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- 2. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
CRYPTOCOCCAL MENINGITIS
2
▰ Cryptococcal meningitis is caused by a capsulated yeast called
Cryptococcus neoformans - capable of producing potentially fatal
meningitis in HIV infected people
- 3. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Species and Serotypes
3
▰ Two species: C.neoformans and C. gattii and four serotypes A, B,
C and D.
▰ Two varieties—C. neoformans var. grubii and C. neoformans var.
neoformans
▰ C. gattii is antigenically diverse and corresponds to the serotypes
B and C
- 4. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Pathogenesis
4
▰ Infection is acquired by inhalation of aerosolized forms of
Cryptococcus
▰ Immunocompetent individuals - defense mechanisms limit the
infection
▰ Low immunity - pulmonary infection - dissemination through
blood
▰ CNS spread: Cross blood-brain barrier - migrate directly across
- 5. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Pathogenesis (Cont..)
5
Virulence factors
▰ Polysaccharide capsule
Antiphagocytic and also inhibits the host’s local immune
responses
▰ Ability to make melanin by enzyme phenyl oxidase
▰ Other enzymes – phospholipase and urease
- 6. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Pathogenesis (Cont..)
6
Risk factors :
▰ Patients with advanced HIV infection with CD4 T cell counts less
than 200/μL
▰ Patients with hematologic malignancies
▰ Transplant recipients
▰ Patients on immunosuppressive or steroid therapy
- 7. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Clinical Manifestations
7
▰ Pulmonary cryptococcosis: First and the most common
presentation
▰ Cryptococcal meningitis: Chronic meningitis, with headache,
fever, sensory and memory loss, cranial nerve paresis and loss
of vision (due to optic nerve involvement)
▰ Skin lesions
▰ Osteolytic bone lesions
- 8. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Epidemiology
8
▰ Geographical distribution: C. neoformans var. grubii (serotype
A) strains are found worldwide
▰ C. neoformans var. neoformans (serotype D) strains are restricted
to Europe
▰ C. gattii is confined to tropics
▰ Habitat: C. neoformans – soils contaminated with avian excreta
and pigeon droppings.
- 9. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Laboratory Diagnosis
9
▰ Specimens - CSF, blood or skin scrapings
- 10. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Direct Detection Methods
10
▰ Negative staining: Modified India
ink stain and nigrosin stain -
demonstrate the capsule
▰ Gram staining - Gram-positive
round budding yeast cells
- 11. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Direct Detection Methods (Cont..)
11
▰ Other stains:
Mucicarmine stain: Stains the carminophilic cell wall of C.
neoformans
Masson-Fontana stain: Demonstrates the production of
melanin
Alcian blue stain to demonstrate the capsule.
- 12. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Culture
12
▰ SDA without antibiotics, blood agar or
chocolate agar and incubated at 37°C
▰ Blood inoculated in biphasic blood
culture bottles
▰ Colonies - Mucoid creamy white and
yeast like
- 13. Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
Culture (Cont..)
13
▰ Confirmation of Cryptococcus species :
Niger seed agar and bird seed agar
Growth at 37°C
Urease test is positive
Assimilation of inositol and nitrate
Mouse pathogenicity test
