Cryptococcal Pleural Effusion in a Patient with Chronic Renal Failure Receiving Long-term Corticosteroid Therapy for Rheumatoid Arthritis.

Fukuchi, Masahiko; Mizushima, Yutaka; Hori, Tooru; Kobayashi, Masashi

doi:10.2169/internalmedicine.37.534

Cited by 17 publications

(12 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because ADA is the enzyme that catalyzes the conversion of adenosine to inosine, and ADA is found in most cells, particularly lymphocytes, it is conceivable that ADA would be elevated in lymphocyte-rich pleural effusions [13]. Cell fractionations of pleural fluid in previously reported cases of cryptococcal infection were lymphocyte rich [3,14,15,16,17]. In our case, the lymphocyte percentage of the pleural fluid could not be determined because cell fractionation analysis of pleural fluid was not available in our hospital.…”

Section: Discussionmentioning

confidence: 99%

“…In a study about tuberculous and nontuberculous pleuritis, evaluation of pleural ADA levels correlates with a CD4+ T lymphocyte population which is related to cellular immunity [20]. Other reported infectious diseases with high pleural ADA levels (other than tubercuosis) include legionellosis, brucellosis, coxiellosis and cryptococcosis [15,21,22,23]. These are intracellular microbial agents, and their pathogenicity is related to cellular immunity [24,25,26,27,28].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cryptococcal Pleuritis Containing a High Level of Adenosine Deaminase in a Patient with AIDS: A Case Report

Kitazawa¹,

Tatsuno²,

Ota³

et al. 2009

Respiration

View full text Add to dashboard Cite

Cryptococcal infection is the 4th most common opportunistic infection in patients with acquired immune deficiency syndrome (AIDS). Although pleural effusion alone is an unusual presentation, we present a case of cryptococcal pleuritis in an AIDS patient which was initially difficult to discriminate from tuberculous pleuritis because of the high level of pleural adenosine deaminase (ADA). Cryptococcus neoformans was detected in the culture of the pleural effusion after the initiation of antituberculous treatment. High levels of ADA in the pleural fluid can be observed in patients with cryptococcal pleuritis, and longer incubation of pleural fluid should be performed in all patients who present with pleuritis associated with a high ADA level as the only significant finding.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cryptococcal Pleuritis Containing a High Level of Adenosine Deaminase in a Patient with AIDS: A Case Report

Kitazawa¹,

Tatsuno²,

Ota³

et al. 2009

Respiration

View full text Add to dashboard Cite

show abstract

“…The AMB concentration in the pleural effusion from patient 7, who had received a cumulative dose of 12,750 mg of ABLC, reached 0.18 g/ml (penetration ratio, 44%). The respective level in plasma was as low as 0.4 g/ml.Since several mycoses, such as candidiasis, aspergillosis, blastomycosis, histoplasmosis, cryptococcosis, and coccidioidomycosis, can cause pleural manifestations (5,6,9,11,13,20), AMB concentrations in pleural effusions can be crucial for …”

mentioning

confidence: 99%

mentioning

confidence: 99%

“…Since several mycoses, such as candidiasis, aspergillosis, blastomycosis, histoplasmosis, cryptococcosis, and coccidioidomycosis, can cause pleural manifestations (5,6,9,11,13,20), AMB concentrations in pleural effusions can be crucial for clinical response. After treatment with AMB lipid formulations, AMB concentrations were substantially lower in pleural effusions than in plasma samples and lung tissue (19).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Penetration of Amphotericin B Lipid Formulations into Pleural Effusion

Weiler

Bellmann‐Weiler²,

Joannidis

et al. 2007

Antimicrob Agents Chemother

View full text Add to dashboard Cite

The penetration of the amphotericin B (AMB) lipid formulations (liposomal AMB, AMB colloidal dispersion, and AMB lipid complex formulations) into pleural effusions in seven critically ill patients was assessed. AMB was detected in all pleural effusion samples at concentrations ranging from 0.02 to 0.43 g/ml. The penetration ratio was 3 to 44%.Invasive fungal infections are a major cause of morbidity and mortality in immunocompromised patients, particularly when the pleural compartment is affected (9). Although many studies on the penetration of antibacterial agents into pleural effusions have been performed, less attention has been paid to target site concentrations of antimycotic drugs in pleural effusions (2, 8, 12, 15-17, 22, 23). Amphotericin B (AMB) lipid formulations have been introduced in therapy to reduce the toxicity of AMB. The lipid moieties of liposomal AMB (LAMB), the AMB colloidal dispersion formulation (ABCD), and the AMB lipid complex (ABLC) exhibit different compositions, structures, and particle sizes, which are reflected in different plasma pharmacokinetics and degrees of lung penetration (1,7,19,21). The aim of the present study was to investigate AMB penetration into pleural effusions during treatment with LAMB, ABCD, or ABLC.The study was approved by the local ethics committee. We determined AMB levels in specimens from seven critically ill patients treated with LAMB (one patient [two sample sets]), ABCD (five patients), or ABLC (one patient) for suspected invasive fungal infection. Demographic and clinical characteristics of the enrolled patients are shown in Table 1. LAMB (AmBisome; Gilead, San Dimas, CA), ABCD (Amphocil; Torrex-Chiesi Pharma, Vienna, Austria), and ABLC (Abelcet; Elan Pharma International Limited, Athlone, Ireland) were dissolved as recommended by the manufacturers and administered intravenously at doses of 3 to 5 mg/kg of body weight over 4 h once a day. Aliquots of pleural effusions were taken during therapeutic thoracentesis. Blood samples were drawn simultaneously from an arterial line and were centrifuged immediately. The plasma and the pleural effusion samples were stored frozen at Ϫ80°C. Samples were purified and concentrated. The lipid-associated fractions of LAMB and ABCD were separated from AMB that had been liberated from its lipid encapsulation (comprising free and protein-bound AMB) by C 18 solid-phase extraction as described previously (with modifications for pleural effusion samples) (3). For ABLC, this separation technique is not feasible. Pleural effusion and plasma specimens were analyzed by reversed-phase high-performance liquid chromatography using a LiChrosorb-RP-8 column, UV detection ( ϭ 405 nm), and acetonitrile-methanol-0.010 M NaH 2 PO 4 buffer (41:10:49, vol/vol) as the mobile phase (3). The detection limit was 0.005 g/ml. The intraassay coefficient of variation was 2.06%. The concentrations were assessed by means of a linear standard curve (R, 0.998 to 0.999) obtained by using external standards comprising pleural effusion samples spiked with ...

show abstract

Isolated cryptococcal pleural effusion in a heart transplant recipient: A case report and literature review of pleural fluid adenosine deaminase levels

Lee,

Park,

Jang

et al. 2024

Respirology Case Reports

View full text Add to dashboard Cite

Isolated cryptococcal pleural effusion is rare as the initial clinical presentation in opportunistic cryptococcal infection. We describe a 59‐year‐old male heart transplantation recipient who presented with a mononuclear‐leukocyte‐predominant exudative pleural effusion, with adenosine deaminase levels (ADA) of 37 IU/L and focal pleural nodularity on computed tomography. A thorough evaluation, including pleural fluid culture, cryptococcal antigen, and histological examination, led to the diagnosis of cryptococcal pleural effusion. Antifungal therapy with fluconazole of 400 mg/day showed clinical and radiological improvement. A literature review identified six cases of cryptococcal pleural effusion that reported pleural fluid ADA levels. All cases, including the present one, involved immunocompromised hosts and exhibited a mononuclear‐leukocyte‐predominant exudate. High pleural fluid ADA levels were observed in approximately half of these cases. The pleural fluid cryptococcal antigen test was an important diagnostic tool for early diagnosis. In an era where immunocompromised hosts are increasing, cryptococcal infection should be considered as a potential aetiology in immunosuppressed patients with an exudative pleural effusion of unknown cause, even if ADA levels are elevated.

show abstract

Cryptococcal Pleural Effusion in a Patient with Chronic Renal Failure Receiving Long-term Corticosteroid Therapy for Rheumatoid Arthritis.

Cited by 17 publications

References 12 publications

Cryptococcal Pleuritis Containing a High Level of Adenosine Deaminase in a Patient with AIDS: A Case Report

Cryptococcal Pleuritis Containing a High Level of Adenosine Deaminase in a Patient with AIDS: A Case Report

Penetration of Amphotericin B Lipid Formulations into Pleural Effusion

Isolated cryptococcal pleural effusion in a heart transplant recipient: A case report and literature review of pleural fluid adenosine deaminase levels

Contact Info

Product

Resources

About