3,4 Yeast colonies isolated from CSF and blood cultures were identified as C. The patient received dual antifungal treatment: liposomal amphotericin B and fluconazole, since flucytosine was unavailable. The cryptococcal antigen test of both the CSF and blood specimens were positive.

Cryptococcus was also detected on the CSF by PCR, using the BIOFIRE® FILMARRAY® system (bioMérieux SA, Marcy-l’Étoile, France). The suspicion of Cryptococcus at the examination of CSF led to India-ink staining, which revealed capsulated yeast typical of Cryptococcus. The lumbar puncture performed in the emergency department showed 60 cells, protein 3.0 g/L, and glucose 0.61 mmol/L. Despite the treatment, the patient was febrile at admission, with a reduced level of consciousness, and, due to hypoxia, she was intubated. She was receiving empiric quadruple anti-tuberculosis treatment in addition to common antimicrobials for 7 days. She was initially diagnosed as having tuberculous meningitis with concomitant pulmonary tuberculosis, based on the clinical picture, chest CT, and compatible early findings of cerebrospinal fluid (CSF). Her medical history was remarkable for myasthenia gravis, treated with mycophenolate mofetil and prednisolone for >1 year allergic and asthmatic bronchitis and Type 2 diabetes. CASE DESCRIPTIONĪ 74-year-old female patient was admitted to the high-dependency unit of the authors’ hospital after being referred by a neurological clinic due to subacute meningitis. 2 The authors report a case of cryptococcal meningoencephalitis and cryptococcaemia in a patient with myasthenia gravis, emphasising the need for clinical suspicion and timely laboratory diagnosis of cryptococcosis in HIV-negative patients. In HIV-negative individuals, predisposing risk factors include: solid organ transplant corticosteroid therapy chronic lung disease and haematologic malignancies. 1,2 Nevertheless, non-HIV patient populations are also at risk. 1,2 Patients with HIV infection are at high risk of developing cryptococcosis. neoformans (cryptococcosis) is of global importance with significant attributable mortality, usually affecting the lungs and the central nervous system. Cryptococcus neoformans is an opportunistic fungal pathogen transmitted to humans by inhalation, mainly of infected bird droppings.

India ink microbiology