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Cranial CT scan and MRI. a Hydrocephaly. b Calcification spots in brain parenchyma. c Abnormal signals in cerebral parenchyma. d Improved hydrocephaly after treated by lateral external ventricular drain
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Abstract Background Disseminated cryptococcosis is a rare and fatal disease, and limited data exist regarding it in children. This study aimed to investigate the clinical characteristics of disseminated cryptococcosis in previously healthy children in China. Methods Hospitalized patients with disseminated cryptococcosis were enrolled during January...
Context in source publication
Context 1
... patients with CNS invasion, 58.3% (21/36) of cases had abnormal neurology imaging. Among them, 52.4% (11/21) had hydrocephalus, including communicating (Fig. 4). Additionally, vascular ultrasonic inspection showed 2 cases with vena iliaca communis thrombosis, and 1 case with iliofemoral vein ...
Similar publications
Air pollution is a leading cause of increasing infectious lung diseases. Pulmonary cryptococcosis is a fatal fungal pneumonia in acquired immunodeficiency syndrome patients. In some cases, the pathogen Cryptococcus neoformans also develops dormant nodules in immunocompetent individuals. In the present study, we demonstrated that fine particulate ma...
Objective
To investigate the clinical manifestations and imaging characteristics of pulmonary cryptococcosis, and discuss its guidance in diagnosing.
Methods
The clinical data of patients diagnosed with cryptococcosis in our hospital from January 2014 to May 2020 were collected and retrospectively analyzed. Patients were divided into the immunocom...
Cryptococcosis is a fungal infection that is rarely reported in patients without human immunodeficiency virus (HIV) infection, especially when the central nervous system (CNS) or pulmonary system is not involved. We report a case of isolated colonic cryptococcosis without disseminated disease in a 64-year-old immunocompetent woman without HIV infec...
Pulmonary infections from the environmental fungus Cryptococcus gattii (C. gattii) are notable for cryptococcomas, which are usually solitary and can be very large. As with infections with Cryptococcus neoformans (C. neoformans) patients can have concomitant cryptococcal meningitis; however, unlike for C. neoformans, infections with C. gattii often...
Citations
... Cryptococcus can not only easily infect patients with immune insufficiency, but also healthy people with apparent normal immune function [2]. The lung and central nervous systems are the most invaded tissues and sites of this pathogen, which show no special symptoms in many cases and easily lead to missed diagnosis or misdiagnosis [3]. Pulmonary cryptococcosis can also spread and cause fatal complications [4,5], posing a significant threat to the central nervous system and respiratory system [5,6]. ...
Background
The most serious manifestation of pulmonary cryptococcosis is complicated with cryptococcal meningitis, while its clinical manifestations lack specificity with delayed diagnosis and high mortality. The early prediction of this complication can assist doctors to carry out clinical interventions in time, thus improving the cure rate. This study aimed to construct a nomogram to predict the risk of cryptococcal meningitis in patients with pulmonary cryptococcosis through a scoring system.
Methods
The clinical data of 525 patients with pulmonary cryptococcosis were retrospectively analyzed, including 317 cases (60.38 %) with cryptococcal meningitis and 208 cases (39.62 %) without cryptococcal meningitis. The risk factors of cryptococcal meningitis were screened by univariate analysis, LASSO regression analysis and multivariate logistic regression analysis. Then the risk factors were incorporated into the nomogram scoring system to establish a prediction model. The model was validated by receiver operating characteristic (ROC) curve, decision curve analysis (DCA) and clinical impact curve.
Results
Fourteen risk factors for cryptococcal meningitis in patients with pulmonary cryptococcosis were screened out by statistical method, including 6 clinical manifestations (fever, headache, nausea, psychiatric symptoms, tuberculosis, hematologic malignancy) and 8 clinical indicators (neutrophils, lymphocytes, glutamic oxaloacetic transaminase, T cells, helper T cells, killer T cells, NK cells and B cells). The AUC value was 0.978 (CI 96.2 %∼98.9 %), indicating the nomogram was well verified.
Conclusion
The nomogram scoring system constructed in this study can accurately predict the risk of cryptococcal meningitis in patients with pulmonary cryptococcosis, which may provide a reference for clinical diagnosis and treatment of patients with cryptococcal meningitis.
... La infección más frecuente es la del sistema nervioso central, luego le sigue la criptococosis diseminada y la criptococosis pulmonar [5][6][7][8][9][10][11][12] . La meningoencefalitis puede presentarse con líquido cefalorraquídeo claro y confundirse con una infección herpética demorando su tratamiento y pudiendo resultar en secuelas irreversibles graves 5 . ...
Objetivo:
Describir un caso de criptococosis pulmonar en un adolescente inmunocompetente detallando el abordaje diagnóstico realizado.
Caso Clínico:
Paciente de 15 años, previamente sano, oriundo de una localidad rural, que consultó por tos y dolor en puntada de costado de un mes de evolución, sin fiebre ni dificultad respiratoria, con dos imágenes de condensación en base pulmonar izquierda en radiografía de tórax. La Tomografía Computada mostró que las imágenes tenían aspecto nodular. Por sospecha de patología neoplásica se completó estudio con Tomografía por Emisión de Positrones que evidenció lesiones nodulares hipermetabólicas. Las características tomográficas, podrían corresponder a compromiso fúngico o granulomatoso. Teniendo en cuenta las imágenes y los factores epidemiológicos de riesgo como el origen rural y contacto con deposiciones de aves, se consideró la posibilidad de micosis. Se realizó punción biopsia pulmonar bajo guía tomográfica. Se identificó Cryptococcus neoformans en el cultivo microbiológico. Recibió tratamiento con itraconazol y fluconazol con buena respuesta clínica y de las imágenes a 10 meses de terapia y seguimiento.
Conclusión:
En pacientes inmunocompetentes con una presentación clínica inespecífica, las imágenes pueden orientar el diagnóstico de criptococosis pulmonar, siendo la búsqueda etiológica fundamental para confirmarlo. En nuestro caso la punción biopsia guiada por tomografía fue de gran utilidad diagnóstica.
... Lung biopsy is a common strategy for diagnosing pulmonary cryptococcosis [30]. When lesions are located in the outer lung field, the success rate of lung puncture operation is higher, followed by pathological examination and detection of cryptococcal capsule antigen [31]. ...
Objective
This study aimed to investigate the potential risk factors associated with disseminated cryptococcosis in HIV-negative individuals.
Methods
A total of 106 HIV-negative patients with cryptococcal disease were enrolled. The observation group consisted of patients with disseminated cryptococcosis (DC), whereas the control groups included patients with pulmonary cryptococcosis (PC) and cryptococcal meningitis (CM). Univariate and multivariate logistic regression algorithms were used to explore the significant clinical and laboratory characteristics that affect the progression of cryptococcal infections. Finally, receiver operating characteristics (ROC) curves are applied to assess the diagnostic value of identified risk factors.LE: Kindly check the edit made in the title.I agree
Results
Of the 106 patients, 57 were diagnosed with pulmonary cryptococcosis, 22 with cryptococcal meningitis, and 27 with disseminated cryptococcosis. The logistic regression equation included five variables: diabetes, decompensated liver cirrhosis, long-term use of immunosuppressive agents, decreased serum albumin level, and elevated plasma cytokine IL-10 level. The ROC curves showed that albumin (AUC > 0.7), IL-10 (AUC > 0.7) and decompensated liver cirrhosis (AUC > 0.6) have relatively high diagnostic capacity in predicting the progression of Cryptococcus.
Conclusion
This study identified elevated IL-10 levels as an independent risk factor for developing disseminated cryptococcosis in the control groups. Furthermore, decompensated liver cirrhosis and decreased serum albumin independently affected the progression of cryptococcosis in the CM and PC groups, respectively.
... Cryptococcal meningitis is the most common manifestation in both immunocompetent and immunocompromised individuals. Pulmonary cryptococcosis is the second most common manifestation and is more common in immunocompetent patients [6]. ...
Pulmonary cryptococcosis, although rare, maybe seen in both immunocompromised and immunocompetent patients. Cryptococcosis presenting as a lung mass mimicking lung cancer is very rare. Here, we report our experience with pulmonary cryptococcosis presenting as a lung mass mimicking malignancy in an immunocompetent patient. In this case, the patient presented to us with left-sided pleural effusion and lung mass on computed tomography (CT) of the chest. Bronchoscopy and endobronchial ultrasound (EBUS)-guided fine needle aspiration cytology (FNAC) was performed, which showed cryptococcal organisms. He responded well to oral anti-fungal therapy without any need for surgical interventions.
... On the other hand, some reports have demonstrated cases of eosinophilia both in immunosuppressed patients and healthy individuals affected by cryptococcosis [59][60][61]. Furthermore, Gao et al. [62] observed high levels of eosinophils and IgE during disseminated cryptococcosis in children, but these levels decreased after antifungal therapy. During nematode infection, there is an increase in IL-5 secretion, which acts on the recruitment and activation of eosinophils [24,63]. ...
Cryptococcosis is a systemic mycosis that causes pneumonia and meningoencephalitis. Strongyloidiasis is a chronic gastrointestinal infection caused by parasites of the genus Strongyloides. Cryptococcosis and strongyloidiasis affect the lungs and are more prevalent in the same world regions, i.e., Africa and tropical countries such as Brazil. It is undeniable that those coincidences may lead to the occurrence of coinfections. However, there are no studies focused on the interaction between Cryptococcus spp. and Strongyloides spp. In this work, we aimed to investigate the interaction between Strongyloides venezuelensis (Sv) and Cryptococcus gattii (Cg) in a murine coinfection model. Murine macrophage exposure to Sv antigens reduced their ability to engulf Cg and produce reactive oxygen species, increasing the ability of fungal growth intracellularly. We then infected mice with both pathogens. Sv infection skewed the host’s response to fungal infection, increasing lethality in a murine coinfection model. In addition to increased NO levels and arginase activity, coinfected mice presented a classic Th2 anti-Sv response: eosinophilia, higher levels of alternate activated macrophages (M2), increased concentrations of CCL24 and IL-4, and lower levels of IL-1β. This milieu favored fungal growth in the lungs with prominent translocation to the brain, increasing the host’s tissue damage. In conclusion, our data shows that primary Sv infection promotes Th2 bias of the pulmonary response to Cg-infection and worsens its pathological outcomes.
... A total of 71.7% of cases were detected from the male population, which is inconsistent with the previous findings, ie, 60.9% from Hunan, China, 75.6% from Wuhan, China, 73% from Beijing China, 79.6% from Colombia, and 69% from Brazil. 14,18,[25][26][27] The high proportion in the male population might be due to their lifestyle and weak immune system compared to the female population. 19 In the present study, the median age of patients was 58 (IQR; 47-66). ...
Objective
Cryptococcosis is a fatal infection that can affect both immunocompetent and immunocompromised patients, and it is little understood in China’s various regions. This research aimed to look at the epidemiology, risk factors, and antifungal susceptibility pattern of Cryptococcus neoformans in eastern Guangdong, China.
Methods
A six-year (2016–2022) retrospective study was conducted at Meizhou People’s Hospital, China. Demographical, clinical, and laboratory data of cryptococcal patients were collected from hospital records and statistically analyzed using the chi-square and ANOVA tests.
Results
Overall, 170 cryptococcal infections were recorded, of which meningitis accounted for 78 (45.88%), cryptococcemia for 50 (29.41%), and pneumonia for 42 (24.7%). The number of cases increased 8-fold during the study duration. The median age of patients was 58 years (Inter quartile range: 47–66), and the high proportion of cases was from the male population (n = 121, 71.17%). The underlying diseases were identified only in 60 (35.29%) patients, of which 26 (15.29%) were severely immunocompromised, and 26 (15.29%) others were mildly immunocompromised. A statistically significant difference was reported for chronic renal failure, and anemia (p < 0.05) persisted in cases of three infection types. A high number of non-wild type (NWT) isolates were found against amphotericin B (n=13/145, 8.96%), followed by itraconazole (n=7/136, 5.15%) and voriconazole (n=4/158, 2.53%). Only six isolates (3.79%) were multidrug-resistant, four of which were from cryptococcemia patients. Compared to meningitis and pneumonia, cryptococcemia revealed a higher percentage of NWT isolates (p < 0.05).
Conclusion
In high-risk populations, cryptococcal infections require ongoing monitoring and management.
... We failed to suspect cryptococcal infection in this child as he was apparently immunocompetent. A previous study reported that the rate of cryptococcal infection could be as high as up to 30% in patients with AIDS compared to 1% in immunocompetent children [3,4]. However, various other studies from China found that the majority (60 -75%) of pediatric patients with cryptococcosis were immunocompetent [5 -7]. ...
... Also, severe neurological complications like hydrocephalus and seizure are more common in immunocompromised patients [9]. Immunocompetent patients usually have a longer duration of symptoms, typical meningeal signs, and neuroimaging findings [4]. The CSF profile in patients with cryptococcal meningitis may reveal a mild lymphocytosis and elevated protein but is often normal [1]. ...
Cryptococcal infection is the third most common fungal infection which commonly affects immune-compromised hosts but is increasingly recognized in immunocompetent hosts also. Here, we report disseminated cryptococcosis in an apparently immunocompetent child presenting with high-grade fever, headache and altered sensorium for one month. He had pallor, lymphadenopathy, skin lesions, decreased vision, sixth and seventh cranial nerve palsy, and hepatosplenomegaly. Cerebrospinal fluid analysis report, contrast-enhanced Computed Tomography of brain, and bone-marrow aspiration were normal. The diagnosis was confirmed on bone marrow biopsy. Early diagnosis and timely management of this disease would be life-saving for many children.
... [24] Pulmonary cryptococcosis may also disseminate and lead to fatal complications. [25][26][27] A previous study reported that 67% of pulmonary cryptococcosis in immunocompetent patients disseminated into the CNS causing cryptococcal meningitis. [25] Patients with pulmonary cryptococcosis concomitantly with cryptococcal meningitis showed inadequate treatment response and poor clinical outcomes compare to cryptococcal meningitis alone. ...
... Repeat investigations such as chest CT scan, CXR and serum CrAg should be used for treatment monitoring. Specific antifungal therapy usually results in a negative serum CrAg within one year, however in some individuals it may remain persistently positive up to 2 years 13,14 . Radiological resolution varies, but complete resolution is expected within 1-2 years. ...
Pulmonary cryptococcosis is rare in immunocompetent individuals. Limited data exist regarding its occurrence in children, especially in developing countries. This case report describes an 8-year-old HIV-negative child with pulmonary cryptococcosis, previously diagnosed and treated for tuberculosis twice without improvement. Fine needle aspiration biopsy confirmed the diagnosis of pulmonary cryptococcosis and serum cryptococcal antigen test was positive. The child improved on amphotericin and fluconazole treatment. Despite the limited diagnostic capacity in many resource-constrained settings like Uganda, this case report highlights the need to investigate other causes of pneumonia in immunocompetent children that are not improving on conventional antimicrobial treatments.
... can present in otherwise immunocompetent individuals, and immunosuppression-related events may reactivate the infection [4]. C. neoformans has a predilection for the central nervous system, whereas C. gattii is detected in the majority of pulmonary tissue [5]. ...
We demonstrated that cytotoxic T cells that had been bioengineered with GXM-targeting chimeric antigen receptor (GXMR-CAR) were able to recognize C. neoformans by promoting the control of titanization. GXMR-CAR, a second-generation CAR, contains a single-chain variable fragment that originates from a 18B7 clone: a human IgG4 hinge, followed by a human CD28 (transmembrane/cytoplasmic domains) and a CD3ς chain. In the current study, we redirected T cells to target distinct C. neoformans and C. gattii cell types by GXMR-CAR. Lentiviral particles carrying the GXMR-CAR sequence were used to transduce Jurkat cells, and these modified cells interacted with the GXM of the C. gattii R265 strain. Moreover, GXMR-CAR mediated the recognition of C. gattii and C. neoformans yeasts with both thin and thick polysaccharide capsules, and GXMR-CAR Jurkat cells interacted with titan cells sourced from both Cryptococcus spp. Thus, bioengineered cells using CAR can improve the treatment of cryptococcosis.
