Cryptococcal Disease and Endemic Mycosis

2011 ◽  
pp. 293-299
Author(s):  
Johan A. Maertens ◽  
Hélène Schoemans
Keyword(s):  
Endemic Mycosis ◽  
Cryptococcal Disease

Prevalence of Asymptomatic Cryptococcal Antigenemia and Association with Follow-up risk of Cryptococcal Meningitis and Mortality among HIV Infected Patients in North West India – A Prospective Cohort Study

2020 ◽  
Vol 18 ◽  
Author(s):  
Rajendra Bhati ◽  
Pramendra Sirohi ◽  
Bharat Sejoo ◽  
Deepak Kumar ◽  
Gopal K Bohra ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Morbidity And Mortality ◽  
People Living With Hiv ◽  
Cryptococcal Antigen ◽  
North West ◽  
Cryptococcal Disease ◽  
Increased Risk ◽  
Living With Hiv ◽  
Inflammatory Syndrome

Objective: Cryptococcal meningitis is an important cause of morbidity and mortality in HIV infected individuals. In the era of universal antiretroviral therapy incidence of immune reconstitution inflammatory syndrome (IRIS) related cryptococcal meningitis has increased. Detection of serum cryptococcal antigen in asymptomatic PLHIV (People Living With HIV) and pre-emptive treatment with fluconazole can decrease the burden of cryptococcal disease. We conducted this study to find the prevalence of asymptomatic cryptococcal antigenemia in India and its correlation with mortality in PLHIV. Method and material: This was a prospective observational study. HIV infected ART naïve patients with age of ≥ 18 years who had CD4 counts ≤ 100 /µL were included and serum cryptococcal antigen test was done. These patients were followed for six months to look for the development of Cryptococcal meningitis and mortality. Results: A total of 116 patients were analysed. Asymptomatic cryptococcal antigenemia was detected in 5.17% patients and it correlated with increased risk of cryptococcal meningitis and mortality on follow-up in PLHIV. Conclusion: Serum cryptococcal positivity is correlated with increased risk of Cryptococcal meningitis and mortality in PLHIV. We recommend the screening of asymptomatic PLHIV with CD4 ≤ 100/µL for serum cryptococcal antigen, so that pre-emptive treatment can be initiated to reduce morbidity and mortality.

scholarly journals Evaluation of a Cryptococcal Antigen Lateral Flow Assay and Cryptococcal Antigen Positivity at a Large Public Hospital in Atlanta, Georgia

2021 ◽  
Author(s):  
Kristin R V Harrington ◽  
Yun F (Wayne) Wang ◽  
Paulina A Rebolledo ◽  
Zhiyong Liu ◽  
Qianting Yang ◽  
...  
Keyword(s):  
Public Hospital ◽  
Clinical Care ◽  
Latex Agglutination ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
Clinical Implications ◽  
Cryptococcal Antigen ◽  
Cryptococcal Disease ◽  
Percent Positivity ◽  
The U.S

Abstract Background Cryptococcus neoformans is a major cause of morbidity and mortality among HIV-infected persons worldwide, and there is scarce recent data on cryptococcal antigen (CrAg) positivity in the U.S. We sought to determine the frequency of cryptococcal disease and compare the performance of a CrAg lateral flow assay (LFA) versus latex agglutination (LA) test. Methods All patients from Grady Health System in Atlanta who had a serum or cerebrospinal fluid (CSF) sample sent for CrAg testing as part of clinical care from November 2017 – July 2018 were included. Percent positivity and test agreement were calculated. Results Among 467 patients, 557 diagnostic tests were performed; 413 on serum and 144 on CSF. Mean age was 44 years, most were male (69%) and had HIV (79%). Twenty-four (6.4%, CI95% = 4.1, 9.4) patients were serum CrAg positive, and eight (5.8%, CI95% = 2.6, 11.2) individuals tested positive for CSF CrAg. While overall agreement between the LA and LFA was substantial to high for CSF (κ= 0.71, CI95% = 0.51, 0.91) and serum (κ= 0.93, CI95% = 0.86, 1.00), respectively, there were important discrepancies. Five patients had false-positive CSF LA tests which affected clinical care, and four patients had discordant serum tests. Conclusions We found a moderately high proportion of cryptococcal disease and important discrepancies between the LA test and LFA. Clinical implications of these findings include accurate detection of serum CrAg and averting unnecessary treatment of meningitis with costly medications associated with high rates of adverse events.

scholarly journals Practice Guidelines for the Management of Cryptococcal Disease

2000 ◽  
Vol 30 (4) ◽  
pp. 710-718 ◽  
Author(s):  
M. S. Saag ◽  
R. J. Graybill ◽  
R. A. Larsen ◽  
P. G. Pappas ◽  
J. R. Perfect ◽  
...  
Keyword(s):  
Practice Guidelines ◽  
Cryptococcal Disease

scholarly journals PARACOCCIDIOIDOMYCOSIS: CHALLENGES IN THE DEVELOPMENT OF A VACCINE AGAINST AN ENDEMIC MYCOSIS IN THE AMERICAS

2015 ◽  
Vol 57 (suppl 19) ◽  
pp. 21-24 ◽  
Author(s):  
Carlos. P. TABORDA ◽  
M.E. URÁN ◽  
J. D. NOSANCHUK ◽  
L.R. TRAVASSOS
Keyword(s):  
Immune Response ◽  
Latin America ◽  
Monoclonal Antibodies ◽  
Clinical Practice ◽  
Therapeutic Vaccines ◽  
Endemic Mycosis ◽  
Paracoccidioides Spp ◽  
Important Means ◽  
Cellular Immune ◽  
Stimulation Of

SUMMARYParacoccidioidomycosis (PCM), caused by Paracoccidioides spp, is an important endemic mycosis in Latin America. There are two recognized Paracoccidioides species, P. brasiliensis and P. lutzii, based on phylogenetic differences; however, the pathogenesis and disease manifestations of both are indistinguishable at present. Approximately 1,853 (~51,2%) of 3,583 confirmed deaths in Brazil due to systemic mycoses from 1996-2006 were caused by PCM. Antifungal treatment is required for patients with PCM. The initial treatment lasts from two to six months and sulfa derivatives, amphotericin B, azoles and terbinafine are used in clinical practice; however, despite prolonged therapy, relapses are still a problem. An effective Th1-biased cellular immune response is essential to control the disease, which can be induced by exogenous antigens or modulated by prophylactic or therapeutic vaccines. Stimulation of B cells or passive transference of monoclonal antibodies are also important means that may be used to improve the efficacy of paracoccidioidomycosis treatment in the future. This review critically details major challenges facing the development of a vaccine to combat PCM.

scholarly journals Cryptococcal Meningoencephalitis in an Immunosuppressed Patient with Chronic Lymphocytic Leukemia

2021 ◽  
Vol 16 (2) ◽  
pp. 87-89
Author(s):  
Md Monirul Hoque ◽  
Sonia Chakraborty ◽  
Arif Ahmed Khan
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Antifungal Agents ◽  
Immunosuppressive Drugs ◽  
Rapid Diagnosis ◽  
Lymphocytic Leukemia ◽  
Cell Mediated Immunity ◽  
Immunosuppressed Patient ◽  
Cryptococcal Meningoencephalitis ◽  
India Ink ◽  
Cryptococcal Disease

Cryptococcal meningoencephalitis, an invasive fungal infection caused by an encapsulated fungus Cryptococcus neoformans should be suspected in immune compromised individuals with defective cell-mediated immunity and patients on immunosuppressive drugs with recent development of fever, confusion and loss of consciousness. A rapid diagnosis is fundamental for decreasing morbidity and mortality from cryptococcal disease. Cerebrospinal fluid (CSF) study and simple stain like India Ink Stain can be performed for diagnosis of cryptococcal meningoencephalitis. Here, we report a case of cryptococcal meningoencephalitis in chronic lymphocytic leukemia (CLL) patient on immunosuppressive drugs diagnosed by CSF study and India ink stain which responded dramatically with antifungal agents after diagnosis. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 87-89

scholarly journals The granuloma in cryptococcal disease

2021 ◽  
Vol 17 (3) ◽  
pp. e1009342
Author(s):  
Laura C. Ristow ◽  
J. Muse Davis
Keyword(s):  
Granulomatous Inflammation ◽  
Granuloma Formation ◽  
Current Understanding ◽  
Mass Lesion ◽  
Disease Entity ◽  
Major Barrier ◽  
Cryptococcal Disease ◽  
Molecular Studies

Although we have recognized cryptococcosis as a disease entity for well over 100 years, there are many details about its pathogenesis which remain unknown. A major barrier to better understanding is the very broad range of clinical and pathological forms cryptococcal infections can take. One such form has been historically called the cryptococcal granuloma, or the cryptococcoma. These words have been used to describe essentially any mass lesion associated with infection, due to their presumed similarity to the quintessential granuloma, the tubercle in tuberculosis. Although clear distinctions between tuberculosis and cryptococcal disease have been discovered, cellular and molecular studies still confirm some important parallels between these 2 diseases and what we now call granulomatous inflammation. In this review, we shall sketch out some of the history behind the term “granuloma” as it pertains to cryptococcal disease, explore our current understanding of the biology of granuloma formation, and try to place that understanding in the context of the myriad pathological presentations of this infection. Finally, we shall summarize the role of the granuloma in cryptococcal latency and present opportunities for future investigations.

scholarly journals Prevalence and Mortality of Cryptococcal Disease in Adults with Advanced HIV in an Urban Tertiary Hospital in Sierra Leone: A Prospective Study

2019 ◽  
Author(s):  
Sulaiman Lakoh ◽  
Hannah Rickman ◽  
Momodu Sesay ◽  
Sartie Kenneh ◽  
Rachael M. Burke ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
World Health ◽  
Categorical Variables ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Cryptococcal Disease

Abstract Background The global annual estimate for cryptococcal disease related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count <100/µl. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone. MethodsA cross-sectional study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm3 from January to April, 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with eight weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher’s exact test was used to compare categorical variables. Results A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm3 (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days). Eight participants had a positive blood CrAg, giving a prevalence of 4.7% (95% CI: 2.4-9.2%). Of those with a positive CrAg, CSF CrAg was positive in five (62.5%). Five (62.5%) CrAg-positive participants died within the first month, while the remaining three were alive and established on ART at eight weeks. ConclusionA substantial prevalence of cryptococcal antigenaemia and poor outcome of cryptococcal disease were demonstrated in our study. The high mortality suggests a need for the HIV programme to formulate and implement policies on screening and pre-emptive fluconazole therapy for all adults with advanced HIV in Sierra Leone, and advocate for affordable access to effective antifungal therapies.

CD4+ lymphocytopenia without HIV in patient with cryptococcal disease

The Lancet ◽  
1991 ◽  
Vol 337 (8732) ◽  
pp. 57-58 ◽  
Author(s):  
Maxime Seligmann ◽  
Selim Aractingi ◽  
Eric Oksenhendler ◽  
Claire Rabian ◽  
Françoise Ferchal ◽  
...  
Keyword(s):  
Cryptococcal Disease

scholarly journals Correlation of Fluconazole MICs with Clinical Outcome in Cryptococcal Infection

2000 ◽  
Vol 44 (6) ◽  
pp. 1544-1548 ◽  
Author(s):  
A. I. Aller ◽  
E. Martin-Mazuelos ◽  
F. Lozano ◽  
J. Gomez-Mateos ◽  
L. Steele-Moore ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Maintenance Therapy ◽  
National Committee ◽  
Yeast Nitrogen Base ◽  
Nitrogen Base ◽  
Cryptococcal Infection ◽  
Microdilution Method ◽  
Cryptococcal Disease ◽  
Fluconazole Therapy

ABSTRACT We have correlated the in vitro results of testing the susceptibility of Cryptococcus neoformans to fluconazole with the clinical outcome after fluconazole maintenance therapy in patients with AIDS-associated cryptococcal disease. A total of 28 isolates of C. neoformans from 25 patients (24 AIDS patients) were tested. The MICs were determined by the broth microdilution technique by following the modified guidelines described in National Committee for Clinical Standards (NCCLS) document M27-A, e.g., use of yeast nitrogen base medium and a final inoculum of 104 CFU/ml. The fluconazole MIC at which 50% of isolates are inhibited (MIC50) and MIC90, obtained spectrophotometrically after 48 h of incubation, were 4 and 16 μg/ml, respectively. Of the 25 patients studied, 4 died of active cryptococcal disease and 2 died of other causes. Therapeutic failure was observed in five patients who were infected with isolates for which fluconazole MICs were ≥16 μg/ml. Four of these patients had previously had oropharyngeal candidiasis (OPC); three had previously had episodes of cryptococcal infection, and all five treatment failure patients had high cryptococcal antigen titers in either serum or cerebrospinal fluid (titers, >1:4,000). Although 14 of the 18 patients who responded to fluconazole therapy had previously had OPC infections, they each had only a single episode of cryptococcal infection. It appears that the clinical outcome after fluconazole maintenance therapy may be better when the infecting C. neoformans strain is inhibited by lower concentrations of fluconazole for eradication (MICs, <16 μg/ml) than when the patients are infected with strains that require higher fluconazole concentrations (MICs, ≥16 μg/ml). These findings also suggest that the MICs determined by the modified NCCLS microdilution method can be potential predictors of the clinical response to fluconazole therapy and may aid in the identification of patients who will not respond to fluconazole therapy.

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