PYROLYSIS TYPING OF ISOLATES FROM A RECURRENCE OF SYSTEMIC CRYPTOCOCCOSIS

Cryptococcal meningitis was diagnosed in a 71-year-old male diabetic p atient with underlying ischaemic heart disease, asthma and bilateral a xillo-femoral vascular grafts. After treatment with fluconazole for 2 months, the patient appeared to be cured. Two years later he presented with an aneurysm of the right graft that was resected and replaced wi th a new graft segment. Cryptococcus neoformans var. neoformans was gr own from post-operative blood cultures and samples of the excised graf t. The patient was treated with fluconazole and discharged after 6 wee ks. Multiple isolates from both episodes had been preserved, and these , together with isolates from other UK patients, were cultured in dupl icate, blind coded and characterised by pyrolysis mass spectrometry (P MS). Duplicate culture and re-isolate sets formed tight clusters, with each patient set clearly distinct. Sets of isolates from the two epis odes in this patient formed a single tight cluster and were indistingu ishable by PMS. These results support the contention that C. neoforman s infection can be reactivated after being dormant for a prolonged per iod.