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Original article

Vol. 150 No. 3132 (2020)

First case of Cryptococcus gattii multilobar pneumonia in Switzerland and associated challenges

DOI
https://doi.org/10.4414/smw.2020.20306
Cite this as:
Swiss Med Wkly. 2020;150:w20306
Published
28.07.2020

Abstract

BACKGROUND

Cryptococcosis is a frequent complication in immunosuppressed patients, causing mainly central nervous system and lung infection, and leading to increased mortality risk.

CASE PRESENTATION

We present the first documented case in Switzerland of Cryptococcus gattii pneumonia in a kidney-pancreas transplant patient, with a concomitant Pneumocystis jirovecii infection mimicking an immune reconstitution syndrome. Diagnosis of cryptococcal pneumonia was based on a positive serum cryptococcal antigen and confirmed by Grocott’s methenamine silver and periodic acid-Schiff stains on bronchoalveolar lavage fliud. C. gattii was identified with mass spectrometry and antifungal susceptibility testing by microdilution was performed. After an initial successful treatment with liposomal amphotericin-B, flucytosine and tapering of immunosuppression, the patient clinically deteriorated, developing bilateral diffuse ground-glass opacities with consolidations on chest computed tomography. A diagnosis of probable P. jirovecii pneumonia versus an immune reconstitution syndrome was considered. Because of a high titre of Pneumocystis on polymerase chain-reaction testing of bronchoalveloar lavage fluid and high serum b-D-glucan, a diagnosis of probable P. jirovecii pneumonia was made.

CONCLUSION

This case illustrates the potential complications of a cryptococcal infection in immunosuppressed hosts, despite timely diagnosis and appropriate antifungal therapy.

References

  1. Forrest GN, Bhalla P, DeBess EE, Winthrop KL, Lockhart SR, Mohammadi J, et al. Cryptococcus gattii infection in solid organ transplant recipients: description of Oregon outbreak cases. Transpl Infect Dis. 2015;17(3):467–76. doi:.https://doi.org/10.1111/tid.12370
  2. Neofytos D, Horn D, Anaissie E, Steinbach W, Olyaei A, Fishman J, et al. Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance registry. Clin Infect Dis. 2009;48(3):265–73. doi:.https://doi.org/10.1086/595846
  3. George IA, Santos CAQ, Olsen MA, Powderly WG. Epidemiology of Cryptococcosis and Cryptococcal Meningitis in a Large Retrospective Cohort of Patients After Solid Organ Transplantation. Open Forum Infect Dis. 2017;4(1):ofx004. doi:.https://doi.org/10.1093/ofid/ofx004
  4. Maziarz EK, Perfect JR. Cryptococcosis. Infect Dis Clin North Am. 2016;30(1):179–206. doi:.https://doi.org/10.1016/j.idc.2015.10.006
  5. Cogliati M, D’Amicis R, Zani A, Montagna MT, Caggiano G, De Giglio O, et al. Environmental distribution of Cryptococcus neoformans and C. gattii around the Mediterranean basin. FEMS Yeast Res. 2016;16(4):fow045. doi:.https://doi.org/10.1093/femsyr/fow045
  6. Hagen F, Colom MF, Swinne D, Tintelnot K, Iatta R, Montagna MT, et al. Autochthonous and dormant Cryptococcus gattii infections in Europe. Emerg Infect Dis. 2012;18(10):1618–24. doi:.https://doi.org/10.3201/eid1810.120068
  7. Hatcher CR, Jr, Sehdeva J, Waters WC, 3rd, Schulze V, Logan WD, Jr, Symbas P, et al. Primary pulmonary cryptococcosis. J Thorac Cardiovasc Surg. 1971;61(1):39–49. doi:.https://doi.org/10.1016/S0022-5223(19)42273-3
  8. Singh N, Alexander BD, Lortholary O, Dromer F, Gupta KL, John GT, et al. Pulmonary cryptococcosis in solid organ transplant recipients: clinical relevance of serum cryptococcal antigen. Clin Infect Dis. 2008;46(2):e12–8. doi:.https://doi.org/10.1086/524738
  9. Litvintseva AP, Thakur R, Vilgalys R, Mitchell TG. Multilocus sequence typing reveals three genetic subpopulations of Cryptococcus neoformans var. grubii (serotype A), including a unique population in Botswana. Genetics. 2006;172(4):2223–38. doi:.https://doi.org/10.1534/genetics.105.046672
  10. Meyer W, Aanensen DM, Boekhout T, Cogliati M, Diaz MR, Esposto MC, et al. Consensus multi-locus sequence typing scheme for Cryptococcus neoformans and Cryptococcus gattii. Med Mycol. 2009;47(6):561–70. doi:.https://doi.org/10.1080/13693780902953886
  11. Neofytos D, Hirzel C, Boely E, Lecompte T, Khanna N, Mueller NJ, et al.; Swiss Transplant Cohort Study. Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort. Transpl Infect Dis. 2018;20(6):e12984. doi:.https://doi.org/10.1111/tid.12984
  12. Fujisawa T, Suda T, Matsuda H, Inui N, Nakamura Y, Sato J, et al. Real-time PCR is more specific than conventional PCR for induced sputum diagnosis of Pneumocystis pneumonia in immunocompromised patients without HIV infection. Respirology. 2009;14(2):203–9. doi:.https://doi.org/10.1111/j.1440-1843.2008.01457.x
  13. Fauchier T, Hasseine L, Gari-Toussaint M, Casanova V, Marty PM, Pomares C. Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients. J Clin Microbiol. 2016;54(6):1487–95. doi:.https://doi.org/10.1128/JCM.03174-15
  14. Obayashi T, Kawai T, Yoshida M, Mori T, Goto H, Yasuoka A, et al. Plasma (1-->3)-beta-D-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episodes. Lancet. 1995;345(8941):17–20. doi:.https://doi.org/10.1016/S0140-6736(95)91152-9
  15. Rhein J, Bahr NC, Morawski BM, Schutz C, Zhang Y, Finkelman M, et al. Detection of High Cerebrospinal Fluid Levels of (1→3)-β-d-Glucan in Cryptococcal Meningitis. Open Forum Infect Dis. 2014;1(3):ofu105. doi:.https://doi.org/10.1093/ofid/ofu105
  16. Baddley JW, Forrest GN ; AST Infectious Diseases Community of Practice. Cryptococcosis in solid organ transplantation. Am J Transplant. 2013;13(s4, Suppl 4):242–9. doi:.https://doi.org/10.1111/ajt.12116
  17. Sun HY, Alexander BD, Huprikar S, Forrest GN, Bruno D, Lyon GM, et al. Predictors of immune reconstitution syndrome in organ transplant recipients with cryptococcosis: implications for the management of immunosuppression. Clin Infect Dis. 2015;60(1):36–44. doi:.https://doi.org/10.1093/cid/ciu711
  18. Boulware DR, Meya DB, Muzoora C, Rolfes MA, Huppler Hullsiek K, Musubire A, et al.; COAT Trial Team. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med. 2014;370(26):2487–98. doi:.https://doi.org/10.1056/NEJMoa1312884
  19. Makadzange AT, Ndhlovu CE, Takarinda K, Reid M, Kurangwa M, Gona P, et al. Early versus delayed initiation of antiretroviral therapy for concurrent HIV infection and cryptococcal meningitis in sub-saharan Africa. Clin Infect Dis. 2010;50(11):1532–8. doi:.https://doi.org/10.1086/652652

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