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KMID : 0311119760170010052
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Yonsei Medical Journal
1976 Volume.17 No. 1 p.52 ~ p.58
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A Case of Cryptococcosis treated with 5-fluorocytosine
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Kim, Soo Hyung
Yun, Duk Jin/Kim, Tai Seung
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Abstract
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A patient, treated for systemic cryptococcal infection with 5-fluorocytosine, an antifungal agent effective in experimental infection with Candida and Cryptococci, exhibited a satisfactory clinical response from therapy. A systemic infection, caused by Cryptococcus neoformans, was confirmed in this case by skin and liver biopsies and cultures. Cerebrospinal fluid also showed yeast-like budding cells on wet India ink preparation with a positive culture of cryptococci.
The treatment of systemic cryptococcal infection recently was done experimentally with a new agent, 5-fluorocytosine, which is effective in Cryptococcus neoformans, Candida albicans and other fungi as an antimetabolite of cytosine in these fungi, but has no antibacterial effect (Holt and Newman, 1973). Crytpococcus neoformansa, non-mycelial budding yeast, is unique among the fungi in that it produces a mucinous capsule which is periodic acid-Shiff-stain positive (Lewis and Rabinovich, 1972). The organism was first isolated about 1895 from agumma-like lesion of the tibia of a patient by Busche (1895) and Busse (1894). Verse (1914) in 1914 reported the first case of meningitis associated with Cryptococcus neoformans infection. The meningeal type of the disease is the best known form, and the most frequently involved organ system is the central nervous system, but the organism has been found in almost all other organ systems including the kidney, heart, spleen, pancreas, adrenals, ovaries, lymphnodes,
skeletal muscle, liver, gastrointestinal tract and skin (Littman and Zimmerman, 1956; Campbell, 1966; Linden and Steffen, 1954; Cawley et al. 1950; Collins, 1950; Rawson et al, 1948; Bowman and Ritchey, 1954; Sabesin et al, 1963; Procknow, et al, 1965; Gollan et al, 1972; Randall et al. 1968; Tillotson and Lerner, 1965). Until 1957, there was no
successful treatment for most cases of cryptococcosis. Cryptococcal meningitis was almost always fatal even with roentgen therapy, sulfonamide, diamidines, iodides, penicillin, tetracycline, ethyl vanilate, nystatin and cycloheximide (Emanuel ; et al, 1961). The introduction of treatment with amphotericin B reduced the mortality of cryptococcal meningitis from about 90.% to 25% over 3 years (Van den ende et 273;1150,1965)
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