Summary
A 40-year old homosexual AIDS patient recovering from a Pneumocystis carinii pneumonia developed a Cryptococcus neoformans infection with involvement of the central nervous system (CNS) which could be treated successfully with amphotericin B and flucytosine. After a symptomfree interval of 4 1/2 months, a new acute fatal disease of the CNS did not reveal a cryptococcosis relapse but a necrotizing Toxoplasma encephalitis, a cytomegalovirus infection and striking cultural findings of Staphylococcus aureus in all organs examined. Neither by culture nor by histology Cr. neoformans could be detected in the CNS or in the other organs examined. The temporal course of the Cr. neoformans infection and its specific diagnosis are commented. It is demonstrated that (during or after successful therapy of Pneumocystis carinii pneumonia) a specific cultural examination of specimens from the respiratory tract for Cr. neoformans is needed, in order to recognize a Cr. neoformans infection in its primary stage, i. e. before hematogenous dissemination of Cr. neoformans leading to the secondary stage of the infection.
Similar content being viewed by others
Literatur
Bennett JE, Dismukes WE, Duma RJ, Medoff G, Sande MA, Gallis H, Leonhard J, Fields BT, Bradshaw M, Haywood H, McGee ZA, Cate TR, Cobbs CG, Warner JF, Alling DH (1979) A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis. N Engl J Med 301:126–131
Bohle Ch, Sinn M, Werner E, Staib F (1986) Cryptococcus neoformans-Meningoencephalitis bei AIDS. Klin Wochenschr 64:165–172
Chandler FW (1985) Pathology of the mycoses in patients with the acquired immunodeficiency syndrome (AIDS). In: McGinnis MR (ed) Current Topics in Myology, Vol I, Springer, New York Berlin Heidelberg, pp 1–23
Edman JC, Kovacs JA, Masur H, Santi DV, Elwood HJ, Sogin ML (1988) Ribosomal RNA sequence shows Pneumocystis carinii to be a member of the fungi. Nature 334:519–522
Gordon MA, Vedder DK (1966) Serologic tests in diagnosis and prognosis of cryptococcosis. JAMA 197:131–137
Grosse G, Niedobitek F, L'age M, Staib F (1981) Chronische Lungenkryptokokkose. Ein kasuistischer Beitrag zur Diagnostik der Kryptokokkose des Menschen aus pathologisch-anatomischer Sicht. Dtsch med Wochenschr 106:1035–1037
Grosse G, Staib F, Seibold M (1987) Zur Pathologie der Cryptococcose bei AIDS. Verh Dtsch Ges Path 71:506
Kovacs JA, Hiemenz JW, Macher AM et al. (1984) Pneumocystis carinii pneumonia: A comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 100:663–671
Kovacs JA, Kovacs AA, Polis M et al. (1985) Cryptococcosis in the acquired immunodeficiency syndrome. Ann Intern Med 103:533–538
Levy RM, Bredesen DE, Rosenblum ML (1985) Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): Experience at UCSF and review of the literature. J Neurosurg 62:475–495
Pifer LL (1984) Editorial: Pneumocystis carinii: A misunderstood opportunist. Eur J Clin Microbiol 3:169–173
Staib F (1981) Pilzinfektionen des Zentralnervensystems. In: Hopf HCh, Poeck K, Schliack H (Hrsg) Neurologie in Praxis und Klinik B II. Thieme, Stuttgart, S 4163–4170
Staib F (1987) Kryptokokkose bei AIDS aus mykologisch-diagnostischer und-epidemiologischer Sicht. AIDS-Forschung 2:363–382
Staib F (1988) Cryptococcus neoformans and cryptococcosis. Historical background. In: Torres RJM (ed) Congress of the International Society for Human and Animal Mycology — ISHAM, June 27-July 1, 1988, Barcelona. JR Prous Science Publishers, Barcelona, pp 101–105
Staib F, Rögler G, Prüfer-Krämer L, Seibold M, Eichenlaub D, Pohle HD (1986) Disseminierte Kryptokokkose bei zwei AIDS-Patienten. Dtsch Med Wochenschr 111:1061–1065
Staib F, Seibold M, Antweiler E, Fröhlich B, Heißenhuber M, Voigt R, Winger U, Pfau H, Krumhaar D, Neusetzer H (1986) Cryptococcus neoformans bei Patienten einer Berliner Lungenklinik. Ein Beitrag zur Diagnostik und Bekämpfung der Cr. neoformans-Mykose. Prax Klin Pneumol 40:86–93
Staib F, Seibold M, Antweiler E, Fröhlich B, Weber S, Blisse A (1987) The brown colour effect (BCE) of Cryptococcus neoformans in the diagnosis, control and epidemiology of C. neoformans infections in AIDS patients. Zbl Bakt Hyg A 266:167–177
Staib F, Seibold M (1988) Mycological-diagnostic assessment of the efficacy of amphotericin B + flucytosine to control Cryptococcus neoformans in AIDS patients. mycoses 31(4):175–186
Staib F, Seibold M (1988) Cryptococcosis and AIDS. Autopsy material and its significance for the mycological evaluation of the efficacy of the therapy with amphotericin B + flucytosine. Rev Iber Micol 5 Suppl 1:46
Wiebecke B, Staib F (1965) Generalisierte Cryptokokkose. Münch Med Wochenschr 107:361–365
Ziefer A, Jacobs T, Seitz HM (1986) Pneumocystis-carinii-Pneumonie — ein Überblick. Immun Infekt 14(5):170–177
Zuger A, Louie E, Holzman RS, Simberkoff MS, Rahal JJ (1986) Cryptococcal disease in patients with the acquired immunodeficiency syndrome. Ann Intern Med 104:234–240
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Zoller, W.G., Kellner, H., Goebel, F.D. et al. Cryptococcus neoformans-Meningoencephalitis und Mehrfachinfektionen bei AIDS. Klin Wochenschr 67, 598–604 (1989). https://doi.org/10.1007/BF01721688
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01721688