mycoses
Diagnosis,Therapy and Prophylaxis of Fungal Diseases
Original article
First case of disseminated cryptococcosis in a Gorilla gorilla Alexander Mischnik,1 Julia Stockklausner,2 Nicole Hohneder,2 Henrik E. Jensen,3 Stefan Zimmermann,1 David E. Reuss,4 Volker Rickerts,5 Kathrin Tintelnot5 and Clemens Stockklausner6 1 Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany, 2Zoo Heidelberg, Heidelberg, Germany, 3Department of Veterinary Disease Biology, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark, 4Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany, 5Robert Koch-Institut, FG 16, Mykologie, Berlin, Germany and 6Department of Pediatric Oncology and Hematology, Heidelberg University Hospital, Heidelberg, Germany
Summary
In humans, Cryptococcus mainly infects individuals with HIV infection or other types of immunosuppression. Here, we report the first case of disseminated cryptococcosis in a simian immunodeficiency virus-negative 27-year-old female Gorilla gorilla presenting with lethargy, progressive weight loss and productive cough. The diagnosis was confirmed by positive lung biopsy culture, serum cryptococcal antigen, and cerebral histopathology demonstrating encapsulated yeasts. Molecular characterisation of lung culture isolate yielded Cryptococcus neoformans var. grubii. An immune-deficiency could not be demonstrated.
Key words: Cryptococcus, meningoencephalitis, gorilla, mucicarmine.
Introduction Cryptococcosis is a systemic fungal infection caused by the encapsulated yeast Cryptococcus neoformans and Cryptococcus gattii. In addition, hybrids between both varieties of C. neoformans and between both species have been described.1 Other species like C. laurentii, C. albidus, C. adeliensis or phylogenetically related species like Filobasidium uniguttulatum are only rarely detected in humans or animals.2,3 C. neoformans mainly infects individuals with impaired immunity, such as patients with HIV infection, oncology patients, subjects with sarcoidosis and other types of immunosuppression.4,5 In humans, cryptococcal infection usually starts with inhalation of the fungus followed by hematogenous spread to the brain. The most frequently Correspondence: Dr A. Mischnik, Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, Heidelberg 69120, Germany. Tel.: +49 6221 5636905. Fax: +49 6221 565857. E-mail: [email protected] Submitted for publication 13 March 2014 Revised 21 May 2014 Accepted for publication 1 June 2014
doi:10.1111/myc.12215
encountered life-threatening manifestation of cryptococcosis is meningoencephalitis predominantly caused by C. neoformans var. grubii. Symptoms typically begin indolently over a period of 1–2 weeks. The most common symptoms are fever, malaise, and headache. Localised infections of the lung and soft tissue have been described. Pulmonary cryptococcosis is well documented especially in infections due to C. gattii among individuals with impaired immunity, but also among non-immunocompromised patients.6 Primary cutaneous cryptococcosis is uncommon and often seems to be caused by C. neoformans var. neoformans.7 In veterinary medicine infections also occur, since it is a ubiquitous fungus found worldwide. Infections have been described in different species which range from localised infections of the skin tissue or other tissues to disseminated cases of cryptococcosis.8,9 Among non-human primates in the narrow sense (syn. great apes which comprise gorillas, bonobos, chimpanzees and orangutans) cryptococcosis infection has not been described to the best of our knowledge. In this study, we report the first case of cryptococcal meningoencephalitis in an simian immunodeficiency virus (SIV)-negative 27-year-old female Gorilla gorilla.
© 2014 Blackwell Verlag GmbH Mycoses, 2014, 57, 664–671
Cryptococcal meningoencephalitis in a gorilla
Subjects and methods Course of the disease
The 27-year-old female Gorilla gorilla was captiveborn in Rotterdam, Netherlands in August 1986 and spent her time in the zoo of Stuttgart, Germany, until she was transferred to Heidelberg Zoo, Germany, in November 1999. There, the animal lived along with one male, two other females and three juvenile gorillas. The inside enclosure was covered with wood chips on the ground and grass in the outside enclosure. The outside enclosure was only accessible for the animals in good weather conditions. The food consisted of several different vegetables, salad and sometimes branches with leaves. The animal did not suffer from severe diseases till April 2013 when it presented with lethargy, progressive weight loss and productive cough. On clinical examinations no significant abnormalities were found. WBC and platelet count were normal with a severe anaemia with erythrocytes of 1.6 T l 1 (International species information system, ISIS range 6–9 T l 1), haemoglobin 5.2 g dl 1 (ISIS range 15–19 g dl 1), MCV 98 fl (ISIS range 60–77 fl), HCT 16% (ISIS range 38–55%), ferritin level of 1738 lg l 1 (range 30–300 lg l 1) and reticulocytes of 45.2&. Serum biochemical analysis revealed elevated liver enzymes with ALT 312 IU l 1 (ISIS range
Diagnosis,Therapy and Prophylaxis of Fungal Diseases
Original article
First case of disseminated cryptococcosis in a Gorilla gorilla Alexander Mischnik,1 Julia Stockklausner,2 Nicole Hohneder,2 Henrik E. Jensen,3 Stefan Zimmermann,1 David E. Reuss,4 Volker Rickerts,5 Kathrin Tintelnot5 and Clemens Stockklausner6 1 Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany, 2Zoo Heidelberg, Heidelberg, Germany, 3Department of Veterinary Disease Biology, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark, 4Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany, 5Robert Koch-Institut, FG 16, Mykologie, Berlin, Germany and 6Department of Pediatric Oncology and Hematology, Heidelberg University Hospital, Heidelberg, Germany
Summary
In humans, Cryptococcus mainly infects individuals with HIV infection or other types of immunosuppression. Here, we report the first case of disseminated cryptococcosis in a simian immunodeficiency virus-negative 27-year-old female Gorilla gorilla presenting with lethargy, progressive weight loss and productive cough. The diagnosis was confirmed by positive lung biopsy culture, serum cryptococcal antigen, and cerebral histopathology demonstrating encapsulated yeasts. Molecular characterisation of lung culture isolate yielded Cryptococcus neoformans var. grubii. An immune-deficiency could not be demonstrated.
Key words: Cryptococcus, meningoencephalitis, gorilla, mucicarmine.
Introduction Cryptococcosis is a systemic fungal infection caused by the encapsulated yeast Cryptococcus neoformans and Cryptococcus gattii. In addition, hybrids between both varieties of C. neoformans and between both species have been described.1 Other species like C. laurentii, C. albidus, C. adeliensis or phylogenetically related species like Filobasidium uniguttulatum are only rarely detected in humans or animals.2,3 C. neoformans mainly infects individuals with impaired immunity, such as patients with HIV infection, oncology patients, subjects with sarcoidosis and other types of immunosuppression.4,5 In humans, cryptococcal infection usually starts with inhalation of the fungus followed by hematogenous spread to the brain. The most frequently Correspondence: Dr A. Mischnik, Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, Heidelberg 69120, Germany. Tel.: +49 6221 5636905. Fax: +49 6221 565857. E-mail: [email protected] Submitted for publication 13 March 2014 Revised 21 May 2014 Accepted for publication 1 June 2014
doi:10.1111/myc.12215
encountered life-threatening manifestation of cryptococcosis is meningoencephalitis predominantly caused by C. neoformans var. grubii. Symptoms typically begin indolently over a period of 1–2 weeks. The most common symptoms are fever, malaise, and headache. Localised infections of the lung and soft tissue have been described. Pulmonary cryptococcosis is well documented especially in infections due to C. gattii among individuals with impaired immunity, but also among non-immunocompromised patients.6 Primary cutaneous cryptococcosis is uncommon and often seems to be caused by C. neoformans var. neoformans.7 In veterinary medicine infections also occur, since it is a ubiquitous fungus found worldwide. Infections have been described in different species which range from localised infections of the skin tissue or other tissues to disseminated cases of cryptococcosis.8,9 Among non-human primates in the narrow sense (syn. great apes which comprise gorillas, bonobos, chimpanzees and orangutans) cryptococcosis infection has not been described to the best of our knowledge. In this study, we report the first case of cryptococcal meningoencephalitis in an simian immunodeficiency virus (SIV)-negative 27-year-old female Gorilla gorilla.
© 2014 Blackwell Verlag GmbH Mycoses, 2014, 57, 664–671
Cryptococcal meningoencephalitis in a gorilla
Subjects and methods Course of the disease
The 27-year-old female Gorilla gorilla was captiveborn in Rotterdam, Netherlands in August 1986 and spent her time in the zoo of Stuttgart, Germany, until she was transferred to Heidelberg Zoo, Germany, in November 1999. There, the animal lived along with one male, two other females and three juvenile gorillas. The inside enclosure was covered with wood chips on the ground and grass in the outside enclosure. The outside enclosure was only accessible for the animals in good weather conditions. The food consisted of several different vegetables, salad and sometimes branches with leaves. The animal did not suffer from severe diseases till April 2013 when it presented with lethargy, progressive weight loss and productive cough. On clinical examinations no significant abnormalities were found. WBC and platelet count were normal with a severe anaemia with erythrocytes of 1.6 T l 1 (International species information system, ISIS range 6–9 T l 1), haemoglobin 5.2 g dl 1 (ISIS range 15–19 g dl 1), MCV 98 fl (ISIS range 60–77 fl), HCT 16% (ISIS range 38–55%), ferritin level of 1738 lg l 1 (range 30–300 lg l 1) and reticulocytes of 45.2&. Serum biochemical analysis revealed elevated liver enzymes with ALT 312 IU l 1 (ISIS range
