Cryptococcal Lung Infections

Skolnik, Kate; Huston, Shaunna M.; Mody, Christopher H.

doi:10.1016/j.ccm.2017.04.007

Cited by 37 publications

(32 citation statements)

References 130 publications

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“…In our study, 40.4% (40/99) overall were immunocompetent. Research has found that Cryptococcus neoformans can be found globally, and that it predominantly affects the immunosuppressed, whereas Cryptococcus gattii is endemic to certain regions and often affects immune‐competent individuals . PC infection is more frequent in male than female .…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary cryptococcosis characteristics in immunocompetent patients—A 20‐year clinical retrospective analysis in China

Hou

Kou

Xiao

et al. 2019

Mycoses

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SummaryBackgroundPulmonary cryptococcosis (PC) is not considered an rare, opportunistic infection anymore. The immunocompetent population accounts for an increasing proportion of the morbidity.ObjectiveThis study investigated the clinical characteristics of PC patients spanning 20 years, in a referral centre of China.Patients/MethodsWe retrospectively investigated the clinical data of 99 patients with PC who were diagnosed at Peking Union Medical College Hospital (PUMCH) from January 1998 to December 2017.ResultsPulmonary cryptococcosis incidence in PUMCH has seen sharp increase in two decades. There were 40.4% (40/99), 17.2% (17/99) and 42.4% (42/99) immunocompetent, mildly immunocompromised and severe immunocompromised patients, respectively. Significantly higher (P = .035) male predominance in immunocompetent and mildly immunocompromised groups (68.4%, 39/57) compared with severe immunocompromised group (45.2%, 19/42) was found. Overall, 27.5% (11/40) immunocompetent patients reported a significant difference (P = .02) in history of more than weekly drinking, higher than mildly or severe immunocompromised. No significant difference occurred in symptoms and radiographic characteristics among the groups. In pulmonary computerised tomography findings, the non‐air pathway feature was the dominant distribution characteristics in all patients with PC (P = .002). The gap in body dissemination frequency between immunocompetent combined with mildly immunocompromised (5.26%, 3/57) and severe immunocompromised (19.0%, 8/42) was marginally significant (P = .05).ConclusionsGender and alcohol drinking could be PC risk factors of concern in patients without severe immunodeficiency. No significant difference occurred in symptoms or radiographic characteristics between patients with different levels of immune status. The unique radiographic non‐air pathway distribution in the lung may be the feature of Cryptococcus invasion that may enhance accurate diagnosis.

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Section: Discussionmentioning

confidence: 99%

“…Cryptococcus can invade the bone, skin, eyes and the prostate, and may even cause disseminated disease and cryptococcemia. These presentations can occur in both immunosuppressed and immunocompetent individuals . Some studies suggest that cryptococcal meningitis was less frequent in HIV‐negative patients than patients with AIDS .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary cryptococcosis characteristics in immunocompetent patients—A 20‐year clinical retrospective analysis in China

Hou

Kou

Xiao

et al. 2019

Mycoses

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“…So, an early diagnosis becomes a challenge. 35 From the C. gattii strains that have been studied in murine model of infection, we chose the strain R265 because of its high virulence relative to R272 and WM276 in C57BL/ 6 and A/JCr mice. 36 The infection of C57BL/6 mice with strain R265 (5 Â 10 4 yeasts) by intra-pharyngeal aspiration was more lethal than that with C. neoformans strain H99.…”

Section: Discussionmentioning

confidence: 99%

iNOS/Arginase-1 expression in the pulmonary tissue over time during Cryptococcus gattii infection

et al. 2019

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Inhalation of Cryptococcus gattii yeasts (causing cryptococcosis) triggers an anti-cryptococcal immune response initiated by macrophages, neutrophils or dendritic cells, and the iNOS expressed by various cells may regulate the function and differentiation of innate and adaptive immune cells. Here, we evaluated the effect of progression of C. gattii infection on the host innate immune response. C. gattii infection in BALB/c mice spreads to several organs by 21 d post infection. The numbers of neutrophils and lymphocytes in the peripheral blood of C. gattii–infected mice were remarkably altered on that day. The frequency of CD11b+ cells and cell concentrations of CD4+ and CD8+ T cells was significantly altered in the pulmonary tissue of infected mice. We found a higher frequency of CD11b+/iNOS+ cells in the lungs of infected mice, accompanied by an increase in frequency of CD11b+/Arginase-1+ cells over time. Moreover, the iNOS/Arginase-1 expression ratio in CD11b+ cells reached its lowest value at 21 d post infection. In addition, the cytokine micro-environment in infected lungs did not show a pro-inflammatory profile. Surprisingly, iNOS knock-out prolonged the survival of infected mice, while their pulmonary fungal burden was higher than that of infected WT mice. Thus, C. gattii infection alters the immune response in the pulmonary tissue, and iNOS expression may play a key role in infection progression.

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“…Cryptococci are encapsulated yeasts with a global distribution. It is a common opportunistic infection in the immunocompromised, especially in HIV-infected patients 2…”

Section: Discussionmentioning

confidence: 99%

Pulmonary cryptococcosis complicating interstitial lung disease in a patient with systemic lupus erythematosus

Gaiba

O'Neill

Lakshmi³

2019

BMJ Case Rep

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We report a case of primary pulmonary cryptococcosis in a 59-year-old female patient with a history of systemic lupus erythematosus, interstitial lung disease and glaucoma. She presented with a cough, severe fatigue, unintentional weight loss, shortness of breath (increase in home oxygen use from baseline) and pleuritic chest pain of 2 months duration. During these 2 months, her symptoms had worsened despite multiple hospital visits, empirical antibiotics and empirical increase of her steroid dosage. Cytopathology of the bronchoalveolar lavage fluid showed yeast cells with narrow-based budding and grew Cryptococcus neoformans on fungal culture. She was treated with oral fluconazole 400 mg/day for 6 months with an improvement in cough, decrease in shortness of breath (return to baseline oxygen use) and resolution of pleuritic chest pain.

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Cryptococcal Lung Infections

Cited by 37 publications

References 130 publications

Pulmonary cryptococcosis characteristics in immunocompetent patients—A 20‐year clinical retrospective analysis in China

Pulmonary cryptococcosis characteristics in immunocompetent patients—A 20‐year clinical retrospective analysis in China

iNOS/Arginase-1 expression in the pulmonary tissue over time during Cryptococcus gattii infection

Pulmonary cryptococcosis complicating interstitial lung disease in a patient with systemic lupus erythematosus

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