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Cryptococcosis can range from asymptomatic pulmonary colonization to life-threatening meningitis and disseminated disease. Most infections occur in immunodeficiency states, though recent reports suggest that immunocompetent individuals may be at risk with some varieties of the yeast. Cryptococcus neoformans var grubii and Cryptococcus neoformans var neoformans infect immunocompromised individuals,1 whereas Cryptococcus neoformans var gattii occurs predominantly in immunocompetent patients and has a strong male preponderance. This variety is found in the tropics in the decaying heartwood of a number of tree species and the outbreak in 2002 on Vancouver Island suggests this region to be the primary ecologic niche of the organism in Canada.2 To date, no cases of C neoformans var gattii in immunocompetent patients have been reported outside British Columbia. We describe clinical features of 3 such patients from Edmonton, Alberta.
Case reports.
Case 1.
A 52-year-old previously healthy man presented with a 2-day history of fever, drowsiness, and neck stiffness. In the previous month, he had experienced new onset headaches, excessive daytime sleepiness, decreased mobility, and occasional disorientation, though routine investigations, including brain CT scan, had been normal. His family had moved from British Columbia in 2006. His HIV serology and chest X-ray were normal. CSF had lymphocytic pleocytosis. Brain CT showed hypodensities in basal ganglia, which appeared as multiple septated cysts (cryptococcoma) on MRI with no enhancement or surrounding edema (figure, A–F). CSF India ink stain was positive for cryptococcus and cultures grew C neoformans var gattii. Induction therapy with amphotericin B and flucytosine was instituted with daily lumbar punctures for raised …
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