Recently, a new species of Cryptococcus was found to cause a fungal infection in a preterm infant with a low birth weight. In this report, the patient was a preterm infant at 31 weeks with low birth weight who developed fungemia and meningitis due to C. albidus. Despite antibiotic treatment, the patient exhibited hypothermia, hypotension, and thrombocytopenia and required increased ventilatory support. However, the patient improved after receiving liposomal amphotericin B and was ultimately extubated.
Compared to term newborns, preterm premature neonates are at an increased risk of serious infection because of the passive acquisition of lower levels of maternally-derived total immunoglobulin G and specific antibodies to bacterial pathogens, poor function of neutrophils, decreased neutrophil storage pools, and immature antibody responses to pulmonary invasion and bacteremia [7]. Notably, important risk factors for this infection include an immature immune system, central line insertion, TPN, broad-spectrum antibiotics, previous use of antifungal medications while on prophylactic fluconazole, and overcrowding in the neonatal intensive care unit [8].
We identified three cases of Cryptococcus non-neoformans infection in pediatric patients. The first case involved a premature neonate with C. laurentii fungemia, who was successfully treated with amphotericin B without complications. The second case featured a 15-year-old girl with Takayasu arteritis and chronic recurrent multifocal osteomyelitis; she was also treated with amphotericin B and experienced no complications. The third case concerned a localized cutaneous C. albidus infection in a 14-year-old boy undergoing etanercept therapy, which resolved following a course of fluconazole [9–11].
Table 1 delineates the clinical presentation of C. albidus infections in adults. Specifically, twenty reported cases from 1965 to 2015 included five patients with meningitis, one with meningoencephalitis, three with pneumonia, one with peritonitis, and one with fungemia. Notably, the risk factors encompassed malignancy, human immunodeficiency virus (HIV), liver cirrhosis, diabetes mellitus, end-stage renal disease, post-transplant status, polycythemia, and prematurity.
Table 1
Summary of Reported Cases of Invasive Cryptococcus albidus Infection
| Age, mean years | 14–85 years Number (20) |
| Risk factors | Malignancy Human deficiency virus Diabetes Mellitus Liver cirrhosis End-stage renal diseases Polycythemia Post-transplant Prematurity |
| Site of infection | Fungemia, meningitis, meningoencephalitis, pneumonia, and peritonitis. |
| Treatment | Amphotericin B, Fluconazole. Itraconazole |
| Outcome | 12 survived, eight died |
Blood culture has long been the gold standard for diagnosing fungal infections. However, the extended time required for results—up to five days for yeasts and four weeks for molds—has historically delayed treatment and impacted outcomes. Conventional methods of identifying and detecting fungi, including microscopy, histopathology, and culture-based tests, often necessitate personnel with specialized knowledge of fungi, a resource that is sometimes limited in many institutions. Therefore, non-culture methods such as fungal antibodies, antigen detection, and DNA identification are crucial [12].
New diagnostic platforms are constantly emerging and gaining approval for use in molecular diagnostics. In diagnosing our case, we used the VITEK® ID card, a convenient, safe, easy-to-use disposable device that can identify up to 50 yeast varieties. Among the antifungal agents tested, amphotericin B was consistently the only agent to which C. albidus was susceptible, as management guidelines for this rare disease are currently lacking [13–17].
Treatment with an antifungal agent other than flucytosine was appropriate in our patient. Moreover, it is crucial to note that C. albidus is intrinsically resistant to echinocandins but is susceptible to posaconazole, fluconazole, voriconazole, itraconazole, and miconazole in some cases [18–21]. Notably, the optimal duration of treatment remains uncertain; however, in cases involving the central nervous system, as in our patient, treatment is typically administered for a period of six weeks.
The occurrence of organisms in a geographical area exceeding the baseline rate during a specific period is noteworthy. This sudden increase could be attributable to a single infection, such as anthrax, healthcare-associated Legionella, or group A Streptococcal infection, or to multiple infections like those arising from food- or water-borne diseases [22]. In this context, we define it as an outbreak in the unit. Stringent infection control measures were enacted, including hand hygiene education and auditing, surveillance, surface swabs, patient isolation, care of central lines, TPN rooms, air-conditioning cleaning, and water supply monitoring.
Here, we report a case of C. albidus fungemia and meningitis in a preterm infant. Risk factors include premature birth and prolonged antibiotic use. Although the patient tested negative for HIV, the major contributing factors to fungemia included indwelling intravenous lines and TPN. Notably, very preterm infants are at high risk owing to their low weight, poor nutrition, malabsorption, low immunity, and underdeveloped barriers. Owing to the rarity of reported cases, there are no approved guidelines or standard treatments for C. albidus. However, we found that liposomal amphotericin B without flucytosine effectively treated our patients without complications. To prevent the spread of infection, it is crucial to implement effective infection control measures.