Cryptococcal infection in non-HIV immunosuppressed patients – Three case reports in a nephrology setting

Aguiar, Pedro; Martins, La Salete; Santos, Josefina; Almeida, Manuela; Pedroso, Sofía; Dias, Leonídio; Henriques, António Castro; Ramos, Helena; Cabrita, António

doi:10.1016/j.mmcr.2013.11.003

Cited by 7 publications

(10 citation statements)

References 16 publications

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“…Cryptococcus neoformans is an encapsulated yeast, ubiquitous in the environment (Goldman et al, 2001). Infections with C. neoformans are commonly diagnosed in immunocompromised patients (Singh et al, 2008; Pappas, 2013; Ventura Aguiar et al, 2014) and with the onset of the HIV/AIDS epidemic, cryptococcosis became a leading cause of death in these patients mainly due to fatal meningoencephalitis (Park et al, 2009). The infectious process begins when the host inhales aerosolized cryptococcal cells.…”

Section: Introductionmentioning

confidence: 99%

Cryptococcus neoformans Induces MCP-1 Release and Delays the Death of Human Mast Cells

Lopes

Stylianou

Backman

et al. 2019

Front. Cell. Infect. Microbiol.

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Cryptococcosis, caused by the basidiomycete Cryptococcus neoformans , is a life-threatening disease affecting approximately one million people per year worldwide. Infection can occur when C. neoformans cells are inhaled by immunocompromised people. In order to establish infection, the yeast must bypass recognition and clearance by immune cells guarding the tissue. Using in vitro infections, we characterized the role of mast cells (MCs) in cryptococcosis. We found that MCs recognize C. neoformans and release inflammatory mediators such as tryptase and cytokines. From the latter group MCs released mainly CCL-2/MCP-1, a strong chemoattractant for monocytic cells. We demonstrated that supernatants of infected MCs recruit monocytes but not neutrophils. During infection with C. neoformans , MCs have a limited ability to kill the yeast depending on the serotype. C. neoformans , in turn, modulates the lifespan of MCs both, by presence of its polysaccharide capsule and by secreting soluble modulators. Taken together, MCs might have important contributions to fungal clearance during early stages of cryptocococis where these cells regulate recruitment of monocytes to mucosal tissues.

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Section: Introductionmentioning

confidence: 99%

Cryptococcus neoformans Induces MCP-1 Release and Delays the Death of Human Mast Cells

Lopes

Stylianou

Backman

et al. 2019

Front. Cell. Infect. Microbiol.

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“…16, 17 The resulting wrong therapy aggravates the infection and delays the administration of the appropriate intervention using antifungal agents. 16, 18, 19, 20 …”

Section: Introductionmentioning

confidence: 99%

Cryptococcal meningitis in systemic lupus erythematosus patients: pooled analysis and systematic review

Fang

Chen

Liu

et al. 2016

Emerging Microbes & Infections

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Cryptococcal meningitis is an important fungal infection among systemic lupus erythematosus patients. We conducted a pooled analysis and systematic review to describe the epidemiological and clinical profile of cryptococcal meningitis in systemic lupus erythematosus patients. From two hospitals in China and nine literature databases, cases and prevalence data were collected for pooled analysis and meta-analysis, respectively. Categorical variables of cases were compared using a χ2-test on the statistical program of SAS. A multiple regression analysis was performed to ascertain independent predictors significantly correlated with prognosis. Meta-analysis was conducted by the statistical program of R. The prevalence of cryptococcal meningitis in systemic lupus erythematosus patients was 0.5%. Patients were predominantly females and adults. A prednisone equivalent of more than 30 mg/day before infection was associated with higher mortality (odds ratio (OR)=9.69 (1.54, 60.73)). In all, 36.8–38.9% patients showed low lupus activity when they developed the crytococcal infection. Moreover, 38.2% of the patients were misdiagnosed. The estimated case-fatality rate was 23.6%. Our results suggest that more emphasis should be placed to further understand lupus-related cryptococcal meningitis and to develop better prophylaxis and management strategies to combat this condition.

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“…Infections and sepsis are major causes of hospitalization, mortality, and morbidity in immunosuppressed patients [ 9 ]. Cryptococcosis is one of the fatal fungal infections reported mainly in immunocompromised hosts; however, several reported cases point to its incidence also in immunocompetent patients [ 10 – 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…In humans, it can colonize the upper airway system. Nevertheless, no animal-to-human nor person-to-person respiratory transmission has been documented [ 9 ]. Our presented case lived in low socioeconomic and hygienic status, and she denied contact with pigeon or birds.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding management of cryptococcosis, the prolonged course (6–10 weeks) of IV amphotericin B monotherapy, together with the reduction of chemotherapy to improve immune status, was the main target. Caution was taken while reducing immunosuppressive therapy, since a rapid reduction is reported to be associated with immune reconstitution inflammatory syndrome (IRIS) in some patients [ 9 ]. There is evidence that supports the requirement for maintenance therapy with fluconazole administered as indefinite secondary prophylaxis, since the rate of recurrence exceeds 50% after apparently successful treatment [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Atypical Presentation of Pediatric Systemic Lupus Erythematosus Complicated by Cryptococcal Meningitis

Hashem

Ibrahim

2021

Case Reports in Medicine

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Background. Cryptococcus is an opportunistic fungal pathogen that leads to life-threatening infections. Cryptococcal infections are mainly reported in HIV patients and less commonly encountered in non-HIV immunocompromised host. Cryptococcus neoformans (C. neoformans) is the most common Cryptococcus species causing diseases in humans which can be presented as pulmonary, meningitis, cutaneous, and/or disseminated cryptococcosis. Case Presentation. A 12-year-old female girl from Cairo, Egypt, presented to the pediatric hospital with signs of systemic lupus erythematosus (SLE). She had an aggressive lupus nephritis course for which corticosteroids, mycophenolate mofetil, and cyclophosphamide were prescribed, and the child gradually improved and was discharged. Two months later, the patient exhibited skin lesions involved both in her legs, massive ulcers were developed and extended rapidly through the entire legs followed by deterioration in her conscious level, and signs of meningitis were documented. Cerebrospinal fluid (CSF) examination and microbiological workup were confirmatory for C. neoformans infection, and mental and motor functions were rapidly deteriorated. Treatment with amphotericin B in addition to supportive treatment and close follow-up of the patient’s medical condition result in obvious clinical improvement and patient discharge with minimal residual weakness in her legs after almost a one-month duration. After six months, the patient was brought to the emergency department complaining of repeated attacks of seizures, a lumbar puncture was performed, and culture results were again confirmatory for C. neoformans. An intensive course of antifungal therapy was prescribed which was successful, evident by resolution of the signs and symptoms of infection in addition to negative culture results and negative sepsis biomarkers. The child clinically improved, but unfortunately, gradual optic nerve degeneration and brain cell atrophy as a sequel of severe and longstanding cryptococcal infection resulted in her death after almost one year from her first attack. Conclusion. Cryptococcal infection among non-HIV patients is a rare disease but can result in advanced medical complications which may be fatal. The disease should be suspected to be reliably diagnosed. Cryptococcus infection can be presented as a skin lesion which, if not treated properly at an earlier time, can result in dissemination and life-threatening consequences. Amphotericin B can be used effectively in cryptococcosis management in the settings where flucytosine is not available. Signs of cryptococcal meningitis can be manifested again after a period of remission and clinical cure which signifies the latency of Cryptococcus in the central nervous system. The second activation of Cryptococcus after its latency is usually life-threatening and mostly fatal.

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Cryptococcal infection in non-HIV immunosuppressed patients – Three case reports in a nephrology setting

Cited by 7 publications

References 16 publications

Cryptococcus neoformans Induces MCP-1 Release and Delays the Death of Human Mast Cells

Cryptococcus neoformans Induces MCP-1 Release and Delays the Death of Human Mast Cells

Cryptococcal meningitis in systemic lupus erythematosus patients: pooled analysis and systematic review

Atypical Presentation of Pediatric Systemic Lupus Erythematosus Complicated by Cryptococcal Meningitis

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