Molecular Microbiology Research 2015, Vol.5, No.4, 1-3
2
cutaneous cryptococcosis due to
C. neoformans
in an
apparently healthy pet bird keeper from Bharauch,
Gujarat, India.
1 Materials and Methods
A 34-year-male bird enthusiast presented with
dermatological disorder at the Skin Outpatient
Department (OPD) of Welfare Hospital and Research
Center, Bharauch, India constituted the material for
this investigation. The punch biopsy from the cutaneous
lesion was performed under sterile conditions to
obtain the sample for cultural isolation. The detailed
clinical, biochemical (blood and urine), and radiological
examination of the patient was done. A small piece of
the skin biopsy was examined directly under microscope
as wet mount preparation in India ink (Pal, 2007). The
skin biopsy, blood, and urine were also cultured on
Pal’s sunflower seed medium, and the inoculated
plates were incubated at 25
℃
. In addition, droppings
and scrapings of wooden cage were also streaked on
to the plates of Pal medium (Pal, 2007). Microscopic
morphology of the isolates was undertaken in Narayan
stain (Pal, 2004).The patient was advised to take
fluconazole 200 mg daily for fourteen weeks. In
addition, vitamin B complex, liver tonic, and antacid
were also prescribed. In case of any complications, the
patient was asked to report to the hospital. The patient
was directed to decontaminate the excreta and wooden
cage of his pet bird by spraying 5% formalin.
2 Results
The clinical examination of the patient showed one
erythematous, ulcerative, and nodular lesion on the
left forearm. The patient narrated that this skin lesion
occurred after receiving injury with wooden cage
during the act of cleaning. The patient’s body
temperature was 38.2
℃
, respiration rate 21 breaths
per minute, and pulse rate 78 beats per minute. The
test for HIV, and TB were negative. The blood profile
showed WBC 12,500 /mm3, Hb 12.8 gm, blood urea
nitrogen 21.5 mg/dl, and creatinine 1.1 mg/dl. The
urine was negative for glucose and protein.
Radiograph of chest did not reveal any abnormality.
Microscopic examination of biopsied tissue in India
ink showed round, wide, thickly encapsulated budding
yeast cells morphologically simulating to
C. neoformans
.
The culture of biopsy tissue from the lesion yielded
many smooth, brown coloured colonies of
C.
neoformans
on Pal’s sunflower seed medium after 3
days of incubation at 25
℃
. Interestingly, the pathogen
was not isolated from the blood, and urine of the
patient suggesting the absence of systemic involvement.
The parrot excreta, and wooden scrapings from parrot
cage also showed innumerable numbers of brown
coloured and smooth colonies
of C. neoformans
on Pal’s
sunflower seed medium. All the fungal isolates
revealed many circular, thinly encapsulated yeast cells
with and without budding in Narayan stain. We could
not isolate the fungus from droppings and wooden
cage after formalin treatment. The patient showed
good clinical response with fluconazole, without any
side effects of the drug.
3 Discussion
The clinical presentation, mycological observation,
and chemotherapeutic response conclusively proved
that our 34- year-old male immunocompetent patient
was suffering with primary cutaneous cryptococcosis
due to
C. neoformans
. This observation is consistent
with the findings of Spiliopoulou and co-investigators
(2012) who described primary cutaneous cryptococcosis
in immunocompetent host. However, primary cutaneous
cryptococcosis has also been recorded in immunoco-
mpromised hosts (Vasanthi et al.,
2002; Christianson
et al., 2003; Yodella and Rao, 2011). Direct inoculation
is considered as the possible mode of entry of the
pathogen. A history of trauma is most frequently
reported risk factor in primary cutaneous cryptococcosis
(Revenga et al., 2002; Bauza et al., 2005; Pal, 2007).
Our patient also gave the history of the skin injury
while cleaning the wooden cage of the caged pet
parrot. Furthermore, we proved the presence of
C.
neoformans
in the dropping and wooden cage of
parrot by conducing retrospective epidemiological
investigation to establish the source of infection. We
advised the patient to decontaminate the saprobic
environment by spraying 5 % solution of formalin.
The fungus could not be recovered from the excreta
and wooden scrapings of the bird’s cage after
decontamination with formalin.
It is pertinent to mention that the skin and brain are
the primary sites following haematogenous dissem-
ination of infection from the lungs (Chang et al.,
2009). Moreover, cutaneous cryptococcosis occurs in
10 to 20 % of cases of disseminated disease (Pal et al.,
2014). In this context, Yodalla and Rao (2011)
mentioned that cutaneous cryptococcosis serves as a
