Cryptococcus neoformans: Pitfalls in diagnosis through evaluation of gram-stained smears of purulent exudates

The recognition of Cryptococcus neoformans in Gram-stained smears of purulent exudates may be hampered by the presence of the large gelatinous capsule which apparently prevents definitive staining of the yeast-like cells. In such stained preparations, C. neoformans may appear either as round cells with gram-positive granular inclusions impressed upon a pale lavender cytoplasmic backgroung or as gram-negative lipoid bodies.