First case of mixed infection with and VNI in an Ivorian HIV-positive patient.

Introduction: Cryptococcal meningitis (CM) may be caused by several species of

Case Presentation: We describe a fatal case of CM in a HIV-positive patient from Ivory Coast infected by VNI and . Isolates were recovered from cerebrospinal fluid (CSF) prior to systemic antifungal treatment. Six isolates were studied (the entire culture plus five isolated colonies from it). Serotyping was performed via LAC 1 and CAP 64 gene amplification. Genotyping was performed using restriction fragment length polymorphism (RFLP) analysis of the URA5 gene, (GACA), (GTG) and M13 PCR fingerprinting. URA5-RFLP analysis identified the original culture with two different molecular type combinations. However, URA5-RFLP profiles of the five colonies isolated from the original sample revealed two different species. Four colonies were identified as and the last isolate as VNI. The susceptibility profile was determined using the standard method according to the CLSI M27-A3 protocol. The isolates were susceptible to the tested antifungals (fluconazole, flucytosine and amphotericin B). Treatment with fluconazole (1200  mg day) was initiated; however, the patient died 17 days after the onset of antifungal therapy.

Conclusion: This is the first reported case of mixed infection with and in a HIV-positive patient.