Fungal infections in lung transplantation
Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell in LUNG Transplantation, 2016
The incidence of cryptococcosis in SOT recipients is 2.8%.116 Cryptococcosis after lung transplantation may be acquired as a result of primary infection, reactivation of latent infection, or donor-derived infection. Disease onset is late, usually beyond 3 years after transplantation.2 Early onset of disease, particularly within 30 days after transplantation, should raise suspicion for donor-derived infection.117 Cryptococcosis is usually manifested as CNS disease or pneumonia. Pulmonary disease ranges from asymptomatic colonization to severe pneumonia. Other clinical manifestations of cryptococcosis include skin infection, osteoarticular infection, prostatitis, liver disease, kidney disease, or disseminated disease with or without CNS involvement.116 Approximately 50% to 75% of SOT recipients with pneumonia have concomitant CNS disease that may or may not be asymptomatic. Overall, cryptococcosis in SOT recipients is associated with a mortality rate between 15% and 49%, depending on the extent of disease.116
Diagnosis of Cryptococcosis
Johan A. Maertens, Kieren A. Marr in Diagnosis of Fungal Infections, 2007
In a high-risk patient, identification of cryptococcal antigen in CSF or serum is rapid, specific, noninvasive, and is virtually diagnostic of meningoence-phalitic or disseminated cryptococcosis, even when the India ink examination or culture is negative (79,121,122). The LA test for serum cryptococcal polysaccharide antigen is widely used for detecting cryptococcal polysaccharide capsule in patients with AIDS as an initial screening test for patients with fever of unclear etiologies or neurological symptoms, and has become a part of routine clinical practice in the standard care of patients with or suspected of cryptococcal infections in geographical areas with a high density of disease (111,123–126). It may perform less well as a screening device in areas in which the incidence of cryptococcal disease is low (127,128). Some clinicians have found that the combined use of a cryptococcal polysaccharide antigen test and bacterial cultures of CSF might replace routine fungal cultures of CSF except in the setting in which fungal pathogens other than C. neoformans and Candida spp. remain important causes of meningitis (129). In some patients, it may represent the only means of achieving an etiologic diagnosis of invasive cryptococcosis (79).
Native And Acquired Resistance To Infection With Cryptococcus Neoformans
Hans H. Gadebusch in Phagocytes and Cellular Immunity, 2020
The first efforts to call attention to potential host resistance mechanisms in cryptococcosis were advanced by clinicians who sought adequate treatment regimens for their patients. As early as 1925, Shapiro and Neal87 attempted the treatment of one of their patients by the intraspinal administration of specific hyperimmune rabbit serum. No beneficial effect was observed. In another case, a crude, heat-killed vaccine of C. neoformans was given with similar results. In the ensuing years, autogenous vaccines were administered on a number of occasions with little more than postponement of the fatal outcome. Only one patient, afflicted with cryptococcal osteomyelitis, appeared to benefit from autogenous vaccine and combined sulfadiazine and iodide therapy.
Future perspectives for cryptococcosis treatment
Published in Expert Opinion on Therapeutic Patents, 2018
Juliana Santos-Gandelman, Márcio Lourenço Rodrigues, Alice Machado Silva
Cryptococcosis is one of the most devastating human fungal infections. This is mostly due to the ability of this microorganism to infect the human brain, causing meningitis/meningoencephalitis in people living with HIV–AIDS [4]. According to a recent study, cryptococcosis remains the second most prevalent cause of death in AIDS patients, accounting for 15% of all AIDS-related deaths [5]. This same study estimated the global incidence of cryptococcal meningitis in HIV patients as 223.100 cases per year, having resulted in around 181.100 deaths in 2014. Sub-Saharan Africa still has the highest burden of HIV-associated cryptococcal disease, with 75% of global death cases [5]. Though the genus Cryptococcus comprises 10 members, human diseases associated to the genus are most frequently caused by C. neoformans and C. gattii [6].
Incidence and clinical outcome of Cryptococcosis in a nation with advanced HIV surveillance program
Published in The Aging Male, 2020
Fatma Ben Abid, Hussam Abdel Rahman S. Al Soub, Muna Al Maslamani, Wanis Hamad Ibrahim, Hafedh Ghazouani, Abdullatif Al-Khal, Saad Taj-Aldeen
Cryptococcosis is a systemic opportunistic fungal infection mainly caused by yeasts belonging to two species complexes: Cryptococcus neoformans and Cryptococcus gattii. Furthermore, few cases of Cryptococcus Laurentii causing human infection were reported in literature. Cryptococcal infections are mostly seen in immunocompromised patients, particularly those with cellular immune defects including advanced HIV infection with predilection of central nervous system [1–4]. The clinical presentation is usually subtle, vague, and indolent over a period of one to two weeks. The prognosis depends on early diagnosis, prompt use of antifungal drugs and reduction of the intracranial pressure. We carried out a retrospective observational study to determine the epidemiological and clinical characteristics of cryptococcosis in the State of Qatar, a country with low HIV prevalence and good surveillance program.
Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging
Published in Expert Review of Respiratory Medicine, 2019
Ana Luiza Di Mango, Gláucia Zanetti, Diana Penha, Miriam Menna Barreto, Edson Marchiori
Cryptococcosis is caused by Cryptococcus spp, a ubiquitous encapsulated yeast like fungus. There are more than 30 species in the environment but only 2 are related to human disease, C. neoformans and C. gatti. Although C. neoformans may cause disease in immunocompetent hosts, it is considered an opportunistic fungal infection that mainly occur in immunosuppressed individuals. It is found worldwide and is associated with decaying wood and bird excreta such as pigeons. On the other hand, C. gatti is considered an endemic mycosis and mainly occurs in immunocompetent individuals. It has a more distinct geographic distribution, being more common on tropical and subtropical areas, such as Australia, Central America, parts of South America and Papua New Guinea, with the primary environmental sources being trees, mainly eucalyptus [74–77].
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