Cryptococcosis by Cryptococcus neoformans/Cryptococcus gattii Species Complexes in non-HIV-Infected Patients in Southeastern Brazil (original) (raw)
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The association between cryptococcal variety and immunocompetent and immunocompromised hosts
Pharmacotherapy
The varieties of Cryptococcus neoformans serotypes are neoformans and gattii. Data suggest an association between cryptococcal variety and host immune status. In addition, the two varieties differ in their epidemiology and pathogenicity. Furthermore, symptoms, outcome, and response of cryptococcosis to antifungal therapy may vary. The two varieties also differ in immune-modulating effects. Sparse clinical data suggest var. gattii is more virulent and may be more recalcitrant to antifungal therapy. Also, its infections produce more sequelae. A better understanding of how cryptococcal variety influences the clinical course and response to the treatment of cryptococcosis is needed. Clinicians should be aware of the association, especially in patients with refractory disease. It may be useful to type the isolate to the variety level and administer prolonged antifungal therapy.
Revista do Instituto de Medicina Tropical de São Paulo, 2017
Cryptococcosis, a systemic disease caused by the fungus Cryptococcus neoformans/ Cryptococcus gattii is more severe in immunocompromised individuals. This study aimed to analyze the epidemiology of the disease, the molecular characteristics and the antifungal susceptibility of C. neoformans isolated from patients treated in a Brazilian university hospital. This retrospective study was conducted in the Clinical Hospital, Federal University of Uberlândia, and evaluated cases of cryptococcosis and strains of C. neoformans isolated from 2004 to 2013. We evaluated 41 patients, 85% of whom were diagnosed with AIDS. The fungus was isolated from the cerebrospinal fluid (CSF) of 21 patients (51%); 19.5% had fungemia and in 24% the agent was isolated from the CSF and blood, concurrently. Meningoencephalitis was the most frequent (75%) manifestation of infection. Despite adequate treatment, the mortality of the disease was 58.5%. Most isolates (97.5%) presented the VNI genotype (serotype A, var. grubii) and one isolate was genotyped as C. gattii (VGI); all the isolates were determined as mating type MATα and showed susceptibility to the tested antifungals (fluconazole, voriconazole, amphotericin B and 5-flucytosine). Although AIDS detection rates remain stable, opportunistic infections such as cryptococcosis remain as major causes of morbidity and mortality in these patients.
Cryptococcosis in apparently immunocompetent patients
QJM, 2006
Background: Few reports have described the clinical and microbiological features of cryptococcosis in immunocompetent patients. Aim: To compare clinical presentations and outcomes of cryptococcosis in immunocompetent vs. immunocompromised patients. Design: Retrospective case series. Methods: All culture-or histology-confirmed cases (n ¼ 46) of cryptococcosis in two acute hospitals in Hong Kong (1995Kong ( -2005 were included. Clinical presentations, rates of fungaemia, cerebrospinal fluid (CSF) parameters and clinical outcomes were recorded. Results: Twenty patients (43.5%) were apparently immunocompetent, 17 (37.0%) had predisposing factors other than HIV infection, and 9 (19.6%) were HIV-positive. Thirty-one (67.4%) presented with meningitis, four (8.7%) with pulmonary cryptococcosis, and 11 (23.9%) with extraneural, extrapulmonary cryptococcosis. Of the immunocompetent patients with retrievable isolates (n ¼ 8), three (37.5%) were Cryptococcus gattii; all isolates (n ¼ 6) from immunocompromised patients were Cryptococcus neoformans var.
Clinical and mycological profile of cryptococcosis in a tertiary care hospital
Indian Journal of Medical Microbiology, 2007
This study examined the extent of cryptococcosis in clinically diagnosed cases of meningitis in HIV-1 seropositive and apparently immunocompetent patients. One hundred and forty-six samples, obtained from 126 chronic meningitis patients comprised of cerebrospinal ß uid (CSF), blood, sputum and urine. The samples were processed by standard microbiological procedures. Cryptococcal isolates were identiÞ ed by microscopy, cultural characteristics, melanin production on niger seed agar and hydrolysis of urea. The isolates were further speciated on cannavanine glycine bromothymol blue (CGB) media. Cryptococcal antigen detection of CSF samples was performed by latex agglutination test (LAT). Minimum inhibitory concentration (MIC) of amphotericin B for the isolates was also tested. Cryptococcosis was diagnosed in 13 patients (eight HIV-1 seropositive and Þ ve apparently immunocompetent). Cryptococcus neoformans var. neoformans was the predominant isolate. Cryptococcal antigen was detected in all, whereas microscopy could detect yeast cells in nine patients. The isolates were sensitive to amphotericin B. CD4 cell counts ranged from 8 to 96/cu mm. The study concludes that all CSF samples with clinical diagnosis of subacute and chronic meningitis should be subjected to tests for detection of Cryptococcus in clinical laboratory irrespective of the immune status.
2014
Cryptococcus neoformans is a basidiomycetous encapsulated yeast with worldwide distribution. After inhalation from environmental sources, this pathogen may result in life-threatening infections in humans commonly affecting the central nervous system or respiratory system. 1 C. neoformans was previously subclassified into three varieties based upon biochemical differences and into four nonhybrid serotypes according to capsular agglutination reactions: 20 C. neoformans var. grubii (serotype A), C. neoformans var. neoformans 21 (serotype D), and C. neoformans var. gattii (serotype B and C). 2,3 22 C. neoformans is the commonest cause of fungal meningitis 23 worldwide. 4,5 C. neoformans var. grubii is an opportunistic pathogen 24 of immunocompromised patients, with HIV infection, corticosteroid 25 therapy, haematological malignancies, and solid-organ transplan-26 tation identified as major risk factors. 6,7 Cryptococcal meningitis is 27 the fourth most common opportunistic infection in patients with 28 HIV, with an estimated one million HIV-associated cryptococcosis 29 cases diagnosed annually worldwide. 5 In Southeast Asia, cryptococ-30 cosis is common amongst HIV-infected individuals, with an 31 estimated 120 cases per 1000 HIV-infected individuals per year. 4 32 The growing size of the immunocompromised patient population 33 from treatment with chemotherapy and biological agents will likely 34 further contribute to the medical importance of cryptococcosis. 6
Cryptococcosis, A Risk for Immunocompromised and Immunocompetent Individuals
The genus Cryptococcus includes at least 37 different species, of which, two are important human pathogens: Cryptococcus neoformans and Cryptococcus gattii. These fungi are opportunistic pathogens and etiologic agents of cryptococcosis disease in humans and animals. A variety of virulence factors interfere with the establishment of cryptococcal infection is usually acquired via inhalation of environmental basidiospores or desiccated yeasts. Cryptococcosis has gained medical importance over the last decade due to the AIDS pandemic, and become an emerging pathogen of immunocompetent individuals, especially in children. This disease in humans may involve every tissue, including cutaneous and pulmonary sites, but the most serious manifestation is central nervous system involvement with meningoencephalitis. In this review, we briefly described the taxonomy, the fungus biology, epidemiology and clinical manifestations of cryptococcosis in immunocompetent and immunocompromised individuals