Bilateral Placoid Choroiditis in an HIV-Positive Patient With Cryptococcus neoformans Meningitis and Disseminated Cryptococcal Disease

2020 ◽  
Vol 4 (6) ◽  
pp. 530-533
Author(s):  
Ryan D. Larochelle ◽  
Marissa B. Larochelle ◽  
Yee Yee Aung ◽  
Thinzar Linn ◽  
David Heiden ◽  
...  
Keyword(s):  
Cryptococcus Neoformans ◽  
Opportunistic Infections ◽  
Posterior Pole ◽  
Hiv Positive ◽  
Cryptococcal Infection ◽  
Multifocal Choroiditis ◽  
Cryptococcal Disease ◽  
Unusual Variant ◽  
Life Threatening ◽  
Ophthalmologic Examination

Purpose: We report a presumptive case of bilateral placoid choroiditis secondary to disseminated Cryptococcus neoformans infection and review the literature on choroidal involvement of C neoformans. Methods: A case report is presented. Results: A 35-year-old HIV-positive man presented with disseminated cryptococcal infection. Cryptococcal meningitis was confirmed by lumbar puncture, and skin involvement was confirmed by microscopy of scrapings from a papular, umbilicated, ulcerated lesion. Ophthalmologic examination revealed intact visual acuity, clear vitreous, and multiple yellowish, placoid-appearing choroidal lesions in the posterior pole bilaterally. Conclusions: Multifocal choroiditis caused by C neoformans is an uncommon manifestation of disseminated infection, and placoid yellowish choroidal lesions are an unusual variant. These findings must be differentiated from choroidal tuberculosis and other infections. Multifocal choroiditis typically occurs in AIDS patients and may precede the presentation of meningitis. In such patients, choroidal lesions warrant investigation for systemic, life-threatening opportunistic infections.

scholarly journals Clinical features of invasive fungal disease in children with no underlying disease

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Juan Huang ◽  
Chentao Liu ◽  
Xiangrong Zheng
Keyword(s):  
Cryptococcus Neoformans ◽  
Candida Parapsilosis ◽  
Invasive Fungal Disease ◽  
Underlying Disease ◽  
Fungal Disease ◽  
The Body ◽  
Fungal Culture ◽  
Cryptococcal Infection ◽  
Cryptococcal Disease ◽  
Eosinophil Counts

AbstractThere is limited research into Invasive fungal disease (IFD) in children with no underlying disease. We undertook a retrospective study of children with IFD who did not suffer from another underlying disease, from June 2010 to March 2018 in Changsha, China. Nine children were identified. Eosinophil counts were elevated in six cases. The level of procalcitonin (PCT) was elevated in six cases. Fungal culture was positive in all patients, including eight cases of Cryptococcus neoformans and one case of Candida parapsilosis. 8.33 days following antifungal treatment, the body temperature of the eight patients affected by cryptococcal disease had returned to normal. Our study indicates that the primary pathogen in IFD was Cryptococcus neoformans in children who had no other underlying disease. Eosinophils can be considered to be indicators of cryptococcal infection. IFD in children with no other underlying disease has a satisfactory prognosis.

scholarly journals Cryptococcal Infection with Ruxolitinib in Primary Myelofibrosis: A Case Report and Literature Review

2021 ◽  
Author(s):  
Zachary Ciochetto ◽  
Njeri Wainaina ◽  
Anna Corey ◽  
Mary Beth Graham ◽  
Muhammad Bilal Abid
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Cryptococcus Neoformans ◽  
Primary Myelofibrosis ◽  
Intracellular Pathogens ◽  
Cryptococcal Infection ◽  
Immunosuppressed Patients ◽  
Life Threatening ◽  
Disseminated Disease ◽  
Immunocompromised Hosts

Cryptococcus neoformans (CN) is an encapsulated yeast that causes disseminated and potentially life-threatening in immunocompromised hosts. We present a patient with primary myelofibrosis on ruxolitinib who developed disseminated disease due to CN. The report underscores the importance of suspecting infections with intracellular pathogens in immunosuppressed patients on ruxolitinib.

scholarly journals The mouse lung early cellular innate immune response is not sufficient to control fungal infection with Cryptococcus neoformans

2019 ◽  
Author(s):  
Jacob Rudman ◽  
Helen Maria Marriott ◽  
Leo M. Carlin ◽  
Simon Andrew Johnston
Keyword(s):  
Immune Response ◽  
Cryptococcus Neoformans ◽  
Post Infection ◽  
Opportunistic Infections ◽  
Ex Vivo ◽  
Mouse Lung ◽  
Cell Mediated Immunity ◽  
Wide Field ◽  
Cryptococcal Infection

AbstractCryptococcus neoformanscauses life-threatening infection in the immunocompromised. This and other opportunistic pathogens are an increasing threat as immunosuppression increases globally. To counter antibiotic resistance, there is precedent for developing immune enhancing therapy. However, our understanding of how immunocompetent patients resolve these infections is poor as opportunistic infections typically resolve subclinically. Because this has led to a lack of clinical data, we rely on animal models. Currentin vivoinfection models either lack mammalian immunity or are not compatible with long term high content imaging required to model the complexities of human host-pathogen interactions. Therefore, we have developed anex vivomurine precision cut lung slice (PCLS) model to understand innate immunity in cryptococcosis. C57BL/6 mice were sacrificed 0 or 24 hours post infection withKN99αcryptococci. Lungs were inflated with 37°C agarose, 300μm thick PCLS were prepared on a vibratome and imaged by confocal or wide-field fluorescence microscopy. Using PCLS and immunofluorescence, we demonstrate cryptococcal replication and clearance rates are balanced over the first 24 hours of infection. Cell-mediated immunity is alveolar macrophage centric, although alveolar macrophages demonstrate limited phagocytosis of cryptococci and enable intracellular cryptococcal replication.Cryptococcus neoformansresponded to the lung environment by forming enlarged cells, although these were not large enough to be titan cells. To further understand cryptococcal proliferationin vivo, we also infected animals withplb1mutantCryptococcus neoformansthat has been shown to exhibit proliferation defectsin vivo. We found no difference in fungal burden withplb1infected animals 24 hours post infection, but observed significantly larger fungal cells and no incidences of phagocytosis. Thus, the PCLS model can be used to assess the lung immune response early in cryptococcal infection, demonstrating that resident lung macrophages cannot control cryptococcal infection and offer an intracellular niche forCryptococcus neoformansgrowth.

scholarly journals Dissemination of Cryptococcus neoformans via localised proliferation and blockage of blood vessels

2017 ◽  
Author(s):  
Josie F Gibson ◽  
Robert J Evans ◽  
Aleksandra Bojarczuk ◽  
Richard Hotham ◽  
Anne K Lagendijk ◽  
...  
Keyword(s):  
Blood Vessel ◽  
Cryptococcus Neoformans ◽  
Blood Vessels ◽  
Cryptococcal Meningitis ◽  
Fungal Pathogen ◽  
Vascular Damage ◽  
Cryptococcal Infection ◽  
Vessel Damage ◽  
Junction Protein ◽  
Life Threatening

AbstractCryptococcus neoformans is an opportunistic fungal pathogen that can cause life-threatening cryptoccocal meningitis, predominantly within immunocompromised individuals. Cortical infarcts are observed in as many as 30% of cryptococcal meningitis cases, being particularly common in severe infection. Limited clinical case studies suggest infarcts are secondary to vasculitis and blood vessel damage caused by cryptococcal infection. However, the cause of infarcts in cryptococcal infection has not been determined. To examine potential causes of vascular damage and cryptococcal dissemination in cryptococcal infection, the zebrafish C. neoformans infection model was used. We demonstrate that spread of cryptococci from the vasculature occurs at sites where cryptococci grow within the blood vessels, originating from a single or small number of cryptococci. We find that cryptococcal cells become trapped within the vasculature and can proliferate there resulting in vasodilation. Localised cryptococcal growth in the vasculature is also associated with sites of dissemination – in some cases simultaneously with a loss of blood vessel integrity. Using a cell-cell junction protein reporter (VE-cadherin) we identified sites dissemination associated with both intact blood vessels and where vessel rupture occurred. Thus, we have identified a mechanism for blood vessel damage during cryptococcal infection that may represent a cause of the vascular damage and cortical infarction observed in cryptococcal meningitis.Author summaryHuman infection by the fungal pathogen, Cryptococcus neoformans, can lead to life-threatening cryptococcal meningitis. In severe cases of cryptococcal meningitis, a lack of blood supply can cause tissue death and a resulting area of dead tissue (infarct) in the brain. Although vasculature inflammation in known to occur in cryptococcal meningitis, the cause of infarcts in unknown. Using a zebrafish model of cryptococcal infection, the growth and dissemination of fungal cells was observed over time. We show that cryptococcal cells become trapped and proliferate in the vasculature, resulting in cryptococcoma that damage the blood vessels. We propose that vessel damage results from increased blood pressure caused by cryptococci blocking blood vessels suggesting that the vascular damage that ensues on cryptococcoma formation may in turn be a cause of infarct formation seen in cryptococcal meningitis.

scholarly journals Antifungal activity of dendritic cell lysosomal proteins against Cryptococcus neoformans

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Benjamin N. Nelson ◽  
Savannah G. Beakley ◽  
Sierra Posey ◽  
Brittney Conn ◽  
Emma Maritz ◽  
...  
Keyword(s):  
Antifungal Activity ◽  
Cryptococcus Neoformans ◽  
Mammalian Cells ◽  
Cysteine Proteases ◽  
Dependent Manner ◽  
Life Threatening ◽  
Opportunistic Fungal Pathogen ◽  
Dose Dependent ◽  
Lysosomal Proteins

AbstractCryptococcal meningitis is a life-threatening disease among immune compromised individuals that is caused by the opportunistic fungal pathogen Cryptococcus neoformans. Previous studies have shown that the fungus is phagocytosed by dendritic cells (DCs) and trafficked to the lysosome where it is killed by both oxidative and non-oxidative mechanisms. While certain molecules from the lysosome are known to kill or inhibit the growth of C. neoformans, the lysosome is an organelle containing many different proteins and enzymes that are designed to degrade phagocytosed material. We hypothesized that multiple lysosomal components, including cysteine proteases and antimicrobial peptides, could inhibit the growth of C. neoformans. Our study identified the contents of the DC lysosome and examined the anti-cryptococcal properties of different proteins found within the lysosome. Results showed several DC lysosomal proteins affected the growth of C. neoformans in vitro. The proteins that killed or inhibited the fungus did so in a dose-dependent manner. Furthermore, the concentration of protein needed for cryptococcal inhibition was found to be non-cytotoxic to mammalian cells. These data show that many DC lysosomal proteins have antifungal activity and have potential as immune-based therapeutics.

scholarly journals Cryptococcus Species Other Than Cryptococcus neoformans and Cryptococcus gattii: Are They Clinically Significant?

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Edison J Cano ◽  
Zachary A Yetmar ◽  
Raymund R Razonable
Keyword(s):  
Cryptococcus Neoformans ◽  
Opportunistic Infections ◽  
Descriptive Analysis ◽  
Laboratory Data ◽  
Invasive Disease ◽  
Cryptococcus Gattii ◽  
Cryptococcus Laurentii ◽  
Cryptococcus Species ◽  
Clinically Significant ◽  
Cryptococcus Spp

Abstract Background Cryptococcus spp is a major cause of opportunistic infections in immunocompromised patients, primarily due to Cryptococcus neoformans and Cryptococcus gattii. There are occasional reports of other Cryptococcus species causing invasive human disease. However, their epidemiology and clinical significance are not fully defined. We sought to describe cases with cultures positive for Cryptococcus species other than C neoformans and C gattii. Methods A retrospective descriptive analysis of clinical and laboratory data of patients with cultures growing Cryptococcus species other than C neoformans and C gattii from November 2011 to February 2019 was performed. Three Mayo Clinic sites in Arizona, Florida, and Minnesota were included. Results From 176 cases with a culture growing Cryptococcus spp, 54 patients (30%) had a culture for Cryptococcus other than C neoformans and C gattii in the study time frame. The most common species were Cryptococcus magnus, Cryptococcus laurentii, and Cryptococcus ater. The organisms were isolated and identified in culture of bronchoalveolar lavage (11), skin (11), urine (7), oral (4), sinus (3), intraoperative soft tissue (3), sputum (2), synovial fluid (2), cerebrospinal fluid (2), and intravenous catheter (2), among others (7). Only 8 (15%) cases were considered to be potentially pathogenic, with 1 case of invasive disease. Antifungal treatment was fluconazole, itraconazole, and griseofulvin, for a mean systemic antifungal duration of 42 days. Conclusions This large series of patients with Cryptococcus spp other than C neoformans and C gattii suggests that these species rarely cause clinically significant infection in humans. Only 1 case of invasive disease was found.

scholarly journals Dectin-2-Targeted Antifungal Liposomes Exhibit Enhanced Efficacy

mSphere ◽  
2019 ◽  
Vol 4 (5) ◽  
Author(s):  
Suresh Ambati ◽  
Emma C. Ellis ◽  
Jianfeng Lin ◽  
Xiaorong Lin ◽  
Zachary A. Lewis ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Aspergillus Fumigatus ◽  
Effective Dose ◽  
Cryptococcus Neoformans ◽  
Amphotericin B ◽  
Antifungal Drugs ◽  
Extracellular Matrices ◽  
Content Type ◽  
Order Of Magnitude ◽  
Life Threatening

ABSTRACT Candida albicans, Cryptococcus neoformans, and Aspergillus fumigatus cause life-threatening candidiasis, cryptococcosis, and aspergillosis, resulting in several hundred thousand deaths annually. The patients at the greatest risk of developing these life-threatening invasive fungal infections have weakened immune systems. The vulnerable population is increasing due to rising numbers of immunocompromised individuals as a result of HIV infection or immunosuppressed individuals receiving anticancer therapies and/or stem cell or organ transplants. While patients are treated with antifungals such as amphotericin B, all antifungals have serious limitations due to lack of sufficient fungicidal effect and/or host toxicity. Even with treatment, 1-year survival rates are low. We explored methods of increasing drug effectiveness by designing fungicide-loaded liposomes specifically targeted to fungal cells. Most pathogenic fungi are encased in cell walls and exopolysaccharide matrices rich in mannans. Dectin-2 is a mammalian innate immune membrane receptor that binds as a dimer to mannans and signals fungal infection. We coated amphotericin-loaded liposomes with monomers of Dectin-2’s mannan-binding domain, sDectin-2. sDectin monomers were free to float in the lipid membrane and form dimers that bind mannan substrates. sDectin-2-coated liposomes bound orders of magnitude more efficiently to the extracellular matrices of several developmental stages of C. albicans, C. neoformans, and A. fumigatus than untargeted control liposomes. Dectin-2-coated amphotericin B-loaded liposomes reduced the growth and viability of all three species more than an order of magnitude more efficiently than untargeted control liposomes and dramatically decreased the effective dose. Future efforts focus on examining pan-antifungal targeted liposomal drugs in animal models of fungal diseases. IMPORTANCE Invasive fungal diseases caused by Candida albicans, Cryptococcus neoformans, and Aspergillus fumigatus have mortality rates ranging from 10 to 95%. Individual patient costs may exceed $100,000 in the United States. All antifungals in current use have serious limitations due to host toxicity and/or insufficient fungal cell killing that results in recurrent infections. Few new antifungal drugs have been introduced in the last 2 decades. Hence, there is a critical need for improved antifungal therapeutics. By targeting antifungal-loaded liposomes to α-mannans in the extracellular matrices secreted by these fungi, we dramatically reduced the effective dose of drug. Dectin-2-coated liposomes loaded with amphotericin B bound 50- to 150-fold more strongly to C. albicans, C. neoformans, and A. fumigatus than untargeted liposomes and killed these fungi more than an order of magnitude more efficiently. Targeting drug-loaded liposomes specifically to fungal cells has the potential to greatly enhance the efficacy of most antifungal drugs.

scholarly journals Pleiotropic Roles of the Msi1-Like Protein Msl1 in Cryptococcus neoformans

2012 ◽  
Vol 11 (12) ◽  
pp. 1482-1495 ◽  
Author(s):  
Dong-Hoon Yang ◽  
Shinae Maeng ◽  
Anna K. Strain ◽  
Anna Floyd ◽  
Kirsten Nielsen ◽  
...  
Keyword(s):  
Cryptococcus Neoformans ◽  
Stress Responses ◽  
Fungal Pathogens ◽  
Independent Manner ◽  
Content Type ◽  
Antifungal Drug Resistance ◽  
Human Fungal Pathogen ◽  
Assembly Factor ◽  
Life Threatening ◽  
Stress Related Genes

ABSTRACT Msi1-like (MSIL) proteins contain WD40 motifs and have a pleiotropic cellular function as negative regulators of the Ras/cyclic AMP (cAMP) pathway and components of chromatin assembly factor 1 (CAF-1), yet they have not been studied in fungal pathogens. Here we identified and characterized an MSIL protein, Msl1, in Cryptococcus neoformans , which causes life-threatening meningoencephalitis in humans. Notably, Msl1 plays pleiotropic roles in C. neoformans in both cAMP-dependent and -independent manners largely independent of Ras. Msl1 negatively controls antioxidant melanin production and sexual differentiation, and this was repressed by the inhibition of the cAMP-signaling pathway. In contrast, Msl1 controls thermotolerance, diverse stress responses, and antifungal drug resistance in a Ras/cAMP-independent manner. Cac2, which is the second CAF-1 component, appears to play both redundant and distinct functions compared to the functions of Msl1. Msl1 is required for the full virulence of C. neoformans . Transcriptome analysis identified a group of Msl1-regulated genes, which include stress-related genes such as HSP12 and HSP78 . In conclusion, this study demonstrates pleiotropic roles of Msl1 in the human fungal pathogen C. neoformans , providing insight into a potential novel antifungal therapeutic target.

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.

Skin Conditions in Crisis Areas

2019 ◽  
pp. 53-61
Author(s):  
Marcia Glass ◽  
Carrie Kovarik ◽  
Mara Haseltine ◽  
Sandra L. Freiwald ◽  
Susan Barbour
Keyword(s):  
Palliative Medicine ◽  
Skin Diseases ◽  
Opportunistic Infections ◽  
Conflict Zones ◽  
Firearm Injuries ◽  
The Third ◽  
Snake Bites ◽  
Common Skin ◽  
Life Threatening ◽  
Skin Conditions

This chapter describes the most common and urgent skin issues facing palliative-medicine providers working in conflict zones, epidemics, and natural disasters. The first section focuses on exposure-related skin conditions, including burns, firearm injuries, frostbite, and snake bites. The second section describes lethal bacteria commonly found in floodwaters. The third section explores common skin conditions facing terminally and severely ill patients in crisis areas. The fourth section explains noninfectious yet potentially life-threatening skin diseases in these settings. The final section describes the opportunistic infections which could target patients with HIV anywhere.

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