Results
Histopathological findings (Figure 1): Alveolar spaces of both the right
and left lungs were filled with round refractile structures with thick
capsule suggestive of cryptococci. There were also few alveolar
macrophages (Figure 1A and 1B). There were similar structures suggestive
of cryptococci in brain tissues too (Figure 1C). Liver was unremarkable,
whereas spleen had areas of extensive congestion along with dense
infiltration by cryptococci (Figure 1D).
Peripheral blood smear was negative for malarial parasites. Serology was
positive for HIV-1 antibodies by HIV-Tri Dot assay but the serological
tests for dengue, malaria, HBsAg, HCV, Brucella and Leptospira were all
negative. Microbiological findings (Figure 2): Gram stain of CSF sample
revealed Gram positive round yeast cells suggestive ofCryptococcus spp (Figure 2A). Typical round encapsulated yeast
forms suggestive of Cryptococcus spp were demonstrated by India
ink preparation of CSF (Figure 2B). Colonies in Sabouraud dextrose agar
were creamy, white and mucoid. Similarly, colonies on blood agar,
chocolate agar and Sabouraud dextrose agar showed gram positive round
budding yeast cells suggestive of Cryptococcus spp . Urease test
was also positive after 48 hours of incubation. The most remarkable
finding was Cryptococcus neoformans complex organism detected by
CSF culture. Additionally, the lung tissue culture showed the growth of