First report of Cryptococcus laurentii meningitis and a fatal case of Cryptococcus albidus cryptococcaemia in AIDS patients

Abstract

We report the first case of Cryptococcus laurentii meningitis and a rare case of Cryptococcus albidus cryptococcaemia in AIDS patients. Both infections were treated with amphotericin B and flucytosine. The C. laurentii meningitis was controlled after 2 weeks of treatment with no evidence of infection 20 months later. The patient with C. albidus cryptococcaemia, despite the amphotericin B/flucytosine combination therapy, died on the 14th day of treatment. The minimum inhibitory concentrations (MICs) for C. laurentii, as determined by Etest on RPMI 1640 agar, were 0·25 μg ml−1 of amphotericin B, 1·25 μg ml−1 flucytosine, 4 &mgr;g ml−1 fluconazole, 0·50 &mgr;g ml−1 itraconazole and 1·0 μg ml−1 of ketoconazole. The MIC of amphotericin B for C. albidus was 0·5 μg ml−1, flucytosine 1·25 μg ml−1, fluzonazole 4 μg ml−1, itraconazole 0·5 μg ml−1 and ketonazole 0·25 μg ml−1. The agreement of the amphotericin B MIC values obtained in antibiotic medium 3 by the broth microdilution method, with those obtained on casitone medium by Etest, was within a two-dilution range for both isolates. C. laurentii may cause meningitis and may also involve the lungs in AIDS patients.