An Introduction to Fungal Meningitis

11 06 2011

By: Aubrey Frazzitta

Candidate for B.S. in Biology, B.A. in Visual Arts, minor in Chemistry

Hello! My name is Aubrey Frazzitta, and I am a rising senior at Duke studying Biology and Visual Arts while following a pre-med track. I am really looking forward to conducting this fieldwork project at the exciting intersection of microbiology and global health!

In the next couple of days, I will arrive in the city of Lomé, the capital of the Togolese Republic, where I will be spending the next 9 weeks researching fungal meningitis. Bordered by Ghana, Benin, and Burkina Faso, this small West African country is agriculturally dependent and has a struggling economy. Togo’s tropical climate provides an environment rich for infectious disease proliferation. In addition to malaria and yellow fever, HIV/AIDS is rampant throughout the country.

Another increasing human health threat is meningoencephalitis. The fungal form, the causative agents primarily being Cryptococcus neoformans and Cryptococcus gattii, is particularly on the rise. These basidiomycete human pathogens are responsible for higher mortality in sub-Saharan Africa than tuberculosis. While C. gattii can infect anyone, C. neoformans mostly affects immune-compromised patients; it is also more ubiquitously spread worldwide than the species gattii. In conjunction with the high prevalence of HIV/AIDS in sub-Saharan Africa, cryptococcosis is a major problem. If not rapidly and aggressively treated, this infection is most likely fatal.

The known environmental reservoirs of pathogenic Cryptococcus species are pigeon guano and certain trees, although the pathogenic yeast survives in the cerebrospinal fluid (CSF) of the mammalian host, including people. While the prevalence and means of acquisition of the infection have been extensively characterized in other areas of the world, the West African region (with its unique flora and fauna) has not been as extensively characterized. Furthermore, the incidence of infection, methods for diagnosis, and treatment availability is not well known.

In the Perfect Laboratory at Duke University Medical Center in the Medical Mycology Research unit, I study nitrogen metabolism in the basidiomycete human pathogens C. gattii and C. neoformans. With this project, I will explore how fungal meningitis is diagnosed, treated, and characterized in this region of the world. My research will include environmental and clinical sampling to isolate and characterize possible West African reservoirs for this pathogen. I will take these samples with me and, once back at Duke, determine the molecular typing of these strains. In addition, I hope to identify the incidence, diagnosis, common co-infections, and problems with treatment of fungal meningitis in Lomé clinics through conversations with community members and physicians.

This research will hopefully create a new strain library of Cryptococcus species for use in other labs throughout the world. Furthermore, locating the specific species and environmental sources most affecting the area will provide the preliminary research to more effectively treat cryptococcosis in this region.

I am very excited to get settled in with my host family and to begin these projects in Togo! Check back for updates soon once I arrive in Lomé.

India Ink Stain of Cryptococcus neoformans

Thanks to the anthropological, clinical, and basic science research of my program advisors Dr. Charles Piot, Dr. John R. Perfect, M.D., and Dr. Ana Litvintseva for much of the background information and mentoring for this project.




One response

23 10 2011

Hi Aubrey, I wish you well. I am an American woman with a history of treatment for a rare autoimmune disease who caught both cryptococcal meningitis AND invasive pulmonary aspergillosis at the same time four years ago (in Southern California).

Prior to my disabling disease ending my career, I earned an M.P.H. on top of my BA in International Relations. I had also worked for a non-profit public health organization and have traveled extensively overseas.

My wish was to go on and earn a Ph.D. in International Public Health. Perhaps I would have focused on fungal infections too, so your story is inspiring. Unfortunately, my health is likely never to improve enough for me to pursue a doctoral degree or work again.

Best wishes

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