A case of pulmonary cryptococcosis followed by pleuritis in an apparently immunocompetent patient during fluconazole treatment.

Cryptococcal pleuritis is rare in individuals with no underlying disease. We report a case of pulmonary cryptococcosis followed by pleuritis in a patient on fluconazole treatment. Biopsy of the pleura revealed a granuloma and a cryptococcal body, while PCR and sequence analysis of extracted DNA from the pleura proved the presence of Cryptococcus species, most likely C. neoformans. Voriconazole with flucytosine and drainage of the pleural effusion were effective in treating the patient

Correlation of anti-fungal susceptibility with clinical outcomes in patients with cryptococcal meningitis

<p>Abstract</p> <p>Background</p> <p>This study aimed to investigate the correlation of minimum inhibiting concentrations (MICs), obtained by broth micro-dilution, and clinical response in patients with cryptococcal meningitis.</p> <p>Methods</p> <p>Using retrospective analyses covering the period 2001–2010, factors affecting clinical therapeutic cure in patients with cryptococcal meningitis 10 weeks after the start of anti-fungal therapy were identified. Specific emphasis was placed on the role of anti-fungal susceptibility.</p> <p>Results</p> <p>Of 46 patients with cryptococcal meningitis identified, 21 were cured after 10 weeks of treatment. Overall, 12 strains (26.1%) were resistant to fluconazole (>8 μg/ml) and 8 (17.4%) had an MIC >1 μg/ml for amphotericin B. Twenty-three patients received combination amphotericin B and fluconazole as their initial antifungal therapy, 17 were given amphotericin B only, five received fluconazole only, and one received a combination of amphotericin B and flucytosine. After 2 weeks, all patients received fluconazole (400–600 mg daily for 8 weeks at least, then 200 mg daily thereafter). The presence of isolates resistant to fluconazole (MIC >8 μg/ml; 4.8% vs. 44%, <it>p</it> < 0.01) were statistically significant among patients who were cured. Anti-fungal susceptibility, reflected by fluconazole MIC >8 μg/ml, was an independent predictor of therapeutic cure at 10-week evaluation (OR = 15.7; 95% CI: 1.8-135.9; <it>p</it> = 0.01), but higher MIC of amphotericin B (>1 μg/ml) was not.</p> <p>Conclusions</p> <p>The MICs of fluconazole, determined by the CLSI method, may be a potential predictor of therapeutic cure in patients with cryptococcal meningitis.</p