Newsome Jelaun, Nguyen Dana
Department of Family Medicine, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310.
Mil Med. 2014 Sep;179(9):e1059-61. doi: 10.7205/MILMED-D-14-00020.
Cryptococcus neoformans is an encapsulated yeast that commonly causes disease in individuals in the setting of immunocompromised states. It is rarely reported in immunocompetent patients in the literature.
An active duty service member with no significant medical history presented with persistent headache, nausea, vomiting, weight loss, and nocturnal fevers for 2 months. The patient was admitted to the hospital where a lumbar puncture was performed showing an elevated white blood cell count, low glucose, and elevated protein. Subsequent cerebral spinal fluid analysis yielded cryptococcal antigen latex screen and culture which speciated C. neoformans. The patient received fluconazole and flucytosine, and completed a 10-week course to result in a full recovery.
C. neoformans is found throughout the world in soil contaminated with bird droppings and usually causes infection and disease in individuals who are immunosuppressed. Rare case reports exist where C. neoformans causes central nervous infection in immunocompetent hosts. This fungal etiology should be considered in all patients presenting with meningitis symptoms and a cerebral spinal fluid panel with low glucose and high protein, or without a clear bacterial etiology. This case illustrates the importance of broadening the differential when previously healthy service members present with common or nonspecific symptoms.
新型隐球菌是一种有荚膜的酵母菌，通常在免疫功能低下的个体中引起疾病。文献中很少有关于免疫功能正常患者感染新型隐球菌的报道。
一名无重大病史的现役军人出现持续头痛、恶心、呕吐、体重减轻和夜间发热2个月。患者入院后进行了腰椎穿刺，结果显示白细胞计数升高、葡萄糖水平降低和蛋白质水平升高。随后的脑脊液分析进行了隐球菌抗原乳胶筛查和培养，鉴定为新型隐球菌。患者接受了氟康唑和氟胞嘧啶治疗，并完成了为期10周的疗程，最终完全康复。
新型隐球菌在世界各地被鸟类粪便污染的土壤中均有发现，通常在免疫抑制个体中引起感染和疾病。文献中有罕见病例报道新型隐球菌可在免疫功能正常的宿主中引起中枢神经系统感染。对于所有出现脑膜炎症状且脑脊液检查显示葡萄糖水平低、蛋白质水平高，或无明确细菌病因的患者，均应考虑这种真菌病因。该病例说明了当既往健康的军人出现常见或非特异性症状时，扩大鉴别诊断范围的重要性。
