Cryptococcus neoformans var. gattii meningitis in Egypt: a case report

Cryptococcus neoformans is an encapsulated yeast ubiquitous in nature which, when it infects humans, typically causes pulmonary disease and occasionally meningitis [1]. Serotyping of the organism has identified 3 main varieties: C. neoformans var. grubii (serotype A), C. neoformans var. neoformans (serotype D) and C. neoformans var. gattii (serotypes B and C) [2]. Serotypes A and D have been isolated throughout the world and have been associated with birds [1]. While C. neoformans var. gattii has been more frequently associated with disease in tropical and subtropical areas, infections throughout the world, including the United States and Europe, have been reported [3,4]. Eucalyptus trees appear to be the principle reservoir for the organism but the infection has been diagnosed in areas lacking eucalyptus, indicating that other environmental sources exist [3,5]. However, prolonged incubation periods can make it difficult to identify the true sources of exposure [6]. Cryptococcosis has rarely been reported from Egypt although a number of factors would predict the country to be an area where the fungus would be common. In the current report, we describe the first case of Cryptococcal neoformans var. gattii serotype (B) from Egypt, in a patient positive for human immunodeficiency virus (HIV). Future work should be performed to better understand the epidemiology and prevalence of cryptococcal disease within the region.