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Inflammatory, Hypersensitivity and Immune Lung Diseases, including Parasitic Diseases.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Many patients develop or present with Pneumocystis pneumonia (which may be lifethreatening), or other infections (mycobacterial - TB, etc - see ps. 19.16 et seq., fungi aspergillosis, nocardia, histoplasmosis, etc., Candida of the throat and oesophagus - see ps. 16.16 - 17, viruses - CMV (causing both lung infection and retinitis - leading to blindness), varicella, or protozoa - toxoplasma, etc.). Not uncommonly a mixture of infections is found (see also opportunistic pneumonias - p. 19.7). Some patients produce drug reactions e.g. Stevens-Johnson syndrome. Non-specific pneumonitis, LIP (p. 19.119) may occur particularly in children, and congestive cardiomyopathy may also be present. Infections are often atypical and chronic and a fatal encephalopathy (particularly in patients with cryptococcal infection) is not uncommon. Sinusitis may also be an important clinical problem - see reference to Chong et al. (below). Secondary infections particularly occur when the T cell CD4 level drops below 200/ cu ml. (When the virus encounters a T cell, proteins on the virus bind to both CD4 and co-receptors and the virus enters the cell and its genetic material is integrated into the T cell's DNA to produce more viral protein which is released into new viruses).
Diagnosing Invasive Fungal Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Invasive fungal infections (IFI) are caused by yeasts and moulds, each with their own population at risk and clinical manifestations. Candidaemia and intra-abdominal candidiasis are the leading causes of fungal infections in critically ill patients; profound neutropaenia is a major risk factor for invasive pulmonary mould infections, predominantly caused by Aspergillus spp. Cryptococcus spp. are a major cause of meningitis in patients with HIV. Pneumocystis jirovecii is an opportunistic pathogen in patients with HIV and other immunocompromised individuals. The choice of diagnostic tests depends on the population at risk and diagnosis is often delayed, leading to high morbidity and mortality. It is therefore worthwhile to consider the following.
Infections in Solid Organ Transplant Recipients Admitted to the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Almudena Burillo, Patricia Muñoz, Emilio Bouza
The incidence of cryptococcosis after SOT is 2.6%–5%. The CNS is involved in 25%–72% of patients [146–149]. Cryptococcus spp. is mostly a cause of meningitis, pneumonia, and skin lesions [150–153]. In a recent series, survival at 6 months tended to be lower in patients whose CSF cultures at 2 weeks were positive compared with those whose CSF cultures were negative (50% vs. 91%, p = 0.06) [154]. No correlation was found between CSF or serum cryptococcal antigen titer and outcome or CSF sterilization at 2 weeks [155].
Cryptococcal granuloma of the the basal ganglia with fatal haemorrhage after stereotactic biopsy: case report
Published in British Journal of Neurosurgery, 2023
GengHuan Wang, HePing Shen, ZhengMin Chu, JianGuo Shen, YiFei Wang
Cryptococcus neoformans is an opportunistic pathogen and widely found in the soil. It can enter into the human body through the respiratory tract and digestive tract.1 Cryptococcosis is a zoonotic disease found in dogs, rats, monkeys and cheetahs.2–5 Patients with immuocompromize such as from acquired immunodeficiency syndrome (AIDS), cancer or diabetes are susceptible to Cryptococcus infection.6 It can cause acute, subacute or chronic infection of lung and brain. If the course of disease progresses slowly, it can lead to the formation of intracranial granuloma. Cryptococcus infection of central nervous system occurs mostly in the forms of meningitis and menigoencephalitis. Intracranial isolated cryptococcus granuloma is infrequently encountered in clinical entity. It may appear insidiously and most of the early symptoms are not obvious. Cryptococcus granulomas in the brain stem, spinal cord, ventricle, and cerebellum had been reported in the literature.7–11Cryptococcus granulomas of this case was located in the basal ganglia. The patient had a headache and was slow to understand or respond.
Clinical characteristics and evaluation of the incidence of cryptococcosis in Finland 2004–2018
Published in Infectious Diseases, 2021
Anne Toivonen, Mari Eriksson, Nathalie Friberg, Timo Hautala, Sohvi Kääriäinen, Jaana Leppäaho-Lakka, Janne Mikkola, Tuomas Nieminen, Jarmo Oksi, Juha H. Salonen, Pekka Suomalainen, Markku Vänttinen, Hanna Jarva, Annemarjut J. Jääskeläinen
Encapsulated Cryptococcus neoformans and Cryptococcus gattii are the most common cryptococcal opportunistic fungal pathogens in humans [1]. The majority of cryptococcal infections worldwide are caused by C. neoformans, which occurs in most temperate regions whereas C. gattii has been found mainly in tropical and subtropical geographic regions [1,2]. Cryptococcus is transmitted by inhalation of infectious cells followed by an infection of the respiratory system. The pulmonary infection may disseminate by haematogenous route and further affect the central nervous system (CNS) causing meningoencephalitis [1]. The infection may also manifest as cryptococcemia, though the most common clinical features are meningoencephalitis and pulmonary cryptococcosis [3]. Moreover, a disseminated cryptococcal infection associates with higher mortality compared to respiratory disease [4]. However, the variable nature of clinical presentations may delay the diagnosis.
Cirrhosis, gastrointestinal bleed, and cryptococcal peritonitis
Published in Baylor University Medical Center Proceedings, 2020
Amy E. Barnett, Karen B. Brust
Cryptococcus neoformans, a ubiquitous encapsulated yeast, is known to cause opportunistic infections of the respiratory and central nervous systems (CNS). HIV-seropositive patients are disproportionally affected at an estimated annual incidence of 17 to 66 per 1000 patients as compared to HIV-negative individuals, at 0.2 to 0.9 per 100,000 patients.1–3 Cryptococcal dissemination can affect most organs (lungs and meninges more than other sites), and risk factors for disseminated infection include lymphoid malignancies, chronic corticosteroid use, solid organ transplantation, sarcoid, and liver cirrhosis.4–9C. neoformans causing spontaneous fungal peritonitis is a rare disease process associated with underlying end-stage liver disease and cirrhosis.1,8