indian HIV population. These unusual forms of cryptococci create a diagnostic predicament in the rapid diagnosis of pulmonary cryptococcosis. A high degree of suspicion and improvement of techniques for culture and identification will contribute to the early diagnosis and treatment of unusual fungal infections.