Correspondence
Cryptococcal Meningitis after Unusual Exposures to Birds
N Engl J Med 1993; 328:1354-1355May 6, 1993
- Article
To the Editor:
Although it is well known that various birds carry cryptococci, the degree of human exposure to birds that is required for the emergence of clinical cryptococcal disease is not known. Two patients with cryptococcal meningitis had unusually intense exposures. The patients were seropositive for the human immunodeficiency virus (HIV) but had been asymptomatic until meningitis developed.
The first patient, a 56-year-old man, helped dismantle an aviary, measuring 16 by 12 by 8 feet, that had been unused for about 10 years. The wooden floor of the aviary was rotten, and its removal produced clouds of dust. Demolishing the remaining wood with a chain saw created more dust. The whole procedure lasted two hours. Seven weeks later, the man had the first symptoms of cryptococcal meningitis. His CD4+ lymphocyte count at that time was 14 per cubic millimeter.
The second patient was a 38-year-old man whose office had no windows. One wall of the office faced an alley infested with pigeons. The bricks on the outside of this wall were loose; pigeons found their way through the wall and nested in the ceiling above the patient's desk. Each day the patient had to remove from his desk the debris that had fallen from the pigeons' nest in the ceiling above. Cryptococcal meningitis developed about 10 weeks after this exposure to pigeons began. The patient's CD4+ lymphocyte count at this time was 57 per cubic millimeter.
On the basis of these case histories, it is possible that the incubation period of cryptococcal disease is between 6 and 10 weeks. It also would seem that the cryptococcus can withstand prolonged drying -- for 10 years in one instance described here -- and remain viable. Exposures of the degree described here may not be rare. In addition to avoiding other possible sources of opportunistic infections, HIV-infected persons should avoid intense exposures to the excreta of birds. It is important to caution, however, that other possible sources of infection cannot be ruled out, because cryptococci are widespread in nature. Specific tests to demonstrate that the cryptococci presumed to be in the pigeon excreta were identical to those that caused disease in the patients were not performed.
W. Jeffrey Fessel, M.D.
Kaiser-Permanente Medical Center, San Francisco, CA 94115- Citing Articles (19)
Citing Articles
1
John R. Perfect, Gary M. Cox. 2010. Cryptococcosis. .
CrossRef2
Joseph N Jarvis, Thomas S Harrison, Elizabeth L Corbett, Robin Wood, Stephen D Lawn. (2010) Is HIV-associated tuberculosis a risk factor for the development of cryptococcal disease?. AIDS 24:4, 612-614
CrossRef3
A. Biglino, P. Crivelli, E. Concialdi, C. Bolla, G. Montrucchio. (2008) Clinical Usefulness of ELISPOT Assay on Pericardial Fluid in a Case of Suspected Tuberculous Pericarditis. Infection 36:6, 601-604
CrossRef4
Sotirios Tsiodras, Theodoros Kelesidis, Iosif Kelesidis, Ulf Bauchinger, Matthew E. Falagas. (2008) Human infections associated with wild birds. Journal of Infection 56:2, 83-98
CrossRef5
C. Cafarchia, D. Romito, C. Coccioli, A. Camarda, D. Otranto. (2008) Phospholipase activity of yeasts from wild birds and possible implications for human disease. Medical Mycology 46:5, 429-434
CrossRef6
R. Mattsson, P. D. Haemig, B. Olsen. (2008) Feral pigeons as carriers of Cryptococcus laurentii, Cryptococcus uniguttulatus and Debaryomyces hansenii. Medical Mycology 37:5, 367
CrossRef7
Joseph N Jarvis, Thomas S Harrison. (2007) HIV-associated cryptococcal meningitis. AIDS 21:16, 2119-2129
CrossRef8
Arturo Casadevall, Liise-Anne Pirofski. (2006) The weapon potential of human pathogenic fungi. Medical Mycology 44:8, 689-696
CrossRef9
C. Cafarchia, D. Romito, R. Iatta, A. Camarda, M. T. Montagna, D. Otranto. (2006) Role of birds of prey as carriers and spreaders of Cryptococcus neoformans and other zoonotic yeasts. Medical Mycology 44:6, 485-492
CrossRef10
S. T. Tay, H. C. Chai, S. L. Na, H. Hamimal, M. Y. Rohani, T. S. Soo-Hoo. (2005) The isolation, characterization and antifungal susceptibilities of Cryptococcus neoformans from bird excreta in Klang Valley, Malaysia. Mycopathologia 159:4, 509-513
CrossRef11
K. LAGROU, J. VAN ELDERE, S. KEULEERS, F. HAGEN, R. MERCKX, J. VERHAEGEN, W. E. PEETERMANS, T. BOEKHOUT. (2005) Zoonotic transmission of Cryptococcus neoformans from a magpie to an immunocompetent patient. Journal of Internal Medicine 257:4, 385-388
CrossRef12
Arturo Casadevall. (2005) Fungal virulence, vertebrate endothermy, and dinosaur extinction: is there a connection?. Fungal Genetics and Biology 42:2, 98-106
CrossRef13
Arturo Casadevall, Liise-anne Pirofski. (2005) Prospects of vaccines for medically important fungi Feasibility and prospects for a vaccine to prevent cryptococcosis. Medical Mycology 43:8, 667-680
CrossRef14
H. A. Abdel-Salam. (2003) Characterization ofCryptococcus neoformans var.neoformans serotype A and A/D in samples from Egypt. Folia Microbiologica 48:2, 261-268
CrossRef15
John R Perfect, Arturo Casadevall. (2002) Cryptococcosis. Infectious Disease Clinics of North America 16:4, 837-874
CrossRef16
T.S. Harrison. (2000) Cryptococcus neoformans and Cryptococcosis. Journal of Infection 41:1, 12-17
CrossRef17
R. Mattsson, P. D. Haemig, B. Olsen. (1999) Feral pigeons as carriers of Cryptococcus laurentii, Cryptococcus uniguttulatus and Debaryomyces hansenii. Medical Mycology 37:5, 367-369
CrossRef18
A. Kapoor, S.M. Flechner, K. O'Malley, D. Paolone, T.M. File, Jr., A.F. Cutrona. (1999) Cryptococcal meningitis in renal transplant patients associated with environmental exposure. Transplant Infectious Disease 1:3, 213-217
CrossRef19
Urban Kumlin, Björn Olsen, Margareta Granlund, Lars-Gunnar Elmqvist, Arne Tärnvik. (1998) Cryptococcosis and starling nests. The Lancet 351:9110, 1181
CrossRef
