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LETTERS TO THE EDITOR |
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| Year : 2021 | Volume
: 24
| Issue : 1 | Page : 89-90 |
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Remembering professor baldev singh: The budding Cryptococcus
Prahlad K Sethi
Professor of Neurology, Gangaram Institute of Post-Graduate Medical Education and Research, Sarhadi Gandhi Marg, Old Rajinder Nagar, New Delhi, India
| Date of Submission | 04-Mar-2020 |
| Date of Acceptance | 05-Mar-2020 |
| Date of Web Publication | 24-Jun-2020 |
Correspondence Address:
Prof. Prahlad K Sethi
Professor of Neurology, Sarhadi Gandhi Marg, Old Rajinder Nagar, Rajinder Nagar, New Delhi - 110 060
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/aian.AIAN_148_20
How to cite this article:
Sethi PK. Remembering professor baldev singh: The budding Cryptococcus. Ann Indian Acad Neurol 2021;24:89-90 |
In 1984, a serving brigadier of the Indian army was admitted under the care of Prof. G.K Ahuja for headache associated with vision impairment. His wife; a major in the Army Medical Corps (AMC) was at that time enrolled in DM Cardiology in AIIMS, Delhi. The patient had a bilateral severe grade of papilledema on fundoscopy and after a CT scan of the head, Prof Ahuja performed a spinal tap. After CSF revealed Cryptococcus, the patient was initiated on inj. amphotericin B and oral flucytosine. In those days, an MRI scan was unavailable. Liposomal amphotericin was also unavailable and the available formulation had plenty of side-effects. After 3 weeks of treatment at AIIMS, the patient was transferred to the Army Hospital under my care. By this time, he was moderately disabled walking with broad-based gait. The vision was severely compromised and the hearing was impaired. CT scan of the head showed increasing hydrocephalus. CSF continued to show budding Cryptococcus although four consecutive CSF cultures were negative. At that time I wanted to stop treatment with antifungal agents. The brigadier's wife was keenly following the case. When I discussed my plan of stopping the treatment, she retorted “how can you stop the treatments if the CSF is still showing budding Cryptococcus?” When I offered to continue amphotericin for another week she again was not happy stating that the medication was causing side-effects.
Frustrated and outfoxed, I consulted Prof Baldev Singh [Figure 1] under whom I had trained in Neurology. One afternoon, I went to his office in AIIMS and narrated my dilemma. I was surprised to learn that the lady officer was also giving him a hard time with respect to her husband's treatment. After dinner when he would walk out of the PG hotel she would suddenly appear from behind a bush and accost him with the same question. If four CFS cultures are negative, how can the CSF still show budding Cryptococcus? Prof. Baldev Singh advised me to consult Prof. Mahapatra; a microbiologist by training. Dr. Mahapatra was in the process of moving houses and gave me a monograph on Cryptococcus to refer to. His only condition was that I read it in his house. So, for the next 4 odd hours, I sat on a luggage box and went through it looking for an answer to my query. One sentence caught my eye which I thought may be helpful. The next day I told Prof. Baldev Singh that there was a line in the monograph stating that dead Cryptococcus may persist in CSF for years. With a twinkle in his eye, he said: “so you mean to tell me these are not budding Cryptococcus, rather that have already budded?” He informed me that he and Prof. Ahuja will pay a visit to the Army Hospital. 2 days later, he visited my hospital. Meticulously after examining the brigadier, he explained to the family that the Cryptococcus had already budded and were now dead and advised that the treatment be stopped. He also advised a shunt surgery for hydrocephalus and 2 days later this was carried out by Col. V S Madan.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1]
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