Fulminant atypical Cryptococcus neoformans pneumonia confirmed by PLEX-ID

Karim Gariani; Mathieu Rougemont; Gesuele Renzi; Jonathan Hibbs; Stéphane Emonet; Jacques Schrenzel

doi:10.1016/j.ijid.2014.01.013

Fulminant atypical Cryptococcus neoformans pneumonia confirmed by PLEX-ID

Int J Infect Dis. 2014 May:22:17-8. doi: 10.1016/j.ijid.2014.01.013. Epub 2014 Mar 1.

Authors

Karim Gariani¹, Mathieu Rougemont², Gesuele Renzi³, Jonathan Hibbs⁴, Stéphane Emonet⁵, Jacques Schrenzel⁶

Affiliations

¹ Department of Internal Medicine, Division of General Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland.
² Infectious Diseases Service, University of Geneva Hospitals and Faculty of Medicine, CH-1211 Geneva 14, Switzerland.
³ Bacteriology Laboratory, Service of Infectious Diseases, Department of Internal Medicine, Geneva University Hospitals, Geneva Switzerland.
⁴ Genomic Research Laboratory, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
⁵ Infectious Diseases Service, University of Geneva Hospitals and Faculty of Medicine, CH-1211 Geneva 14, Switzerland; Bacteriology Laboratory, Service of Infectious Diseases, Department of Internal Medicine, Geneva University Hospitals, Geneva Switzerland.
⁶ Infectious Diseases Service, University of Geneva Hospitals and Faculty of Medicine, CH-1211 Geneva 14, Switzerland; Bacteriology Laboratory, Service of Infectious Diseases, Department of Internal Medicine, Geneva University Hospitals, Geneva Switzerland; Genomic Research Laboratory, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address: Jacques.schrenzel@hcuge.ch.

PMID: 24589681
DOI: 10.1016/j.ijid.2014.01.013

Abstract

Use of the PLEX-ID system can lead to a rapid molecular diagnosis in microbiology. To illustrate the clinical implications of this new diagnostic tool, we present the case of a 46-year-old patient admitted with severe respiratory failure and septic shock. Cryptococcal pneumonia was diagnosed by Fungi-Fluor™ staining of the bronchoalveolar lavage (BAL) and the patient tested positive for HIV. Unfortunately, he died 12h after admission despite intensive care support and treatment with broad-spectrum antibiotics, amphotericin B, and flucytosine. Retrospective use of the PLEX-ID on the BAL, bronchial aspirate, and blood yielded Cryptococcus neoformans in all fluids tested. Rapid molecular diagnosis with PLEX-ID, especially when performed on the blood of septic patients, may reduce the time to adequate treatment and limit the number of diagnostic procedures needed.

Keywords: Cryptococcus neoformans; Molecular diagnostic; PLEX-ID.

Publication types

Case Reports

MeSH terms

Amphotericin B / therapeutic use
Anti-Bacterial Agents / therapeutic use
Antifungal Agents / therapeutic use
Bronchoalveolar Lavage Fluid / microbiology
Coinfection
Cryptococcosis / diagnosis*
Cryptococcosis / drug therapy
Cryptococcosis / microbiology
Cryptococcosis / pathology
Cryptococcus neoformans / genetics*
Cryptococcus neoformans / isolation & purification
Fatal Outcome
Female
Flucytosine / therapeutic use
HIV Infections / diagnosis*
HIV Infections / pathology
HIV Infections / virology
Humans
Male
Middle Aged
Nucleic Acid Amplification Techniques
Pneumonia / diagnosis*
Pneumonia / drug therapy
Pneumonia / microbiology
Pneumonia / pathology

Substances

Anti-Bacterial Agents
Antifungal Agents
Amphotericin B
Flucytosine