Isolation of Cryptococcus laurentii in a patient of renal transplantation

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. Some authors reported a case of pulmonary cryptococcosis caused by C. laurentii in a diabetic AIDS patient who was on antituberculosis and antiretroviral treatments. 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 of 43 year old male patient who presented with fever, cough, chest pain and expectoration for 3 days. The patient gave the history of hypertension, diabetes mellitus and kidney transplantation. The patient gave a history of corticosteroid treatment for last 5 years. Sputum and pus samples were received in the lab in sterile container was cultured on blood and mac Conkey 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). Conclusion: To the best of my knowledge it is the first case reported from IGIMS, Patna, Bihar. In the present case report the patient was having renal transplantation and on prolonged corticosteroid therapy so was immunocompromised. Recent report on the outbreak of Cryptococcus infections should be considered as an alarming signal. Generally, immunocompromised 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 compared to AIDS (2%) patients who suffer from disseminated Cryptococcal disease.