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Evidence of Zoonotic Transmission of Cryptococcus neoformans from a Pet Cockatoo to an Immunocompromised Patient

Joshua D. Nosanchuk, MD; Shmuel Shoham, MD; Bettina C. Fries, MD; Daniel S. Shapiro, MD; Stuart M. Levitz, MD; and Arturo Casadevall, MD, PhD
[+] Article and Author Information

From Albert Einstein College of Medicine, Bronx, New York; and Boston University School of Medicine, Boston, Massachusetts.


Acknowledgments: The authors thank L. Freundlich for assistance with the API 20C clinical yeast system.

Requests for Single Reprints: Arturo Casadevall, MD, PhD, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461; e-mail, casadeva@aecom.yu.edu.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Nosanchuk, Fries, and Casadevall: Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461.

Drs. Shoham, Shapiro, and Levitz: Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118.

Author Contributions: Conception and design: J.D. Nosanchuk, S. Shoham, S.M. Levitz, A. Casadevall.

Analysis and interpretation of the data: J.D. Nosanchuk, B.C. Fries, D.S. Shapiro, S.M. Levitz, A. Casadevall.

Drafting of the article: J.D. Nosanchuk, S. Shoham, A. Casadevall.

Critical revision of the article for important intellectual content: B.C. Fries, S.M. Levitz, D.S. Shapiro.

Final approval of the article: J.D. Nosanchuk, B.C. Fries, S. Shoham, D.S. Shapiro, S.M. Levitz, A. Casadevall.

Provision of study materials or patients: B.C. Fries, S. Shoham, D.S. Shapiro, S.M. Levitz.

Obtaining of funding: J.D. Nosanchuk, B.C. Fries, S.M. Levitz, A. Casadevall.

Administrative, technical, or logistic support: D.S. Shapiro, S.M. Levitz, A. Casadevall.

Collection and assembly of data: J.D. Nosanchuk, S. Shoham.


Ann Intern Med. 2000;132(3):205-208. doi:10.7326/0003-4819-132-3-200002010-00006
Text Size: A A A

Background: Although cryptococcosis has been associated with birds for almost 50 years, point sources for infection have not been identified.

Objective: To document zoonotic transmission of Cryptococcus neoformans.

Design: Case report.

Setting: A home in Boston, Massachusetts.

Patient: A 72-year-old woman who received a diagnosis of cryptococcal meningitis in November 1998. The patient, who had been taking immunosuppressant drugs since undergoing renal transplantation in 1989, owned a pet cockatoo.

Measurements: Cryptococcus neoformans was isolated from the feces of the cockatoo. Isolates from excreta and from the patient were compared by using biochemical profiles, monoclonal antibody binding patterns, restriction fragment length polymorphism analysis, and karyotyping.

Results: The isolates from the patient and the cockatoo had identical biochemical profiles, the same monoclonal antibody immunofluorescence patterns, and indistinguishable patterns on restriction fragment length polymorphism analysis and karyotyping.

Conclusions: The indistinguishable patient and cockatoo isolates strongly suggest that the patient's infection resulted from exposure to aerosolized cockatoo excreta. Although the incidence of cryptococcal infection due to such exposure is unknown, it may be prudent to advise immunocompromised patients to avoid pet birds and avian excreta.

Figures

Grahic Jump Location
Figure.
Electrophoretic karyotyping and restriction fragment length polymorphism (RFLP) analysis of the clinical (Pt) and excreta (A3, B1) isolates.A.Saccaromyces cerevisiaeB.

Electrophoretic karyotypes obtained by contour-clamped homogeneous electric field (CHEF) analysis; the molecular weight markers of chromosomal DNA (Bio-Rad, Richmond, California) are indicated on the right. The CHEF analysis was done on 2 different days, with similar results. The RFLP figure is a composite that was generated by scanning autoradiograms of the same gel and printing the lanes next to each other. Minor differences in the migration distances of the upper bands are the results of differences in the amount of DNA loaded in the lanes. The CNRE-1 analysis was done on 3 different days, and the results were consistent.

Grahic Jump Location

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Summary for Patients

A Case of Cryptococcal Infection in a Patient with an Abnormal Immune System and a Pet Cockatoo

The summary below is from the full report titled “Evidence of Zoonotic Transmission of Cryptococcus neoformans from a Pet Cockatoo to an Immunocompromised Patient.” It is in the 1 February 1999 issue of Annals of Internal Medicine (volume 132, pages 205-208). The authors are J.D. Nosanchuk, S. Shoham, B.C. Fries, D.S. Shapiro, S.M. Levitz, and A. Casadevall.

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