Table 1.
Blood and CSF laboratory parameters and microbiologic and pathology analyses of various tissues from the three patients at diagnosis
| Patient 1 | Patient 2 | Patient 3 | |
|---|---|---|---|
| Age at onset (years), Sex | 34, male | 40, female | 44, female |
| Hemogram | |||
| Hemoglobin (g/dL) | 13 (ref. 13–17) | 14 (ref. 12–15) | 15 (ref. 12–15) |
| Hematocrit (%) | 45.1 (ref. 40–52) | 41 (ref. 36–47) | 44 (ref. 36–47) |
| WBC (ref. 4–10 × 109/L) | 13.7 | 9.2 | 15.1 |
| Neutrophils (ref. 2–8 × 109/L) | 8,8 | 4.8 | 11.3 |
| Lymphocytes (ref. 1–4 × 109/L) | 1.2 | 0.9 | 2.6 |
| Monocytes (ref. 0.2–0.8 × 109/L) | 0.6 | 0.6 | 0.6 |
| Eosinophils (ref. < 0.5 × 109/L) | 0.0 | 0.1 | 1.3 |
| Platelets (ref. 150–450 × 109/L) | 428 | 328 | 506 |
| Blood urea nitrogen (ref. 8–21 mg/dL) | 14 | 13 | 13 |
| Creatinine (ref. 0.8–1.3 mg/dL) | 0.95 | 0.71 | 0.75 |
| C-reactive protein (ref. 0.01–0.82 mg/dL) | 3.7 | 5.0 | 0.7 |
| HIV serum antibodies (ELISA) | Negative | Negative | Negative |
| HIV serum viral load (HIV-1 RNA/mL) | Negative | Negative | Negative |
| Cerebrospinal fluid (CSF) | |||
| Total protein (ref. 5–45 mg/dL) | 82 | 242 | 68 |
| Glucose (ref. 45–80 mg/dL) | 22 | 31 | 48 |
| WBC (ref. 0–5 cells/µL) | 200 | 50 | 92 |
| Opening pressure (ref. 10–25 cm H2O) | 47 | 20 | 21 |
| ADA (15–60 mg/dL) | 13 | 24 | 3 |
| Microbiologic and histologic tests | |||
| Gram/India ink staining of selected samples | Positive for Cryptococcus spp. (sputum, CSF) | Positive for Cryptococcus spp. (CSF) | Positive for Cryptococcus spp. (CSF) |
| Serum cryptococcal antigen test and titer | 1:512 (LFA) | 1:256 | 1:128 |
| Sabouraud dextrose agar cultures of selected samples and biopsies | All positive for C. neoformans (sputum, CSF, peripheral blood, BAL, mediastinal mass, esophageal ulcer, papular skin lesions, soft tissues and bone) | Positive for C. neoformans (CSF and mediastinal mass) | Positive for C. gattii (CSF and mediastinal mass) |
| Urea hydrolysis and L-canavanine glycine bromothymol blue (CGB) | Positive for C. neoformans (CSF and mediastinal mass) | Positive for C. neoformans (CSF and mediastinal mass) | Positive for C. gattii (CSF and mediastinal mass) |
| Minimum inhibitory concentration (MIC) | FLC < 2 | FLC < 2 |
FLC 16 VRC < 0.125 |
| Pathology findings and silver methenamine and mucicarmine staining of selected tissues |
Severe active chronic inflammation Silver methenamine and mucicarmine staining positive for blastoconidia (esophagus, skin and mediastinal mass) |
Extensive coagulation necrosis, chronic inflammation Silver methenamine and mucicarmine staining positive for blastoconidia (mediastinal mass) |
Histiocytic pneumonia, chronic inflammation Silver methenamine and mucicarmine staining positive for blastoconidia (lung mass) |
| Other | |||
| Aerobic cultures | Negative | Negative | Negative |
| PCR mycobacteria/Mycobacterium cultures | Negative | Negative |
Negative at diagnosis Positive for M. tuberculosis 5 years later |
Values in bold are outside the normal range for age
FLC fluconazole, VRC voriconazole, BAL bronchoalveolar lavage, LFA lateral flow assay, CSF cerebrospinal fluid