High prevalence of central nervous system cryptococcosis using a fingerprick whole-blood lateral flow assay in individuals with neurological symptoms and advanced HIV disease in a Brazilian emergency department.

Timely diagnosis is key in managing central nervous system (CNS) cryptococcosis in people living with HIV/AIDS (PLWHA). There are few data on implementing fingerprick whole-blood cryptococcal antigen (CrAg) lateral flow assay (LFA) as the first test for diagnosing CNS cryptococcosis. We evaluated the prevalence of CNS cryptococcosis and cryptococcal antigenemia using fingerprick whole-blood in a referral emergency department (ED) in São Paulo, Brazil. This was a prospective cohort study of consecutive adult PLWHA with advanced HIV disease and neurological symptoms. Fingerprick whole-blood CrAg LFA was performed at bedside. Seventy-four individuals were enrolled (median age = 40 years; males = 62%). Prevalence of CNS cryptococcosis was 17.6% (13/74); 95% confidence interval (CI), 9.4-30.0%, and prevalence of positive fingerprick whole-blood CrAg LFA was 25.7% (19/74); 95% CI, 15.5-40.1%. Among the six (8.1%) patients with positive fingerprick whole-blood CrAg LFA and negative CSF CrAg LFA, four (5.4%) had isolated asymptomatic cryptococcal antigenemia, one (1.3%) had symptomatic cryptococcal antigenemia, and one (1.3%) had cryptococcemia. Prevalence of CNS cryptococcosis and cryptococcal antigenemia using fingerprick whole-blood CrAg LFA was high. Point-of-care testing was important for diagnosing CNS cryptococcosis in an ED from a middle-income country.

Granulomatous leptomeningitis in a goat associated with infection by Cryptococcus neoformans

A case of granulomatous leptomeningitis caused by Cryptococcus neoformans is described in a 2-year-old mixed-breed, female goat which presented acute neurological signs including ataxia, nystagmus, bilateral blindness, opisthotonus, hyperesthesia, and spastic paresis of forelimbs. Granulomatous inflammation was detected in the pia arachnoid covering the frontal, parietal and occipital lobes of the telencephalon; cerebellum, thalamus, mesencephalon, pons, medulla, and cervical and thoracolumbar segments of the spinal cord. Yeast-like organisms with morphology compatible with Cryptococcus spp. were observed. A 350 base pair sequence was amplified from DNA extracted from the formalin fixed paraffin embedded (FFPE) tissue. The amplified sequence matched 100% Cryptococcus neoformans. It is suggested that cryptococcal meningitis should be included in the differential diagnosis list of goat diseases with neurological signs such as ataxia, opisthotonus, nystagmus, hyperesthesia and spastic paresis.

Granulomatous leptomeningitis in a goat associated with infection by Cryptococcus neoformans

A case of granulomatous leptomeningitis caused by Cryptococcus neoformans is described in a 2-year-old mixed-breed, female goat which presented acute neurological signs including ataxia, nystagmus, bilateral blindness, opisthotonus, hyperesthesia, and spastic paresis of forelimbs. Granulomatous inflammation was detected in the pia arachnoid covering the frontal, parietal and occipital lobes of the telencephalon; cerebellum, thalamus, mesencephalon, pons, medulla, and cervical and thoracolumbar segments of the spinal cord. Yeast-like organisms with morphology compatible with Cryptococcus spp. were observed. A 350 base pair sequence was amplified from DNA extracted from the formalin fixed paraffin embedded (FFPE) tissue. The amplified sequence matched 100% Cryptococcus neoformans. It is suggested that cryptococcal meningitis should be included in the differential diagnosis list of goat diseases with neurological signs such as ataxia, opisthotonus, nystagmus, hyperesthesia and spastic paresis.(AU)

Cerebral cryptococcomas in a cow.

Cerebral cryptococcomas are described in a 5-year-old mixed-breed cow without manifestations of systemic cryptococcosis. Two cryptococcomas were observed grossly. Microscopical examination revealed accumulations of yeast that were morphologically consistent with Cryptococcus neoformans. Immunohistochemistry characterized the organisms as C. neoformans var. grubii.

Bovine cryptococcal meningoencephalitis.

Cryptococcal meningitis and encephalitis is reported in a 5-year-old bull. The clinical signs included multifocal neurological deficits manifested by hypermetria, ataxia, depression, circling, impaired vision, head pressing, low head carriage, wide-based stance, and falling to the side or backwards. At necropsy, 6 cavities with a gelatinous content were observed in the brain and brain stem, and the meninges were thickened and off white. Numerous yeasts, with a nonstaining capsule, and associated mild inflammatory reaction were observed histologically. Specimens for culture were not collected at necropsy, but the identity of the yeast in tissue sections as Cryptococcus neoformans var. grubii was supported by immunohistochemistry.