Pulmonary Cryptococcosis in Nonimmunocompromised Patients

Nadrous, Hassan F.; Antonios, Vera S.; Terrell, Christine L.; Ryu, Jay H.

doi:10.1016/s0012-3692(15)31671-8

Cited by 123 publications

(130 citation statements)

References 21 publications

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“…As with previous studies, pleural effusion is also uncommon, found in less than 10% of cases, and is often small in size (3)(4)(5)(6)(7)(8)(9)(10)18).…”

Section: Discussionsupporting

confidence: 76%

“…Cavitation and air-filled bronchograms within nodules or consolidation, observed in 58.3% of our cases, have been variably demonstrated in previous studies, ranging from 0% to 42% of cases (4)(5)(6)(7)(8)(9)(10)(11)15). Nonenhanced, low-attenuation areas within the areas of consolidation or masses, previously shown to represent gelatinous collections of large numbers of fungal organisms or rarely ischemic necrosis (12,15,16) were also frequently demonstrated on CT images in our study but have rarely been described (17).…”

Section: Discussionsupporting

confidence: 64%

“…In rare circumstances, the infection occurs in otherwise healthy individuals. According to previous studies from many countries in North America, Europe, and the East (3)(4)(5)(6)(7)(8)(9)(10)(11), most immunocompetent individuals have mild or no clinical symptoms with isolated pulmonary involvement through single or multiple small pulmonary nodules. These findings are somewhat different from the more aggressive clinical and radiographic findings described in isolated case reports among Thai immunocompetent patients (6,(12)(13)(14) and in a study from South America (3).…”

Section: P Ulmonary Cryptococcosis Is An Emerging Infection Caused Bymentioning

confidence: 99%

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Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Suwatanapongched

Sangsatra²,

Boonsarngsuk³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to investigate clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment. MATERIALS AND METHODSWe retrospectively reviewed the medical records, initial and follow-up chest computed tomography scans and/or radiographs for initial clinical and radiologic manifestations and outcomes following antifungal treatment of 12 immunocompetent patients diagnosed with pulmonary cryptococcosis between 1990 and 2012. RESULTSTwelve patients (age range, 21-62 years; males, eight patients [66.7%]) were included. Nine (75%) patients were symptomatic, eight of whom had disseminated infection with central nervous system involvement. Initial pulmonary abnormalities consisted of single nodules/masses (n=5), single segmental or lobar mass-like consolidation (n=3), multiple cavitary and noncavitary nodules (n=1), and multifocal consolidation plus nodules (n=3). These lesions ranged from less than 1 cm to 15 cm in greatest diameter. Distinct subpleural and lower lung predominance was observed. Seven patients (58.3%) had one or more atypical/aggressive findings, namely endobronchial obstruction (n=4), calcified (n=1) or enlarged (n=4) mediastinal/hilar lymph nodes, vascular compression (n=1), pericardial involvement (n=1), and pleural involvement (n=2). Following antifungal therapy, radiologic resolution was variable within the first six months of eight nonsurgical cases. Substantial (>75%) improvement with some residual abnormalities, bronchiectasis, cavitation, and/or fibrotic changes were frequently observed after 12-24 months of treatment (n=6). CONCLUSIONPulmonary cryptococcosis in immunocompetent patients frequently causes disseminated infection with atypical/aggressive radiologic findings that are gradually and/or incompletely resolved after treatment. The presence of nonenhanced low-attenuation areas within subpleural consolidation or mass and the absence of tree-in-bud appearance should raise concern for pulmonary cryptococcosis, particularly in patients presenting with meningitis.

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“…As with previous studies, pleural effusion is also uncommon, found in less than 10% of cases, and is often small in size (3)(4)(5)(6)(7)(8)(9)(10)18).…”

Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 64%

Section: P Ulmonary Cryptococcosis Is An Emerging Infection Caused Bymentioning

confidence: 99%

See 1 more Smart Citation

Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Suwatanapongched

Sangsatra²,

Boonsarngsuk³

et al. 2013

Diagn Interv Radiol

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“…(30) Patients with acute pulmonary cryptococcosis can present fever, productive cough, chest pain and weight loss. (34) The organs that constitute the CNS are the most commonly affected by C. neoformans and C. gattii, which can cause acute, subacute or chronic meningitis, as well as severe meningoencephalitis. The signs and symptoms are generally present for various weeks and include headache, fever, cranial neuropathy, altered level of consciousness, lethargy, memory loss, signs of meningeal irritation and coma.…”

Section: Introductionmentioning

confidence: 99%

Capítulo 3: criptococose pulmonar

Severo

Gazzoni²,

Severo

2009

J. bras. pneumol.

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on the agglutination reactions of capsular polysaccharide antigens. Serotype A and serotype D strains, as well as the AD hybrid, are classified as C. neoformans, whereas serotype B and serotype C strains have been classified as C. gattii. Serotype A strains have been designated C. neoformans var. grubii, whereas serotype D strains have been designated C. neoformans var. neoformans.(3) This classification was based on the differences in capsular structure and DNA between the strains, as well as on a complete comparison of the genomic sequencing of these two serotypes (strains).(3) In addition, based on new molecular data and on evolutionary studies, IntroductionCryptococcosis is an infection caused by the naturally encapsulated basidiomycete of the genus Cryptococcus, which has recently become the most relevant opportunistic fungal pathogen.(1) The infection caused by the species C. neoformans has become the most critically relevant opportunistic infection as a consequence of the AIDS epidemic. In addition, C. gattii recently caused an isolated cryptococcosis outbreak among apparently immunocompetent humans and animals on Vancouver Island, Canada. AbstractCryptococcosis is a systemic mycosis caused by two species of the encapsulated basidiomycetes, Cryptococcus neoformans and C. gattii, which, respectively, cause infection in immunocompromised individuals and in immunologically normal hosts. Patients with T-cell deficiencies are more susceptible to this infection. The spectrum of the disease ranges from asymptomatic pulmonary lesions to disseminated infection with meningoencephalitis. The medical relevance of cryptococcosis increased dramatically as a consequence of the AIDS epidemic and organ transplants.Keywords: Cryptococcus neoformans; Pneumonia; Acquired immunodeficiency syndrome; Amphotericin B; Fluconazole. ResumoCriptococose é uma micose sistêmica causada por duas espécies do basidiomiceto encapsulado, Cryptococcus neoformans e C. gattii, que, respectivamente, causam infecção em indivíduos imunocomprometidos e em hospedeiros imunocompetentes, respectivamente. Pacientes com deficiência em células T são mais suscetíveis. A infecção se inicia por lesões pulmonares assintomáticas e a doença disseminada frequentemente cursa com meningoencefalite. A importância médica da criptococose aumentou significativamente em consequência da epidemia da AIDS e dos transplantes de órgãos.

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“…Na Síndrome da Imunodeficiência Humana Adquirida (AIDS), a criptocococe manifesta-se majoritariamente como meningoencefalite, sendo ela a infecção oportunista neurológica de maior prevalência neste grupo de pacientes. É considerada doença definidora de AIDS já que se associa a baixas contagens de linfócitos T CD4 no soro (abaixo de 100 células) (Nadrous et al, 2003) Globalmente, estima-se que a infecção criptocócica cause cerca de um milhão de casos de meningite por ano entre pessoas com AIDS no mundo, resultando em aproximadamente 625 mil mortes (Centros de Controle e Prevenção de Doenças, CDC, Atlanta, EUA, http://www.cdc.gov/).…”

Section: A Criptococoseunclassified

Características clínicas, epidemiológicas e laboratoriais da criptococose no Distrito Federal no período de 2006 a 2013

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Pulmonary Cryptococcosis in Nonimmunocompromised Patients

Cited by 123 publications

References 21 publications

Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Capítulo 3: criptococose pulmonar

Características clínicas, epidemiológicas e laboratoriais da criptococose no Distrito Federal no período de 2006 a 2013

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