Disseminated infection due to Nocardia transvalensis coincident with Cryptococcus neoformans variety gattii meningitis

A case of meningitis due to Cryptococcus neoformans var. gattii coincident with disseminated Nocardia transvalensis infection is reported. Nocardia in fection initially progressed despite high-dose antimicrobial therapy. Altho ugh a specific immunologic defect could not be defined, in vitro lymphocyte proliferation in response to stimulation with the Nocardia isolate was red uced. It is proposed that coinfection with Cryptococcus neoformans may have contributed to the observed impairment of lymphocyte function, leading to disseminated Nocardia disease and a suboptimal treatment response.