A recent case of Cryptococcus neoformans infection led doctors to call for the public to be mindful of their health and to take special care of patients who have used steroids for a long time, have diabetes or are undergoing dialysis, as they are in a high-risk group prone to infection.
About six months ago, an 18-year-old student complained of pain in her left knee when walking and checked in to the Taipei City Hospital. Doctors diagnosed that she had been infected with the Cryptococcus neoformans fungus in her femur, Huang Ming-che (黃明哲) of the hospital’s orthopedic division said on Friday.
X-rays and nuclear magnetic resonance scans helped doctors to discover that the cortical surface of the student’s femur had been corroded and the tissue around the infection was already collecting interstitial fluid, Huang said.
He added that the hospital had to conduct a pathological examination to determine whether it was a bone neoplasm or an infection.
The results of the examination showed the presence of the Cryptococcus neoformans fungus, Huang said, adding that the condition had been suppressed after treatment with antifungal agents.
If treating the infection had been delayed any longer it would have resulted in severe damage to the femur’s structure and would have left a lingering after-effect of persistent aches, Huang said.
The primary path of infection is from touching or inhaling dirt and air tainted with bird feces — especially that of pigeons — and once the fungus enters the body it can be transmitted to other organs through the circulatory system, Huang said.
Though the patient’s family does not keep any birds or pigeons, there is a pigeon coop close to her home, Huang said, adding that it was possible that she had accidentally come into contact with earth contaminated with pigeon excrement.
Huang said that the patient had suffered from systemic lupus erythematosus seven years ago and had been on steroid therapy for a long time to control the disease.
However, Huang added that the patient’s case was rare, as infection with the fungus usually led to pneumonia or meningitis, both of which could become fatal if left untreated.
Meanwhile, Centers for Disease Control (CDC) doctor Luo Yi-chun (羅一均) said that the Cryptococcus neoformans fungus is ubiquitous. He added that pigeon feces and eucalyptus leaves have a high pH, which is conducive to the fungus’ breeding, and they therefore tend to contain a higher concentration of the fungus.
Luo said that as pigeon excrement incubates the fungus and concentrates it to a high degree, soil contaminated with pigeon feces is more dangerous than normal earth.
Only people with a low resistance to viral infections — such as those suffering from uncontrolled diabetes, cirrhosis of the liver, renal failure, or autoimmune diseases like HIV/AIDS — are susceptible to full-body infection, Luo said, adding that the fungus was not medically viewed as a transmittable disease because of the nature of its infections.
CDC deputy director Chou Jih-haw (周志浩) said that people should take care to distance themselves from potential sources of contamination and pay attention to personal hygiene, as well as environmental sanitation.