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Bai J, Qiao J. Multiple Umbilicated Papules on the Face. JAMA Dermatol 2024; 160:103-104. [PMID: 37966830 DOI: 10.1001/jamadermatol.2023.4162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
A man in his 20s presented to the dermatology department with a monthlong history of gradually progressing papules and nodules on the face, accompanied by fever, fatigue, and weight loss. What is your diagnosis?
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Affiliation(s)
- Juan Bai
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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2
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Castro-Lopez N, Wormley FL. Models for Inducing Experimental Cryptococcosis in Mice. Methods Mol Biol 2024; 2775:29-46. [PMID: 38758309 DOI: 10.1007/978-1-0716-3722-7_3] [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] [Indexed: 05/18/2024]
Abstract
Cryptococcus neoformans and Cryptococcus gattii are the predominant etiological agents of cryptococcosis, a particularly problematic disease in immunocompromised individuals. The increased clinical use of immunosuppressive drugs, the inherent ability of Cryptococcus species to suppress and evade host immune responses, and the emergence of drug-resistant yeast support the need for model systems that facilitate the design of novel immunotherapies and antifungals to combat disease progression. The mouse model of cryptococcosis is a widely used system to study Cryptococcus pathogenesis and the efficacy of antifungal drugs in vivo. In this chapter, we describe three commonly used strategies to establish cryptococcosis in mice: intranasal, intratracheal, and intravenous inoculations. Also, we discuss the methodology for delivering drugs to mice via intraperitoneal injection.
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Affiliation(s)
| | - Floyd L Wormley
- Department of Biology, Texas Christian University, Fort Worth, TX, USA.
- South Texas Center for Emerging Infectious Diseases, University of Texas at San Antonio, San Antonio, TX, USA.
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3
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Sousa NSOD, Almeida JDRD, Frickmann H, Lacerda MVG, Souza JVBD. Searching for new antifungals for the treatment of cryptococcosis. Rev Soc Bras Med Trop 2023; 56:e01212023. [PMID: 37493736 PMCID: PMC10367226 DOI: 10.1590/0037-8682-0121-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/19/2023] [Indexed: 07/27/2023] Open
Abstract
There is a consensus that the antifungal repertoire for the treatment of cryptococcal infections is limited. Standard treatment involves the administration of an antifungal drug derived from natural sources (i.e., amphotericin B) and two other drugs developed synthetically (i.e., flucytosine and fluconazole). Despite treatment, the mortality rates associated with fungal cryptococcosis are high. Amphotericin B and flucytosine are toxic, require intravenous administration, and are usually unavailable in low-income countries because of their high cost. However, fluconazole is cost-effective, widely available, and harmless with regard to its side effects. However, fluconazole is a fungistatic agent that has contributed considerably to the increase in fungal resistance and frequent relapses in patients with cryptococcal meningitis. Therefore, there is an unquestionable need to identify new alternatives or adjuvants to conventional drugs for the treatment of cryptococcosis. A potential antifungal agent should be able to kill cryptococci and "bypass" the virulence mechanism of the yeast. Furthermore, it should have fungicidal action, low toxicity, high selectivity, easily penetrate the central nervous system, and widely available. In this review, we describe cryptococcosis, its conventional therapy, and failures arising from the use of drugs traditionally considered to be the reference standard. Additionally, we present the approaches used for the discovery of new drugs to counteract cryptococcosis, ranging from the conventional screening of natural products to the inclusion of structural modifications to optimize anticryptococcal activity, as well as drug repositioning and combined therapies.
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Affiliation(s)
| | | | - Hagen Frickmann
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Germany
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Germany
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
- Instituto de Pesquisas Leônidas & Maria Deane, Fiocruz, Manaus, AM, Brasil
- University of Texas Medical Branch, Galveston, USA
| | - João Vicente Braga de Souza
- Programa de Pós-Graduação em Biodiversidade e Biotecnologia da Rede BIONORTE, Manaus, AM, Brasil
- Instituto Nacional de Pesquisas da Amazônia, Manaus, AM, Brasil
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4
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A Possible New Diagnostic Method for Early Diagnosis of Cryptococcus Infection in Lymphoma Patient Co-Infected with SARS-CoV-2. REPORTS 2023. [DOI: 10.3390/reports6010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
A Cryptococcus subspecies, neoformans, represents the most pathogenic infection for humans, particularly in immunocompromised hosts (e.g., cancer patients, drug users). In the present study, we described a 67-year old woman with non-Hodgkin lymphoma who developed an infectious disease sustained by Cryptococcus neoformans. Biochemical data documented a decrease in lymphocytes count while clinical evaluation was suggestive on meningeal infection. The microbiological analysis of the serum, using a dilution pattern through the CrAg lateral flow assay (Immy, Norman, OK 73069, USA) detected the antigen of Cryptococcus (dilution 1/1280), and a treatment with liposomal amphotericin B (3 mg/kg id) plus flucytosine (100 mg/kg per day orally in four divided doses) were started, showing an improvement of symptoms. This case report suggests that an antigen dilution can be used to perform a rapid diagnosis and to quickly start the pharmacological treatment.
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Seyer Cagatan A, Taiwo Mustapha M, Bagkur C, Sanlidag T, Ozsahin DU. An Alternative Diagnostic Method for C. neoformans: Preliminary Results of Deep-Learning Based Detection Model. Diagnostics (Basel) 2022; 13:diagnostics13010081. [PMID: 36611373 PMCID: PMC9818640 DOI: 10.3390/diagnostics13010081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
Cryptococcus neoformans is an opportunistic fungal pathogen with significant medical importance, especially in immunosuppressed patients. It is the causative agent of cryptococcosis. An estimated 220,000 annual cases of cryptococcal meningitis (CM) occur among people with HIV/AIDS globally, resulting in nearly 181,000 deaths. The gold standards for the diagnosis are either direct microscopic identification or fungal cultures. However, these diagnostic methods need special types of equipment and clinical expertise, and relatively low sensitivities have also been reported. This study aims to produce and implement a deep-learning approach to detect C. neoformans in patient samples. Therefore, we adopted the state-of-the-art VGG16 model, which determines the output information from a single image. Images that contain C. neoformans are designated positive, while others are designated negative throughout this section. Model training, validation, testing, and evaluation were conducted using frameworks and libraries. The state-of-the-art VGG16 model produced an accuracy and loss of 86.88% and 0.36203, respectively. Results prove that the deep learning framework VGG16 can be helpful as an alternative diagnostic method for the rapid and accurate identification of the C. neoformans, leading to early diagnosis and subsequent treatment. Further studies should include more and higher quality images to eliminate the limitations of the adopted deep learning model.
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Affiliation(s)
- Ayse Seyer Cagatan
- Department of Medical and Clinical Microbiology, Faculty of Medicine, Cyprus International University, TRNC Mersin 10, Nicosia 99010, Turkey
| | - Mubarak Taiwo Mustapha
- Operational Research Center in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey
| | - Cemile Bagkur
- DESAM Research Institute, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey
| | - Tamer Sanlidag
- DESAM Research Institute, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey
| | - Dilber Uzun Ozsahin
- Operational Research Center in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey
- Medical Diagnostic Imaging Department, College of Health Science, University of Sharjah, Sharjah 27272, United Arab Emirates
- Correspondence:
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6
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Hitchcock M, Xu J. Analyses of the Global Multilocus Genotypes of the Human Pathogenic Yeast Cryptococcus neoformans Species Complex. Genes (Basel) 2022; 13:2045. [PMID: 36360282 PMCID: PMC9691084 DOI: 10.3390/genes13112045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/18/2023] Open
Abstract
Cryptococcus neoformans species complex (CNSC) is a globally distributed human opportunistic yeast pathogen consisting of five major molecular types (VNI, VNII, VNB, VNIII and VNIV) belonging to two species, C. neoformans (VNI, VNII and VNB, collectively called serotype A) and C. deneoformans (VNIV, commonly called serotype D), and their hybrids (VNIII, serotype AD). Over the years, many studies have analyzed the geographical distribution and genetic diversity of CNSC. However, the global population structure and mode of reproduction remain incompletely described. In this study, we analyze the published multilocus sequence data at seven loci for CNSC. The combined sequences at the seven loci identified a total of 657 multilocus sequence types (STs), including 296 STs with known geographic information, representing 4200 non-redundant isolates from 31 countries and four continents. Among the 296 STs, 78 and 52 were shared among countries and continents, respectively, representing 3643 of the 4200 isolates. Except for the clone-corrected serotype D sample among countries, our analysis of the molecular variance of the 4200 isolates revealed significant genetic differentiations among countries and continents in populations of CNSC, serotype A, and serotype D. Phylogenetic analyses of the concatenated sequences of all 657 STs revealed several large clusters corresponding to the major molecular types. However, several rare but distinct STs were also found, representing potentially novel molecular types and/or hybrids of existing molecular types. Phylogenetic incompatibility analyses revealed evidence for recombination within all four major molecular types-VNI, VNII, VNIV and VNB-as well as within two VNB subclades, VNBI and VNBII, and two ST clusters around the most common STs, ST5 and ST93. However, linkage disequilibrium analyses rejected the hypothesis of random recombination across most samples. Together, our results suggest evidence for historical differentiation, frequent recent gene flow, clonal expansion and recombination within and between lineages of the global CNSC population.
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Affiliation(s)
| | - Jianping Xu
- Department of Biology, McMaster University, Hamilton, ON L8S 4K1, Canada
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Krishnan G, Power M, Bariola JR, Dare R. Comparison of Indirect Fungal Diagnostic Tests in Patients With Proven Histoplasmosis. Open Forum Infect Dis 2022; 9:ofac609. [PMID: 36447609 PMCID: PMC9697584 DOI: 10.1093/ofid/ofac609] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/11/2022] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Histoplasmosis is a common cause of invasive fungal infection in endemic regions and accurate diagnosis is difficult without direct tissue culture or pathology. Indirect fungal antigen testing for various fungal pathogens are typically performed to assist with diagnostic workup, though cross-reaction can lead to difficulty in interpreting results. We aimed to compare indirect fungal diagnostic tests and evaluate prevalence of positive antigen testing for non-Histoplasma fungal pathogens in patients with proven histoplasmosis. METHODS We performed a single-center retrospective review of adult patients with proven histoplasmosis diagnosed by fungal culture and/or cytology from January 2010 to March 2018. Patient demographics, clinical characteristics, and results of fungal antigen testing for Histoplasma, Blastomyces, Aspergillus, Cryptococcus, and (1→3)-β-D-glucan were evaluated. Two different urine Histoplasma antigen assays were used during the study period. RESULTS Fifty-seven of 182 (31.3%) patients reviewed had proven histoplasmosis and presented with acute pulmonary (n = 10), chronic pulmonary (n = 7), and disseminated (n = 40) disease. Forty-one (72%) of these patients were immunosuppressed. Urine Blastomyces antigen (93%) and serum (1→3)-β-D-glucan (88%) were commonly positive in patients with histoplasmosis, whereas Aspergillus antigen was detected in 50% of patients and Cryptococcus antigenemia was rare (5%). In patients with disseminated disease, the MiraVista urine Histoplasma antigen assay had higher sensitivity than the Viracor urine Histoplasma antigen assay (86% vs 50%, respectively; P = .019). CONCLUSIONS Noninvasive fungal antigen assays are helpful diagnostic tools; however, given their low specificity, clinicians must be aware of the various clinical presentations of invasive fungal infections and be aware of the limitations of these tests.
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Affiliation(s)
- Gayathri Krishnan
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
| | - Margaret Power
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, North Carolina, USA
| | - J Ryan Bariola
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ryan Dare
- Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Hure E, Camí G, Mosconi N, Raimondi M, Rizzotto M. Synthesis, characterization, lipophilicity and antifungal properties of three new complexes of sulfamerazine (HSMR) with Ag(I): [Ag(SMR)], [Ag2(SMR)SCN] and [Ag(SMR)o-phenanthroline]. Polyhedron 2022. [DOI: 10.1016/j.poly.2022.115979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Souza HI, Pereira ABM, Oliveira JR, Silva PR, Teixeira DNS, Silva-Vergara ML, Rogério AP. Cryptococcus neoformans in Association with Dermatophagoides pteronyssinus has Pro- (IL-6/STAT3 Overproduction) and Anti-inflammatory (CCL2/ERK1/2 Downregulation) Effects on Human Bronchial Epithelial Cells. Inflammation 2022; 45:1269-1280. [PMID: 35015189 DOI: 10.1007/s10753-021-01619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 11/23/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Abstract
Cryptococcosis (caused, for example, by Cryptococcus neoformans) and allergic asthma (caused, for example, by Dermatophagoides pteronyssinus) target the respiratory tract (the lung and bronchial epithelium). C. neoformans and D. pteronyssinus can coexist in the same indoor environment, and exposure to both can cause alterations in the local airway inflammatory milieu and exacerbation of airway inflammatory diseases. Here, we evaluated the effects of the association between C. neoformans and D. pteronyssinus in the modulation of airway inflammatory responses in an in vitro experimental model using human bronchial epithelial cells. BEAS-2B cells were cultivated and stimulated with D. pteronyssinus (10 μg/mL) and/or C. neoformans (MOI 100) for 24 h. No cytotoxic effect was observed in cells stimulated by C. neoformans and/or D. pteronyssinus. The production of IL-8, IL-6, and/or CCL2, but not IL-10, as well as the activation of NF-kB, STAT3, STAT6, and/or ERK1/2 were increased in cells stimulated by C. neoformans or D. pteronyssinus compared to controls. C. neoformans in association with D. pteronyssinus inhibited the CCL2‑ERK1/2 signaling pathway in cells treated with both pathogens compared to cells stimulated by D. pteronyssinus alone. In addition, their association induced an additive effect on the IL-6/STAT3 signaling pathway in cells compared to cells stimulated with D. pteronyssinus or C. neoformans only. D. pteronyssinus increased the internalization and growth of C. neoformans in BEAS-2B cells. D. pteronyssinus in association with C. neoformans promoted pro- and anti-inflammatory responses, which can modulate cryptococcal infection and asthmaticus status.
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Affiliation(s)
- Henrique Ismarsi Souza
- Department of Clinical Medicine, Laboratory of Experimental Immunopharmacology, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Aline Beatriz Mahler Pereira
- Department of Clinical Medicine, Laboratory of Experimental Immunopharmacology, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Jhony Robison Oliveira
- Department of Clinical Medicine, Laboratory of Experimental Immunopharmacology, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Paulo Roberto Silva
- Department of Clinical Medicine, Laboratory of Experimental Immunopharmacology, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - David Nascimento Silva Teixeira
- Department of Clinical Medicine, Laboratory of Experimental Immunopharmacology, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Mario Leon Silva-Vergara
- Department of Clinical Medicine, Laboratory of Mycology, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Alexandre Paula Rogério
- Department of Clinical Medicine, Laboratory of Experimental Immunopharmacology, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil.
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Liu H, Shen S, Wang Q. Recurrent pulmonary cryptococcosis during chronic HBV infection: A case report. Medicine (Baltimore) 2021; 100:e28250. [PMID: 34918692 PMCID: PMC8677983 DOI: 10.1097/md.0000000000028250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pulmonary cryptococcosis is one of the important opportunistic infections and has a wide range of symptoms depending on the underlying conditions. Here, we reported a case living with chronic hepatitis B virus infection who had a recurrent pulmonary cryptococcosis. PATIENT CONCERNS A 51-year-old male patient was admitted to our center because of cough, fatigue, and shortness of breath for 2 weeks. DIAGNOSIS Pulmonary infection was suggested by chest computed tomography. Most lab examinations for infection were negative and only cryptococcal antigen testing was positive. Therefore, a clinical diagnosis of pulmonary cryptococcosis was made. INTERVENTIONS Fluconazole (200 mg/day) and bicyclol (50 mg/day) was given orally. OUTCOMES During the follow-up of 3 and 6 months, his conditions improved, and he recovered fully. Moreover, cryptococcal antigen level was 12.57 ng/mL. During the 2-year follow-up, no recurrence occurred. LESSONS This case highlights the importance of the awareness of opportunistic infections during chronic hepatitis B virus infection, especially the potential of recurrence.
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Pereira ABM, Oliveira JR, Souza ALJ, Andrade-Silva L, Silva MV, Silva PR, Silva-Vergara ML, Rogerio AP. Effects of cigarette smoke extract on bronchial epithelial cells stimulated with Cryptococcus neoformans. Med Microbiol Immunol 2021; 210:221-233. [PMID: 34228244 DOI: 10.1007/s00430-021-00715-4] [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: 02/05/2020] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
In the airways, the adhesion of Cryptococcus neoformans with airway epithelial cells is crucial for the establishment of cryptococcosis. Tobacco smoke is considered a risk factor for cryptococcosis. Here, we evaluated the effects of cigarette smoke extract (CSE) on human bronchial epithelial cells (BEAS-2B) stimulated with C. neoformans. Multiplicities of infection (MOIs) of 1-100 of C. neoformans per cell led to increased IL-8 production and no cytotoxic effects when compared to those of controls. C. neoformans (MOI 100) also significantly increased the concentration of IL-6. In cells stimulated with CSE doses (1.0, 2.5 and 5.0%) from one or five cigarettes, increased IL-1β production was observed only in doses from one (1.0%) and five (2.5%) cigarettes when compared to that of controls. However, only 1.0% CSE failed to show cytotoxic effects. In addition, CSE significantly increased the concentration of IL-8. Cells stimulated with both CSE and C. neoformans demonstrated a reduction in IL-6/STAT3 signalling compared to that in cells stimulated by C. neoformans. In addition, a significant increase in IL-10 production was also observed. No alterations in NF-kB or ICAM-1 expression were observed among the groups. The combination of CSE and C. neoformans favoured the increase of fungal numbers and extracellular adhering of C. neoformans on BEAS-2B cells. In addition, the internalization of C. neoformans on BEAS-2B cells was reduced after CSE stimulation. In conclusion, the association of CSE and C. neoformans induced an anti-inflammatory effect in bronchial epithelial cells, which might favour the development of C. neoformans infection in the airways.
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Affiliation(s)
- Aline Beatriz Mahler Pereira
- Laboratory of Experimental Immunopharmacology, Department of Clinical Medicine, Institute of Health Sciences, Federal University of Triangulo Mineiro, Street Vigário Carlos 162, Uberaba, MG, 38025-380, Brazil
| | - Jhony Robison Oliveira
- Laboratory of Experimental Immunopharmacology, Department of Clinical Medicine, Institute of Health Sciences, Federal University of Triangulo Mineiro, Street Vigário Carlos 162, Uberaba, MG, 38025-380, Brazil
| | - Ana Leticia Julio Souza
- Laboratory of Experimental Immunopharmacology, Department of Clinical Medicine, Institute of Health Sciences, Federal University of Triangulo Mineiro, Street Vigário Carlos 162, Uberaba, MG, 38025-380, Brazil
| | - Leonardo Andrade-Silva
- Laboratory of Mycology, Department of Clinical Medicine, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Marcos Vinicius Silva
- Laboratory of Immunology, Institute Department of Clinical Medicine, of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Paulo Roberto Silva
- Laboratory of Experimental Immunopharmacology, Department of Clinical Medicine, Institute of Health Sciences, Federal University of Triangulo Mineiro, Street Vigário Carlos 162, Uberaba, MG, 38025-380, Brazil
| | - Mario Leon Silva-Vergara
- Laboratory of Mycology, Department of Clinical Medicine, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Alexandre Paula Rogerio
- Laboratory of Experimental Immunopharmacology, Department of Clinical Medicine, Institute of Health Sciences, Federal University of Triangulo Mineiro, Street Vigário Carlos 162, Uberaba, MG, 38025-380, Brazil.
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Antifungal, phyto, cyto, genotoxic and lipophilic properties of three complexes of sulfadimethoxine (HSDM) with Ag(I). Synthesis and characterization of [Ag3SDM(SCN)2]·H2O and [Ag2(SDM)2o-phenanthroline]·H2O. Polyhedron 2021. [DOI: 10.1016/j.poly.2020.114965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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Cryptococcal Immune Reconstitution Inflammatory Syndrome: An Unusual Presentation on the Tongue. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Ballén J, Quiroga C, Palma F. Síndrome inflamatorio de reconstitución inmune criptocócico: presentación inusual en la lengua. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:617-619. [DOI: 10.1016/j.ad.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 10/24/2022] Open
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Cutaneous cryptococcosis: an underlying immunosuppression? Clinical manifestations, pathogenesis, diagnostic examinations and treatment. Postepy Dermatol Alergol 2020; 37:154-158. [PMID: 32489347 PMCID: PMC7262803 DOI: 10.5114/ada.2020.94833] [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: 08/06/2018] [Accepted: 09/02/2018] [Indexed: 12/13/2022] Open
Abstract
Due to constantly growing population of immunocompromised patients the fungi became a widespread threat to modern medicine. HIV carriers, solid organ transplant recipients constitute most of those patients. Cryptococcosis is a frequent cause of life-threatening infections, affecting mostly immunosuppressed patients. This article presents current knowledge on cryptococcal infections, including epidemiology, clinical aspects, diagnosis and recommended treatment. In reference to our patient, who developed a disseminated and fulminant subtype of the disease, we wanted to underline the need to examine patients thoroughly. The highest aim of those measures would be to avoid lethal consequences.
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de Sá NP, de Barros PP, Junqueira JC, Vaz JA, de Oliveira RB, Rosa CA, Santos DA, Johann S. Thiazole derivatives act on virulence factors of Cryptococcus spp. Med Mycol 2019; 57:84-91. [PMID: 29471408 DOI: 10.1093/mmy/myx158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/06/2017] [Indexed: 01/16/2023] Open
Abstract
Cryptococcosis is an opportunistic or primary fungal infection considered to be the most prevalent fatal fungal disease worldwide. Owing to the limited number of available drugs, it is necessary to search for novel antifungal compounds. In the present work, we assessed the antifungal efficacy of three thiazole derivatives (1, 2, and 3). We conducted in vitro and in vivo assays to investigate their effects on important virulence factors, such as capsule and biofilm formation. In addition, the phagocytosis index of murine macrophages exposed to compounds 1, 2, and 3 and the in vivo efficacy of 1, 2, and 3 in Galleria mellonella infected with Cryptococcus spp. were evaluated. All compounds exhibited antifungal activity against biofilms and demonstrated a reduction in biofilm metabolic activity by 43-50% for C. gattii and 26-42% for C. neoformans. Thiazole compounds promoted significant changes in the capsule thickness of C. gattii compared to that of C. neoformans. Further examination of these compounds suggests that they can improve the phagocytosis process of peritoneal murine macrophages in vitro, causing an increase in the phagocytosis rate. Survival percentage was examined in the invertebrate model Galleria mellonella larvae, and only compound 3 could increase the survival at doses of 5 mg/kg after infection with C. gattii (P = .0001) and C. neoformans (P = .0007), similar to fluconazole at 10 mg/kg. The results demonstrated that thiazole compounds, mainly compound 3, have potential to be used for future studies in the search for new therapeutics for cryptococcosis.
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Affiliation(s)
- Nívea Pereira de Sá
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Patrícia Pimentel de Barros
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, Univ Estadual de São Paulo, São José dos Campos, São Paulo, Brazil
| | - Juliana Campos Junqueira
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, Univ Estadual de São Paulo, São José dos Campos, São Paulo, Brazil
| | - Jéssica Aparecida Vaz
- Department of Pharmaceutical Products, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Renata Barbosa de Oliveira
- Department of Pharmaceutical Products, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carlos Augusto Rosa
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Daniel Assis Santos
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Susana Johann
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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He R, Hu C, Niu R. Analysis of the Clinical Features of Tracheobronchial Fungal Infections with Tumor-Like Lesions. Respiration 2019; 98:157-164. [PMID: 31067555 DOI: 10.1159/000496979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/14/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Tracheobronchial fungal infections (TBFI) cause life-threatening complications in immunocompromised hosts but are rarely reported. Misdiagnosis and delayed antifungal treatment are associated with the high mortality rate of patients with TBFI. OBJECTIVES This study analyzed the bronchoscopic features of TBFI and their roles in the early diagnosis of TBFI. METHODS The demographic, clinical, radiologic, and bronchoscopic data of 53 patients diagnosed with TBFI in our department during a 15-year period were retrospectively analyzed. RESULTS Most of the TBFI patients were male, and mass was the most common radiologic abnormality. Obvious predilection in primary bronchus distributions was observed. 41.9% of the 43 Aspergillus tracheobronchitis (AT) patients, 70% of the 10 tracheobronchial mucormycosis (TM) patients, and 100% of the 3 endobronchial cryptococcosis patients had been misdiagnosed as having cancer on bronchoscopy because of the presence of tumor-like lesions. The most common features of AT were bronchial occlusion with a mass or mucosal necrosis, bronchial stenosis with mucosal hyperplasia, or uneven mucosa. The main descriptions of TM were bronchial stenosis or obstruction due to mucosal necrosis, uneven mucosa, or a mass. The endoscopic characteristics of endobronchial cryptococcosis included occlusion due to uneven mucosa or mass, or external compressive stricture. CONCLUSION Immunocompromised patients and immunocompetent patients with underlying disease displaying tumor-like lesions on bronchoscopy should be differentially diagnosed with cancer. Bronchial biopsy is indispensable for the early diagnosis of TBFI.
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Affiliation(s)
- Ruoxi He
- Department of Respiratory Medicine (National Key Clinical Specialty), Xiangya Hospital, Central South University, Changsha, China
| | - Chengping Hu
- Department of Respiratory Medicine (National Key Clinical Specialty), Xiangya Hospital, Central South University, Changsha, China
| | - Ruichao Niu
- Department of Respiratory Medicine (National Key Clinical Specialty), Xiangya Hospital, Central South University, Changsha, China,
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Anacona C, González C FE, Vásquez-A LR, Escandón P. First isolation and molecular characterization of Cryptococcus neoformans var. grubii in excreta of birds in the urban perimeter of the Municipality of Popayán, Colombia. Rev Iberoam Micol 2018; 35:123-129. [PMID: 30274952 DOI: 10.1016/j.riam.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cryptococcosis is a systemic opportunistic mycosis, caused by Cryptococcus neoformans and Cryptococcus gattii, which affects mainly the central nervous system of immunocompromised patients; no reports have been made on the isolation of the fungus from the environment of Popayán, Colombia. AIMS The main objective of this investigation was to determinate the incidence of C. neoformans in the urban perimeter in the City of Popayán, Colombia. METHODS A total of 303 samples from droppings of Columba livia and Bubulcus ibis were collected between September 2012 and June 2013. The samples were processed by conventional techniques; identification of colonies was performed by biochemical tests, and molecular patterns were determined by PCR fingerprinting with the primer (GTG)5 and restriction fragment length polymorphism (RFLP) of the gene URA5. RESULTS A total of 118 (38.94%) samples were positive for Cryptococcus in excreta of C. livia, and 361 strains belonging to Cryptococcus neoformans var. grubii were isolated. From the latter, 99.2% corresponded to the molecular pattern VNI and 0.8% to VNII, with an increased occurrence (24.4%) at a temperature of 22.5°C and a humidity of 60.8%. The excreta of B. ibis did not show the presence of the fungus. CONCLUSIONS C. livia excreta is a key environmental niche for C. neoformans var. grubii, type VNI, supporting growth and reproduction, and serving as a major source of infection for susceptible populations in Popayán. This represents the first report on the isolation of the agent of cryptococcosis from the environment in this region, with a significant prevalence in bird excreta.
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Affiliation(s)
- Cristian Anacona
- Centro de Estudios en Microbiología y Parasitología CEMPA, Universidad del Cauca, Popayán, Colombia
| | - Fabiola E González C
- Centro de Estudios en Microbiología y Parasitología CEMPA, Universidad del Cauca, Popayán, Colombia
| | - Luis Reinel Vásquez-A
- Centro de Estudios en Microbiología y Parasitología CEMPA, Universidad del Cauca, Popayán, Colombia
| | - Patricia Escandón
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia.
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Ferrara G, Panizo MM, Urdaneta E, Alarcón V, García N, Moreno X, Capote AM, Reviakina V, Dolande M. Characterization by PCR-RFLP of the Cryptococcus neoformans and Cryptococcus gattii species complex in Venezuela. ACTA ACUST UNITED AC 2018. [DOI: 10.22209/ic.v59n1a03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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20
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Cryptococcosis. INPATIENT DERMATOLOGY 2018. [PMCID: PMC7123826 DOI: 10.1007/978-3-319-18449-4_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Infection with encapsulated yeast Cryptococcus neoformans or gattii. C. neoformans is found in bird and bat droppings and contaminated soil/dust; C. gattii colonizes trees/wood debris.
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21
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Romero M, Messina F, Marín E, Arechavala A, Negroni R, Depardo R, Walker L, Benchetrit A, Santiso G. [Clinical problems in medical mycology: Problem number 51]. Rev Iberoam Micol 2017; 35:56-58. [PMID: 29169813 DOI: 10.1016/j.riam.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/12/2017] [Indexed: 11/15/2022] Open
Abstract
A 48 year-old immunocompetent woman, who had a nodular lesion in the neck and a dense infiltrate at the lower lobe of the left lung, presented at the Mycology Unit of Muñiz Hospital of Buenos Aires City. The pulmonary infiltrate disappeared spontaneously 3 months later. The histopathological study of the nodular lesion showed capsulated yeasts (mucicarmin and alcian blue positive stains) compatible with Cryptococcus. The mycological study of a new sample, obtained by a nodular puncture, allowed the isolation of yeasts, identified as Cryptococcus gattii (VGII). Latex test for Cryptococcus capsular antigen in serum was positive (1/100). CSF cultures rendered negative results. Fluconazole at a daily dose of 800mg was given during 45 days with partial improvement; as cultures from a new clinical sample were positive for Cryptococcus, the antimycotic was changed to itraconazole 400mg/day for 5 months, with an excellent clinical response.
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Affiliation(s)
- Mercedes Romero
- Unidad Micología, Hospital de Infecciosas «Dr. Francisco Javier Muñiz», Buenos Aires, Argentina
| | - Fernando Messina
- Unidad Micología, Hospital de Infecciosas «Dr. Francisco Javier Muñiz», Buenos Aires, Argentina
| | - Emmanuel Marín
- Unidad Micología, Hospital de Infecciosas «Dr. Francisco Javier Muñiz», Buenos Aires, Argentina
| | - Alicia Arechavala
- Unidad Micología, Hospital de Infecciosas «Dr. Francisco Javier Muñiz», Buenos Aires, Argentina.
| | - Ricardo Negroni
- Unidad Micología, Hospital de Infecciosas «Dr. Francisco Javier Muñiz», Buenos Aires, Argentina
| | - Roxana Depardo
- Unidad Micología, Hospital de Infecciosas «Dr. Francisco Javier Muñiz», Buenos Aires, Argentina
| | - Laura Walker
- Unidad Micología, Hospital de Infecciosas «Dr. Francisco Javier Muñiz», Buenos Aires, Argentina
| | - Andrés Benchetrit
- Unidad Micología, Hospital de Infecciosas «Dr. Francisco Javier Muñiz», Buenos Aires, Argentina
| | - Gabriela Santiso
- Unidad Micología, Hospital de Infecciosas «Dr. Francisco Javier Muñiz», Buenos Aires, Argentina
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Arechavala A, Negroni R, Messina F, Romero M, Marín E, Depardo R, Walker L, Santiso G. Cryptococcosis in an Infectious Diseases Hospital of Buenos Aires, Argentina. Revision of 2041 cases: Diagnosis, clinical features and therapeutics. Rev Iberoam Micol 2017; 35:1-10. [PMID: 29129578 DOI: 10.1016/j.riam.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/22/2017] [Accepted: 04/21/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cryptococcosis is still a life-threatening mycosis that continues to be of serious concern in Latin American countries, especially among HIV+positive population. However, there is not any reliable information about the prevalence of this disease in this region. AIMS The aim of this study is to report data of 2041 patients with cryptococcosis that were attended at the Infectious Diseases Hospital F. J. Muñiz over a 30 year-period. METHODS Information about demographic and clinical data, survival time and the applied treatment, was taken from the Mycology Unit database. Mycological exams from different clinical samples were performed. Cryptococcal capsular antigen in serum and cerebrospinal fluid was detected through the latex agglutination technique. Cryptococcus isolates were phenotypically identified and the genotype was determined in some of them. Susceptibility tests were carried out following M27-A3 document. RESULTS Seventy five percent of HIV+positive patients and 50% of the HIV-negative population were males. Mean ages were 34.1 in HIV+positive patients and 44.8 in the HIV-negative. Cryptococcosis was associated with AIDS in 98% of the cases. Meningeal compromise was seen in 90% of the patients. Although cerebrospinal fluid rendered more positive results, blood culture was the first diagnostic finding in some cases. Cryptococcal antigen showed positive results in 96.2% of the sera samples and in the 93.1% of the cerebrospinal fluid samples. Most of the isolates were Cryptococcus neoformans and belonged to genotype VNI. Minimal inhibitory concentration values were mostly below the epidemiological cutoff values. CONCLUSIONS We observed that thanks to a high level of clinical suspicion, early diagnosis, combined therapy and intracranial pressure control by daily lumbar punctures, the global mortality rate has markedly decreased through the years in the analyzed period.
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Affiliation(s)
- Alicia Arechavala
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina.
| | - Ricardo Negroni
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Fernando Messina
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Mercedes Romero
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Emmanuel Marín
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Roxana Depardo
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Laura Walker
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Gabriela Santiso
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
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Tirelli F, Vernal S, Roselino AM. Final diagnosis of 86 cases included in differential diagnosis of American tegumentary leishmaniasis in a Brazilian sample: a retrospective cross-sectional study. An Bras Dermatol 2017; 92:642-648. [PMID: 29166500 PMCID: PMC5674696 DOI: 10.1590/abd1806-4841.20175794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/29/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis is distributed worldwide, including Brazil. Its several clinical forms need to be distinguished from other dermatoses. Clinical similarities and lack of a gold standard diagnostic tool make leishmaniasis-like lesions a challenging diagnosis. OBJECTIVES. To report the final diagnosis of patients primarily suspected of having American tegumentary leishmaniasis (ATL). METHODS. A retrospective cross-sectional study was conducted on the basis of medical records of 437 patients with clinical suspicion of ATL, registered in electronic hospital system between 1980 and 2013. Demographic, clinical, and laboratory data were compiled. RESULTS. Analysis of 86 cases (19.7%) registered as ATL in one of the hypothesis revealed a different final diagnosis; 55 (63.9%) and 31 cases (36.1%) had skin and mucosal lesions, respectively. In 58 cases (67.4%), the requested PCR did not identify Leishmania sp. In 28 cases (32.5%), biopsies established the diagnosis and confirmed tumors, mycobacteriosis, and subcutaneous or systemic mycosis. Overall, 27% of the cases had inflammatory etiology, mainly nasal nonspecific inflammatory processes; 27% had infectious etiology, especially paracoccidioidomycosis and leprosy; 20% had neoplastic etiology, mainly basal and squamous cell carcinoma; 15% had miscellaneous etiology, including neuropathic ulcer, traumatic ulcers, idiopathic ulcer; 11% missed the follow-up. STUDY LIMITATIONS Some cases had no final diagnosis due to loss of follow-up. CONCLUSION. ATL can be confused with several differential diagnoses, especially inflammatory and infectious granulomatous diseases as well as non-melanoma skin cancers. Clinicians working in tropical areas should be aware of the main differential diagnosis of leishmaniasis-like lesions.
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Affiliation(s)
- Fernanda Tirelli
- Division of Dermatology, Department of Medical Clinics, Faculdade
de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP)
- Ribeirão Preto (SP), Brazil
| | - Sebastian Vernal
- Medical Clinics Pos graduated Area, Faculdade de Medicina de
Ribeirão Preto da Universidade de São Paulo (FMRP-USP) -
Ribeirão Preto (SP), Brazil
| | - Ana Maria Roselino
- Division of Dermatology, Department of Medical Clinics, Faculdade
de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP)
- Ribeirão Preto (SP), Brazil
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Heterocycle Thiazole Compounds Exhibit Antifungal Activity through Increase in the Production of Reactive Oxygen Species in the Cryptococcus neoformans-Cryptococcus gattii Species Complex. Antimicrob Agents Chemother 2017; 61:AAC.02700-16. [PMID: 28533240 DOI: 10.1128/aac.02700-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/08/2017] [Indexed: 01/09/2023] Open
Abstract
Human cryptococcosis can occur as a primary or opportunistic infection and develops as an acute, subacute, or chronic systemic infection involving different organs of the host. Given the limited therapeutic options and the occasional resistance to fluconazole, there is a need to develop novel drugs for the treatment of cryptococcosis. In this report, we describe promising thiazole compounds 1, 2, 3, and 4 and explore their possible modes of action against Cryptococcus To this end, we show evidence of interference in the Cryptococcus antioxidant system. The tested compounds exhibited MICs ranging from 0.25 to 2 μg/ml against Cryptococcus neoformans strains H99 and KN99α. Interestingly, the knockout strains for Cu oxidase and sarcosine oxidase were resistant to thiazoles. MIC values of thiazole compounds 1, 2, and 4 against these mutants were higher than for the parental strain. After the treatment of C. neoformans ATCC 24067 (or C. deneoformans) and C. gattii strain L27/01 (or C. deuterogattii) with thiazoles, we verified an increase in intracellular reactive oxygen species (ROS). Also, we verified the synergistic interactions among thiazoles and menadione, which generates superoxides, with fractional inhibitory concentrations (FICs) equal to 0.1874, 0.3024, 0.25, and 0.25 for the thiazole compounds 1, 2, 3, and 4, respectively. In addition, thiazoles exhibited antagonistic interactions with parasulphonatephenyl porphyrinato ferrate III (FeTPPS). Thus, in this work, we showed that the action of these thiazoles is related to an interference with the antioxidant system. These findings suggest that oxidative stress may be primarily related to the accumulation of superoxide radicals.
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Correa N, Covarrubias C, Rodas PI, Hermosilla G, Olate VR, Valdés C, Meyer W, Magne F, Tapia CV. Differential Antifungal Activity of Human and Cryptococcal Melanins with Structural Discrepancies. Front Microbiol 2017; 8:1292. [PMID: 28744276 PMCID: PMC5504158 DOI: 10.3389/fmicb.2017.01292] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/27/2017] [Indexed: 12/04/2022] Open
Abstract
Melanin is a pigment found in all biological kingdoms, and plays a key role in protection against ultraviolet radiation, oxidizing agents, and ionizing radiation damage. Melanin exerts an antimicrobial activity against bacteria, fungi, and parasites. We demonstrated an antifungal activity of synthetic and human melanin against Candida sp. The members of the Cryptococcus neoformans and C. gattii species complexes are capsulated yeasts, which cause cryptococcosis. For both species melanin is an important virulence factor. To evaluate if cryptococcal and human melanins have antifungal activity against Cryptococcus species they both were assayed for their antifungal properties and physico-chemical characters. Melanin extracts from human hair and different strains of C. neoformans (n = 4) and C. gattii (n = 4) were investigated. The following minimum inhibitory concentrations were found for different melanins against C. neoformans and C. gattii were (average/range): 13.7/(7.8–15.6) and 19.5/(15.6–31.2) μg/mL, respectively, for human melanin; 273.4/(125–>500) and 367.2/(125.5–>500) μg/mL for C. neoformans melanin and 125/(62.5–250) and 156.2/(62–250) μg/mL for C. gattii melanin. Using Scanning Electron Microscopy we observed that human melanin showed a compact conformation and cryptococcal melanins exposed an amorphous conformation. Infrared spectroscopy (FTIR) showed some differences in the signals related to C-C bonds of the aromatic ring of the melanin monomers. High Performance Liquid Chromatography established differences in the chromatograms of fungal melanins extracts in comparison with human and synthetic melanin, particularly in the retention time of the main compound of fungal melanin extracts and also in the presence of minor unknown compounds. On the other hand, MALDI-TOF-MS analysis showed slight differences in the spectra, specifically the presence of a minor intensity ion in synthetic and human melanin, as well as in some fungal melanin extracts. We conclude that human melanin is more active than the two fungal melanins against Cryptococcus. Although some physico-chemical differences were found, they do not explain the differences in the antifungal activity against Cryptococcus of human and cryptococcal melanins. More detailed studies on the structure should be considered to associate structure and antifungal activity.
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Affiliation(s)
- Néstor Correa
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de ChileSantiago, Chile.,Facultad de Medicina Clínica Alemana, Universidad del DesarrolloSantiago, Chile.,Escuela de Tecnología Médica, Universidad San SebastiánSantiago, Chile
| | - Cristian Covarrubias
- Laboratorio de Nanomateriales, Facultad de Odontología, Universidad de ChileSantiago, Chile
| | - Paula I Rodas
- Center for Integrative Medicine and Innovative Science, Facultad de Medicina, Universidad Andres BelloSantiago, Chile
| | - Germán Hermosilla
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de ChileSantiago, Chile
| | - Verónica R Olate
- Instituto de Química de Recursos Naturales, Universidad de TalcaTalca, Chile.,Center for Systems Biotechnology, Fraunhofer Chile ResearchSantiago, Chile
| | - Cristián Valdés
- Laboratorio de Fisicoquímica, Universidad de TalcaTalca, Chile
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney Medical School - Westmead Hospital, Westmead Institute for Medical Research, University of Sydney, SydneyNSW, Australia
| | - Fabien Magne
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de ChileSantiago, Chile
| | - Cecilia V Tapia
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de ChileSantiago, Chile.,Laboratorio de Clínica DávilaSantiago, Chile
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26
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Sacht GL, Lima AMD, Perdomo YC, Boigues RS, Takita LC, Hans G. Disseminated cryptococcosis with cutaneous involvement in an immunocompetent patient. An Bras Dermatol 2017; 91:832-834. [PMID: 28099613 PMCID: PMC5193202 DOI: 10.1590/abd1806-4841.20165478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 06/09/2016] [Indexed: 11/22/2022] Open
Abstract
Cryptococcosis is a fungal infection of opportunistic behavior that is unusual in immunocompetent patients. We report a rare case of disseminated cryptococcosis with cutaneous involvement in an immunocompetent individual. During hospitalization, Cryptococcus gattii was isolated from skin lesions, lung and spinal fluid. The diagnosis of disseminated cryptococcosis was confirmed and treatment was established. The patient showed improvement. Due to the probable clinical severity of the disease and the possibility that skin lesions may be the first manifestation of this illness, prompt diagnosis must be established and treatment provided.
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Affiliation(s)
| | | | | | | | - Luiz Carlos Takita
- Universidade Federal de Mato Grosso do Sul (UFMS) - Campo Grande (MS), Brasil
| | - Günter Hans
- Universidade Federal de Mato Grosso do Sul (UFMS) - Campo Grande (MS), Brasil
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Gyimesi A, Bátor A, Görög P, Telegdy E, Szepes É, Kappéter Á, Gyulai R, Lengyel Z. Cutaneous Cryptococcus albidus infection. Int J Dermatol 2017; 56:452-454. [PMID: 28198004 DOI: 10.1111/ijd.13576] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Alíz Gyimesi
- Department of Dermatology, Venereology and Oncodermatology, University of Pécs, Pécs, Hungary
| | - Anna Bátor
- Department of Dermatology, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Petra Görög
- Department of Dermatology, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Enikő Telegdy
- Department of Dermatology, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Éva Szepes
- Department of Dermatology, Venereology and Oncodermatology, University of Pécs, Pécs, Hungary
| | - Ágnes Kappéter
- Department of Infectology, University of Pécs, Pécs, Hungary
| | - Rolland Gyulai
- Department of Dermatology, Venereology and Oncodermatology, University of Pécs, Pécs, Hungary
| | - Zsuzsanna Lengyel
- Department of Dermatology, Venereology and Oncodermatology, University of Pécs, Pécs, Hungary
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Papadakis GZ, Holland SM, Quezado M, Patronas NJ. Adrenal cryptococcosis in an immunosuppressed patient showing intensely increased metabolic activity on 18F-FDG PET/CT. Endocrine 2016; 54:834-836. [PMID: 27473097 PMCID: PMC5107323 DOI: 10.1007/s12020-016-1040-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/24/2016] [Indexed: 12/17/2022]
Abstract
Disseminated cryptococcosis most commonly occurs in immunosuppressed patients and can rarely affect the adrenal glands. We report on a patient with biopsy proven bilateral adrenal cryptococcosis resulting in primary adrenal insufficiency, which was evaluated with whole-body positron emission tomography/computed tomography scan using 18F-FDG. Both enlarged adrenal glands presented intensely increased 18F-FDG activity in the periphery, while central necrotic regions were photopenic. Although diagnosis was established by adrenal gland biopsy, 18F-FDG positron emission tomography/computed tomography scan can significantly contribute to the assessment of disease activity and monitoring of treatment response. Furthermore, fungal infections should always be considered when encountering hypermetabolic adrenal masses, especially in the setting of immunodeficient patients.
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Affiliation(s)
- Georgios Z Papadakis
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, 20892, USA
| | - Steven M Holland
- Immunopathogenesis Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Martha Quezado
- Department of Pathology, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Nicholas J Patronas
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, 20892, USA.
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Carrasco-Zuber J, Navarrete-Dechent C, Bonifaz A, Fich F, Vial-Letelier V, Berroeta-Mauriziano D. Cutaneous involvement in the Deep Mycoses: A Review. Part II—Systemic Mycoses. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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31
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Carrasco-Zuber J, Navarrete-Dechent C, Bonifaz A, Fich F, Vial-Letelier V, Berroeta-Mauriziano D. Afectación cutánea en las micosis profundas: una revisión de la literatura. Parte 2. Micosis sistémicas. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:816-822. [DOI: 10.1016/j.ad.2016.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/29/2016] [Indexed: 01/13/2023] Open
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Pereira CB, Pereira de Sá N, Borelli BM, Rosa CA, Barbeira PJS, Cota BB, Johann S. Antifungal activity of eicosanoic acids isolated from the endophytic fungus Mycosphaerella sp. against Cryptococcus neoformans and C. gattii. Microb Pathog 2016; 100:205-212. [PMID: 27693577 DOI: 10.1016/j.micpath.2016.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/16/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022]
Abstract
The antifungal effects of two eicosanoic acids, 2-amino-3,4-dihydroxy-2-25-(hydroxymethyl)-14-oxo-6,12-eicosenoic acid (compound 1) and myriocin (compound 2), isolated from Mycosphaerella sp. were evaluated against Cryptococcus neoformans and C. gattii. The compounds displayed antifungal activities against several isolates of C. neoformans and C. gattii, with minimal inhibitory concentration (MIC) values ranging from 0.49 to 7.82 μM for compound 1 and 0.48-1.95 μM for compound 2. In the checkerboard microtiter test, both compounds exhibited synergistic activity with amphotericin B against C. gattii. Ultrastructural analysis revealed several signs of damage in C. gattii and C. neoformans cells treated with compounds 1 and 2, including deformities in cell shape, depressions on the surface, and withered cells. The cells of C. gattii treated with compounds 1 and 2 showed less loss of cellular material in comparison to those treated with amphotericin B. The difference in cellular material loss increased in a test compound concentration-dependent manner. Consistent with this observation, compounds 1 and 2 were able to internalize propidium iodide (PI) in C. gattii cells. In addition, compound 2 induced the formation of several pseudohyphae, suggesting that it could reduce virulence in C. gattii cells. The study results show that these natural products led to membrane damage; however, this may not be the main target of action. These compounds have potential antifungal activity and could be useful in further studies for developing more effective combination therapies with amphotericin B and reducing side effects in patients.
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Affiliation(s)
- Cristiane Bigatti Pereira
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Laboratório de Química de Produtos Naturais Bioativos, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Nívea Pereira de Sá
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Beatriz Martins Borelli
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carlos Augusto Rosa
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Paulo Jorge Sanches Barbeira
- Departamento de Química, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Betania Barros Cota
- Laboratório de Química de Produtos Naturais Bioativos, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Susana Johann
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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de Azevedo MI, Ferreiro L, Da Silva AS, Tonin AA, Monteiro DU, Casali EA, Moritz CE, Schirmbeck GH, Cardoso VV, Flores MM, Fighera R, Stefani LM, Santurio JM. Participation of purines in the modulation of inflammatory response in rats experimentally infected by Cryptococcus neoformans. Microb Pathog 2016; 99:36-40. [DOI: 10.1016/j.micpath.2016.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 07/22/2016] [Indexed: 12/20/2022]
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Oliveira VM, Carraro E, Auler ME, Khalil NM. Quercetin and rutin as potential agents antifungal against Cryptococcus spp. BRAZ J BIOL 2016; 76:1029-1034. [PMID: 27166572 DOI: 10.1590/1519-6984.07415] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/11/2015] [Indexed: 01/30/2023] Open
Abstract
Amphotericin B is a fungicidal substance that is treatment of choice for most systemic fungal infections affecting as cryptococcosis the immunocompromised patients. However, severe side effects have limited the utility of this drug. The aim of this study was to evaluate the antifungal effect of the combination of amphotericin B with quercetin or rutin and as a protective of citotoxic effect. The antifungal activity to amphotericin B, quercetin and rutin alone and in combination was determined in Candida sp and Cryptococcus neoformans strains. Cytotoxicity test on erythrocytes was performed by spectrophotometric absorbance of hemoglobin. The amphotericin B MIC was reduced when used in combination with quercetin or rutin to C. neoformans ATCC strain and reduced when combined with rutin to a clinical isolate of C. neoformans. In addition, the combination of quercetin with amphotericin B may reduce the toxicity of amphotericin B to red blood cells. Our results suggest that quercetin and rutin are potential agents to combine with amphotericin B in order to reduce the amphotericin dose to lessen side effects and improve antifungal efficacy.
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Affiliation(s)
- V M Oliveira
- Laboratório de Virologia, Programa de Pós-graduação em Ciências Farmacêuticas, Departamento de Farmácia, Universidade Estadual do Centro-Oeste - UNICENTRO, Rua Simeão Camargo Varelá de Sá, 03, CEP 85040-080, Guarapuava, PR, Brazil
| | - E Carraro
- Laboratório de Virologia, Programa de Pós-graduação em Ciências Farmacêuticas, Departamento de Farmácia, Universidade Estadual do Centro-Oeste - UNICENTRO, Rua Simeão Camargo Varelá de Sá, 03, CEP 85040-080, Guarapuava, PR, Brazil
| | - M E Auler
- Laboratório de Pesquisa em Fungos Patogênicos, Departamento de Farmácia, Universidade Estadual do Centro-Oeste - UNICENTRO, Rua Simeão Camargo Varelá de Sá, 03, CEP 85040-080, Guarapuava, PR, Brazil
| | - N M Khalil
- Laboratório de Nanotecnologia Farmacêutica, Programa de Pós-graduação em Ciências Farmacêuticas, Departamento de Farmácia, Universidade Estadual do Centro-Oeste - UNICENTRO, Rua Simeão Camargo Varelá de Sá, 03, CEP 85040-080, Guarapuava, PR, Brazil
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Deshayes S, Bouvier N, Chatelet V, Hurault de Ligny B, Dargère S, Bonhomme J, Béchade C. Severe cryptococcal-associated neurological immune reconstitution inflammatory syndrome in a renal transplant recipient treated with adalimumab. Transpl Infect Dis 2016; 18:461-465. [PMID: 26929435 DOI: 10.1111/tid.12522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/09/2016] [Accepted: 02/13/2016] [Indexed: 12/18/2022]
Abstract
Cryptococcosis is a major concern in organ transplant recipients. A decrease in immunosuppressants following the initiation of antifungal therapy is currently recommended, but can occasionally be complicated by the onset of immune reconstitution inflammatory syndrome (IRIS). We report on a case of cryptococcosis in a kidney transplant recipient, compounded by severe neurological IRIS, the outcome of which was unfavorable despite the use of anti-tumor necrosis factor-alpha monoclonal antibodies.
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Affiliation(s)
- S Deshayes
- Department of Internal Medicine, CHU de Caen, Caen, France
| | - N Bouvier
- Department of Nephrology, CHU de Caen, Caen, France
| | - V Chatelet
- Department of Nephrology, CHU de Caen, Caen, France
| | | | - S Dargère
- Department of Infectious Diseases, CHU de Caen, Caen, France
| | - J Bonhomme
- Department of Microbiology, CHU de Caen, Caen, France
| | - C Béchade
- Department of Nephrology, CHU de Caen, Caen, France
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Rossi SA, Trevijano-Contador N, Scorzoni L, Mesa-Arango AC, de Oliveira HC, Werther K, de Freitas Raso T, Mendes-Giannini MJS, Zaragoza O, Fusco-Almeida AM. Impact of Resistance to Fluconazole on Virulence and Morphological Aspects of Cryptococcus neoformans and Cryptococcus gattii Isolates. Front Microbiol 2016; 7:153. [PMID: 26909069 PMCID: PMC4754443 DOI: 10.3389/fmicb.2016.00153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/29/2016] [Indexed: 01/12/2023] Open
Abstract
Cryptococcus sp. are responsible for around 1 million cases of meningitis every year. Fluconazole (FLU) is commonly used in the treatment of cryptococcosis, mainly in immunocompromised patients and the resistance is usually reported after long periods of treatment. In this study, the morphological characterization and virulence profile of FLU-susceptible and FLU-resistant clinical and environmental isolates of C. neoformans and C. gattii were performed both in vitro and in vivo using the Galleria mellonella model. FLU-susceptible isolates from C. neoformans were significantly more virulent than the FLU-resistant isolates. FLU-susceptible C. gattii isolates showed a different virulence profile from C. neoformans isolates where only the environmental isolate, CL, was more virulent compared with the resistant isolates. Cell morphology and capsule size were analyzed and the FLU-resistant isolates did not change significantly compared with the most sensitive isolates. Growth at 37°C was also evaluated and in both species, the resistant isolates showed a reduced growth at this temperature, indicating that FLU resistance can affect their growth. Based on the results obtained is possible suggest that FLU resistance can influence the morphology of the isolates and consequently changed the virulence profiles. The most evident results were observed for C. neoformans showing that the adaptation of isolates to antifungal selective pressure influenced the loss of virulence.
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Affiliation(s)
- Suélen A Rossi
- Faculdade de Ciências Farmacêuticas, UNESP - Universidade Estadual Paulista, Campus Araraquara, Departamento de Análises Clíncas São Paulo, Brazil
| | - Nuria Trevijano-Contador
- Centro Nacional de Microbiologia, Unidad de Micologia, Instituto de Salud Carlos III, Majadahonda Madrid, Spain
| | - Liliana Scorzoni
- Faculdade de Ciências Farmacêuticas, UNESP - Universidade Estadual Paulista, Campus Araraquara, Departamento de Análises Clíncas São Paulo, Brazil
| | | | - Haroldo C de Oliveira
- Faculdade de Ciências Farmacêuticas, UNESP - Universidade Estadual Paulista, Campus Araraquara, Departamento de Análises Clíncas São Paulo, Brazil
| | - Karin Werther
- Faculdade de Medicina Veterinária e Zootecnia, USP - Universidade de São Paulo, Departamento de Patologia São Paulo, Brazil
| | - Tânia de Freitas Raso
- Faculdade de Medicina Veterinária e Zootecnia, USP - Universidade de São Paulo, Departamento de Patologia São Paulo, Brazil
| | - Maria J S Mendes-Giannini
- Faculdade de Ciências Farmacêuticas, UNESP - Universidade Estadual Paulista, Campus Araraquara, Departamento de Análises Clíncas São Paulo, Brazil
| | - Oscar Zaragoza
- Centro Nacional de Microbiologia, Unidad de Micologia, Instituto de Salud Carlos III, Majadahonda Madrid, Spain
| | - Ana M Fusco-Almeida
- Faculdade de Ciências Farmacêuticas, UNESP - Universidade Estadual Paulista, Campus Araraquara, Departamento de Análises Clíncas São Paulo, Brazil
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A retrospective research of HIV-negative cryptococcal meningoencephalitis patients with acute/subacute onset. Eur J Clin Microbiol Infect Dis 2016; 35:299-303. [PMID: 26792138 DOI: 10.1007/s10096-015-2545-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
Cryptococcal meningoencephalitis (CM) may present as an acute, subacute, or chronic infection. It manifests as a chronic process in over 75 % of cases, but, sometimes, it presents with a more acute onset, mostly in HIV-associated patients. Until now, there has been no study performed on the clinical features of HIV-negative CM patients with acute/subacute onset. We collected 106 HIV-negative patients diagnosed with CM in our hospital during a 15-year period, analyzed their epidemiological and clinical features, as well as the outcomes, and explored the independent prognosis factors and the factors related to the survival time among them. We found that impaired consciousness (23.4 % vs. 3.4 %, p = 0.017) was more common in CM patients with acute/subacute onset, while decreased cerebrospinal fluid (CSF) glucose (51.9 % vs. 75.9 %, p = 0.026) was less common. The ratio of CSF glucose/blood glucose [odds ratio (OR) 0.04, 95 % confidence interval (CI) 0.004-0.262, p = 0.02], impaired consciousness (OR 5.09, 95 % CI 1.477-17.522, p = 0.01), and hospitalization length (OR 0.98, 95 % CI 0.977-0.999, p = 0.04) were indicated to be not only independent prognosis factors in HIV-negative CM patients with acute/subacute onset, but also factors significantly related to the survival time. The results of our study demonstrated that the contact history and potential history risk factors would not affect the onset process of HIV-negative CM patients, and the mortality, hospitalization length, and survival time has not been related to the onset process. However, the ratio of CSF glucose/blood glucose, consciousness level, and hospitalization length of the HIV-negative CM patients with acute/subacute onset should be of greater focus in the clinical work.
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Seto H, Nishimura M, Minamiji K, Miyoshi S, Mori H, Kanazawa K, Yasuda H. Disseminated Cryptococcosis in a 63-year-old Patient with Multiple Sclerosis Treated with Fingolimod. Intern Med 2016; 55:3383-3386. [PMID: 27853088 PMCID: PMC5173513 DOI: 10.2169/internalmedicine.55.7255] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We herein report the case of a 63-year-old man who presented with a 3-month history of a cutaneous nodular lesion of his jaw, low grade fever, lethargy and progressive cognitive impairment. He had a 30-year history of multiple sclerosis and had been treated with fingolimod for the previous 2 years. Laboratory data revealed CD4 lymphocytopenia and a tissue culture of the skin nodule was positive for Cryptococcus neoformans. Cerebrospinal fluid and serum cryptococcal antigen tests were also positive and we diagnosed him to have disseminated cryptococcosis. This dissemination might be associated with fingolimod-induced CD4 lymphocytopenia. The risk of an opportunistic infection should therefore be considered when encountering fingolimod-treated patients.
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Affiliation(s)
- Hiroyuki Seto
- Department of General Internal Medicine, Kobe University Hospital, Japan
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Calderaro A, Martinelli M, Montecchini S, Motta F, Covan S, Larini S, Medici MC, Arcangeletti MC, Chezzi C, De Conto F. Higher recovery rate of microorganisms from cerebrospinal fluid samples by the BACTEC culture system in comparison with agar culture. Diagn Microbiol Infect Dis 2015; 84:281-6. [PMID: 26867963 DOI: 10.1016/j.diagmicrobio.2015.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/12/2015] [Accepted: 12/21/2015] [Indexed: 11/24/2022]
Abstract
The aim of this study was to assess the diagnostic value of the BACTEC FX blood culture (BC) system as compared to the agar culture (AC) of cerebrospinal fluid samples (CSF), evaluating the recovery rate and the time to detection of microorganisms in a 3.5-year period. From December 2011 to May 2015, 1326 CSF samples (694 patients) were submitted to both AC and BC. Among the 150 positive samples (96 patients), 165 microorganisms were detected: 81 by both the protocols, 77 by BC alone, and 7 by AC alone, demonstrating a higher detection rate of BC (95.8%) than AC (53.3%). Although BC presents some disadvantages, it is able to improve the yield of clinically significant microorganisms, and it could potentially reduce the reporting time as compared to AC. The results obtained highlighted the necessity of a combined approach for the successful detection of central nervous system microbial infections.
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Affiliation(s)
- Adriana Calderaro
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy.
| | - Monica Martinelli
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy
| | - Sara Montecchini
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy
| | - Federica Motta
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy
| | - Silvia Covan
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy
| | - Sandra Larini
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy
| | - Maria Cristina Medici
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy
| | - Maria Cristina Arcangeletti
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy
| | - Carlo Chezzi
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy
| | - Flora De Conto
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Viale A. Gramsci 14, 43126 Parma, Italy
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Pereira de Sá N, Lino CI, Fonseca NC, Borelli BM, Ramos JP, Souza-Fagundes EM, Rosa CA, Santos DA, Barbosa de Oliveira R, Johann S. Thiazole compounds with activity against Cryptococcus gattii and Cryptococcus neoformans in vitro. Eur J Med Chem 2015; 102:233-42. [PMID: 26276437 DOI: 10.1016/j.ejmech.2015.07.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/08/2015] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
Abstract
Human cryptococcosis can occur as a primary or opportunistic infection and develop as an acute, subacute, or chronic, systemic infection involving different host organs. We evaluated the antifungal activity of thirteen compounds against Cryptococcus gattii and Cryptococcus neoformans in vitro, by assessing the toxicity of the compounds showing the greatest antifungal activity in VERO cells and murine macrophages. From these results, four compounds were considered promising for further studies because they displayed low cytotoxicity and significant antifungal activity. The heterocyclic compounds 1b, 1c, 1d, and 1m have antifungal activity levels between that of amphotericin B and fluconazole in vitro. The death curve of Cryptococcus spp. treated with these four compounds was similar to the curve obtained for amphotericin B, in that we observed a significant reduction in cell viability within the first 24 h of treatment. Additionally, we found that there was no effect when these compounds were combined with amphotericin and fluconazole, except for 1c, which antagonized the effect of amphotericin B against C. gattii, also reflected in the reduction of the post-antifungal effect (PAFE); however, this interaction did not alter the ergosterol content. The results shown in this paper reveal the discovery of novel thiazole compounds, which are easy to synthesize, and with potentially exhibit antifungal activity, and display low cytotoxicity in normal mammalian cells. These compounds can be used as prototypes for the design of new antifungal drugs against C. gattii and C. neoformans.
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Affiliation(s)
- Nívea Pereira de Sá
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Cleudiomar Inácio Lino
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia da UFMG, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Nayara Cristina Fonseca
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia da UFMG, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Beatriz Martins Borelli
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Jonas Pereira Ramos
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Elaine Maria Souza-Fagundes
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carlos Augusto Rosa
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Daniel Assis Santos
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Renata Barbosa de Oliveira
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia da UFMG, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Susana Johann
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Nenoff P, Reinel D, Krüger C, Grob H, Mugisha P, Süß A, Mayser P. Tropen- und Reise-assoziierte Dermatomykosen. Hautarzt 2015; 66:522-32. [DOI: 10.1007/s00105-015-3635-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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42
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Corti M, Priarone M, Negroni R, Gilardi L, Castrelo J, Arechayala AI, Messina F, Franze O. Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly. Rev Soc Bras Med Trop 2015; 47:524-7. [PMID: 25229298 DOI: 10.1590/0037-8682-0176-2013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodeficiency virus (HIV)-positive, and frequently involves the central nervous system. METHODS We assessed the potential of ventriculoperitoneal shunting (VPS) in preventing mortality due to uncontrollable intracranial hypertension (ICH) in 15 patients with acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis. RESULTS After 2 weeks of antifungal therapy consisting of amphotericin B deoxycholate with or without fluconazole, patients with persistent ICH underwent VPS, despite having persistent Cryptococcus neoformans infection. In 12 patients, the uncontrollable ICH was resolved by VPS. CONCLUSIONS Patients with cryptococcal meningoencephalitis who have ICH must be considered for VPS even with positive cerebrospinal fluid cultures.
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Affiliation(s)
- Marcelo Corti
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Maria Priarone
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Negroni
- Mycology Unit, Francisco Javier Muñiz Hospital, Buenos Aires, Argentina
| | - Leonardo Gilardi
- Sociedad Iberoamericana de Información Cientifica, Buenos Aires, Argentina
| | - Jimena Castrelo
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Fernando Messina
- Mycology Unit, Francisco Javier Muñiz Hospital, Buenos Aires, Argentina
| | - Osvaldo Franze
- Neurosurgery Department, Francisco Javier Muñiz Hospital, Buenos Aires, Argentina
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43
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Cattana ME, Fernández MS, Rojas FD, Sosa MDLÁ, Giusiano G. [Genotypes and epidemiology of clinical isolates of Cryptococcus neoformans in Corrientes, Argentina]. Rev Argent Microbiol 2015; 47:82-3. [PMID: 25638353 DOI: 10.1016/j.ram.2014.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/01/2014] [Accepted: 09/08/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- María E Cattana
- Área Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Chaco, Argentina.
| | - Mariana S Fernández
- Área Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Chaco, Argentina
| | - Florencia D Rojas
- Área Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Chaco, Argentina
| | | | - Gustavo Giusiano
- Área Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Chaco, Argentina
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44
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Zhou HX, Lu L, Chu T, Wang T, Cao D, Li F, Ning G, Feng S. Skeletal cryptococcosis from 1977 to 2013. Front Microbiol 2015; 5:740. [PMID: 25642211 PMCID: PMC4294201 DOI: 10.3389/fmicb.2014.00740] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 12/05/2014] [Indexed: 12/18/2022] Open
Abstract
Skeletal cryptococcosis, an aspect of disseminated cryptococcal disease or isolated skeletal cryptococcal infection, is a rare but treatable disease. However, limited information is available regarding its clinical features, treatment, and prognosis. This systematic review examined all cases published between April 1977 and May 2013 with regard to the factors associated with this disease, including patient sex, age, and epidemiological history; affected sites; clinical symptoms; underlying diseases; laboratory tests; radiological manifestations; and delays in diagnosis, treatment, follow-up assessments, and outcomes. We found that immune abnormality is a risk factor but does not predict mortality; these observations are due to recent Cryptococcus neoformans var gattii (CNVG) outbreaks (Chaturvedi and Chaturvedi, 2011). Dissemination was irrespective of immune status and required combination therapy, and dissemination carried a worse prognosis. Therefore, a database of skeletal cryptococcosis cases should be created.
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Affiliation(s)
- Heng-Xing Zhou
- Department of Orthopaedics, Tianjin Medical University General Hospital Tianjin, China
| | - Lu Lu
- Department of Orthopaedics, Tianjin Medical University General Hospital Tianjin, China
| | - Tianci Chu
- Department of Orthopaedics, Tianjin Medical University General Hospital Tianjin, China
| | - Tianyi Wang
- Department of Orthopaedics, Tianjin Medical University General Hospital Tianjin, China
| | - Daigui Cao
- Department of Orthopaedics, Tianjin Medical University General Hospital Tianjin, China
| | - Fuyuan Li
- Department of Orthopaedics, Tianjin Medical University General Hospital Tianjin, China
| | - Guangzhi Ning
- Department of Orthopaedics, Tianjin Medical University General Hospital Tianjin, China
| | - Shiqing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital Tianjin, China
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Abstract
The first description of dermatophytosis was recorded by Celsus, a Roman encyclopaedist who described a suppurative infection of scalp (‘porrigo’ or ‘kerion of Celsus’) in De Re Medicina (30 A.D.). Throughout the middle ages, several descriptions of dermatophytosis were produced where it is described as ‘tinea’. The keratin-destroying moths which made circular holes in the woollen garments are known as Tinea. Due to similarity in the structure of circular lesion of dermatophytosis on the smooth skin with the circular hole made by moth, Cassius Felix introduced the term ‘tinea’ to describe the lesions. In 1806, Alibert used the term ‘favus’ to describe the honey-like exudate in some scalp infections. However, the fungal aetiology of tinea was first detected by Robert Remak, a Polish physician who first observed the presence of hyphae in the crusts of favus. This detection is also a landmark in medical history because this is the first description of a microbe causing a human disease. He himself did not publish his work, but he permitted the reference of his observations in a dissertation by Xavier Hube in 1837. Remak gave all the credits of his discovery to his mentor Schoenlein who first published the fungal etiological report of favus in 1839. He observed the infectious nature of the favus by autoinoculation into his own hands and also successfully isolated the fungus later (1945) and named Achorion schoenleinii (Trichophyton schoenleinii) in honour of his mentor. In 1844, Gruby described the etiologic agent of tinea endothrix, later became known as Trichophyton tonsurans. The genus Trichophyton was created and described by Malmsten (1845) with its representative species T. tonsurans. Charles Robin identified T. mentagrophytes in 1847 and T. equinum was identified by Matruchot and Dassonville in 1898. Raymond Jacques Adrien Sabouraud (France) first compiled the description of Trichophyton in his book (Les Teignes) in 1910 which was based on his observation in artificial culture. The sexual state of dermatophyte was described by Nannizzi (1927). Emmons (1934) first reported the classification of dermatophytes based on vegetative structures and conidia. Gentles (1958) established the successful treatment of tinea capitis with griseofulvin.
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Spies FS, de Oliveira MB, Krug MS, Severo CB, Severo LC, Vainstein MH. Cryptococcosis in patients living with hepatitis C and B viruses. Mycopathologia 2014; 179:307-12. [PMID: 25528539 DOI: 10.1007/s11046-014-9843-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 11/27/2014] [Indexed: 12/22/2022]
Abstract
Cryptococcosis, a systemic fungal infection, has become a significant, global public health problem. Patients with liver disease have an increased predisposition to infections, such as Cryptococcosis. To report the underlying disease, the variety of etiologic agents involved and the outcomes of the Cryptococcosis in patients living with HBV and/or HCV, we reviewed 34 medical records of patients who were diagnosed with Cryptococcosis by the Mycology Laboratory of Santa Casa Hospital, Porto Alegre, Brazil. Males corresponded to 79% of the patients, and the average patient age was 46.9 years. The cultures of 26/34 patients were positive: 25 patients were infected with Cryptococcus neoformans and one with C. gattii. A total of 14 deaths (41%) occurred. As a criterion of our study, all patients had viral hepatitis infection: 27 (80%) were infected with HCV, five (15%) were infected with HBV, and two patients were infected with both viruses. Because HBV and/or HCV are transmitted among drug users through infected blood, and the end-stage cirrhotic liver must be transplanted, these two population types were well represented in this study and were analyzed in detail. Cryptococcosis patients living with HCV and/or HBV appear to have the same symptoms, mean age and gender distribution as the general Cryptococcosis population. Once Cryptococcosis affects the brain, a high mortality rate ensues; therefore, physicians must be aware of the possible occurrence of this disease in patients living with HCV and HBV.
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Affiliation(s)
- Fernanda Sá Spies
- Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul, Avenida Bento Gonçalves 9500, 43421, Setor 4, Porto Alegre, RS, 91501-970, Brazil,
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Bacterial etiologies of five core syndromes: laboratory-based syndromic surveillance conducted in Guangxi, China. PLoS One 2014; 9:e110876. [PMID: 25360596 PMCID: PMC4215986 DOI: 10.1371/journal.pone.0110876] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/18/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Under the existing national surveillance system in China for selected infectious diseases, bacterial cultures are performed for only a small percentage of reported cases. We set up a laboratory-based syndromic surveillance system to elucidate bacterial etiologic spectrum and detect infection by rare etiologies (or serogroups) for five core syndromes in the given study area. METHODS Patients presenting with one of five core syndromes at nine sentinel hospitals in Guagnxi, China were evaluated using laboratory-based syndrome surveillance to elucidate bacterial etiologies. We collected respiratory and stool specimens, as well as CSF, blood and other related samples for bacterial cultures and pulse field gel electrophoresis (PFGE) assays. RESULTS From February 2009 to December 2011, 2,964 patients were enrolled in the study. Etiologies were identified in 320 (10.08%) patients. Streptococcus pneumonia (37 strains, 24.18%), Klebsiella pneumonia (34, 22.22%), Pseudomonas aeruginosa (19, 12.42%) and Haemophilus influenza (18, 11.76%) were the most frequent pathogens for fever and respiratory syndrome, while Salmonella (77, 81.05%) was most often seen in diarrhea syndrome cases. Salmonella paratyphi A (38, 86.36%) occurred in fever and rash syndrome, with Cryptococcus neoformans (20, 35.09%), Streptococcus pneumonia (5, 8.77%), Klebsiella pneumonia (5, 8.77%),streptococcus suis (3, 5.26%) and Neisseria meningitides group B (2, 3.51%) being the most frequently detected in encephalitis-meningitis syndrome. To date no pathogen was isolated from the specimens from fever and hemorrhage patients. CONCLUSIONS In addition to common bacterial pathogens, opportunistic pathogens and fungal infections require more attention. Our study contributes to the strengthening of the existing national surveillance system and provides references for other regions that are similar to the study area.
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Synthesis, characterization, microbiological evaluation, genotoxicity and synergism tests of new nano silver complexes with sulfamoxole: X-ray diffraction of [Ag2(SMX)2]·DMSO. J Inorg Biochem 2014; 141:58-69. [PMID: 25217718 DOI: 10.1016/j.jinorgbio.2014.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 08/08/2014] [Accepted: 08/08/2014] [Indexed: 11/20/2022]
Abstract
The synthesis and microbiological evaluation of two new Ag(I) complexes with sulfamoxole (SMX), [Ag2(SMX)2]·H2O and [Ag4(SCN)3(SMX)]·H2O are described. Both were characterized by elemental analysis, thermogravimetry, powder and single crystal X-ray diffraction, NMR, Raman and experimental and theoretical IR spectroscopies. Their antibacterial and antifungal properties were evaluated by agar and broth dilution assays, respectively. In addition, synergism tests for Pseudomonas aeruginosa were performed, and genotoxicity studies were carried out employing the Allium cepa test. Both complexes displayed good activity against Escherichia coli, Staphylococcus aureus, P. aeruginosa, and 10 fungi strains, with lower minimum inhibitory concentrations (MICs) than that of free SMX in all cases. The nanometrical crystallite particle size determined from XRPD, DLS and TEM might explain the good microbiological activity in spite of the low solubility of both complexes. The fractional inhibitory concentration (FIC) calculated from the P. aeruginosa test data indicated that the activity of the complexes is not due to synergism of the free components in the concentration ratios studied. Moreover, none of the complexes displayed cytotoxic effects on onions in the concentration range tested, and chromosome aberrations were not observed.
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Abstract
OBJECTIVE Combined anatomic and functional imaging with (18)F-FDG PET/CT is slowly gaining foothold in the management of various infective pathologic abnormalities. However, limited literature is available regarding the role of FDG PET/CT in patients with fungal infections. CONCLUSION Here, we briefly review the available literature and highlight the potential role that FDG PET/CT can play in the diagnosis and management of fungal infections.
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Chirch LM, Cataline PR, Dieckhaus KD, Grant-Kels JM. Proactive infectious disease approach to dermatologic patients who are taking tumor necrosis factor–alfa antagonists. J Am Acad Dermatol 2014; 71:1.e1-8; quiz 1.e8-9, 10. [DOI: 10.1016/j.jaad.2014.01.875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/22/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
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