First report ofCryptococcus laurentiimeningitis and a fatal case ofCryptococcus albiduscryptococcaemia in AIDS patients

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Abstract
We report the first case of Cryptococcus laurentii meningitis and a rare case of Cryptococcus albidus cryptococcaemia in AIDS patients. Both infections were treated with amphotericin B and flucytosine. The C laurentii meningitis was controlled after 2 weeks of treatment with no evidence of infection 20 months later. The patient with C albidus cryptococcaemia, despite the amphotericin B/flucytosine combination therapy, died on the 14th day of treatment. The minimum inhibitory concentrations (MICs) for C laurentii, as determined by Etest on RPMI 1640 agar, were 0·25 µg ml−of amphotericin B, 1·25 µg ml-1 flucytosine, 4 µg ml −1 fluconazole, 0·50 µg ml−1 itraconazole and 1·0µg ml−1 of ketoconazole. The MIC of amphotericin B for C. albidus was 0·5 µg ml−1, flucytosine 1·25 µg ml−1, fluzonazole 4 µg ml−1, itraconazole 0·5 µg ml−1 and ketonazole 0·25 µg ml−1. The agreement of the amphotericin B MIC values obtained in antibiotic medium 3 by the broth microdilution method, with those obtained on casitone medium by Etest, was within a two-dilution range for both isolates. C laurentii may cause meningitis and may also involve the lungs in AIDS patients.