1
|
Hu D, Jiang W, Zhu X, Hou Q, Chen M, Xue X, Zhao J, Ilkit M, Arastehfar A, Fang W, Lin S, Pan W, Liao W. Phaeohyphomycosis caused by Corynespora cassiicola, a plant pathogen worldwide. Mycology 2023; 15:91-100. [PMID: 38558843 PMCID: PMC10977011 DOI: 10.1080/21501203.2023.2247433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 04/04/2024] Open
Abstract
Although rare, trans-kingdom infection features an interesting infection biology concept, in which highly versatile pathogenic attributes allow successful infections in evolutionarily highly divergent species. Corynespora cassiicola is a phytopathogenic fungus and occasionally causes human infections. Herein, we report a phaeohyphomycosis case caused by C. cassiicola. Given that sporadic reports may contribute to a lack of awareness of the transmission route, clinical manifestations, and diagnostic and clinical management, we systematically reviewed the cases reported thus far. Nine patients were identified and included in the pooled analysis, 88.9% (8/9) of whom were reported after 2010. All patients were from Asian, African, and Latin American countries, among whom 77.8% (7/9) were farmers or lived in areas with active agriculture. Exposed body parts were the major affected infection area, and clinical manifestations were mainly non-specific inflammatory reactions. Although biochemical and morphological examinations confirmed the presence of fungal infection, molecular analysis was used for the final diagnosis, with 77.8% (7/9) being identified by internal transcribed spacer sequencing. Whereas voriconazole, terbinafine, and AmB, either alone or in combination, resulted in successful infection resolution in most cases (5/9; 55.5%), those suffering from invasive facial infections and CARD9 deficiency showed poor outcomes. Our patient is the third case of invasive facial infection caused by C. cassiicola and was successfully treated with intravenous LAmB followed by oral voriconazole combined with topical antifungal irrigation. Molecular identification of fungus and prompt antifungal treatment is pivotal in the clinical success of patients suspected to have phaeohyphomycosis. Moreover, as evidenced by our data, itraconazole treatment is not recommended.
Collapse
Affiliation(s)
- Dongying Hu
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Weiwei Jiang
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xinlin Zhu
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qing Hou
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Min Chen
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiaochun Xue
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jing Zhao
- Department of Dermatology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Wenjie Fang
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Shunzhang Lin
- Department of Otorhinolaryngology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Weihua Pan
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Wanqing Liao
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| |
Collapse
|
2
|
Zhang L, Xiao J, Du M, Lei W, Yang W, Xue X. Post-translational modifications confer amphotericin B resistance in Candida krusei isolated from a neutropenic patient. Front Immunol 2023; 14:1148681. [PMID: 36936926 PMCID: PMC10015421 DOI: 10.3389/fimmu.2023.1148681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Neutropenia is a common complication in the treatment of hematological diseases and the most common predisposing factor for invasion by fungi, such as Candida krusei. Recent studies have shown that C. krusei, a life-threatening pathogen, has developed resistance to amphotericin B (AMB). However, the mechanisms that led to the rapid emergence of this AMB-resistant phenotype are unclear. In this study, we found the sensitivity for AMB could be promoted by inhibiting histone acyltransferase activity and western blot analysis revealed differences in the succinylation levels of C. krusei isolated from immunocompromised patients and of the corresponding AMB-resistant mutant. By comparative succinyl-proteome analysis, we identified a total of 383 differentially expressed succinylated sites in with 344 sites in 134 proteins being upregulated in the AMB-resistant mutant, compared to 39 sites in 23 proteins in the wild-type strain. These differentially succinylated proteins were concentrated in the ribosome and cell wall. The critical pathways associated with these proteins included those involved in glycolysis, gluconeogenesis, the ribosome, and fructose and mannose metabolism. In particular, AMB resistance was found to be associated with enhanced ergosterol synthesis and aberrant amino acid and glucose metabolism. Analysis of whole-cell proteomes, confirmed by parallel reaction monitoring, showed that the key enzyme facilitating lysine acylation was significantly upregulated in the AMB-resistant strain. Our results suggest that lysine succinylation may play an indispensable role in the development of AMB resistance in C. krusei. Our study provides mechanistic insights into the development of drug resistance in fungi and can aid in efforts to stifle the emergence of AMB-resistant pathogenic fungi.
Collapse
Affiliation(s)
- Li Zhang
- Institute of Dermatology, Naval Medical University, Shanghai, China
| | - Jinzhou Xiao
- Institute of Dermatology, Naval Medical University, Shanghai, China
| | - Mingwei Du
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai, China
| | - Wenzhi Lei
- Institute of Dermatology, Naval Medical University, Shanghai, China
- *Correspondence: Wenzhi Lei, ; Weiwei Yang, ; Xiaochun Xue,
| | - Weiwei Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
- *Correspondence: Wenzhi Lei, ; Weiwei Yang, ; Xiaochun Xue,
| | - Xiaochun Xue
- Department of Pharmacy, 905th Hospital of PLA Navy, Shanghai, China
- *Correspondence: Wenzhi Lei, ; Weiwei Yang, ; Xiaochun Xue,
| |
Collapse
|
3
|
Alobaidi D, Mahgoub AE, Bachuwa G, Osterholzer D. Cryptococcus neoformans var. grubii septic arthritis in an immunocompromised patient on haemodialysis with history of splenectomy and sarcoidosis. BMJ Case Rep 2022; 15:e248217. [PMID: 35787508 PMCID: PMC9255371 DOI: 10.1136/bcr-2021-248217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/03/2022] Open
Abstract
A male adult in his mid-40s with end-stage renal disease (ESRD) on haemodialysis, with history of splenectomy and sarcoidosis, developed septic arthritis of the knee. Excision and drainage was performed and empiric antibiotics were initiated. Cultures were initially negative without clinical improvement. Eventually, the aerobic synovial fluid culture grew Cryptococcus neoformans (formerly Cryptococcus neoformans var. grubii). The patient was treated with liposomal amphotericin B and then switched to fluconazole until the infection resolved. This case highlights the less well-recognised association between cryptococcal arthritis and immunodeficiency states like ESRD, splenectomy and sarcoidosis.
Collapse
Affiliation(s)
- Demah Alobaidi
- Internal Medicine, Hurley Medical Center / Michigan State University, Flint, Michigan, USA
| | | | - Ghassan Bachuwa
- Internal Medicine, Hurley Medical Center / Michigan State University, Flint, Michigan, USA
| | - Danielle Osterholzer
- Internal Medicine - Division of Infectious Diseases, Hurley Medical Center / Michigan State University, Flint, Michigan, USA
| |
Collapse
|
4
|
Zhao J, Weng W, Chen C, Zhang J. The prevalence and mortality of cryptococcal meningitis in patients with autoimmune diseases: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2021; 40:2515-2523. [PMID: 34258688 DOI: 10.1007/s10096-021-04293-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022]
Abstract
Growing evidence suggests that autoimmune diseases (AIDs) are risk factors for cryptococcal meningitis (CM). Therefore, understanding the epidemiological and clinical profile of CM in patients with AIDs is important. This meta-analysis assessed the prevalence, clinical profiles, and clinical outcomes of CM in AIDs. Studies on CM in patients with AIDs were searched for in PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure, and meta-analyses were performed using the statistical program of R. Nineteen studies with 36,631 patients with AIDs were analyzed. The overall pooled CM prevalence was 0.4% (95% confidence interval [CI], 0.3-0.6%), 90.7% of which occurred in female patients. Thirteen studies with 77 patients with AIDs diagnosed with CM were analyzed, and the mortality rate was 26.7% (95% CI, 9.5-47.2%). Of patients with systemic lupus erythematosus, 30.1% of CM cases were initially misdiagnosed (95% CI, 0-65.6%). The primary symptom of CM with AIDs was headache (99.4%; 95% CI, 92.1-100%), followed by fever (93.7%; 95% CI, 82.8-100%) and vomiting (37.2%; 95% CI, 13.2-61.2%). The prevalence of CM infections among patients with AIDs should not be underestimated despite non-specific clinical presentations as there were fatal outcomes. Our results suggest that more research is needed to understand the relationship between AIDs and CM, and clinical trials are necessary to improve treatment strategies.
Collapse
Affiliation(s)
- Jing Zhao
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Weipin Weng
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chunli Chen
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jie Zhang
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China.
| |
Collapse
|
5
|
Heard F, Allen J, Joseph A. Disseminated cryptococcal disease presenting as peritonitis in a patient on automated peritoneal dialysis: Could it have been prevented? Perit Dial Int 2021; 42:227-228. [PMID: 33823708 DOI: 10.1177/08968608211004678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Francesca Heard
- Department of Microbiology, Queens Medical Centre, Nottingham University Hospitals Trust, UK
| | - Jenny Allen
- Department of Renal Medicine, City Hospital, Nottingham University Hospitals Trust, UK
| | - Annie Joseph
- Department of Microbiology, Queens Medical Centre, Nottingham University Hospitals Trust, UK
| |
Collapse
|
6
|
Li H, Li X, Zhang L, Fang W, Zhang K, Arastehfar A, Ilkit M, Hu D, Chen X, Wang H, Ling L, Lin J, Xu B, Liao W, Pan W, Zhang Q. The clinical profiles and outcomes of HIV-negative cryptococcal meningitis patients in type II diabetes mellitus. BMC Infect Dis 2021; 21:224. [PMID: 33639846 PMCID: PMC7913410 DOI: 10.1186/s12879-021-05867-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 02/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background The clinical profiles and outcomes of cryptococcal meningitis have been shown to vary depending on the underlying condition. The aim of this study was to investigate clinical characteristics and outcomes in patients with and without type II diabetes mellitus. Methods A retrospective study was performed. Clinical data of HIV-negative cryptococcal meningitis patients with type II diabetes mellitus (n = 26) and without type II diabetes mellitus (n = 52) referring to the Jiangxi Chest Hospital between January 2012 to December 2018 were analyzed. The data were analyzed using chi square, none-parametric tests, and logistic regression. P-values < 0.05 were considered significant. Results In this study, cryptococcal meningitis patients suffering from type II diabetes mellitus had a higher mortality (23.08% vs. 7.69%; P = 0.055), and required longer hospitalization (59.58 vs. 42.88 days; P = 0.132). Moreover, cerebrospinal fluid examinations revealed that cryptococcal meningitis patients with type II diabetes mellitus had higher opening pressure (271.54 vs. 234.23 mmH2O; P = 0.125).The results of multivariate regression analysis revealed that cryptococcal meningitis patients with type II diabetes were more often presented with visual disorders (28.54% vs. 11.54%; [95% CI 0.056–0.705]; p = 0.012), and had higher cerebrospinal fluid protein levels (1027.62 ± 594.16 vs. 705.72 ± 373.88 mg/l; [95% CI 1.000–1.002]; p = 0.016). Among patients with type II diabetes mellitus, nausea and vomiting was more frequent at the initial visit in those died (100% vs. 50%; p = 0.027), and 66% of died type II diabetes mellitus patients were poorly controlled blood glucose level, compared with 30% in survival type II diabetes mellitus patients. Conclusion This study suggests that cryptococcal meningitis patients with type II diabetes mellitus differ significantly from cryptococcal meningitis patients without type II diabetes mellitus with respect to clinical symptoms such as visual disorders and cerebrospinal fluid examination. The presence of nausea and vomiting among type II diabetes mellitus patients could have implication in mortality.
Collapse
Affiliation(s)
- Hang Li
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China
| | - Xiaojing Li
- Department of Dermatology, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, P. R. China
| | - Lei Zhang
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China
| | - Wenjie Fang
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China
| | - Keming Zhang
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China
| | - Amir Arastehfar
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - Macit Ilkit
- Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Dongying Hu
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China
| | - Xianzhen Chen
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China
| | - Huiwei Wang
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China
| | - Liyan Ling
- Department of Laboratory Medicine, Pinghu Second People's Hospital, Zhejiang, P. R. China
| | - Jianjun Lin
- Department of Clinical Laboratory, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, Zhejiang, P. R. China
| | - Bin Xu
- Department of Neurology, Jiangxi Chest Hospital, Jiangxi, 330000, P. R. China
| | - Wanqing Liao
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China
| | - Weihua Pan
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China. .,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.
| | - Qilong Zhang
- Department of Neurology, Jiangxi Chest Hospital, Jiangxi, 330000, P. R. China. .,Department of Neurology, Jiangxi Provincial people's Hospital, Nanchang, 330006, P. R. China.
| |
Collapse
|
7
|
Li Y, Zou M, Yin J, Liu Z, Lu B. Microbiological, Epidemiological, and Clinical Characteristics of Patients With Cryptococcal Meningitis at a Tertiary Hospital in China: A 6-Year Retrospective Analysis. Front Microbiol 2020; 11:1837. [PMID: 32849436 PMCID: PMC7403485 DOI: 10.3389/fmicb.2020.01837] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022] Open
Abstract
Cryptococcal meningitis, mainly caused by Cryptococcus neoformans/gattii species complexes, is a lethal infection in both immunosuppressive and immunocompetent populations. We characterized 110 Cryptococcus strains collected from Xiangya Hospital of Central South University in China during the 6-year study period between 2013 and 2018, and performed their antifungal susceptibility testing. Furthermore, the clinical features, laboratory and imaging data, treatment strategies and outcomes of the subjects were retrospectively analyzed. Of 110 Cryptococcus strains, C. neoformans species complexes accounted for 96.4% (106/110), including C. neoformans sensu stricto (VNI molecular type, 95.5%, 105/110) and Cryptococcus deneoformans (VNIV molecular type, 0.9%, 1/110), and Cryptococcus deuterogattii (VGII molecular type) accounted for 3.6% (4/110). The strains were further classified into 17 individual sequence types (STs) by using multilocus sequence typing (MLST). 89.1% (98/110) were represented by ST5; seven C. deuterogattii strains and one Cryptococcus deneoformans strain were assigned as ST7 and ST260, respectively. Antifungal minimal inhibitory concentrations above the epidemiological cutoff values (ECVs) were found mainly in C. neoformans species complexes strains (nine for amphotericin B, nine for fluconazole and seven for 5-fluorocytosine). Furthermore, 60.9% (67/110) of the subjects were male, and 40.0% (44/110) did not have underlying diseases. Hepatic diseases (hepatitis/HBV carrier status and cirrhosis) were the most common underlying health conditions (11.8%, 13/110), followed by autoimmune disorders (10.9%, 12/110) and chronic kidney disease (6.36%, 7/110). Only 4.5% (5/110) of the patients were HIV/AIDS positives. For clinical presentation, headache (77.3%, 85/110), fever (47.3%, 52/110), and stiff neck (40.9%, 45/110) were commonly observed. The mortality rate was 35.0% (36/103). In conclusion, our data were characterized by a high prevalence of the Cryptococcal meningitis patients without HIV/AIDS and other underlying health conditions, a relatively high non-wild-type rate of fluconazole and amphotericin B resistance, and low genetic diversity in Cryptococcus strains. The present study will provide evidence for further improvement of the diagnosis and treatment of cryptococcosis in China.
Collapse
Affiliation(s)
- Yanbing Li
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Mingxiang Zou
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jun Yin
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ziqing Liu
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Binghuai Lu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Guangdong Key Laboratory for Emerging Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, China
| |
Collapse
|
8
|
Yao K, Qiu X, Hu H, Han Y, Zhang W, Xia R, Wang L, Fang J. Pulmonary cryptococcosis coexisting with central type lung cancer in an immuocompetent patient: a case report and literature review. BMC Pulm Med 2020; 20:161. [PMID: 32503511 PMCID: PMC7275487 DOI: 10.1186/s12890-020-01200-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/28/2020] [Indexed: 12/27/2022] Open
Abstract
Background Pulmonary Cryptococcosis is a common fungal infection mainly caused by Cryptococcus neoformans/C.gattii species in immunocompromised patients. Cases of pulmonary cryptococcosis in patients with normal immune function are increasingly common in China. Clinical and radiographic features of pulmonary cryptococcosis are various and without obvious characteristics, so it is often misdiagnosed as pulmonary metastatic tumor or tuberculosis. When coexisting with malignant lung tumors, it was more difficult to differentiate from metastatic lung cancer, although the coexistence of pulmonary cryptococcosis and central type lung cancer is rare. Reviewing the imaging manifestations and diagnosis of the case and the relevant literature will contribute to recognition of the disease and a decrease in misdiagnoses. Case presentation A 72-year-old immunocompetent Han Chinese man had repeated dry cough for more than half a year. CT examination of chest showed an irregular mass at the left hilum of the lung, and two small nodules in the right lung, which were considered as the left central lung cancer with right lung metastasis. However, the patient was diagnosed with pulmonary cryptococcosis coexisting with central type lung cancer based on the results of laboratory examination, percutaneous lung biopsy, fiberoptic bronchoscopy, and surgical pathology. The patient underwent surgical resection of the left central type lung cancer and was placed on fluconazole treatment after a positive diagnosis was made. Five years after the lung cancer surgery, the patient had a recurrence, but the pulmonary cryptococcus nodule disappeared. Conclusion Our case shows that CT findings of central type lung cancer with multiple pulmonary nodules are not necessarily metastases, but may be coexisting pulmonary cryptococcosis. CT images of cryptococcosis of the lung were diverse and have no obvious characteristics, so it was very difficult to distinguish from metastatic tumors. CT-guided percutaneous lung biopsy was a simple and efficient method for identification.
Collapse
Affiliation(s)
- Kelin Yao
- Affiliated Hospital of Shaoxing university, Shaoxing, 312000, Zhejiang Province, China
| | - Xiaofang Qiu
- Yuecheng district maternal and child health and family planning service center, Shaoxing, 312000, Zhejiang Province, China
| | - Hongjie Hu
- Sir Run Run Shaw Hospital affiliated Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China.
| | - Yuxin Han
- Sir Run Run Shaw Hospital affiliated Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China
| | - Wenming Zhang
- Sir Run Run Shaw Hospital affiliated Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China
| | - Ruiming Xia
- Affiliated Hospital of Shaoxing university, Shaoxing, 312000, Zhejiang Province, China
| | - Liang Wang
- Affiliated Hospital of Shaoxing university, Shaoxing, 312000, Zhejiang Province, China
| | - Jieming Fang
- City Hope National Medical Center, Duarte, California, USA
| |
Collapse
|
9
|
Tashiro H, Haraguchi T, Takahashi K, Sadamatsu H, Tajiri R, Takamori A, Kimura S, Sueoka-Aragane N. Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis. BMC Pulm Med 2020; 20:116. [PMID: 32349734 PMCID: PMC7191728 DOI: 10.1186/s12890-020-1149-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/14/2020] [Indexed: 02/08/2023] Open
Abstract
Background Pulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. The severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have not been fully assessed. The purpose of this study was to clarify the clinical characteristics of advanced CKD in patients with pulmonary cryptococcosis. Methods The present study retrospectively investigated 56 patients who had non-human immunodeficiency virus (HIV) pulmonary cryptococcosis and were treated at Saga University Hospital between 2005 and 2018. The clinical characteristics were evaluated and compared between patients with estimated glomerular filtration rate (eGFR) > 45 mL/min/1.73 m2 (n = 42, early CKD) and those with eGFR < 45 mL/min/1.73 m2 (n = 14, advanced CKD. Results Compared with patients with early CKD, those with advanced CKD had significantly higher rate of disseminated cryptococcosis (21.4% vs. 2.4%, p = 0.03); lower percentage of patients who recovered after treatment (63.6% vs. 92.5%, p = 0.02); and more frequent clinical features of fever (57.1% vs. 19.0%, p < 0.01), pleural effusion (21.4% vs. 2.4%, p = 0.03), high white blood cell count (8550/mL vs. 6150/mL, p = 0.01) and C-reactive protein (CRP) (2.1 mg/dL vs. 0.2 mg/dL, p = 0.02), and low level of serum albumin (3.0 g/dL vs. 3.8 g/dL, p < 0.01). Multivariate analysis adjusted by immunosuppressive drug use indicated the significant factors of fever (odds ratio or β value [95% confidence interval] 6.4 [1.65–20.09], p < 0.01), high white blood cell count (1293.2 [110.2–2476.2], p = 0.03), C-reactive protein (0.89 [0.18–1.59], p = 0.01) and low level of serum albumin (− 0.34 [− 0.54 – − 0.14], p < 0.01) in patients with eGFR < 45 mL/min/1.73m2. Conclusion Advanced CKD was associated with poor clinical characteristics and outcomes in patients with non-HIV pulmonary cryptococcosis. Trial registration The patients in this study were registered retrospectively.
Collapse
Affiliation(s)
- Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan.
| | - Tetsuro Haraguchi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Hironori Sadamatsu
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Ryo Tajiri
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| |
Collapse
|
10
|
Zhang Y, Cooper B, Gui X, Sherer R, Cao Q. Clinical diversity of invasive cryptococcosis in AIDS patients from central China: report of two cases with review of literature. BMC Infect Dis 2019; 19:1003. [PMID: 31775716 PMCID: PMC6882200 DOI: 10.1186/s12879-019-4634-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/13/2019] [Indexed: 01/09/2023] Open
Abstract
Background Although antiretroviral therapy (ART) has greatly improved the prognosis of acquired immunodeficiency syndrome (AIDS) patients globally, opportunistic infections (OIs) are still common in Chinese AIDS patients, especially cryptococcosis. Case presentation We described here two Chinese AIDS patients with cryptococcal infections. Case one was a fifty-year-old male. At admission, he was conscious and oriented, with papulonodular and umbilicated skin lesions, some with ulceration and central necrosis resembling molluscum contagiosum. The overall impression reminded us of talaromycosis: we therefore initiated empirical treatment with amphotericin B, even though the case history of this patient did not support such a diagnosis. On the second day of infusion, the patient complained of intermittent headache, but the brain CT revealed no abnormalities. On the third day, a lumbar puncture was performed. The cerebral spinal fluid (CSF) was turbid, with slightly increased pressure. India ink staining was positive, but the cryptococcus antigen latex agglutination test (CrAgLAT: IMMY, USA) was negative. Two days later, the blood culture showed a growth of Cryptococcus neoformans, and the same result came from the skin culture. We added fluconazole to the patient’s treatment, but unfortunately, he died three days later. Case two was a sixty-four-year-old female patient with mild fever, productive cough, dyspnea upon movement, and swelling in both lower limbs. The patient was empirically put on cotrimoxazole per os and moxifloxacin by infusion. A bronchofibroscopy was conducted with a fungal culture, showing growth of Cryptococcus laurentii colonies. Amphotericin B was started thereafter but discontinued three days later in favor of fluconazole 400 mg/d due to worsening renal function. The patient became afebrile after 72 h of treatment with considerable improvement of other comorbidities and was finally discharged with continuing oral antifungal therapy. Conclusions Our cases illustrate that cryptococcal disease is an important consideration when treating immunocompromised individuals such as AIDS patients. Life threatening meningitis or meningoencephalitis caused by C. neoformansmay still common in these populations and can vary greatly in clinical presentations, especially with regard to skin lesions. Pulmonary cryptococcosis caused by C. laurentii is rare, but should also be considered in certain contexts. Guidelines for its earlier diagnosis, treatment and prophylaxis are needed.
Collapse
Affiliation(s)
- Yongxi Zhang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Brian Cooper
- Section of Infectious Diseases and Global Health, University of Chicago, 5841 S. Maryland Avenue, MC5065, Chicago, IL, 60637, USA
| | - Xi'en Gui
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Renslow Sherer
- Section of Infectious Diseases and Global Health, University of Chicago, 5841 S. Maryland Avenue, MC5065, Chicago, IL, 60637, USA
| | - Qian Cao
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| |
Collapse
|
11
|
Meena P, Gupta A, Gaur L, Shingada A, Gupta P, Bhargava V, Rana DS. Cryptococcosis masquerading as disseminated tuberculosis in a patient on chronic hemodialysis. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:1179-1183. [PMID: 31696861 DOI: 10.4103/1319-2442.270278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic hemodialysis (HD) recipients are nearly ten times more prone to fungal infections compared to the general population. However, infections such as cryptococcosis usually affect immunocompromised patients, unusual in otherwise immunocompetent patients. Here, we describe a unique case of cryptococcosis in a human immunodeficiency virus negative end-stage renal disease (ESRD) patient. A 26-year-old female patient, diagnosed with ESRD, on maintenance HD for the past six months, presented with pyrexia of unknown origin associated with cervical lymphadenopathy, biopsy of which showed granulomatous inflammation. The patient was initiated on anti-tubercular treatment but did not respond to treatment. A month later, she developed skin lesions; biopsy and culture from scrapings of the lesions were suggestive of infection with Cryptococcus neoformans. She responded to antifungal therapy very well, with a resolution of fever and skin lesions within a month. This is a unique case report, in which cryptococcosis mimicked tuberculosis in an otherwise immunocompetent patient with ESRD.
Collapse
Affiliation(s)
- Priti Meena
- Department of Nephrology, Sir Gangaram Hospital, New Delhi, India
| | - Anurag Gupta
- Department of Nephrology, Sir Gangaram Hospital, New Delhi, India
| | - Lovy Gaur
- Department of Nephrology, Sir Gangaram Hospital, New Delhi, India
| | - Aakash Shingada
- Department of Nephrology, Sir Gangaram Hospital, New Delhi, India
| | - Pallav Gupta
- Department of Pathology, Sir Gangaram Hospital, New Delhi, India
| | - Vinant Bhargava
- Department of Nephrology, Sir Gangaram Hospital, New Delhi, India
| | - Devender S Rana
- Department of Nephrology, Sir Gangaram Hospital, New Delhi, India
| |
Collapse
|
12
|
Zhang Q, Li H, Zhang K, Arastehfar A, Daneshnia F, Fang W, He P, Kuang W, Jiang G, Chen M, Boekhout T, Li S, Jiang W, Liao W, Pan W. Lumbar drainage for the treatment of refractory intracranial hypertension in HIV-negative cryptococcal meningitis. Future Microbiol 2019; 14:859-866. [PMID: 31165635 DOI: 10.2217/fmb-2019-0084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aim: This study aims to evaluate lumbar drainage (LD) for controlling refractory intracranial hypertension among non-HIV cryptococcal meningitis patients. Patients & methods: A case–control study was designed to compare LD (case) with repeated lumbar puncture (control). Results: Both LD and repeated lumbar puncture can efficiently control refractory intracranial hypertension. LD group showed better clinical symptom remission, such as lower rate of headache, vision disorders, signs of meningeal irritation and conscious disturbance, than control group. LD group was reported with higher intracranial pressure reduction (173.75 ± 17.72 mmH2O) than those among control group (113.50 ± 14.94 mmH2O; p < 0.05). Conclusion: LD is an effective and safe alternative to control refractory intracranial hypertension in HIV-negative cryptococcal meningitis patients.
Collapse
Affiliation(s)
- Qilong Zhang
- Department of Internal Neurology, Jiangxi Chest Hospital, Jiangxi 330000, PR China
| | - Hang Li
- Department of Internal Neurology, Jiangxi Chest Hospital, Jiangxi 330000, PR China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
| | - Keming Zhang
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
| | - Amir Arastehfar
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - Farnaz Daneshnia
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - Wenjie Fang
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
| | - Peijuan He
- Department of Internal Neurology, Jiangxi Chest Hospital, Jiangxi 330000, PR China
| | - Weifeng Kuang
- Department of Internal Neurology, Jiangxi Chest Hospital, Jiangxi 330000, PR China
| | - Guoqiang Jiang
- Department of Internal Neurology, Jiangxi Chest Hospital, Jiangxi 330000, PR China
| | - Min Chen
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
| | - Teun Boekhout
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
- Institute of Biodiversity & Ecosystem Dynamics, University of Amsterdam, Amsterdam 1012 WX, The Netherlands
| | - Shuai Li
- Department of Clinical Laboratory, Yan'an People’s Hospital, Shanxi 716000, PR China
| | - Weiwei Jiang
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
| | - Wanqing Liao
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
| | - Weihua Pan
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, PR China
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Cryptococcosis has become a common opportunistic infection among non-HIV immunocompromised hosts. Recent reports have shown the incidence of Cryptococcosis among HIV-negative immunocompromised patients reaches close to half of the overall cases reported in the USA. Management of this infection in this population carries unique challenges. We aim to review relevant and recent research findings to develop treatment recommendations for this type of population. RECENT FINDINGS Most of the recommendations for the management of non-HIV immunocompromised host are extrapolated from HIV studies. Cryptococcosis among non-HIV patients is common but often overlooked. Some clinical factors, when present, may increase the risk of Cryptococcosis among HIV-negative patients and appropriate screening and assessment for the disease is necessary. Treating clinicians should consider a longer duration of induction with Amphotericin B depending on the type of host, immunocompromised state, antifungal response and presence of neurological complications. Baseline fluconazole resistance can reach up to 12%, which is an important consideration for cryptococcal meningitis relapses or suboptimal responses to therapy. SUMMARY Cryptococcus spp. conveys a high disease burden among immunocompromised hosts. Clinicians must consider numerous variables and factors in a dynamic way to offer the best possible treatment and to monitor their response to therapy. Due to the high cost and associated toxicities, we still need new affordable therapies and studies among non-HIV immunocompromised patients.
Collapse
|
14
|
Hua W, Vogan A, Xu J. Genotypic and Phenotypic Analyses of Two “Isogenic” Strains of the Human Fungal Pathogen Cryptococcus neoformans var. neoformans. Mycopathologia 2019; 184:195-212. [DOI: 10.1007/s11046-019-00328-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/09/2019] [Indexed: 12/21/2022]
|
15
|
Xu L, Hu C, Hu H, Dai X, Gao H, Guo Y, Huang Y, Yang Z, Tao R, Zhu B, Xu Y. Importance of fibrosis 4 index score and mode of anti-fungal treatment to the outcome of Cryptococcal meningitis in hepatitis B virus-infected patients. Infect Dis (Lond) 2019; 51:113-121. [PMID: 30676149 DOI: 10.1080/23744235.2018.1523553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) and the associated cirrhosis are risk factors for cryptococcal meningitis (CM). However, the clinical features of co-infection with HBV and CM are unclear. METHODS Seventy-nine HBV-infected CM patients and 79 HBV-uninfected CM patients were enrolled in a case-control matching study from 476 CM patients. Fibrosis 4 index (FIB4) was used for assessment of HBV-related fibrosis/cirrhosis. Demographic characteristics, symptoms, routine blood tests, liver function and cerebrospinal fluid (CSF) profiles were compared between the two groups. Kaplan-Meier analysis and Cox proportional hazards model were used to assess factors associated with 10-week mortality. RESULTS Male gender was associated with HBV-infected CM patients (p = .006). CM patients with HBV experienced similar frequencies of symptoms but had lower white blood cell (WBC) (p < .001), platelet (p < .001) and albumin (p = .012), and increased aspartate amino transaminase (AST) (p = .009) and total bilirubin (TBIL) levels (p < .001). Patients with and without HBV infection had similar 10-week cumulative survival rates (85.9 ± 4.2% vs. 78.6 ± 5.4%, p = .569). The hazard ratio was 3.7 times higher for those with FIB4 ≥ 3.25 (p = .020) and 4.5 times higher for those with HBV infection not treated with Amphotericin B + flucytosine ± fluconazole (p = .023). CONCLUSION HBV-infected CM population experience lower WBC, platelet and albumin, and higher AST and TBIL. Ten-week survival rate was similar between HBV-infected and HBV-uninfected CM patients. CM patients with high FIB4 or not treated with Amphotericin B + flucytosine ± fluconazole are at a higher risk of death.
Collapse
Affiliation(s)
- Lijun Xu
- a The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China.,b Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Caiqin Hu
- a The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Hangbin Hu
- c Burn unit , Jinhua municipal Central hospital , Jinhua , China
| | - Xiahong Dai
- a The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China.,d Department of infectious diseases , Shulan hospital , Hangzhou , China
| | - Hainv Gao
- d Department of infectious diseases , Shulan hospital , Hangzhou , China
| | - Yongzheng Guo
- a The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China.,b Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Ying Huang
- a The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Zongxing Yang
- e Department of HIV/AIDS , Xixi Hospital of Hangzhou , Hangzhou , China
| | - Ran Tao
- a The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China.,b Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Biao Zhu
- a The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China.,b Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Yan Xu
- a The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| |
Collapse
|