The microscopic recognition of typical rounded capsulated yeasts in centrifuged cerebrospinal fluid (CSF), stained with India ink, is a common, rapid and effective method for the diagnosis of cryptococcal meningitis among AIDS patients. The presence of atypical forms of Cryptococcus neoformans var. neoformans in samples of CSF of an AIDS patient with cryptococcosis treated at the University Hospital of Infectious Disease is presented. The India ink microscopy of three consecutive CSF samples revealed capsulated yeast with India ink particles in the deteriorated capsules and capsulated pseudohyophae. Clinically, the patient showed a subacute meningoencephalitis, with a clinical picture not particularly different from those commonly observed in patients with AIDS-associated cryptococcosis treated in our hospital. In all cases, the culture of the CSF showed colonies of C. neoformans with typical macro and micromorphology, and the in vitro susceptibility tests to amphotericin B, fluocitosine, itraconazole and fluconazole showed MIC values into the limits of sensitivity. The presence of atypical forms of C. neoformans, considered as an atypical finding, could be the consequence of an adaptive phenomenon of this fungal species to an impaired immunological status present in the host.

Here we present a survey including 52 drug-naive recently HIV-1 Y infected subjects from Buenos Aires City and province (79%) and 3 other regions in Argentina (21%). Recent infections were established from previous negative serology (32/ 52), indeterminate Western blot (12/52), or acute retroviral syndrome after high-risk HIV exposure (8/52) within 9 months before genotyping (median time, 4.2 months). Genotyping was performed from plasma by sequencing both protease and reverse transcriptase. Phylogenetic analysis combined with bootscanning resulted in 21 subtype B sequences and 31 B/F recombinants (RecBF). On protease, minor resistance-related mutations were found in both subtype B and RecBF with low frequencies. The substitution L89M, recently suggested as a resistance-related mutation in some subtype F viruses, was observed in 1 RecBF. On reverse transcriptase, major resistance-related mutations were found in 4 of 52 (7.7%) patients from different health centers: M41L (subtype B) and K103NTP225H (1 RecBF and 2 subtype B). The greater than 5% resistance threshold found indicates a need for sentinel resistance surveillances calling for an update in the current resistance testing guidelines in Argentina.

Here we present a survey including 52 drug-naive recently HIV-1 Y infected subjects from Buenos Aires City and province (79%) and 3 other regions in Argentina (21%). Recent infections were established from previous negative serology (32/ 52), indeterminate Western blot (12/52), or acute retroviral syndrome after high-risk HIV exposure (8/52) within 9 months before genotyping (median time, 4.2 months). Genotyping was performed from plasma by sequencing both protease and reverse transcriptase. Phylogenetic analysis combined with bootscanning resulted in 21 subtype B sequences and 31 B/F recombinants (RecBF). On protease, minor resistance-related mutations were found in both subtype B and RecBF with low frequencies. The substitution L89M, recently suggested as a resistance-related mutation in some subtype F viruses, was observed in 1 RecBF. On reverse transcriptase, major resistance-related mutations were found in 4 of 52 (7.7%) patients from different health centers: M41L (subtype B) and K103NTP225H (1 RecBF and 2 subtype B). The greater than 5% resistance threshold found indicates a need for sentinel resistance surveillances calling for an update in the current resistance testing guidelines in Argentina.