Pleural involvement in cryptococcal infection

Georgakopoulou, Vasiliki; Damaskos, Christos; Sklapani, Pagona; Τράκας, Νικόλαος; Gkoufa, Aikaterini

doi:10.12998/wjcc.v10.i16.5510

Cited by 4 publications

(6 citation statements)

References 32 publications

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“…In contrast, the positivity rates for pleural fluid culture and serum antigen test were 42%–74% and 63%, respectively 8–10 . Furthermore, the pleural fluid cryptococcal antigen test exhibited a high specificity 8,14 . Serum cryptococcal antigen can serve as an adjunctive screening test, although its sensitivity is not as high as that of pleural fluid cryptococcal antigen 14 .…”

Section: Discussionmentioning

confidence: 96%

“…[8][9][10] Furthermore, the pleural fluid cryptococcal antigen test exhibited a high specificity. 8,14 Serum cryptococcal antigen can serve as an adjunctive screening test, although its sensitivity is not as high as that of pleural fluid cryptococcal antigen. 14 However, even though our case showed positive results for pleural fluid cryptococcal antigen and culture, as well as a serum cryptococcal antigen test, these positive results were not consistently reproducible.…”

Section: Discussionmentioning

confidence: 99%

“…8,14 Serum cryptococcal antigen can serve as an adjunctive screening test, although its sensitivity is not as high as that of pleural fluid cryptococcal antigen. 14 However, even though our case showed positive results for pleural fluid cryptococcal antigen and culture, as well as a serum cryptococcal antigen test, these positive results were not consistently reproducible. The test results appear to be influenced by either the progression of the infection or its severity.…”

Section: Discussionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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

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“…Cryptococcal pleurisy occurs mainly in immunocompromised patients. A review of 76 patients with pulmonary cryptococcosis revealed that five cases involved pleural effusions, with two of these patients being immunocompetent [ 9 ]. Our case is considered noteworthy due to cryptococcal pleuritis in an immunocompetent patient.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Pleuritis in an Immunocompetent Patient: A Case Report and Literature Review

Yamamoto,

Tobino,

Sogabe

et al. 2024

Cureus

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Cryptococcosis, primarily an opportunistic infection, often occurs in immunocompromised patients but can also affect immunocompetent individuals. Cryptococcosis typically manifests in the lungs, but pleurisy is rare, particularly in immunocompetent patients. This report details a case of cryptococcal pleuritis in a 74-year-old immunocompetent male with a history of heart failure, presenting initially with pleural effusion. Diagnostic challenges arose due to the initial absence of intrapulmonary lesions. The diagnosis was eventually established through a surgical biopsy and tissue culture, revealing Cryptococcus neoformans . This case underscores the complexity of diagnosing cryptococcal infections, particularly in immunocompetent patients, and highlights the need for considering cryptococcosis in differential diagnoses of lymphocyte-predominant exudative pleural effusions.

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“…Diagnosis of a cryptococcal pleural effusion relies on at least one of the following: positive cryptococcal culture from a pleural fluid or pleural biopsy sample; positive CrAg from pleural fluid or characteristic histopathological findings from a pleural biopsy specimen 12. Histopathological detection of Cryptococcus neoformans is considered the gold standard for diagnosis, and invasive sampling via thoracoscopic or closed pleural biopsy is sometimes necessary, as pleural fluid cultures are frequently negative due to the small number of fungal organisms present in the pleural space 13…”

Section: Discussionmentioning

confidence: 99%

DisseminatedCryptococcus neoformanspresenting with an isolated pleural effusion in a patient receiving temozolomide and long-term steroids

Fraser,

Munawar,

Halani

et al. 2023

BMJ Case Rep

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Cryptococcus neoformansis a ubiquitous environmental organism found worldwide. Infection with this organism occurs predominantly in immunocompromised hosts, including persons living with HIV or those with impaired cellular immunity. Cryptococcal pleural effusions have been described in cases with extensive pulmonary involvement. Here we present the case of a woman receiving temozolomide and steroids for glioblastoma multiforme, who developed cough and dyspnoea and was found to have an uncomplicated pleural effusion. Pleural fluid culture grewCryptococcus neoformanswith negative culture on bronchoalveolar lavage. High serum cryptococcal antigen titre of 1:64 prompted lumbar puncture which demonstrated positive cerebrospinal fluid forCryptococcus neoformans. She was treated with liposomal amphotericin B and flucytosine, followed by consolidation and maintenance therapy with fluconazole. Pleural involvement in the absence of pulmonary involvement has rarely been reported. We review pulmonary and radiographic manifestations of cryptococcal infection, when to assess for disseminated infection, and management principles.

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Pleural involvement in cryptococcal infection

Cited by 4 publications

References 32 publications

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

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

Cryptococcal Pleuritis in an Immunocompetent Patient: A Case Report and Literature Review

DisseminatedCryptococcus neoformanspresenting with an isolated pleural effusion in a patient receiving temozolomide and long-term steroids

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