Infectious Disease
Case 24: An HIV ‐Positive Patient with Vomiting and Fever
CASE
A 30‐year‐old HIV‐positive man has a poor adherence to his anti‐retroviral treatment. He has a CD4 count of 45/mm3. He attended clinic with a 2‐week history of persistent vomiting, fever and an intense headache. Examination revealed a pyrexia of 38°C, a heart rate of 115 beats/min and an arterial blood pressure of 110/70 mmHg. He had no focal neurology or meningism, nor did he have evidence of papilloedema on fundoscopy. He had hepatosplenomegaly, although his chest was clear.
He was admitted to hospital for investigation and the following results were available to you:
CSF Appearance Clear Microscopy No organisms seen WCC 2 cells/mm3 RCC 10 cells/mm3 Biochemistry Protein 0.45 g/L Glucose >50% Cryptococcal antigen Positive >1 in 256 CMV/VZV/HSV/EBV PCR Not detected Syphilis serology Negative Toxoplasma serology Negative
Blood culture: positive for Cryptococcus sp.
CT of the head: normal
QUESTION 1
Your score this session: 0 of 0
Which staining method would have been used in the cerebrospinal fluid (CSF) and blood sample to detect the cryptococcal pathogen?