Cryptococcus albidus (Naganishia albida) meningitis in a young Patient with T-cell Acute Lymphoblastic Leukemia

  1. Amber Prasad
  2. Minakshi Singh
  3. Priyal Anand

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Abstract

Cryptococcus albidus, an emerging pathogen, poses diagnostic and therapeutic challenges, especially in immunocompromised patients. We report a C. albidus meningitis case in a young T cell-ALL patient, initially suspected of HSV encephalitis. CSF analysis confirmed C. albidus, leading to antifungal therapy with liposomal amphotericin B and flucytosine, resulting in clinical improvement. Elevated procalcitonin levels suggest a potential role in fungal infections. This case underscores the importance of early identification and appropriate treatment in C. albidus meningitis.

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  1. Version published to 10.1099/acmi.0.000920.v2 on Access Microbiology
  2. Access Microbiology

    Please make sure to address all concerns voiced by the reviewers. At this stage both reviewers have stated the results only partially support the conclusions made by this study. Further, please address the methodological concerns by one reviewer about streaking the culture for single colonies, which should be a simple experimental task.

  3. Access Microbiology

    Comments to Author

    The manuscript presents a rare case of meningitis caused by Cryptococcus albidus in a young patient with T-cell acute lymphoblastic leukemia, emphasizing its relevance in addressing an emerging pathogen and providing novel insights into the role of procalcitonin as a potential marker in fungal infections. The manuscript would benefit greatly from the inclusion of a conclusions section or a final paragraph within the discussion, which clearly and concisely outlines the key findings of the study. This section should summarize the primary outcomes, emphasizing the clinical significance of the case and the value of the findings, such as the emerging role of Cryptococcus albidus as a pathogen and the potential of procalcitonin as a biomarker in fungal infections. Additionally, the conclusion should underscore the implications of these results for the clinical management of immunosuppressed patients and highlight the need for further research in this field.

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  4. Access Microbiology

    Comments to Author

    Reviewer's Comments: 1. Abstract: Lines 16-17. Please reframe the sentence. (Grammar) Write Spellings of U.K. English 4. Introduction: Lines 30-32: Please reframe the sentence with correction of grammatical mistakes. 5. Case presentation: Case presentation can be shortened Please enter CSF findings in the table, e.g. 'Cerebrospinal fluid (CSF) analysis included microscopy, India ink staining, cytopathology, aerobic bacterial culture, Ziehl-Neelsen (ZN) stain and Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) for tuberculosis, and fungal culture.' 6. Figures & tables: Why inoculation of CSF deposit was not streaked appropriately to get isolated colonies? One must get typical isolated colonies on petri plates. We should use Petri plate for culture of yeast. Request to the author to write in details the CSF processing protocol for Fungal (yeast) & bacterial culture separately and to be written briefly in the manuscript. Was CSF sample centrifuged? Also, Gram staining of CSF deposit done? All CSF results should be entered in a table. Did you see yeast cells in the Gram staining of the CSF deposit? Was any catheter tip was sent for culture?

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  5. Access Microbiology

    Comments to Author

    This is an interesting case and does add to the literature. I have made a number of comments that I hope will improve the manuscript. Major General: What was the timing of blood culture and CSF collection in relation to antibiotic therapy? Line 49: what features were suggestive of HSV infection? Line 52: What cartridge? Cepheid GeneXpert? Line 57: That "yeast" is Cryptococcus sp., and should be mentioned Line 63: What susceptibility method was used? Line 84: CSF opening pressure? The diagnostic assessments section is somewhat repetitive. Could this be transformed into a timeline figure? Line 105-109: Noting the limitations of this assay including a high false negative rate for HSV and a lower sensitivity for Cryptococcus cf antigen testing. Line 109: Culture is an imperfect gold standard and therefore cannot completely exclude bacterial infection. Line 123: I assume repeat LP was performed. Was this on day 12 of therapy? What was the repeat opening pressure? Line 139-140: Possibly. However if antibiotics were initiated prior to csf sampling or blood cultures then a dual infection is possible. Minor Line 44: grammar "back" Line 46: upper and lower limb tone and power? Line 50: Stands to reason it would not show an abnormality given lower sensitivity for CNS infection. The current sentence seems to suggest there was a discrepancy of results. Line 64: Referral instead of reference Line 114: intravenous liposomal amphotericin? Line 115: Replace ampoule with total amount in mmol or similar Line 145: Surname only Line 147: Suggest: "and symptomatically improved" or similar instead of "got" Line 151-153: Was this death attributed to the cryptococcus infection? Would be important to state one way or the other.

    Please rate the quality of the presentation and structure of the manuscript

    Satisfactory

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  6. Version published to 10.1099/acmi.0.000920.v1 on Access Microbiology