Primary Prophylaxis for Cryptococcosis With Fluconazole in Human Immunodeficiency Virus–Infected Patients With CD4 T-Cell Counts &lt;100 Cells/µL and Receiving Antiretroviral Therapy

Sungkanuparph, Somnuek; Savetamornkul, Chutchaiwat; Pattanapongpaiboon, Warisara

doi:10.1093/cid/cix036

Cited by 10 publications

(9 citation statements)

References 11 publications

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“…In a recent two-year prospective observational cohort study conducted by Sungkanuparph et al [ 87 ] in Thailand, 302 HIV–infected patients who had a CD4 T-cell count < 100 cells/µL and negative serum cryptococcal antigen initiating antiretroviral therapy were enrolled. Five patients developed cryptococcosis on either arm (2.5% of the fluconazole group and 5% of the control group) and two patients died, one in each group.…”

Section: Antifungal Prophylaxis For Cryptococcal Meningitismentioning

confidence: 99%

“…Five patients developed cryptococcosis on either arm (2.5% of the fluconazole group and 5% of the control group) and two patients died, one in each group. This demonstrates that in settings where ART is widely available and HIV-infected patients who have CD4 counts < 100 cells/µL are initiated on ART and are negative for serum cryptococcal antigen, the primary prophylaxis for cryptococcosis with fluconazole has no survival benefit and may not be necessary [ 87 ].…”

Section: Antifungal Prophylaxis For Cryptococcal Meningitismentioning

confidence: 99%

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HIV-Associated Cryptococcal Disease in Resource-Limited Settings: A Case for “Prevention Is Better Than Cure”?

Oladele

Bongomin

Gago

et al. 2017

JoF

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Cryptococcal disease remains a significant source of global morbidity and mortality for people living with HIV, especially in resource-limited settings. The recently updated estimate of cryptococcal disease revealed a global incidence of 223,100 cases annually with 73% of these cases being diagnosed in sub-Saharan Africa. Furthermore, 75% of the estimated 181,100 deaths associated with cryptococcal disease occur in sub-Saharan Africa. Point-of-care diagnostic assays have revolutionised the diagnosis of this deadly opportunistic infection. The theory of asymptomatic cryptococcal antigenaemia as a forerunner to symptomatic meningitis and death has been conclusively proven. Thus, cryptococcal antigenaemia screening coupled with pre-emptive antifungal therapy has been demonstrated as a cost-effective strategy with survival benefits and has been incorporated into HIV national guidelines in several countries. However, this is yet to be implemented in a number of other high HIV burden countries. Flucytosine-based combination therapy during the induction phase is associated with improved survival, faster cerebrospinal fluid sterilisation and fewer relapses. Flucytosine, however, is unavailable in many parts of the world. Studies are ongoing on the efficacy of shorter regimens of amphotericin B. Early diagnosis, proactive antifungal therapy with concurrent management of raised intracranial pressure creates the potential to markedly reduce mortality associated with this disease.

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Section: Antifungal Prophylaxis For Cryptococcal Meningitismentioning

confidence: 99%

Section: Antifungal Prophylaxis For Cryptococcal Meningitismentioning

confidence: 99%

HIV-Associated Cryptococcal Disease in Resource-Limited Settings: A Case for “Prevention Is Better Than Cure”?

Oladele

Bongomin

Gago

et al. 2017

JoF

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“…In fact, paracoccidioidomycosis is the eighth most important cause of mortality among chronic infectious diseases, reaching rates of 1.65 deaths per 106 inhabitants ( de Oliveira et al, 2015 ). Collectively, these invasive fungal infections are more prevalent in immunocompromised patients ( Woyciechowsky et al, 2011 ; Kaur et al, 2017 ; Sungkanuparph et al, 2017 ). In addition, they are in general also associated with antifungal resistance, making their treatment ineffective for most cases ( Gullo et al, 2013 ; Chowdhary et al, 2014 ; Scorzoni et al, 2017 ).…”

Section: Plant Lectins For Treatment Of Fungal Infectionsmentioning

confidence: 99%

Targeting the Immune System with Plant Lectins to Combat Microbial Infections

et al. 2017

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The arsenal of drugs available to treat infections caused by eukaryotic and prokaryotic microbes has been declining exponentially due to antimicrobial resistance phenomenon, leading to an urgent need to develop new therapeutic strategies. Host-directed immunotherapy has been reported as an attractive option to treat microbial infections. It consists in the improvement of host defenses by increasing the expression of inflammatory mediators and/or controlling of inflammation-induced tissue injury. Although the in vitro antimicrobial and immunomodulatory activities of lectins have been extensively demonstrated, few studies have evaluated their in vivo effects on experimental models of infections. This review aims to highlight the experimental use of immunomodulatory plant lectins to improve the host immune response against microbial infections. Lectins have been used in vivo both prophylactically and therapeutically resulting in the increased survival of mice under microbial challenge. Other studies successfully demonstrated that lectins could be used in combination with parasite antigens in order to induce a more efficient immunization. Therefore, these plant lectins represent new candidates for management of microbial infections. Furthermore, immunotherapeutic studies have improved our knowledge about the mechanisms involved in host–pathogen interactions, and may also help in the discovery of new drug targets.

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“…After the HAART program became accessible worldwide with a significant reduction of mortality and morbidity in HIV patients, prophylactic therapy for CM became unclear, primarily because of fluconazole resistance and drug interactions [ 22 , 23 ]. Additionally, results from a study conducted by Sungkanuparph et al [ 24 ] concluded that there was no difference in the occurrence of newly diagnosed cryptococcosis between patients with and without primary prophylaxis. None of our 24 patients came to regular visits or blood analysis and all had low adherence to the ARV treatment.…”

Section: Discussionmentioning

confidence: 99%

Clinical Profile of 24 AIDS Patients with Cryptococcal Meningitis in the HAART Era: A Report from an Infectious Diseases Tertiary Hospital in Western Romania

et al. 2021

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Management of cryptococcal infections among patients suffering from acquired immunodeficiency syndrome (AIDS) represents a medical challenge. This retrospective study aims to describe the disease management and outcomes among 24 AIDS patients who suffered from Cryptococcus neoformans meningitis. The parameters evaluated from our patients’ database records include epidemiological data, clinical manifestations, biochemical and microbiological analysis of patients’ cerebrospinal fluid (CSF), treatment profiles, and disease outcomes. All patients included in the study had a lymphocyte count of less than 200 CD4/mm3. Of the 24 patients included in this study, five had been diagnosed with HIV infection since childhood, after receiving HIV-infected blood transfusions. The most prominent symptom was fatigue in 62.5% of patients, followed by nausea/vomiting and headache. Seven patients had liver cirrhosis due to hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, while Kaposi sarcoma and cerebral toxoplasmosis were found in two patients. Six out of 24 patients died due to bacterial sepsis and acute respiratory distress syndrome (ARDS). High intracranial pressure was the strongest predictive factor for mortality (OR = 2.9), followed by ARDS (OR = 1.8), seizures at disease onset (OR = 1.4), and diabetes mellitus (OR = 1.2). Interestingly, patients younger than 40 years old had a significantly lower survival rate than that of the older patients. Before developing Cryptococcal meningitis, all patients had low adherence to the early ART treatment scheme and skipped the follow-up visits. All patients received a combination of amphotericin B and flucytosine as induction therapy, adding fluconazole for maintenance. Simultaneously, AIDS HAART was initiated at diagnosis of the cryptococcal infection. A combined regimen of antifungals and highly active antiretroviral therapy showed improved patient recovery with minor side effects.

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Primary Prophylaxis for Cryptococcosis With Fluconazole in Human Immunodeficiency Virus–Infected Patients With CD4 T-Cell Counts <100 Cells/µL and Receiving Antiretroviral Therapy

Cited by 10 publications

References 11 publications

HIV-Associated Cryptococcal Disease in Resource-Limited Settings: A Case for “Prevention Is Better Than Cure”?

HIV-Associated Cryptococcal Disease in Resource-Limited Settings: A Case for “Prevention Is Better Than Cure”?

Targeting the Immune System with Plant Lectins to Combat Microbial Infections

Clinical Profile of 24 AIDS Patients with Cryptococcal Meningitis in the HAART Era: A Report from an Infectious Diseases Tertiary Hospital in Western Romania

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