ISOLATION OF CRYPTOCOCCUS LAURENTII IN BAL FLUID IN AN ASTHMATIC PATIENT -A CASE REPORT
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Isolation of Cryptococcus laurentii in BAL fluid in an asthmatic patient.
Background: Cryptococcus laurentii is one of the several non neoformans Cryptococci that has rarely been associated with human infection. However in recent years, there has been an increase in incidence of opportunistic infections with Cryptococcus laurentii Cryptococci are a saprophytic fungi present in soil contaminated with bird droppings mainly pigeons, roosting sites and decaying vegetables. Cryptococcus species is now recognized as a potential pathogen which can cause superficial as well as systemic disease,the most common presentation being meningitis, but can cause lung disease, pneumonia or respiratory failure. Here we report a case of55 year old male patient who presentedwith fever, cough, chest pain and expectoration for 3 days. There was no history of hypertension, Diabetes mellitus or CAD. The patient gave a history of asthma on corticosteroid treatment for last 5 years. BAL fluid received in the lab in sterile container was cultured on Blood and MacConkey agar plates. On the basis of colony morphology, gram staining, Yeast panel was selected for identification and sensitivity of the microorganism on Vitec II,Fully automated microbiology analyser (Biomerieux) The growth of gram positive budding yeast cells was identified as Cryptococcus laurentii by Vitec II Susceptible to Amphotericin B.
Conclusion: In the present case report the patient was an asthmatic patient on prolonged corticosteroid therapy but was otherwise immunocompetent as his HIV status was negative. Recent report on the outbreak of Cryptococcus infections should be considered as an alarming signal. Generally, immuno compromised patients are at risk of Cryptococcal infection, but infection in immunocompetent patients cannot be ruled out. The infection is easy to miss, so a high degree of clinical suspicion, improved culture methods and identification techniques like Vitec II can contribute to the diagnosis of unusual fungal infections. Previous report have suggested that HIV negative patients ( 30-70 )% suffer from pulmonary cryptococcosis more frequently as comparedto AIDS (2%) patients who suffer from disseminated Cryptococcal disease.
Key Words: Cryptococcus laurentii, BAL fluid, Non neoformans Cryptococci,