First European Case of Serotype A MATa Cryptococcus neoformans Infection

To the Editor: Cryptococcus neo-formans is an opportunistic fungus that causes meningoencephalitis, primarily in immunocompromised patients. However, C. neoformans can also cause illness in apparently normal hosts. The yeast is a heterothallic basidiomycete with two mating types, MATa and MATα identified in all the four serotypes, A, B, C, and D. However, the mating type a of serotype A is a rare and recent finding. One strain was isolated from a Tanzanian AIDS patient and a second from the Italian environment; the first was mating defective (1,2). We report the isolation of a serotype A MATa strain of clinical origin that was characterized by mating at high frequency under standard laboratory conditions. In August 1998, a 45-year-old Hungarian man was admitted to the Laszlo Hospital for Infectious Diseases in Budapest because of septic fever. The patient had a history of hematologic malignancy (Hodgkin disease), which was diagnosed in 1991. He had received several courses of chemotherapy and radiation. After 4 years when his cancer was in remission , in September 1995, the disease recurred (stage IVa) for which he received several more courses of chemotherapy, according to protocols BEAM (carmustine, etoposide, cytarabine, melphalan) and CEP (lomustine, etoposide, prednimus-tine). In February 1998, another relapse was diagnosed and the patient was given chemotherapy, according to protocol COPP (cyclophosphamide, vincristine, prednisolone, procar-bazine) four times. In April 1998, he was hospitalized with herpes zoster infection and treated with acyclovir. At the last admission, in August 1998, he was pancytopenic and had septic fever. Salmonella enteritidis was cultured from his blood. The salmonella septicemia was successfully treated with ceftriaxone. As palliative treatment , he received 4x10 mg vinblas-tine for his residual disease. On September 30, he became febrile again. Cryptococcus neoformans was isolated from his blood, although cerebrospinal fluid culture and sero-logic tests were negative. On the right fossa cubitalis, cellulitis and a tender mass were present, although he did not have a history of recent central line or cytostatic treatment on this side. Cryptococcus neoformans was isolated from the sample taken from the mass. Antifungal treatment was started with 600 mg fluconazole per day and continued with amphotericin B, 1 mg/kg/day. The patient died 6 weeks after the isolation of Cryptococcus, probably because of his uncontrolled Hodgkin disease. As far as the physician was aware, the patient had not visited other countries. The strain, isolated from the patient's blood during the European Confederation of …